Are there certain products that help with issues common to elderly patients?

With elderly patients, it’s helpful if they don’t have to fumble around for a lock. If I think they can [learn, I put KAFO patients] in a swing-phase lock. Or trigger locks are helpful. I haven’t done drop locks in a long time. Otto Bock also does a knee extension assist that can help get people up out of a chair.

Some of the brace makers will number the straps, and that’s very helpful. For people with arthritis, loops on the straps are helpful. An AFO that doesn’t have to be tightened at the ankle, but can tighten at the knee is helpful. With [lumbosacral braces], the ease of getting it on is key.

If makers can limit the number of straps, that helps. Trying to get [some of these products] on can be like trying to untangle a garden hose.

Rod McComber, CO
Springer Prosthetic & Orthotic Services Inc.
Lansing, Mich.

Skin is probably the biggest concern. Diabetes is the worst one. [For foot orthoses], we use plastizote, PPT—material with softer durometers. Some silicones are on the market.

The products are good; it’s just fabricating them that can create problems, because it’s custom fabrication. For instance, a custom arch support is made out of plastizote, but it starts with a plaster model. Getting that model correct makes the difference. That’s the critical point, and it just takes hands-on experience.

There’s a lot of new technology, like CAD-CAM, but a lot of it just comes from feel—your hands and your brain.

With CAD-CAM, I think it’s great, but you just have a computer screen and a file downloaded. Your hands only touch the keys.

Craig Jones, CO
Clinical Director, Oregon Orthotic Services Inc.
Portland, Ore.

Even though stump socks on a prosthesis are marked in color bands, [older patients] can’t always remember. Often what you have to do is give them written instructions for proper donning procedures. I usually give them a card listing the sock and color and ply so they can refer back to that.

Another issue is the nighttime. Most of us can make it through the night, but in many cases they can’t. Sometimes these individuals have nighttime needs to get up and move, so they have to be able to don [prosthetic and orthotic devices] easily.

Dan Hill, BOCO, CPO
Marshfield Clinic Prosthetic & Orthotic Department
Marshfield, Wis.

Something you certainly have to worry about is that their skin, as they get older, can get very fragile, particularly if they’re diabetic.

Prosthetic-wise, a good part of my geriatric practice is diabetic. With skin problems, more often than not, it’s that they haven’t changed their liners and they haven’t washed them properly, including rinsing off the soap, which can be [an irritant].

What I find works well in almost all cases is one of the gel liners. I do find that I don’t favor the suspension sleeves for geriatrics because of hand strength. Also, with pin suspension I usually use the one that clicks in, because patients like to be able to hear that. They know the prosthesis isn’t going to fall off. Of course they’re not going to be doing [much that’s] high activity, so pin suspension isn’t going to be a problem.

[With older patients,] I look very carefully at whether they have the ability to go to a K3 level. If I think they have the strength or willingness for K3 then I’ll fit them with a Freedom or FlexFoot, or College Park TruStep Tribute. I can step down a Tribute for a K2, but you don’t get the coding. I recently had a geriatric AK patient that I thought would be able to handle a Geolite knee, but I found that with the aphasia from one of her strokes, she had a hard time compressing and extending it.

[Some older patients] had polio back prior to 1952 and may not have even had a brace for some years. We have found that the stance control knee is very beneficial to some of these patients if they have some sort of thigh control. I’ve seen some remarkable things going on there with older patients.

Ted A. Gaskell, CP
Facility Manager, Horton’s Orthotic Lab Inc.
Fort Smith, Ark.

What’s really common is that [elderly patients] want to walk without any walking assist. I do encourage the use of walkers, canes—whatever is applicable. The people that were active before their amputation think they’re going to get back to that too quickly.

Kenny Fulton, CP, FAAOP
Cape Prosthetics-Orthotics Inc.
Cape Girardeau, Mo.

Have a question? If you’d like to suggest a question—or answer one—for this column, contact Becky Kesner at bkesner@AOPAnet.org or (571) 431-0815.