Is patients' activities of daily living self-care score in Norwegian home care a proxy for workers standing at work?

BACKGROUND: Prolonged standing at work may contribute to increased risk of musculoskeletal pain in home care workers. Patients' activities of daily living (ADL) score may be a proxy for home care workers' standing time at work. The objective of the present study was to investigate the association between patients' ADL self-care score, and workers standing time. METHODS: This cross-sectional study measured time spent standing, sitting and in physical activity for seven days using thigh-worn accelerometers, among 14 home care workers. Patients' ADL self-care scores are routinely adjusted by home care nurses, and time intervals of home care visits are stored in home care services electronic patient journal. We collected ADL self-care scores and start and end time points of visits, and categorized ADL self-care scores as low (ADL ≤ 2.0), medium (ADL > 2.0 to 3.0) or high (ADL > 3.0). Physical behavior data were transformed to isometric log-ratios and a mixed-effect model was used to investigate differences in physical behavior between the three ADL self-care score categories. RESULTS: We analyzed 931 patient visits and found that high ADL self-care scores were associated with longer standing times relative to sitting and physical activity, compared to low ADL score (0.457, p = 0.001). However, no significant differences in time spent standing were found between high and medium ADL patient visits (0.259, p = 0.260), nor medium and low (0.204, p = 0.288). High ADL score patients made up 33.4% of the total care time, despite only making up 7.8% of the number of patients. CONCLUSION: Our findings suggest that caring for patients with high ADL self-care score requires workers to stand for longer durations and that this group of patients constitute a significant proportion of home care workers' total work time. The findings of this study can inform interventions to improve musculoskeletal health among home care workers by appropriate planning of patient visits.

Association between musculoskeletal pain and exposures to awkward postures during work: a compositional analysis approach.

OBJECTIVES: This study aimed to explore the association between arm elevation and neck/shoulder pain, and trunk forwarding bending and low back pain among home care workers. METHODS: Home care workers (N = 116) from 11 home care units in Trondheim, Norway, filled in pain assessment and working hours questionnaire, and wore 3 accelerometers for up to 7 consecutive days. Work time was partitioned into upright awkward posture, nonawkward posture, and nonupright time, i.e. sitting. Within a compositional approach framework, posture time compositions were expressed in terms of log-ratio coordinates for statistical analysis and modeling. Poisson generalized linear mixed models were used to analyze the relationship between arm elevation in upright postures and neck/shoulder pain, and between trunk forward bending in upright postures and low back pain, respectively. Isotemporal substitution analysis was used to investigate the association of pain assessment with the reallocation of time spent in the different postures. RESULTS: Time spent in awkward postures was modest, especially for the more extreme angles (60° and 90°). Adjusting for age, gender, and body mass index, our study suggested that the compositions of time spent by home care workers in awkward postures were significantly associated with pain assessment (P < 0.01). Isotemporal substitution analysis showed that reallocating 5 min from upright posture with arms elevated below to above 60° and 90° was associated with a 6.8% and 19.9% increase in the neck/shoulder pain score, respectively. Reallocating 5 min from a forward bending posture while upright below to above 30°, 60°, and 90° was associated with 1.8%, 3.5%, and 4.0% increase in low back pain, respectively. CONCLUSIONS: Although the exposure to awkward postures was modest, our results showed an association between increased time spent in awkward postures and an increase in neck/shoulder pain and low back pain in home care workers. As musculoskeletal pain is the leading cause of sickness absence, these findings suggest that home care units could benefit from re-organizing work to avoid excessive arm elevation and trunk forward bending in workers.

Aging at home: factors associated with independence in activities of daily living among older adults in Norway-a HUNT study.

Background: Maintaining independence in activities of daily living (ADL) is essential for the well-being of older adults. This study examined the relationship between demographic and living situation factors and ADL independence among community-dwelling older adults in Norway. Methods: Data was collected in Norway between 2017 and 2019 as part of the fourth wave of the ongoing Trøndelag Health Study (HUNT) survey, sent to all citizens in Trøndelag county over 20 years of age, which is considered representative of the Norwegian population. Included in the current cross-sectional study were 22,504 community-living individuals aged 70 years or older who completed the survey and responded to all items constituting the ADL outcome measure. Group differences in ADL independence were examined with Chi Square tests, while crude and adjusted associations with ADL independence were examined with logistic regression analyses. Statistical significance was set at p < 0.05. Results: The participants reported a high degree of independence in primary ADL and slightly lower in instrumental ADL. In the fully adjusted analyses, ADL independence was associated with lower age, female gender, higher levels of education and income, higher subjective well-being, having no chronic or disabling disease, and having someone to talk to in confidence. Surprisingly, women who were married had higher likelihood of ADL independence than unmarried women, whereas married men had lower likelihood of ADL independence than unmarried men. Conclusion: In addition to known demographic and disease-related factors, the social context affects independence in ADL even in a society that offers advanced health and homecare services to all older adults equally. Furthermore, the same social setting can have differential effects on men and women. Despite the healthcare system in Norway being well-developed, it does not completely address this issue. Further improvements are necessary to address potential challenges that older adults encounter regarding their social connections and feelings of inclusion. Individuals with limited education and income are especially susceptible to ADL dependency as they age, necessitating healthcare services to specifically cater to this disadvantaged demographic.

Can home care work be organized to promote health among the workers while maintaining productivity? An investigation into stakeholders' perspectives on organizational work redesign concepts based on the Goldilocks Work principles.

BACKGROUND: Due to the aging population, the need for home care services is increasing in most Western countries, including Norway. However, the highly physical nature of this job could contribute to make recruiting and retaining qualified home care workers (HCWs) challenging. This issue may be overcome by adopting the Goldilocks Work principles, aiming at promoting workers' physical health by determining a "just right" balance between work demands and recovery periods while maintaining productivity. The aim of this study was to 1) gather suggestions from home care employees on suitable organizational (re)design concepts for promoting HCWs' physical health and 2) have researchers and managers define actionable behavioral aims for the HCWs for each proposed (re)design concept and evaluate them in the context of the Goldilocks Work principles. METHODS: HCWs, safety representatives, and operation coordinators (n = 14) from three Norwegian home care units participated in digital workshops led by a researcher. They suggested, ranked, and discussed redesign concepts aimed at promoting HCWs' health. The redesign concepts were subsequently operationalized and evaluated by three researchers and three home care managers. RESULTS: Workshop participants suggested five redesign concepts, namely "operation coordinators should distribute work lists with different occupational physical activity demands more evenly between HCWs", "operation coordinators should distribute transportation modes more evenly between HCWs", "Managers should facilitate correct use of ergonomic aids and techniques", "HCWs should use the stairs instead of the elevator", and "HCWs should participate in home-based exercise training with clients". Only the first two redesign concepts were considered to be aligned with the Goldilocks Work principles. A corresponding behavioral aim for a "just right" workload was defined: reduce inter-individual differences in occupational physical activity throughout a work week. CONCLUSIONS: Operation coordinators could have a key role in health-promoting organizational work redesign based on the Goldilocks Work principles in home care. By reducing the inter-individual differences in occupational physical activity throughout a work week, HCWs' health may be improved, thus reducing absenteeism and increasing the sustainability of home care services. The two suggested redesign concepts should be considered areas for evaluation and adoption in practice by researchers and home care services in similar settings.

Can home care work be organized to promote musculoskeletal health for workers? Study protocol for the Norwegian GoldiCare cluster randomized controlled trial.

BACKGROUND: Home care workers perform physically strenuous tasks, in particular when handling patients with high care demands. Thus, musculoskeletal pain and sick leave is greater in this group than in the general population. To ease these issues, we will implement a Goldilocks Work intervention (GoldiCare), redistributing schedules between workers to achieve a "just right" weekly structure of physical work that can promote health. This protocol paper describes the content, design, implementation and evaluation of the cluster randomized controlled trial of the GoldiCare intervention in home care. METHODS: The cluster randomized controlled trial is a 16-week workplace organizational intervention implemented through operations managers at the home care units. The operations managers will be introduced to the Goldilocks Work Principle and a GoldiCare tool, to assist the operations managers when composing a "just right" distribution of work schedules throughout the week. The GoldiCare tool provides an overview of the physical strain for each shift, based on the number of patients and their need for care. We expect to include 11 units, which will be randomized to either intervention or control at a 1:1 ratio. Home care workers assigned to the control group will continue to work as normal during the intervention period. Musculoskeletal pain in neck/shoulder and lower back will be the primary outcomes and we will also evaluate the composition of physical behaviors as well as fatigue after work as secondary outcomes. We will collect data using (1) daily questions regarding musculoskeletal pain and fatigue after work, (2) 7 days of objective measurements of physical behavior, (3) questionnaires about the participant's characteristics, health, and workplace psychosocial stressors and (4) information on the implementation of the GoldiCare tool. In addition, a process evaluation will be conducted using focus group discussions and individual interviews. DISCUSSION: Due to the increasing aging population in need of care, measures that can improve the health of home care workers are paramount for the sustainability of this sector. This organizational intervention is based on information available nation-wide, and therefore has the potential to be scaled to all municipalities in Norway if proven effective. TRIAL REGISTRATION: This clinical trial was registered on 08/05/2022 under NCT05487027 .

Assessment of Physical Work Demands of Home Care Workers in Norway: An Observational Study Using Wearable Sensor Technology.

OBJECTIVES: High physical work demands are believed to be partly responsible for the high sickness absence among home care workers, but no studies have assessed their physical work demands using precise device-based measurements. Hence, the objective of this observational study was to assess physical work demands in home care, using wearable sensors. METHODS: From six home care units in a large municipality in Norway, 114 of 195 eligible home care workers filled in a questionnaire, a diary about work hours, and wore five accelerometers, and a heart rate sensor for up to six consecutive workdays. RESULTS: On average, the homecare workers spent 50% of the working hours sitting, 25.2% standing, 11.4% moving, 8.3% walking fast, 1.9% walking slow, 1.2% stair-climbing, 0.3% cycling, and 0.05% running. We found the following exposures to demanding postures: arm-elevation in an upright body position ≥30° was 36.7%, ≥60° was 4.1%, and ≥90°was 0.5%; forward trunk inclination in an upright body position ≥30° was 9.9%, ≥60° was 4%, and ≥90° was 1%; and for kneeling it was 0.8%. We found the average cardiovascular load (%heart rate reserve) during work to be 28%. There was considerable individual variation in these physical exposures at work. CONCLUSIONS: This study presents precise information on various physical work demands of home care workers in Norway. Home care workers spent on average half the workday sitting and the remaining time in various occupational physical activities. Presently, few device-based exposure limits have been proposed for acceptable amounts of occupational physical exposures, but the level of arm-elevation, forward trunk inclination, and the considerable variation of physical workloads among home care workers, indicate that preventive measures should be taken.

Home care workers' experiences of work conditions related to their occupational health: a qualitative study.

BACKGROUND: The need for home care workers (HCWs) is rapidly growing in Norway due to the increasingly growing elderly population. HCWs are exposed to a number of occupational hazards and physically demanding work tasks. Musculoskeletal disorders, stress, exhaustion, high sick leave rates and a high probability of being granted a disability pension are common challenges. This qualitative study explored the views of HCWs on how working conditions affect their safety, health, and wellbeing. METHODS: A descriptive and explorative design was utilised using semi-structured individual interviews with eight HCWs from three home care units in a middle-sized Norwegian city. Interviews were conducted in the Norwegian language, audio-recorded, and transcribed verbatim. The data was analysed by systematic text condensation. Key data quotes were translated into English by the authors. RESULTS: HCWs reported that meaningful work-related interactions and relationships contributed to their improved wellbeing. Challenging interactions, such as verbal violence by consumers, were deemed stressful. The unpredictable work conditions HCWs encounter in users' homes contributed to their exposure to environmental hazards and unhealthy physical workloads. This was the case, although the employer promoted ergonomic work practices such as ergonomic body mechanics when mobilising and handling of clients, using safe patient handling equipment. HCWs perceived high level of individual responsibility for complying with company safety policies and practices, representing a health barrier for some. Organisational frameworks created unhealthy work conditions by shift work, time pressure and staffing challenges. Performing tasks in accordance with HCWs professional skills and identity was perceived as health-promoting. CONCLUSIONS: This study suggests that unpredictable working conditions at users' home can adversely affect the safety, health, and wellbeing of HCWs. The interaction between the unpredictable environment at users' homes, HCWs' perceived high level of individual responsibility for complying with company safety policies and practices, and staffing challenges due to sickness-related absences upon the workplace creates tense work conditions with a negative influence on HCWs health.

Home health aides' experiences of their occupational health: a qualitative meta-synthesis.

Home health aides (HHA) have high sickness absence while the need for home care services is rapidly growing. The aim of this study was to derive new conceptual understandings by identifying, describing and interpreting key concepts across qualitative studies on how HHA experience their occupational health related to their working conditions.A qualitative ethnographic meta-synthesis was used as a method to analyze 27 articles included from systematic searches in CINAHL, MEDLINE and PsycINFO.HHA experience physical strenuous work task demands in combination with unfortunate organizational conditions in an uncontrolled and ever-changing psychosocial and physical working environment as the main obstacle to their occupational health, although many positive presence factors with opposite effects were reported.More research is needed to investigate whether physical demanding work tasks can have positive effects on HHA's occupational health by reorganizing their work while preserving patients' empowerment at their home.