The ergonomics of providing care for a frail older adult Slide Decks... · 2017-04-25 · The ergonomics of providing care for a frail older adult Emily King, MASc ... Transfer Poles

Practical Advice for Caring Safely: The ergonomics of providing care for

a frail older adult

Emily King, MASc

PhD Candidate at Toronto Rehab & U Toronto

My background & interests

• Bachelor’s: Mechanical Engineering – Biomechanics Option

• Masters focus: Falls – why do they happen more as we get older

and how can they be prevented?

• PhD focus: Helping people to live well in their own homes for as

long as possible, as independently as possible, without hurting

their caregivers

• How? Research, education, product design

*Disclaimer: I’m not a clinician*

Poll: Do you provide care for a friend or family member?

Poll: Are you a… • Clinician

• Educator

• Researcher

• Policy maker

• None of the above

Safe caregiving takes problem solving

In this webinar, we will…

• Provide a simple summary of how injuries happen (statistical & biomechanical)

• Identify things to think about each time you provide care

• Discuss how these basic ergonomic principles can be applied in common home care scenarios

– Bathing

– Toileting (including sit-to-stand transfers)

Are there (other) specific things you are hoping to get out of today’s webinar?

Please use the chat box to let me know

Questions? Please use the chat box or the ‘raise your hand’ feature to ask questions throughout the webinar

Poll: Have you had any training in how to lift?

(body mechanics, safe patient handling, manual materials handling)

• Yes, lots • Some • A little bit • A little, but so long ago I can barely remember it • No, none

How do injuries happen?

Two types of injury

• Acute (sudden events)

– Care recipient falls/collapses • “his knees gave out”

– Poor coordination/co-operation between caregivers, or with the care recipient

• “client tried to sit too early”

Two types of injury • Acute (sudden events)

– Care recipient falls/collapses • “his knees gave out”

– Poor coordination/co-operation between caregivers, or with the care recipient

• “client tried to sit too early”

• Cumulative – Build-up of small bits of damage over time… but each

time is not enough to feel/hurt

– Persistent back pain can tell you that this is becoming a serious problem

Most caregiving injuries are back injuries

0

5

10

15

20

25

30

35

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Back Shoulder Abdomen Arm Wrist Leg Multiple Body Parts

% L

os

t-ti

me

In

juri

es

(US BLS 2010)

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5

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Overexertion Falls, slips and trips Transportation Violence Contact withobjects

% o

f In

jury

Illn

ess

Event leading to injury or illness for home health care services workers

BLS, 2013

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5

10

15

20

25

30

35

40

45

Overexertion Falls, slips and trips Transportation Violence Contact withobjects

% o

f In

jury

Illn

ess

Event leading to injury or illness for home health care services workers

BLS, 2013

0

5

10

15

20

25

30

35

40

45

Overexertion Falls, slips and trips Transportation Violence Contact withobjects

% o

f In

jury

Illn

ess

Event leading to injury or illness for home health care services workers

BLS, 2013

https://trihomeandcommunity.com/falls/

0

5

10

15

20

25

30

35

40

45

Overexertion Falls, slips and trips Transportation Violence Contact withobjects

% o

f In

jury

Illn

ess

Event leading to injury or illness for home health care services workers

BLS, 2013

Responsive behaviours? -http://behaviouralsupportsontario.ca/ -http://www.alzheimer.ca/

0

5

10

15

20

25

30

35

40

45

Overexertion Falls, slips and trips Transportation Violence Contact withobjects

% o

f In

jury

Illn

ess

Event leading to injury or illness for home health care services workers

BLS, 2013

Not listed: Stress increases your risk of injury and illness www.uhn.ca/PatientsFamilies

0

5

10

15

20

25

30

35

40

45

Overexertion Falls, slips and trips Transportation Violence Contact withobjects

% o

f In

jury

Illn

ess

Event leading to injury or illness for home health care services workers

BLS, 2013

Most caregiving injuries are back injuries

0

5

10

15

20

25

30

35

40

45

50

Back Shoulder Abdomen Arm Wrist Leg Multiple Body Parts

% L

os

t-ti

me

In

juri

es

(US BLS 2010)

What’s happening in the back?

Ligaments

Layers of muscles

Layers of muscles

Layers of muscles

Ligaments

• Stretch

• Inflammation

Intervertebral Disc

Compression

Muscular

Hyper-excitablity

Instability

NIOSH Low Back Compression Force Safety Limit

Safe 760 lb Unsafe

(3400N)

So why can’t we lift that much?

20lbs 80lbs

600lbs

20lbs 80lbs

600lbs

Total = 600+80+20

20lbs 80lbs

600lbs

Total = 600+80+20 = 700 lb

Even in the best posture Safe limit = 35lbs

Move the load closer

to your body

Move the load closer

to your body

Move the load closer

to your body

Reduce the load

Move the load closer

to your body

Reduce the load

SafeBack!

• FREE Mobile App that estimates low back compression

• Fast and detailed posture-specific feedback

Your back posture matters!

Used with permission from Toronto Rehabilitation Institute

Keep the curve! (stick your bum out)

Disks have to support the whole load!

Bones of the spine can share the load

The Safety Zone

Images courtesy of Saint Elizabeth Health Care

Which is easy to talk about…

…especially in empty classrooms…

…but harder in real life.

In this webinar, we will…

• Provide a simple summary of how injuries happen (statistical & biomechanical)

• Identify things to think about each time you provide care

• Discuss how these basic ergonomic principles can be applied in common home care scenarios

– Bathing

– Toileting (including sit-to-stand transfers)

EVERY TIME, ask yourself:

• Is this safe for me to do right now?

– How do I feel right now?

– How is the care recipient right now?

– Do we have enough time?

– Is the environment safe?

• Space to move, no trip hazards, floor dry, etc.

• Make sure you plan ahead to have everything you need set up while the care recipient is still in a safe, stable place.

Back risks

Lateral Bend Forward Flexion Axial Twist

>16kg (35lb)

Flexion Lateral bending Twisting Too much weight

Body parts can be heavy – especially legs

Bodypart % Bodyweight 100 lb person

200 lb person

Head & neck 8% 8 lb 16 lb

Trunk 50% 50 lb 100 lb

1 Arm 5% 5 lb 10 lb

Whole leg 16% 16 lb 32 lb

Lower leg (below knee) 6% 6 lb 12 lb

Other body posture tips

• Stable stance

– Keep your feet apart, one in front of the other

– Keep your knees slightly bent

• Move in the same direction as the care recipient

https://youtu.be/k4nFZqqjqT0?t=163

In this webinar, we will…

• Provide a simple summary of how injuries happen (statistical & biomechanical)

• Identify things to think about each time you provide care

• Discuss how these basic ergonomic principles can be applied in common, difficult home care scenarios

– Bathing

– Toileting (including sit-to-stand transfers)

Bathing

• What to watch for

• Safe techniques for ideal conditions

• Tools and techniques for coping with reality

• Alternatives

– When is it not safe to bathe and toilet in the bathroom?

– What are the other options?

Line up Undress Sit Go Clean Stand Dress

What’s hardest?

Clothing management

• Lower only as far as you need to

• Plan your access route to minimize bending

• Bend at the knees if you can

Hygienic care

• Can cause instability for the care recipient

• Sustained awkward postures required by the caregiver

Bidet Seats

Sitting down & Standing up

Tools for Sit to Stand

Armrests or a walker?

“Because with the walker, like when she bends over, she’s holding there and

she’s down. So with the armrests, I have to use one arm when she’s wiping and

kinda block her, if she’s gonna fall.”

“I feel more secure that I am closer to the person than, you know. The

armrests comes out more, like here. And you have to be behind the armrests.”

Transfer Poles

• Stable way to increase the base of support and reduce the horizontal momentum needed to rise

Double or single poles: Near position is more helpful than far

• Install at approx 75% of thumb-tip reach

• This installation allows the pole to take

more of the load during Sit-to-Stand, reducing individual joint forces.

Vena et al, 2015

Bathing: what’s the problem? Getting in & out

– Standing entry/exit

– Seated entry/exit

Foot care

Many people avoid grab bars

• People try to get by grabbing the wall, soap dishes, etc

• Only 19-25% of older adults in the community have grab bars

– “I will install one when I’m ready”

• 3.7x more likely to fall with no grab bars than with grab bars

Grab bars help caregivers too

“The two gives her more support inside when you’re inside the tub”

Install one at home now!

• Why? Because you’ll use it if it’s there. It’ll make your life easier, even if you don’t need it.

• It will help to destigmatize grab bars. This will help the older people you care about to consider installing one in their house.

Install one at home now!

Some find transfer poles helpful

Seated tub entry/exit

Seated entry/exit

Seated entry/exit

Lifting the legs

Lifting the legs

Severely flexed posture to lift the foot from ground-level

Legs can be heavy

- Swelling

- Stiff joints (resistance)

- How much can the care recipient help?

High obstacle to lift over

Can we make lifting the legs easier?

Lifting the legs

Can we reduce the weight of the lift?

• Lift one leg at a time

• Ways for the care recipient to help?

Can we make lifting the legs easier?

Lifting the legs

Can we reduce the bending needed?

• Sit to lift?

• Leg lifter?

Can we reduce the weight of the lift?

• Lift one leg at a time

• Ways for the care recipient to help?

•Better for back

•Easier on right shoulder

Budget option: a towel, or other loop of fabric

•Much better for back

•Harder on right arm and left shoulder

•Sitting is work for the legs

Can we make lifting the legs easier?

Lifting the legs Can we reduce the height of the lift?

• Less destabilizing

• Good for stiff joints

Can we reduce the bending needed?

• Sit to lift?

• Leg lifter?

Can we reduce the weight of the lift?

• Lift one leg at a time

• Ways for the care recipient to help?

Seated entry/exit

Shifting on the bench

Seated entry/exit

Shifting on the bench

Can be an awkward posture

• Bench positioning?

• How much help do you need to give? Hand positions

Shifting on the bench

Seated entry/exit Can be an awkward posture

• Bench positioning?

• How much help do you need to give? Hand positions

Can we reduce the force needed?

• How much can the care recipient do themselves?

• Friction-reducing bench

• Budget options

Sliding/rotating bath bench • Awkward catch locations

• Substantial reductions in force required to slide

• Easier on the back

Cheaper (but less effective) ways to reduce push/pull forces • Garbage bag is better than nothing on a dry bench

• Wet bench is easier than a dry bench, about the same as the garbage bag.

Washing the feet/lower legs

Ways to get nearer the feet

In this webinar, we will…

• Provide a simple summary of how injuries happen (statistical & biomechanical)

• Identify things to think about each time you provide care

• Discuss how these basic ergonomic principles can be applied in common, difficult home care scenarios

– Bathing

– Toileting (including sit-to-stand transfers)

Safe caregiving takes

problem solving

Back risks

Lateral Bend Forward Flexion Axial Twist

>16kg (35lb)

Flexion Lateral bending Twisting Too much weight

Keep the curve! (stick your bum out)

Disks have to support the whole load!

Bones of the spine can share the load

Ways to reduce the impact of lifting on your back

• Can I reduce the weight I’m lifting?

– Can the care recipient help more? • Are other assistive devices needed?

– Can I lift less at once?

– (can someone else help me?)

• Can we be closer?

– Knee on the bed? Sit on the side of the tub?

– Shifting nearer the side of a bed/bathtub?

• Can I avoid bending and twisting?

• Stick your bum out

EVERY TIME, ask yourself:

• Is this safe for me to do right now?

– How do I feel right now?

– How is the care recipient right now?

– Do we have enough time?

– Is the environment safe?

• Space to move, no trip hazards, floor dry, etc.

• Make sure you plan ahead to have everything you need set up while the care recipient is still in a safe, stable place.

Stay safe!

Emily.King@uhn.ca