Foot amputation in an 89-year-old?

My father had an amputation and revascularization. But because of his poor health and bad luck( long standing D.M, smoking , renal dialysis) he is going to need another amputation( below the knee) He has flat out refused. He is on antibiotics , they have helped bring down his WBC count but his general health is extremely poor. The infection is in his bones. I know other people similar to my father who kept having amputations till they decided no more and eventually passed away. Some people died right away some people took over a year but eventually passed away. It is brutal to deal with in any case.
We've been dealing with my father's ulcer since April, he had his first amputation in May, Dr. said he needed another one in July. He refused hoping he would die but it's been two months and I'm starting to think he should have just done it because he is really suffering and dying a slow death because of his osteomyelitis.

Surprisingly his first amputation site healed but he was unlucky enough to have a pocket of pus that the Dr. missed.
I would say give it a time limit- a month or so if he isn't getting better or starts getting worse or getting a fever- go for the amputation. Vac therapy helps close the wounds. Good luck and you are going to need help, don't try to do this all on your own.

You might ask your SF's Podiatrist about Dalvance infusions. For people with compromised kidney function they give it in two infusions with a week between. It's what DH's podiatrist is giving him for MRSA in his diabetic foot ulcers and he's got stage 3 kidney failure. His nephrologist was OK with it.

You may be looking at systemic infection killing him if this is not reacting to antibiotics. That is not to say that an operation can heal or help this. You may be up against a time when there are no good options. If someone has POA for health care it is time to have a palliative care consult. See if there is a way to save, or if this is just cutting off an inch at a time the very slow way.

My husband is younger but probably facing the same decision for the same reason. I read the study on the NIH site. According to that, for people your step father's age there is an 85% chance of death within 5 years. My husband immediately jumped to the conclusion that the artificial leg is what caused the high death rate. However, if someone has health issues so bad that amputation is required then you can't blame the artificial leg. I told my husband that you have to look at the quality of life you can expect for that 5 years. If your step father's quality of life with the ulcers, antibiotics and frequent Dr. visits is acceptable then he should probably keep up with that course of treatment. If he's just mentally done with it all, then an artificial limb might not be a bad idea. It's a major surgery with painful therapy and a significant time cost but the thought of being free of the foot ulcers might be a motivator. The novelty of being able to go to therapy might appeal to him. His insurance may or may not pay for it as well. I'm sure that they have some formula they apply to each case. There is a lot to consider and your step father's mental abilities and willingness to work hard definitely factors into it.

My mom (age 96) also has dementia. I had to move her into a nursing home when she reached a point where she would try to walk unassisted, forget to take pills, and stay in bed all day because it was "too much trouble" to pull a ready-made meal out of the fridge. The main thing is this: you want your LO to live comfortably and with as little pain as possible. This is why I determined some years ago that she will have no procedure that requires anesthesia. If that doesn't kill her, any number of steps in the procedure may cause death or worse: painful decline lying in bed 24 x 7.

It's hard for any of us to understand the experience of amputation, so how can someone with dementia know what he's in for? If he were mentally sound, you could have a conversation about this.I wouldn't put him through that ordeal. As it is, his dementia is going to get worse. The risk of adding pain to his decline far outweighs any benefit I can think of. Ask yourself: what might he gain? Then ask: what might he lose? I'm not saying it's easy, but for me, it's about any quality of life that's possible for him (or my mom) once a path is chosen.

Doctors are stuck with the job of fixing a physical problem. Their standards prohibit them from considering the whole person and the quality of their life that will result from the problems they "fix." That's why we caretakers have to advocate for our LOs. You've already said that his prospects don't look good. Your goals for your LO are much greater than the doctor's. Your main question may be this: Is this surgery likely to make his remaining days happier?

The anesthesia ALONE would be a problem. The fact with diabetes and amputations is the non healing and the fact that "stump revision" often requires more and more. Of course this infection could easily go to gangrene or to systemic infection, and either way the odds are not in your favor. Is it time for hospice or palliative care? Is there a POA involved who knows the wishes of this senior? Wishing you the best of luck in your decisions.

I don't know, what a decision. He has so many health problems. If not amputated he may get gangrene and die. But with his Dementia, he may not do what needs to be done to care for the wound or understand what needs to be done with the PT. I had a therapist tell me Mom didn't follow directions, didn't remember her exercises. My response, SHE HAS DEMENTIA. My GF had her leg removed up to the knee. There will be pain and phantom pain. He will be in a hospital and then rehab for a few weeks. This may be a problem for a Dementia patient. What I see here, is SDad will not return home. Which may be a good thing.

Hopefully others can give more insight.

Can you be specific about what kind of poor health? My uncle had both legs amputated above the knees when he was 91. He has COPD but I think that's the extent of his health issues. He is a physically strong guy, owned and worked his construction business. He just celebrated his 93rd bday. He is doing well but his daughter is his full-time caregiver. He tried to have prosthetics but it was too difficult for him since he was 6'3" and he just couldn't get the knack. Now he's in a fancy motorized wheelchair from the VA. He is from hearty Italian-American immigrant stock, a tough old bird, and I personally am blown away by his progress. My mom, his younger sister (age 90) is a retired RN and also is astounded. I think the key is having really good after care and a good attitude. Wishing him the best.