Background
Methods
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work tasks and aspects of work that have become more difficult for rural health workers as they have become older;
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age-related changes and other exacerbating factors contributing to these difficulties
Results
Challenges in particular work settings
Tasks impacted by age-related factors | Reported reasons why each is more difficult |
---|---|
1. Reading drug labels and information sheets
|
Age related factors:
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2. Reading other print communications
| ▪ Deteriorating vision |
Exacerbated by:
| |
▪ Poor light at night, environmentally friendly light bulbs | |
▪ Small print (eg. drug labels, information sheets, ampoules, imprints on foil packs) | |
▪ Colour of print (eg. orange or red writing on ampoules) | |
▪ Reading through plastic sleeves | |
▪ Losing glasses - continually taking them on and off | |
▪ Increased computer work - associated eye strain | |
▪ Size of phones, keypads, text messages | |
3. Administering medications
|
Age-related factors specific to these tasks -
|
Including: | ▪ Reduced strength in hands and wrists |
▪ Cracking ampoules | ▪ Pain in hands and wrists |
▪ Administering IV medications and removing IV lines | ▪ Fine motor co-ordination reduced |
▪ Openning packages - lids, jars, plastic overwrap, boxes with tape, dressing packs, seals, child proof packages, IV fluid bags | ▪ Reduced dexterity |
▪ Increased cramping of fingers | |
Exacerbated by:
| |
▪ Smaller, more secure packaging | |
▪ Environmentally friendly gloves | |
4. Hearing in the hospital ward or unit
|
Age related factors:
|
In particular:
| ▪ Deteriorating hearing |
▪ Hearing patients | ▪ For some, noise induced hearing loss |
▪ Hearing at the work- station | |
- Drug orders, other instructions and conversation over the phone |
Exacerbated by:
|
- Other staff | ▪ Accents of some non-English-speaking staff |
- Alarms and distinguishing between them | ▪ High background noise level of wards with open office |
▪ Distractions - constancy of phones ringing, others talking | |
▪ Anywhere where there's a crowd | |
▪ Speech of younger staff | |
5. Manual handling - lifting and/or moving patients and equipment
|
Age-related factors:
|
In particular:
| ▪ Musculo-skeletal changes affecting strength, muscle tone, flexibility |
▪ Examining patients | ▪ Stability and balance |
▪ Dressing patients - shoes & socks, adjusting clothes/attire | ▪ Increased pain, stiffness (+/- osteoarthritis) in: |
▪ Holding limbs and draping surgical patients | - Joints - hips, knees, hands, feet |
▪ Pushing/pulling equipment - eg. beds, chairs | - Neck and shoulders |
▪ Showering patients | - Back |
▪ Toileting patients in difficult areas | ▪ Manoeuvring more difficult when older; fuller figures of both patients and staff |
▪ Squatting or kneeling - for procedures, picking things up off floor |
Exacerbated by:
|
▪ Doing dressings | ▪ Manoeuvrability and maintenance of equipment |
▪ Making beds, adjusting bed heights | ▪ Workplace ergonomics and design of facilities (old) |
▪ Walking up and down steps | ▪ Narrow bathrooms and doors don't allow room for lifting aids |
▪ Transporting objects, records | ▪ No shelves or poor position of shelves |
▪ Unco-operative patients | |
▪ All-in-one gowns - difficult for examining patients | |
6. Shift work
|
Age-related factors:
|
In particular:
| ▪ Tiredness, especially after lunch |
▪ 10 hr shifts, longer shifts, more shifts, double shifts, early shifts, split shift | ▪ Reduced stamina from physical demands on body |
▪ Rigid roster | ▪ Longer recovery periods - "takes 2 days to get over a double shift" |
▪ On call | ▪ Lack of sleep, disturbed sleep patterns, "waking at 3 am" |
▪ Long working days | ▪ More anxious, not dealing with lack of sleep as well as before |
▪ Strong work ethic of older workers - "if you were younger, you would just go off" | |
Exacerbated by:
| |
▪ Inflexible work hours | |
▪ Lack of staff - "can't go off sick, no one to replace you" | |
▪ Unable to take time out to recover | |
▪ Poor recovery after inconsistent shifts; insufficient rest times between rotations and being on call | |
▪ Some older workers more resistant to shift changes | |
7. Long periods of standing, walking or sitting
|
Age-related factors:
|
In particular:
| ▪ Manoeuvring more difficult when older, fuller figures of both patients and staff |
▪ Sitting down for long periods eg. data entry | ▪ More difficult to get mobile quickly after sitting, due to stiffness and back problems |
▪ Standing/walking, being on your feet for long periods or all day. eg. in operating theatre | |
▪ Unnecessary walking |
Exacerbated by:
|
▪ Past surgical procedures | |
▪ Design of facilities - long distances to medication rooms, utility rooms | |
▪ Running phones up and down to patients, "have to leave what you are doing" | |
8. Midwifery
|
Age-related factors:
|
In particular:
| ▪ More difficult to lean, bend, stand for long periods now older |
▪ Delivery of babies - long periods of: | ▪ Back pain and stiffness |
- Leaning over beds | ▪ (As above for manual handling)
|
- Bending | |
- Being on your feet |
Exacerbated by:
|
- On floor with mother | ▪ New options/positions for birthing & birthing chairs |
▪ Presentations now more complex, with more requirements | |
9. Physiotherapy
|
Age-related factors:
|
In particular:
| ▪ Back pain and stiffness |
▪ Patient exercises - bending/reaching over beds leading to back-strain | ▪ (As above for manual handling)
|
Exacerbated by:
| |
▪ Allied health workers in rural areas are often sole practitioners with no help |
"Patients are older and heavier ... and so are we."
"It takes 2 days to get over a double shift.""You can't go off sick - there's no one to replace you."
"I think (these are) reasons why some older nurses no longer practice midwifery."
Tasks impacted by age-related factors | Reported reasons why each is more difficult |
---|---|
1. Work involving vehicles
|
Age-related factors specific to these tasks -
|
In particular:
| ▪ Arthritis, sore joints, backaches - caused or exacerbated by vehicles and driving |
▪ General driving during the day | - Less flexibility, manoeuvrability for getting in and out of cars |
▪ Reversing vehicles | - Harder to turn around to look behind/harder to see out of cars |
▪ Getting in and out of cars and the 'Day Care' bus | ▪ More fatigued for report writing, after driving around during the day |
▪ Carrying equipment to/from vehicles and homes eg. baby scales |
Exacerbated by:
|
▪ Ergonomics of smaller and lower cars ("green policy") | |
- Hard to get in and out of, not comfortable, poor seating | |
▪ 'Day Care' bus, bumping up and down along the road | |
▪ Tight time frames, rushing | |
▪ General safety issues related to night and long-distance driving - vision, fatigue, time allowed | |
2. Work involving home visits
|
Age-related factors specific to these tasks -
|
In particular:
| ▪ Musculoskeletal changes - strength, tone, flexibility, pain and stiffness, backache - caused/exacerbated by vehicles and driving |
▪ Carrying equipment to/from vehicles and homes eg. baby scales | ▪ Manoeuvring, mobility and stability on feet (with clutter) more difficult when older |
▪ Moving around and manoeuvring in cluttered houses |
Exacerbated by:
|
▪ Home clutter and trip hazards | |
▪ Manoeuvrability of equipment | |
▪ Home ergonomics and design - narrow bathrooms and doors that don't allow room for manoeuvring |
"The (smaller car brands) are too low - you have to 'roll out of them.'"
Challenges impacted by age-related factors | Reported reasons why each is more difficult |
---|---|
1. Physical aspects
|
Age-related factors
|
In particular
| ▪ Neck, shoulders strain, tired at end of day |
▪ Use of mouse, developing carpel tunnel | ▪ Stiffness when sitting for long periods |
▪ Keyboard dexterity | ▪ Hand problems, clicking on mouse |
▪ Seeing screens | ▪ Eye strain and vision |
▪ Sitting at computers for long periods for data entry |
Exacerbated by:
|
2.
Mental aspects
| ▪ More clicking on the mouse required for newer programs |
In particular:
| ▪ Ergonomic factors: |
▪ Use of new technology | - Sitting more, less active |
▪ Learning new programs and changes to programs | - Posture and seating, some computers badly set up, on a bench |
▪ Statistics | ▪ IT education provision |
▪ Remembering passwords | - not tailored to particular needs |
▪ Interpreting computerised results | - Not enough time allowed for older workers to learn, absorb and apply knowledge. "Younger workers already with computer skills, get the same amount of training time" |
- "Helpdesk" is on the computer, not in hardcopy" | |
▪ Historical-generational learning factors | |
- Not having computers at home and not growing up with computers | |
- Computers not seen as a priority | |
- Learn differently, "we are more practical people" | |
- Harder for shift workers to adapt to computer | |
▪ General lack of confidence and support with computers and new technology: | |
- IT support not always available when needed | |
- Frequency of use - affects confidence | |
- Tendency to avoid new technology due to difficulty with equipment |
"I.T trainers assume a skill level that is not necessarily so""Some have even left because of the computers... or some can't work in emergency department (ED) ... because they can't use the computer."
Challenges impacted by age-related factors | Reported reasons why each is more difficult |
---|---|
1. Travel to meetings and conferences
|
Age-related factors:
|
In particular:
| ▪ Less stamina, staying power for long distance driving |
▪ Long distance and night driving to meetings | ▪ Night driving: |
- Glare of lights, vision not as sharp | |
- "Lots of signs, adds to confusion" | |
Exacerbated by:
| |
▪ Ergonomics of smaller and lower cars | |
▪ Tight time frames (rushing) | |
2. Participation in ongoing education
|
Age related factors:
|
In particular:
| ▪ Difficulty retaining 'new learnings' |
▪ Going to educational courses |
Exacerbated by:
|
▪ Difficulty learning new skills eg. surgical procedures | ▪ Can't find time to go, can't find the time to read about courses |
▪ Negative responses to older workers wanting/participating in training | ▪ Locations - hard to get to (see travel difficulties) |
- Usually located hours away - time to get there and back | |
- Very early leaving and very late getting back | |
▪ Attitudes toward older workers showing an interest or participating in courses: | |
- Offered to younger staff in preference | |
- Feeling of being overlooked for courses, "you'll be retiring soon" ...but a prevailing belief it is more likely older workers will stay in a place for longer | |
▪ In contrast, participants also reported that some workers "flatly refuse to go/change or learn - doggedness" (which doesn't help those who want to) | |
3. Hearing speech in video and teleconferencing meetings
|
Age related factors:
|
▪ Deteriorating hearing - 'noise induced' for some | |
Exacerbated by:
| |
▪ Nature of communication system |
Challenges spanning work tasks and settings
Challenges impacted by age-related factors | Reported reasons why each is more difficult |
---|---|
1. Dealing with mental demands of work
|
Age-related factors:
|
In particular:
| ▪ Memory and recall not as good as when younger |
▪ Dealing with the paperwork | ▪ Added stresses affect cognitive function |
▪ Remembering things | ▪ More difficult to concentrate for long periods and with distractions |
- Passwords | ▪ Mental fatigue leads to tiredness |
- Clients names |
Exacerbated by:
|
- Where "lists are" | ▪ Constant changes in work systems |
▪ Emails and other required reading | ▪ More hats to wear - roles, variety of tasks and multi-tasking |
▪ Keeping mind on task | ▪ Information overload |
▪ Managing stress and burn-out | - Increased emails, required reading, amount of reading within tasks |
- "Too many meetings" | |
▪ Stress and expectation to have "stuff in your head" | |
- New information and passwords (see computers)
| |
- Client expectations to remember their names | |
▪ Pressure of meeting several demands at once | |
▪ Longer term impacts - always stretched, physical and emotional stress, less happy, less tolerant etc. | |
2. Meeting the physical demands of workload as an older health worker
|
Age-related factors:
|
▪ Musculo-skeletal changes - increased pain, stiffness | |
▪ General tiredness and fatigue - especially after lunch, end of day, focusing for long periods | |
▪ Reduced fitness and endurance - reduced energy levels and loss of weight (or gain) | |
▪ Slower physically - takes longer to do things, including routine tasks, can't walk as quickly | |
Exacerbated by:
| |
▪ A sense there is more to do, but not enough time to do everything, or do it well | |
▪ "Patients (and populous) are older, heavier- and so are we" | |
▪ Sicker, more dependent and debilitated patients | |
3. Coping with change
|
Age related factors:
|
These may be:
| ▪ Subdued mental reflexes/agility |
▪ Procedural | ▪ Need more time to assimilate knowledge/change |
▪ Organisational | ▪ Less/lack of adaptability |
In particular:
| |
▪ Role changes |
Exacerbated by/resistance to change due to:
|
▪ Coping with change both cognitively and emotionally | ▪ "Constant change" referring to the many changes in the health service over the past 15 years eg. in systems, procedures, roles |
Coping with sudden change | ▪ Change often associated with increased paperwork requirements, new computer programmes |
▪ Less tolerance for supposedly 'new things' and "reinventing wheels" | |
▪ Experience of older workers not valued, "people don't ask us (about the change), the opportunity is not provided" | |
▪ Casual workers - don't always know about changes | |
▪ In contrast, participants also noted that some workers refuse to change or learn - "doggedness") | |
4. Dealing with emotional impacts of attachment, loss and awareness of own ageing and mortality
|
Age related factors:
|
In particular:
| ▪ Confronted by ageing process in clients, colleagues |
▪ Emotional stress after episodes in acute care | ▪ Death of older people affects us more as we age - closer to own age" |
▪ Death of older people, who are often well-known to workers | ▪ Dealing with ageing in clients and own ageing/mortality |
▪ Loss, grief associated with colleagues leaving | ▪ Slower recovery from physical and emotional stress |
Coming to work with younger colleagues | ▪ Difficulty sleeping |
Exacerbated by:
| |
▪ Patients are becoming peers, bonds formed over any years - "Now you know them, they're not just a patient" | |
▪ No debriefing available | |
5. Dealing with emotional impacts of not achieving personal standards and goals
|
Age related factors:
|
Including: | ▪ Self-awareness that things take longer/workload |
▪ A sense of change from total patient care to something less, with lower standards |
Exacerbated by:
|
▪ Lack of time to achieve higher standards of care | ▪ Difficulty saying no to physical work required (ethic) |
▪ Less job satisfaction: | ▪ Lack of time to achieve high standards leading to feelings of 'guilt, frustration, lack of pride, poor job satisfaction' |
▪ Seeming lack of understanding by higher executives of encroachment of administrative work on clinical time | |
▪ Declining work conditions over the years - shared offices, technology, work cultural changes, more stimulation | |
6. Emotional impacts of not meeting/fulfilling expectations of others
|
Age related factors:
|
Including
:
| ▪ Less able to cope with stress and changing roles (see above)
|
▪ Patients expectations |
Exacerbated by:
|
▪ Organisational expectations relating to workload and workforce: | ▪ Nature of job - increasingly stressful and changing roles at a time of life when less able to cope |
▪ Peer expectations - supporting other staff and being the "stable" staff member | ▪ High expectations of clients for complete recovery and short recovery times mismatched with staff perspective - leading to tension/stress |
▪ High organisational expectations relating to workload | |
- Sense that required documentation is largely driven by fear/risk of litigation | |
- Workforce issues - recruitment in rural areas, getting harder | |
▪ Supporting other staff - exhausting | |
- "Others revolve, rotate around you and you have to take on more of the support/responsibility role" | |
7. Balancing work/family life commitments
|
Age -related factors:
|
Including:
| ▪ Own health issues - need for health appointments, specialists |
▪ Juggling work, family and sharing time with all family members | ▪ Coping with the many facets of life and still keeping your mind on the job |
▪ Time to fulfil all commitments | ▪ Less energy, slower, more weary, yet seemingly more tasks to do |
▪ No time for self - to look after yourself | ▪ Wisdom - desire for balance of work and family life |
Generational factors:
| |
▪ Main carer role in family - | |
- Ageing parents | |
- Looking after husband, older parents, growing children, adult children needing help eg. minding grandchildren | |
- Going home to do more physical work | |
Exacerbated by:
| |
▪ Other shift workers in family | |
▪ Split days off | |
▪ Distances to travel to see family | |
▪ "More to do (family), less time to do it", | |
▪ Assumptions by organisation and younger colleagues that older workers don't have family commitments | |
8. Staying engaged and positive in spite of difficulties
|
Age related factors:
|
Including:
| ▪ Less capable of dealing with the increased physical/emotional workload posed by demanding patients (see above) |
▪ Maintaining tolerance for attitudes and behaviours of patients, organisation and younger workers | - On the one hand, tolerance often lower for rudeness of people - "get to an age where you say - hang on, you can't speak to me like that" |
▪ Maintaining tolerance for attitudes and behaviours of patients, organisation and younger workers | ▪ In contrast: wisdom and tolerance gained through experience |
- "As you get older, you realise you can't fix things... you can only do so much" | |
▪ Sensitivities and the "psychology of ageism" | |
- More sensitive to criticism when older | |
- Negative thinking/spin from others and from self eg. "I'm too old" | |
▪ Tiredness dealing with difficult situations eg. confrontation associated with "dealing with destructive and undermining behaviours - would rather avoid it" | |
Exacerbated by:-
| |
▪ Attitudes and behaviours of patients, organisation, younger workers | |
▪ Interpersonal communication | |
- Communication with younger workers difficult - language used, seem "less compassionate", seem to "only half listen" | |
- In contrast: "Not in our team, we work well and communicate well," (need to) "beware of generalising" |
"It's just harder when things mount up at end of the day."
"A new system every year, you learn it, then it changes again."
"What goes around comes around, a revolving door of ideas, ... you've done it before and nothing ever came of it."
"The death of older people affects us more as we age ourselves - they're closer to our own age now.""Now you know them, they're not just a patient."
"When finished work, (we are) still carrying the bricks - caring for our own sick elderly.""At our age, we have children growing up, with their children, and elderly parents, (we are) the main carer."
"It's not the work you do, it's the work you cannot do that is frustrating and emotionally distressing and results in less job satisfaction."
Discussion
Conclusions
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Older health workers should be involved in development of "a resource booklet" on ageing and other factors that impact upon work with practical suggestions for addressing these at personal and local level
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The Health Service should establish a health service "Task Force", comprising managers, older rural health workers and an occupational therapist, to examine the study findings and implement area-wide policy and practice solutions, as well as recommendations for state-wide policy development.