PhD ceremony Ms. L.V. Fortington: Enabling the elderly person with lower limb amputation through surgery, rehabilitation and long term care

PhD ceremony: Ms. L.V. Fortington, 12.45 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: Enabling the elderly person with lower limb amputation through surgery, rehabilitation and long term care

Promotor(s): prof. J.H.B. Geertzen, prof. P.U. Dijkstra

Faculty: Medical Sciences

In the Netherlands, 80% of people undergoing lower limb amputation are over 65 years of age. Chronic peripheral vascular disease or diabetes mellitus has led to irreversible ischemia or a life threatening infection. Despite advances in preventative care, medical treatment and (peripheral) revascularisation procedures, in some cases, an amputation remains the best option for ending ongoing pain, hospitalisation and infection/ischaemia, and ultimately, enabling a person to live. It is the enabling a person to live that the research presented in this thesis focuses on. How, and how well, is the elderly population enabled from the decision to amputate and their subsequent rehabilitation and long-term care?

Key findings of the research support clinical knowledge that older age does not prevent someone achieving good mobility outcomes after amputation. However, amputation rehabilitation for the elderly person must extend beyond their limb, encompassing psychosocial elements and alternative options for mobility. Pre-amputation, research and decisions are mostly surgically focussed and may benefit from increased input of the rehabilitation team. For example, changing treatment options, particularly in respect to limb-salvage, present new questions over the timing of amputation and the population who, as a consequence, require rehabilitation. Post-amputation, measures and research of non-prosthetic outcomes are lacking and treatment from a wider group of the multidisciplinary team available in long-term care should be considered.