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Rehabilitation of the elderly amputee.

A rehabilitation service based in a department of geriatric medicine and dealing exclusively with amputees aged 65 years or over, is described. Provision of prostheses has been expedited, and the multi-disciplinary approach of the department has been beneficial in rehabilitation especially of the amputee with multiple pathology. The experience of the first 146 patients with an average age of 74.1 years is reviewed. Discharge home was achieved in 77.6% of the patients provided with a prosthesis and in a small multi-centre study of the post discharge status of 20 elderly amputees it was found that over 90% used their prosthesis regularly and the great majority were independent in the activities of daily living. Although BKA (Below knee amputation) is preferable to AKA (Above knee amputation), the functional benefit in this age group is not always as significant as traditional attitudes would suggest whereas a failed BKA has serious consequences in terms of psychological impact, morbidity and length of hospital stay. In order to minimise the number of BKA's requiring revision or re-amputation every effort should be made to ensure that the initial procedure is carried out by a surgeon with experience of amputation in this age group. Limb provision is cost effective and the frequent difficulty with regard to the financing of prostheses for elderly amputees is counter-productive.