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" | |