– by Kevin Carroll, MS, CP, FAAOP
Let’s face it… we are aging. This includes you, me, and every other person on the planet. Whether you’re 19, 90, or somewhere in between, as each year passes, you are getting older. The dictionary defines aging as “progressive deterioration of bodily function over time.” This can be a difficult idea to accept, especially when most advertisements, magazine covers and billboards feature people who are young, active and beautiful. Clearly, our culture is in denial about the fact that people age…that the majority of people are not 20-somethings and in optimal physical condition. What does all this have to do with prosthetics? Everything.
People who have lost a limb face unique concerns about how the aging process affects their mobility and their prosthetic needs. There are several important connections between aging and prosthetics. First of all, consider that about 70 percent of the prosthetic users in this country are older adults. The majority of these people have lost a limb as a result of diabetes, vascular disease, or cancer–all illnesses that are associated with aging. Even before losing a limb, these older adults were beginning to face the physical and mental changes that accompany aging.
Getting older is not something that younger prosthetic users are likely to be thinking about. Generally, they want to be active and are interested in trying some of the more specialized components that are coming out. Yet aging can have a dramatic effect on the skeletal and cardiovascular systems… the two body systems that are most vital to the prosthetic user. Any one over the age of 30 needs to recognize that aging will have an effect on his or her mobility.
Finally, there is an important psychological aspect to the relationship between aging and prosthetics. Both older adults and the practitioners who serve them need to keep a positive outlook about what it means to be getting older. It is critically important to believe in the potential for good outcomes and happy lives, regardless of a person’s biological age.
Young at heart
Recently, I visited with a prosthetic patient who was 95 years old. She was not preoccupied with her age or her health, but she was interested in getting a lightweight leg so she could be more active. Her main expectation was that her prosthesis would last at least five years before it needed to be replaced. After all, she had a lot to do and she didn’t want to be slowed down by any mechanical problems with her artificial limb. This one lady – who’s planning on getting her next prosthesis around age 100 – symbolizes the positive mindset of a productive older adult.
She has a sense of purpose in her life and goals that motivate her to stay active and mobile. It may be gardening, or spending time with friends, but whatever the case, being interested in life is critical to your success as an older prosthetic user. So is playing a proactive role in your prosthetic care. When this woman had her prosthetic evaluation with me, she took the lead, telling me what she wanted from her prosthesis and what her expectations were. At 95, she wasn’t about to settle for a dormant life, wearing a heavy leg, or not being heard by her prosthetist. Many older adults struggle with their ability to hear, which means they might have to ask their care providers to speak slowly and loudly. Like this lady, if you insist on being heard, you are much more likely to get what you want, need and deserve to have. Her approach to life offers many lessons for both prosthetic patients and clinicians.
Use it or lose it
Prosthetic users of all ages need to know that as they get older, their skeletal system changes in ways that could affect their mobility. It is vital to be aware of these changes and of what you as an individual can do to strengthen and protect your bones.
Bone density, mass and strength all naturally begin to decrease with age. One example of this is the decrease in height that begins in males around age 40, and in females around age 43. After the age of 50, loss of bone tissue shows a marked increase, particularly among women. This process, known as osteoporosis, results in bones that are porous, thinning and vulnerable to fracture. Most women will lose about 30 percent of their bone tissue, while men average a 17 percent loss. More than 1.5 million American women will suffer some kind of fracture this year due to osteoporosis.
Lower-extremity prosthetic users, in particular, need to protect their bones. Long-term use of a prosthesis requires a strong and healthy residual limb, including the residual bone that supports it. The most strengthening thing we can do for our bones is to be active. Did you know that an unstressed lower limb will lose up to one-third of its bone mass? This presents a real dilemma to lower-extremity users. Amputation through the bone means the leg can no longer directly bear weight, and yet weight-bearing activities strengthen the bone.
X-rays of above-knee amputees often reveal significant bone loss in the residual limb just a few weeks after amputation. This is why it is vital for people of all ages to get moving as soon as they can following an amputation, and to stay active for the rest of their lives. Walking, running, skating, aerobics, weight lifting, dancing, tennis and basketball are all bone-strengthening activities that many prosthetic users enjoy.
Even with regular activity, the bones of residual limbs become brittle over time, particularly in above-knee amputees. It is essential for those who use lower-extremity prostheses to spend a few minutes every day contracting and releasing the muscles of the residual limb. This “fires” the muscles so that they grow and serve as greater protection for the bone.
Staying active is important for another reason: Regular exercise helps prevent cardiovascular disease, the leading cause of death in the United States. About 60 percent of men over 60 and women over 80 will experience major narrowing of the arteries. In fact, vascular problems are one of the primary causes of lower-extremity amputation in older adults. Many older adult prosthetic users are especially vulnerable to cardiovascular problems that stem from inactivity.
Emotions such as sadness and fear can be immobilizing, but physical therapy and an ongoing exercise program can help counter these feelings.
Studies have proven that regular exercise stimulates the release of chemical endorphins that help lift depression.
What you eat is also important and can have a marked effect on your bones and your cardio-vascular systems. It is important to include calcium-rich foods in your daily diet like milk, yogurt, fish and dark green vegetables. Eating for cardiovascular health means reducing your intake of fats and increasing your consumption of vegetables, fruits and whole grains. I recommend that prosthetic users discuss concerns about osteoporosis and sufficient calcium intake with their physician. A painless bone density scan can show whether or not your bones are osteoporotic. Depending on your specific situation, your physician may prescribe calcium and vitamin D supplements, estrogen or fluoride.
Unfortunately, an uncomfortable prosthesis is often the biggest hurdle to recovery that many lower-extremity users face. If the socket doesn’t fit properly, the result is pain and discomfort, making it almost impossible to be active. Older adults need to know that with modern technology, they can expect their prosthesis to be both lightweight and comfortable. Gone are the days of rigid, heavy limbs. Advanced materials such as urethanes, improved silicones, titanium and carbon fibers have led to the development of flexible contoured sockets and limbs that are very lightweight.
The comfort level of the prosthesis has everything to do with the socket design. A better understanding of the underlying anatomy of the residual limb results in a socket that is con-toured for bone, muscle and vascular areas. These total contact sockets also bend, expand and contract, providing a massage-like feature that improves circulation and reduces swelling in the older adult’s residual limb. When the user steps on the prosthesis, the muscles in the residual limb expand and the socket also expands. When the muscles relax in the swing phase of the gait, the socket instantly contracts and clamps back onto the residual limb. This responsive quality of the socket material is known as “memory.” Prosthetic consumers frequently tell me that their sense of stability and confidence is increased when wearing this type of dynamic socket.
Older adults generally have fragile skin due to age-related changes such as thinning of sub-dermal tissue and loss of surface elasticity. This makes protection of the skin on the residual limb very important. Consumers can find the protection they need in one of the many gel-type liners that are now available. This is infinitely more cushioning than a sock or even several layers of socks. Liners provide a supple cushioning layer that reduces stress to the residual limb and the surface friction that naturally occurs with movement, protecting the skin against breakdown. This helps the older adult user to be more comfortable and enjoy longer periods of activity.
Components such as shock-absorbing pylons and dynamic-response feet are not just for younger prosthetic consumers. Older adults have equally as much to gain from incorporating these performance-oriented elements into their limb. Today’s dynamic pylons allow for flexibility during ambulation and can provide vertical shock absorption and torque absorption.
The ankle and foot unit of the prosthesis should be adjustable and provide dynamic response. This combination offers extra cushioning and makes walking easier, thus increasing the activity level and the quality of life for older adults.
Understanding the aging process The aging process is something American culture tends to deny. Prosthetic users, regardless of their age, need to be aware of the special concerns they will be faced with as they age. If your goal is mobility for the long run, be mindful of the following strategies.
- Develop an understanding of the aging process and its effect on the body.
- Strive to maintain a positive mental outlook and to keep setting goals.
- Seek personalized medical care.
- Participate in physical rehabilitation and regular exercise.
- Eat a heart-healthy, calcium-rich diet.
- Work at being an informed and proactive prosthetic consumer.
Team up with a prosthetic provider who listens to you and wants to help you reach your goals, whatever they may be.
Older adults deserve access to the same standard of high-performance prosthetic technology as younger users. Remember, the best years of life just may be the ones that arrive after age 60.
About the Author:
Kevin Carroll, MS, CP, FAAOP, has been a practicing prosthetist for 24 years. He is the vice-president of prosthetics for Hanger Orthotics and Prosthetics in Bethesda, Mary-land. As such, he presents scientific symposiums to healthcare professionals across the country and manages one-day prosthetic clinics for patients who are difficult to fit. Kevin specializes in the prosthetic care of older adults and is a member of the National Association of Professional Geriatric Care Managers. He was recently named a Fellow by the American Academy of Orthotics & Prosthetics. He can be reached at 1-800/522-4428 or at email@example.com
Disclaimer: The following information is provided and owned by the Amputation Coalition of America and was previously published on the website http://www.amputee-coalition.org or the Coalitions Newsletter, inMotion.