Rehabilitation of the geriatric vascular amputee patient: A population-based study

Objectives: To determine the rate of successful prosthetic fitting in geria tric vascular amputees in the community and to determine: predictors of suc cessful fit. Design: Epidemiologic survey. Setting: General community, Olmsted County, Minnesota. Patients: All Olmsted County residents more than 65 years old who had a maj or lower extremity amputation (below knee amputation [BKA] or higher) for p eripheral vascular disease between 1974-1995, of whom 199 were identified. Median age at amputation was 79.7 years with a median survival of 1.5 years . Intervention: A retrospective chart review. Main Outcome Measure: Successful prosthetic fit. Results: Amputation levels were: 64% BKA, 4.5% knee disarticulation, 31% ab ove knee amputation (AKA), and 0.5% hip disarticulation. Only 36% of the po pulation was successfully fitted, compared with 74% of patients referred to the Amputee Clinic. Major reasons for not being fitted included death, rea mputation, cerebrovascular disease, and cognitive deficits. Increased age ( p < .001), cerebrovascular disease (p < .001), dementia (p = .002), and AKA (p < .001) were associated with failure to fit. Conclusion: The high probability of successful prosthetic fitting reported among referral practices cannot be generalized to unselected elderly indivi duals. However, selected individuals can successfully be fitted with a pros thesis; knowledge of predictors of prosthetic fitting may facilitate settin g of realistic goals during presurgical counseling in this age group. (C) 2001 by the American Congress of Rehabilitation Medicine and the Americ an Academy of Physical Medicine ann Rehabilitation.