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
% Lost-time Injuries (US BLS 2010) Most caregiving injuries 50 are back injuries 45 40 35 30 25 20 15 10 5 0 Back Shoulder Abdomen Arm Wrist Leg Multiple Body Parts
% of Injury Illness 45 Event leading to injury or illness for home health care services workers 40 35 30 25 20 15 10 5 0 Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013
% of Injury Illness 45 Event leading to injury or illness for home health care services workers 40 35 30 25 20 15 10 5 0 Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013
% of Injury Illness 45 Event leading to injury or illness for home health care services workers 40 35 30 25 20 15 10 5 0 https://trihomeandcommunity.com/falls/ Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013
% of Injury Illness 45 Event leading to injury or illness for home health care services workers 40 35 30 25 20 15 Responsive behaviours? -http://behaviouralsupportsontario.ca/ -http://www.alzheimer.ca/ 10 5 0 Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013
% of Injury Illness 45 40 35 30 25 20 15 10 5 0 Event leading to injury or illness for home health care services workers Not listed: Stress increases your risk of injury and illness www.uhn.ca/patientsfamilies Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013
% of Injury Illness 45 Event leading to injury or illness for home health care services workers 40 35 30 25 20 15 10 5 0 Overexertion Falls, slips and trips Transportation Violence Contact with objects BLS, 2013
% Lost-time Injuries (US BLS 2010) Most caregiving injuries 50 are back injuries 45 40 35 30 25 20 15 10 5 0 Back Shoulder Abdomen Arm Wrist Leg Multiple Body Parts
What s happening in the back?
Ligaments
Layers of muscles
Layers of muscles
Layers of muscles
Ligaments Stretch Inflammation Intervertebral Disc Compression Instability Muscular Hyper-excitablity
NIOSH Low Back Compression Force Safety Limit Safe 760 lb (3400N) Unsafe
So why can t we lift that much?
600lbs 20lbs 80lbs
600lbs 20lbs 80lbs Total = 600+80+20
600lbs 20lbs 80lbs Even in the best posture Safe limit = 35lbs Total = 600+80+20 = 700 lb
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
FREE Mobile App that estimates low back compression SafeBack! 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 >16kg (35lb) Flexion Lateral bending Twisting Too much weight Forward Flexion Lateral Bend Axial Twist
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?
What s hardest? Line up Undress Sit Go Clean Stand Dress
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 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?
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? 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?
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? 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?
Seated entry/exit Shifting on the bench
Seated entry/exit 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 Shifting on the bench 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 >16kg (35lb) Flexion Lateral bending Twisting Too much weight Forward Flexion Lateral Bend Axial Twist
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