INTRODUCTION
Aging adults are known for certain stereotypes. Some include wise, smarter,
sweet, or happy, but most of the time these stereotypes are things like cranky, boring,
sleepy, slow, etc. This is what the majority of aging adults have to face. Veterans often
have some of the same stereotypes: lonely, will talk your ear off, cranky, particular, etc.
Amputees have to face discrimination against disabilities and stereotypes such as:
dependent on others, can’t move, weak, or depressed. Now what if we have someone
who has all three of those identities intersecting? What physical things do aging
limbless veterans have to face in the world? What is their aging process like and do
they get the help they deserve/need?
Amputations for any age/population group is a deteriorating disability. Amputees
can experience phantom pain/sensation which is an extreme pain or sensation in the
limb that is no longer there, stump pain, and chronic back pain from muscle overuse.
Chronic back pain is especially prevalent in lower limb amputees, but even having an
amputated arm will likely throw natural balance patterns off, causing the need for back
muscles to compensate. Amputees also suffer from overuse injuries in their
non-amputated limb. Most of these physical symptoms can and will get worse as the
veteran starts the aging process or continues it (Ebrahimzadeh et al, 2009).
FINDINGS
Quality of Life
It’s easy to pity the limbless population, and even easier to do so with an aging
veteran who has most likely already gone through so much. However, as it turns out,
the quality of life for the majority of limbless veterans was still high despite all the
physical pain they were in. According to Caddick’s literature review in 2018, the quality
of life for aging limbless veterans is related to their personal attitude/sense of
independence, but also the kind of support they have at home.
Many veterans have a certain attitude that was most likely picked up from their
military days and was needed to get through. In another 2018 article from Caddick,
“Resisting decline? narratives of independence among aging limbless veterans,” he
found a “get on with it” attitude that was prevalent in this population. This attitude was
spun either negatively or positively whichever way the individual decided to look at life.
The veterans who had a negative lens, thinking they had to just ‘get on with it’ and
accept they had less mobility, were more likely to depend on others, more likely to stay
in their house, and less likely to ask for help due to the fear that other people would tell
them they had to get on with it. On the flip side, veterans who had a positive lens used
that ‘get on with it’ phrase to get going with life and were actually more likely to adapt
themselves to handle the struggles, more likely to be independent, and more likely to
ask for help when they needed it. One narrative in Caddick’s article was a 64 year old
above knee amputee with limited use of one hand. When talking about eventually
needing a wheelchair, he didn’t deny or refuse it but rather said “I’ve tried a wheelchair
one-handed and it’s quite difficult. So I'll just have to adapt it in some way, and, God, I –
in my mind I don’t want it to come even though it’s going to.” He was able to still have a
positive mindset about adapting to using a wheelchair despite not being happy about it.
He could have easily ‘got on with the process’ and started using a wheelchair already,
and he also could have flat out refused ever needing a wheelchair because he just
needs to get on with his life despite his situation. However, he decided to accept that it
was his reality, and was able to get over the idea enough to understand he can still be
independent for the most part with adaptations. This goes to show how powerful
mindset can be in determining how you tackle certain obstacles and the outcome of
your quality of life.
Medical Discrimination
When it comes to the amputation itself, many doctors are hesitant to do it due to
the patient's age. However, when looking at reasons of death after amputations, the
reasons were not due to age. If a patient died in the hospital after amputation, the cause
of death was most likely due to sepsis. If they died within a year afterwards, it is most
likely due to an associated illness. Furthermore, it was found that veterans who had to
undergo amputations had less deaths following the procedure than the average citizen
(Bates et al, 2006).
Physical Activity
Physical activity is important for many reasons, but for the reason of this paper
we’ll go by the benefits Foote et al mentioned (2015). Physical activity helps prevent
diabetes, heart risks, and weight gain. These are important to highlight, because post
amputation patients are at an increased risk of all three of those things. Physical activity
tends to drop after an amputation, and drops even more so for veterans going from a
unilateral amputation to a bilateral amputation– 48% of unilateral amputees report
walking, while that number drops to only 10% after a second amputation occurs
(Shareth et al, 2015). Maybe not so surprisingly, pre/post medical care and simple
conversations with doctors can actually play a major role in the amount of physical
activity a patient partakes in after the procedure (Littman et al, 2017). One amputee
from Littman’s study reported that a doctor had simply told him he could still play
basketball in a wheelchair and that was all he needed to then find out exactly how for
himself. He didn’t need the doctor to tell him exactly how, just that it was possible. This
is so important to be able to integrate into medical centers, because not everyone
knows that you can simply adapt certain games and activities so that you can do it.
There is no one size fits all for physical activity, and it should definitely be talked about
more.
Housing
Perhaps the hardest part of an amputation would be finally getting home after a
long hospital stay just to wonder how you're going to make it into the doorway.
Unfortunately, that’s a reality for many limbless veterans, especially those in
wheelchairs. Not everyone has a support person strong enough to wheel them up and
down stairs all day long. The majority of homes are made for able bodies (showers,
doorsteps, stairs, narrow hallways/doorways, etc.), and remodeling a house to include
stair lifts, wheelchair ramps, wider doorways, wheelchair friendly bathrooms, and
accessible cabinets/storage is extremely expensive and difficult. As a result, many
veterans are lost, confused, dealing with a major life altering change, and confined to
only a few rooms of their own home (Wilson et al, 2020).
DISCUSSION
Quality of life is such an important factor, but it’s a factor that can be influenced
by many things. Attitude, like mentioned earlier, is only one thing. It’s easier to have a
good attitude when you have a good medical team, good support at home, and an
understanding of how the VA works. The VA is one thing that veterans have that the
average citizen does not have. It could also potentially be the reason that less deaths
happen among the amputated veterans compared to the average citizen (Bates et al,
2006). The VA provides many benefits for veterans, including health care. Every veteran
has a right to access benefits from the VA, which is incredibly helpful for those that are
disabled. The VA can also pay for housing modifications, rehoming, and assistive
devices. However, despite these benefits, we still have many veterans stuck inside their
own home, unable to shower alone, use the bathroom, or even wander around their
house. The VA is not easily accessible and can absolutely have a negative effect on a
patient’s attitude.
Physical activity was also an important part of quality of life. Physical activity can
greatly help provide a sense of independence as well as purpose. We discovered earlier
that pre/post medical interactions can have major effects on if an amputated veteran
partakes in physical activity afterwards. This is so important because decreased sense
of independence and declining mobility was strongly linked with poorer quality of life
(Caddick; Cullen, et al, 2018). If a veteran isn’t walking or going from place to place
independently, and is getting depressed due to the situation, what are the chances
they’ll participate in another form of physical activity that’ll they’ll have to figure out how
to adapt for themselves? Our world isn’t the best when it comes to limited mobility.
There’s not a lot of information out there about sports in wheelchairs, or even simple
tips on how to adapt fun games to work for the individual. Adapting doesn’t always
come easy for everyone, and it’s not like the majority of people who were just put in a
wheelchair are immediately going to think how they can participate in physical activity.
This needs to be changed, and can start in the hospitals. Doctors can open up
conversations with patients and families, and give resources to adapted physical
activities. This is so important to be able to integrate into medical centers, because not
everyone knows that you can simply adapt certain games and activities so that you can
do it. There is no one size fits all for physical activity, and it should definitely be talked
about more.
CONCLUSION
Amputations make life easier in the way that one doesn’t have a bum limb
anymore. Other than that, amputees have to face a number of physical discomforts.
These discomforts include less mobility, phantom pain, chronic back pain, and muscle
compensation injuries. On top of the physical discomforts, aging limbless veterans have
to face discrimination, confusion on their rights, and may not even be able to move
around their own home.
Because of the physical and situational discomforts this population has to face,
it’s important we give them grace while also treating them like a human being. There
needs to be a way to educate amputated veterans on their benefits: how to access
them, who can help, and what they are, as well as educate them on the importance of
physical activity and how to adapt.
References
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associated with mortality in veteran population following transtibial or transfemoral
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https://doi.org/10.1682/jrrd.2006.03.0030
Caddick, N., Cullen, H., Clarke, A., Fossey, M., Hill, M., McGill, G., Greaves, J., Taylor, T.,
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