Practical Advice for Caring Safely: The ergonomics of providing care for a frail older adult

Transcription

1 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

2 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*

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

4 Poll: Are you a Clinician Educator Researcher Policy maker None of the above

5 Safe caregiving takes problem solving

6 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)

7 Are there (other) specific things you are hoping to get out of today s webinar? Please use the chat box to let me know

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

9 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

10 How do injuries happen?

11 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

12 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

13 % Lost-time Injuries (US BLS 2010) Most caregiving injuries 50 are back injuries Back Shoulder Abdomen Arm Wrist Leg Multiple Body Parts

14 % of Injury Illness 45 Event leading to injury or illness for home health care services workers Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013

15 % of Injury Illness 45 Event leading to injury or illness for home health care services workers Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013

16 % of Injury Illness 45 Event leading to injury or illness for home health care services workers Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013

17 % of Injury Illness 45 Event leading to injury or illness for home health care services workers Responsive behaviours? Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013

18 % of Injury Illness Event leading to injury or illness for home health care services workers Not listed: Stress increases your risk of injury and illness Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013

19 % of Injury Illness 45 Event leading to injury or illness for home health care services workers Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013

20 % Lost-time Injuries (US BLS 2010) Most caregiving injuries 50 are back injuries Back Shoulder Abdomen Arm Wrist Leg Multiple Body Parts

21 What s happening in the back?

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23 Ligaments

24 Layers of muscles

25 Layers of muscles

26 Layers of muscles

27 Ligaments Stretch Inflammation Intervertebral Disc Compression Instability Muscular Hyper-excitablity

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42 NIOSH Low Back Compression Force Safety Limit Safe 760 lb (3400N) Unsafe

43 So why can t we lift that much?

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48 600lbs 20lbs 80lbs

49 600lbs 20lbs 80lbs Total =

50 600lbs 20lbs 80lbs Even in the best posture Safe limit = 35lbs Total = = 700 lb

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52 Move the load closer to your body

53 Move the load closer to your body

54 Move the load closer to your body Reduce the load

55 Move the load closer to your body Reduce the load

56 FREE Mobile App that estimates low back compression SafeBack! Fast and detailed posture-specific feedback

57 Your back posture matters! Used with permission from Toronto Rehabilitation Institute

58 Keep the curve! (stick your bum out) Disks have to support the whole load! Bones of the spine can share the load

59 The Safety Zone Images courtesy of Saint Elizabeth Health Care

60 Which is easy to talk about

61 especially in empty classrooms

62 but harder in real life.

63 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)

64 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.

65 Back risks >16kg (35lb) Flexion Lateral bending Twisting Too much weight Forward Flexion Lateral Bend Axial Twist

66 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

67 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

68 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)

69 Bathing

70 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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72 What s hardest? Line up Undress Sit Go Clean Stand Dress

73 Clothing management Lower only as far as you need to Plan your access route to minimize bending Bend at the knees if you can

74 Hygienic care Can cause instability for the care recipient Sustained awkward postures required by the caregiver

75 Bidet Seats

76 Sitting down & Standing up

77 Tools for Sit to Stand

78 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.

79 Transfer Poles Stable way to increase the base of support and reduce the horizontal momentum needed to rise

80 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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82 Bathing: what s the problem? Getting in & out Standing entry/exit Seated entry/exit Foot care

83 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

84 Grab bars help caregivers too The two gives her more support inside when you re inside the tub

85 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.

86 Install one at home now!

87 Some find transfer poles helpful

88 Seated tub entry/exit

89 Seated entry/exit

90 Seated entry/exit Lifting the legs

91 Lifting the legs High obstacle to lift over Severely flexed posture to lift the foot from groundlevel Legs can be heavy - Swelling - Stiff joints (resistance) - How much can the care recipient help?

92 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?

93 Can we make lifting the legs easier? Can we reduce the bending needed? Sit to lift? Leg lifter? Lifting the legs Can we reduce the weight of the lift? Lift one leg at a time Ways for the care recipient to help?

94 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

95 Can we make lifting the legs easier? Can we reduce the bending needed? Sit to lift? Leg lifter? Lifting Can we reduce the legs the height of the lift? Less destabilizing Good for stiff joints 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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97 Seated entry/exit Shifting on the bench

98 Seated entry/exit Can be an awkward posture Bench positioning? How much help do you need to give? Hand positions Shifting on the bench

99 Seated entry/exit Can be an awkward posture Bench positioning? How much help do you need to give? Hand positions Shifting on the bench Can we reduce the force needed? How much can the care recipient do themselves? Friction-reducing bench Budget options

100 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.

101 Washing the feet/lower legs

102 Ways to get nearer the feet

103 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)

104 Safe caregiving takes problem solving

105 Back risks >16kg (35lb) Flexion Lateral bending Twisting Too much weight Forward Flexion Lateral Bend Axial Twist

106 Keep the curve! (stick your bum out) Disks have to support the whole load! Bones of the spine can share the load

107 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

108 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.

109 Stay safe!