Amputations Bad–Public Health Good

If you spend a lot of your working time nagging people to keep their blood sugar under control and to take good care of their feet you will appreciate this. From the Centers for Disease Control…

CDC report finds large decline in lower-limb amputations among U.S. adults with diagnosed diabetes

The rate of leg and foot amputations among U.S. adults aged 40 and older with diagnosed diabetes declined by 65 percent between 1996 and 2008, according to a study by the Centers for Disease Control and Prevention and published today in the journal, Diabetes Care. The age–adjusted rate of nontraumatic lower–limb amputations was 3.9 per 1,000 people with diagnosed diabetes in 2008 compared to 11.2 per 1,000 in 1996. Non–traumatic lower–limb amputations refer to those caused by circulatory problems that are a common complication among people with diabetes rather than amputations caused by injuries.

The study, “Declining Rates of Hospitalization for Nontraumatic Lower–Extremity Amputation in the Diabetic Population Aged 40 years or Older: U.S., 1988–2008,” is published in the current online issue of Diabetes Care.

The study also found that among people with diagnosed diabetes in 2008, men had higher age–adjusted rates of leg and foot amputations than women (6 per 1,000 vs. 1.9), and blacks had higher rates than whites (4.9 per 1,000 vs. 2.9). Adults aged 75 years and older had the highest rate – 6.2 per 1,000 – compared to other age groups.

The study authors note that improvements in blood sugar control, foot care and diabetes management, along with declines in cardiovascular disease, are likely to have contributed to the decline in leg and foot amputations among people with diagnosed diabetes.

Awesome. This kind of progress comes from educating the public, engaging health care workers, and lots of government involvement. And everyone knows that it’s better to have legs than not. I see that up close all the time.

When I started out as an aide in a nursing home, back in the mid-80′s, bedsores were common and the general attitude was just beginning to shift from ‘nothing can be done’ to ‘we’d better do something or Medicare is going to whack us.’ It’s no longer routine or accepted that people get bedsores, and the people I see now who have them tend to be very immobile or paralyzed. It’s a terrible problem that is best prevented. But prevention required a big investment of labor and an attitude adjustment. The payoff comes later.

I gotta run to work, I have lots of people to nag. Have a nice day.

Bedsores

Bedsores used to be common in immobile, debilitated patients. Early in my career in the 1980′s I saw horrendous sores in hospitalized patients. Muscle and bone exposed. The hospital nurses claimed it came from nursing homes, and nursing homes claimed it came from hospitals.

Preventing pressure sores is labor-intensive, requiring staff to turn the patients every 2 hours around the clock and treat signs of pressure aggressively. A red spot that doesn’t go away is a Stage I pressure sore. You don’t wait to treat until the skin breaks down. Pressure on skin is bad.

Pressure on nursing homes, however, is good. Bedsores are now the exception, not an inevitable consequence of age and disability. The heavy jack-booted inspectors from that government program, Medicare, deserve a lot of the credit.

Summit Commons, an East Side skilled-nursing center that had until Tuesday to correct deficiencies that were deemed serious enough to put some patients in immediate jeopardy from bedsores, has met the conditions to continue participating in the federal Medicare program.

It’s not that it’s not aggravating to have some state worker do the white-glove routine, when you are up to your armpits in work and feel like you’re bailing a sinking ship. Nursing home workers run their legs off trying to keep the patients clean and safe. Facilities have a financial incentive to keep staff as low as possible.

Having a big government program with the power stand up to big nursing home chains is protection for the patients. I am really happy that nursing homes generally are better than they were twenty years ago, and that bedsores are not acceptable.