Table 5

Challenges reported that span work settings and particular tasks

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"


Fragar and Depczynski BMC Health Services Research 2011 11:42   doi:10.1186/1472-6963-11-42

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