Table 1.

Tasks and challenges in hospital ward settings that have become more difficult with age

Tasks impacted by age-related factors	Reported reasons why each is more difficult
1. Reading drug labels and information sheets	Age related factors:
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