The ergonomics of providing care for a frail older adult Slide Decks... · 2017-04-25 · The...
Transcript of The ergonomics of providing care for a frail older adult Slide Decks... · 2017-04-25 · The...
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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
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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*
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Poll: Do you provide care for a friend or family member?
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Poll: Are you a… • Clinician
• Educator
• Researcher
• Policy maker
• None of the above
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Safe caregiving takes problem solving
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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)
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Are there (other) specific things you are hoping to get out of today’s webinar?
Please use the chat box to let me know
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Questions? Please use the chat box or the ‘raise your hand’ feature to ask questions throughout the webinar
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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
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How do injuries happen?
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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”
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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
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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)
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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
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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
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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/
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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/
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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
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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
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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)
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What’s happening in the back?
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Ligaments
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Layers of muscles
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Layers of muscles
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Layers of muscles
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Ligaments
• Stretch
• Inflammation
Intervertebral Disc
Compression
Muscular
Hyper-excitablity
Instability
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NIOSH Low Back Compression Force Safety Limit
Safe 760 lb Unsafe
(3400N)
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So why can’t we lift that much?
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20lbs 80lbs
600lbs
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20lbs 80lbs
600lbs
Total = 600+80+20
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20lbs 80lbs
600lbs
Total = 600+80+20 = 700 lb
Even in the best posture Safe limit = 35lbs
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Move the load closer
to your body
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Move the load closer
to your body
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Move the load closer
to your body
Reduce the load
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Move the load closer
to your body
Reduce the load
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SafeBack!
• FREE Mobile App that estimates low back compression
• Fast and detailed posture-specific feedback
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Your back posture matters!
Used with permission from Toronto Rehabilitation Institute
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Keep the curve! (stick your bum out)
Disks have to support the whole load!
Bones of the spine can share the load
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The Safety Zone
Images courtesy of Saint Elizabeth Health Care
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Which is easy to talk about…
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…especially in empty classrooms…
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…but harder in real life.
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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)
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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.
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Back risks
Lateral Bend Forward Flexion Axial Twist
>16kg (35lb)
Flexion Lateral bending Twisting Too much weight
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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
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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
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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)
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Bathing
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• 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?
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Line up Undress Sit Go Clean Stand Dress
What’s hardest?
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Clothing management
• Lower only as far as you need to
• Plan your access route to minimize bending
• Bend at the knees if you can
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Hygienic care
• Can cause instability for the care recipient
• Sustained awkward postures required by the caregiver
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Bidet Seats
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Sitting down & Standing up
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Tools for Sit to Stand
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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.”
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Transfer Poles
• Stable way to increase the base of support and reduce the horizontal momentum needed to rise
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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
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Bathing: what’s the problem? Getting in & out
– Standing entry/exit
– Seated entry/exit
Foot care
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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
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Grab bars help caregivers too
“The two gives her more support inside when you’re inside the tub”
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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.
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Install one at home now!
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Some find transfer poles helpful
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Seated tub entry/exit
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Seated entry/exit
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Seated entry/exit
Lifting the legs
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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
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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?
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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?
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•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
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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?
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Seated entry/exit
Shifting on the bench
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Seated entry/exit
Shifting on the bench
Can be an awkward posture
• Bench positioning?
• How much help do you need to give? Hand positions
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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
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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.
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Washing the feet/lower legs
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Ways to get nearer the feet
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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)
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Safe caregiving takes
problem solving
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Back risks
Lateral Bend Forward Flexion Axial Twist
>16kg (35lb)
Flexion Lateral bending Twisting Too much weight
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Keep the curve! (stick your bum out)
Disks have to support the whole load!
Bones of the spine can share the load
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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
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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.