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Trends in rehabilitation after amputation for geriatric patients with vascular disease: Implications for future health resource allocation

  • Dade D. Fletcher
    Affiliations
    Department of Physical Medicine and Rehabilitation (Fletcher, Andrews), Division of Vascular Surgery (Hallett), Section of Biostatistics (Rowland), Section of Clinical Epidemiology (Jacobsen), Mayo Clinic and Mayo Foundation, Rochester, MN; and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, AZ (Butters)
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  • Karen L. Andrews
    Affiliations
    Department of Physical Medicine and Rehabilitation (Fletcher, Andrews), Division of Vascular Surgery (Hallett), Section of Biostatistics (Rowland), Section of Clinical Epidemiology (Jacobsen), Mayo Clinic and Mayo Foundation, Rochester, MN; and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, AZ (Butters)
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  • John W. Hallett Jr
    Affiliations
    Department of Physical Medicine and Rehabilitation (Fletcher, Andrews), Division of Vascular Surgery (Hallett), Section of Biostatistics (Rowland), Section of Clinical Epidemiology (Jacobsen), Mayo Clinic and Mayo Foundation, Rochester, MN; and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, AZ (Butters)
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  • Matthew A. Butters
    Affiliations
    Department of Physical Medicine and Rehabilitation (Fletcher, Andrews), Division of Vascular Surgery (Hallett), Section of Biostatistics (Rowland), Section of Clinical Epidemiology (Jacobsen), Mayo Clinic and Mayo Foundation, Rochester, MN; and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, AZ (Butters)
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  • Charles M. Rowland
    Affiliations
    Department of Physical Medicine and Rehabilitation (Fletcher, Andrews), Division of Vascular Surgery (Hallett), Section of Biostatistics (Rowland), Section of Clinical Epidemiology (Jacobsen), Mayo Clinic and Mayo Foundation, Rochester, MN; and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, AZ (Butters)
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  • Steven J. Jacobsen
    Affiliations
    Department of Physical Medicine and Rehabilitation (Fletcher, Andrews), Division of Vascular Surgery (Hallett), Section of Biostatistics (Rowland), Section of Clinical Epidemiology (Jacobsen), Mayo Clinic and Mayo Foundation, Rochester, MN; and the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Scottsdale, AZ (Butters)
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      Abstract

      Fletcher DD, Andrews KL, Hallett JW Jr, Butters MA, Rowland CM, Jacobsen SJ. Trends in rehabilitation after amputation for geriatric patients with vascular disease: implications for future health resource allocation. Arch Phys Med Rehabil 2002;83:1389-93. Objective: To assess the effect of demographic changes on rehabilitation of geriatric patients after amputation and the implications for future health resource allocation. Design: Population-based study. Setting: Olmsted County, MN. Participants: Residents over the age of 65 years who had a major lower-extremity amputation because of peripheral arterial disease between 1956 and 1995. Patients who had amputations between 1956 and 1973 (earlier cohort) were compared with those who had amputations between 1974 and 1995 (later cohort). Interventions: Not applicable. Main Outcome Measures: Demographic and clinical features, total number of amputations, amputation rates, and rate of successful prosthetic fitting over time. Results: Of 292 patients, 93 had amputations between 1956 and 1973 and 199 between 1974 and 1995. Amputation rates declined after 1985, but the total number of amputations was unchanged. Patients in the later cohort were more likely to have a below-knee amputation (P<.001) and cerebrovascular disease (P=.008) and to be discharged to a nursing home (P<.001). There was no significant difference in median age at amputation, survival, or rates of successful prosthetic fitting over time. Conclusion: Although amputation rates have declined, the total number of amputations has increased. The rate of successful prosthetic fitting in the geriatric population has not changed significantly over 40 years. Amputations in the geriatric population in the United States will probably double from 28,000 to 58,000 per year by 2030, requiring considerable resources. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

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      Linked Article

      • Rehabilitation of the geriatric vascular amputee patient: A population-based study
        Archives of Physical Medicine and RehabilitationVol. 82Issue 6
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          Fletcher DD, Andrews KL, Butters MA, Jacobsen SJ, Rowland CM, Hallett JW Jr. Rehabilitation of the geriatric vascular amputee patient: a population-based study. Arch Phys Med Rehabil 2001;82:776-9. Objectives: To determine the rate of successful prosthetic fitting in geriatric vascular amputees in the community and to determine predictors of successful fit. Design: Epidemiologic survey. Setting: General community, Olmsted County, Minnesota. Patients: All Olmsted County residents more than 65 years old who had a major lower extremity amputation (below knee amputation [BKA] or higher) for peripheral vascular disease between 1974-1995, of whom 199 were identified.
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