seniors residences accommodate those elderly men and women whose personal and family circumstances (eg not to have a sufficient degree of autonomy to perform activities of daily living) requiring replacement of the home.
Often, these centers are a landmark in the neighborhood environment where they are located. The organization of homes for older people is based on a coexistence model, which combines various activities to promote personal autonomy of residents and relationships between them and their environment. The above model gives greater weight to those services, followed by other health activities, preventive and rehabilitative.
direct care professionals carry out much of these activities. In this group, labor groups and health assistants geriatric assistants perform most tasks considered most at risk of injury to the musculoskeletal system, according to specialized research.
call musculoskeletal disorders (MSDs) to all painful conditions of muscles, tendons and nerves. The causes of the diseases are different, but related work especially with repetitive movements and awkward postures. The pain occurs during the development of work activity and is often maintained during rest periods.
Here is a classification of activity-related MSDs care:
• Inflammation of tendons and muscles:
- Tendinitis.
- Bursitis.
• Deterioration of cartilage and bone:
- Some osteoarthritis.
- Problems column.
- nerve compression problems such as carpal tunnel syndrome.
Studies by the European Agency for Safety and Health at Work shows that the sector professional health and social care have the second highest incidence rate of MSDs, second only to the construction 1.
The Sixth National Survey on Working Conditions (ENCT), drawn from a representative sample of the working population in the English State in 2006 has the following objectives:
• A 74.2% of workers surveyed expressed discomfort in areas of body postures and efforts attributed to the workplace.
• Of the respondents, the group says most complaints in this regard is the health sector (80.7% expressed discomfort type musculoskeletal). It may be recalled that within this sector include medical assistants, geriatric and home).
• The discomfort that occur most frequently are located in the lower back (40%), neck-neck (27%) and upper back (26.6%).
• Again, the medical staff who expressed greater discomfort in the neck-neck area (40.7% of respondents in the sector) 2 .
public nursing homes in Catalonia, the group of geriatric assistants more than 60% of workers. They are also the most frequently affected: the total accidents Low reported by public housing, the 49.48% were geriatric aides. Most low-accident releases of this group gave the cause of the accident physical overexertion (a 63.89%) 3 .
The literature refers to the combination of different factors to determine the causes MSDs can motivate professionals in direct care nursing homes.
Factors associated with the practice of the profession
manual mobilization of people (MMP) such as:
• Transfers, mobilization and repositioning of people bedridden or sitting.
• Personal hygiene of bedridden people in their own room (changing diapers, cleaning the bathtub geriatric, etc.) Or in the bathroom (toilet hygiene in the bathroom chair or booth, etc.).
• Feeding people seated or in bed.
• Follow the walking of people who can walk. Other
gerocultura related tasks: making beds, occupied or not, moving cars of clothing, food, medicines, wheelchairs carrying, transporting and handling other geriatric bath aids.
The MMP includes the following "stressors Ergonomic "
• Physical exertion, which is the force required to hold a job or to maintain control over the equipment and tools. In this sense, maintaining control of people might result in overuse in the case of reacting to sudden movements or falls by residents. The movement geriatric aide done to prevent falls or to hold an elderly usually implemented quickly and at little or no appropriate positions, so the risk of injury increases significantly.
• Repetitions: Perform the same series of moves continuously and frequently. The work of assistant geriatrics is full of small movements repeated throughout the day.
• Postural problems: the performance of postures that stress the body, especially the forced movement of the back, push the limits of protection and redress mechanisms. For example, charging back while carrying a wheelchair, is made hygiene an old man, makes his bed, or make turns forced back while moving a resident.
Factors related to work organization
Studies of the European Agency for Safety and Health at Work shows that certain working conditions act the individual from the psychosomatic point of view and may intensify symptoms of MSDs 4 . Some of these working conditions are:
• Pace of work: the higher the pace of work in health care settings, the greater the risk of back injury. Working with haste means more speed work and not respecting the established protocols for moving patients.
• Exercise monotonous and repetitive, specialized studies show that the work monotonous or repetitive strain accumulate more mental work. An example: the trapezius muscle, located on both sides of the rear neck, used to suffer the effects of psychological stress (hardens, it becomes painful to the touch, etc.).. If we add the repetitiveness of the speed, the perception of physical fatigue increased significantly.
• Limited flexibility in working hours: this is a condition closely related to autonomy in the workplace and the ability to organize tasks. It is scientifically proven that the posts with strict working hours, with little possibility of organizing the holiday periods (vacation, personal business, freely available) is a major source of stress.
• Types of schemes wage means the wage compensation is one of the most important work. If one concludes that is not worth the effort for work, fall into a negative perception of job satisfaction, psychosocial risk factor. Psychosocial factors
Although no scientific proof of the relationship between psychosocial factors and cardiovascular diseases is not so clear connection between them and the risk of injury to the musculoskeletal system. Nonetheless, there are studies that correlate certain aspects psychosocial disturbances musculoskeletal system. Can be summarized as following:
• Job satisfaction: the unsatisfied with the work they do show a higher risk of suffering from stress-related diseases than those who were satisfied. Dissatisfaction can lead to disregard for the risk taken, no use of mobilization techniques right, more muscle tension, etc.
• Social support at work, poor industrial relations impede communication between coworkers and are a major source of stress.
• Control of working time, closely related to the lack of flexibility in working hours. The worker or the worker can not establish self control of working time, because it depends on external factors (hours of breakfast, baths, walks, etc..). Individual factors
• Age: This factor is very close to the years during which a person develops the same job. For example, the reported accidents at work with low public residences for the elderly received during the year 2006, the highest number is for workers aged between 36 and 45 years (36.05%) and 46 - 55 (39.53%) 5 .
• Gender: studies conducted by institutions and agencies internationally renowned show that women suffer more injuries than men in the musculoskeletal system. But the scientific explanation is not too obvious. According to traditional models, referred to biological differences in the dimensions, muscle strength and aerobic capacity of women to men. Recently, these differences have been added to psychosocial variables, such as the double presence of women at work and at home, the distribution of the labor market (in this case, the percentage of women is geriatric assistants 98%) and the most obvious reaction of women to a harmful work environment or just favorable.
• Training and knowledge prior to the exercise of the task: if a person does not know the techniques of mobilization, will do as well as you know but this does not guarantee that you do it properly. In this sense, provide a complete and thorough training staff has to perform manual mobilizations of people is essential to reduce the number of back injuries. On the other hand, workers with the skills to mobilize people in general suffer less injury, or they are less severe and occur much later in time than people who know these techniques.
• Physical form: enjoy strong muscles is very important to meet the demands caused by the manual movement of people. When it exceeds the tolerance of the structures of the back, they become more susceptible to musculoskeletal injuries. In this sense, maintaining a correct healthy posture when carrying out the manual movement of people is important because, although it does not prevent back injuries, it does delay its onset. Notwithstanding
said, must take into account the genetic component, as each person, regardless of other factors (such as age and gender) has a different quality muscles.
To prevent the impact of MSDs, it is first necessary to evaluate jobs with adequate and reliable methodology. You must then switch to preventive intervention. This, in the case of those geriatric assistants, should combine the ergonomic and psychosocial aspects. In this sense, the procedure can be performed at three levels:
• Development of the task: modify your exercise to reduce awkward postures, preventing fatigue, etc.
• Location and work environment: improving the equipment and tools, such as providing technical support for the mobilization and transfer, replacing the traditional beds beds with motor, etc..
• Work organization: shifts, breaks, hierarchical structure, etc.
also highlight the importance of health checkups or periodic medical examinations and the existence of active channels for staff participation in decisions that are made about the organization of work and the distribution of tasks in schools.
Finally, technical training of staff is presented as an important ally in the Occupational Health and Safety, not only in initial training before starting a job, but in session "booster" and especially periodic training related skills the job. This is what we call "integrated training" 6 . Integrated training
promotes integrated learning practices incorporating prevention of musculoskeletal disorders in the technical training for any of the methods used today. These practices include three blocks of content:
Transmission of the importance of daily postural hygiene in the prevention of musculoskeletal disorders
postural hygiene and ergonomics are effective in preventing back pain because they have the order to reduce the burden of this body part support during activities of daily living.
A activity may be taking different positions. Postural hygiene and ergonomics taught to do all sorts of activities more secure and less cumbersome for the back. Both handling charges (MMC) and the manipulation of people (MMP) require the observation of a number of basic rules to the exercise is to get the most out of the body with minimal effort.
standards listed below are based on the laws of mechanical movement of the human musculoskeletal system (laws of biomechanics), and apply equally to activities developed during our business hours and in everyday life:
• Keep your back straight (correct use of the column.)
• Having a good base of support (feet apart, one in the direction of movement).
• Make the effort with the leg strength (bending) and the inertia of the body.
• Mobilize the load close to body (center of gravity).
• Do not make money from the trunk, but the pelvic tilt (move your hips to move a linear load).
The implementation of protocols that include good hygiene practices postural
The most common operations in the homes of older people fall into two areas:
• Transfers.
• Volunteer 7.
Transfers and demonstrations are those acts performed by professionals on old people's homes residents:
• The relocation of the resident from one place to another, so that it carries out activities of daily living ( get out of bed, sit in a chair, go the bathroom) and can not do alone because of their disability or dependency.
• Postural changes, movements which purpose is to allow priests in the resident's body found in bed, or put on and remove objects under the body of the person in bed: sheets, wedges, diapers, etc.
• Assisting residents to get off the ground when falling or rising from a chair.
• The flare, or action of placing the resident in a good position: if you have slipped into bed and has gone head to toe, or if, being seated, has slipped to be in the seat edge risk of falling.
• The accompaniment to walking, professional operation ranks among the activities "Verticalization" and that is to render assistance to walk to the resident, so it has a clear perception of ease, safety, dignity and relative independence.
are operations that are performed daily in residential centers. For geriatric care professionals is, first, a high repetition of movement (it can get repetitive over a hundred a day), and secondly, the continued maintenance of awkward postures. Both factors, taken together, are responsible for most injuries from overexertion.
Based on logical principles study of human biomechanics and the care and rehabilitative techniques existing standardized protocols constitute the proceedings of each transfer or mobilization. The purpose of processing is:
• Avoid, as far as possible, awkward postures.
• Minimize the impact of repetitive movements. • Saving
physical effort.
• Encourage communication-resident worker.
• Make the transfer or movement is a movement as normal as possible for the resident.
These operations are conducted with people whose dependence medium or low. The determination of the degree of dependence is given by the level of assistance required: people with low dependence require some incentive to walk, stand, etc.. But do not require the physical assistance of auxiliary geriatric at a rate above 25% . People with mean dependence, also called partially assisted, requiring physical assistance percentage ranging between 25 and 50%. This depends on the degree of cooperation (voluntary or otherwise) in the mobilization or transfer.
Training in the use of technical aids
Technical aids are instruments (devices, equipment) that allow the users or residents performing daily activities that otherwise would be very difficult to execute. In the homes of older people, assistive devices are an important instrument to facilitate the daily tasks of direct care staff.
Keep in mind that technical aids are valid for certain types of assistance and specific types of users. Whenever possible, should be encouraged by the mobility of the resident, and promoting independence, but in those cases where professionals (physiotherapist, doctor, occupational therapist) indicates, it is necessary to use assistive technologies. Generally, they are indicated in the following cases:
• uncooperative residents, especially those who can not work with the / the auxiliary. Where not want to collaborate, should be encouraged to maximize their cooperation, but not to incur risk of injury, it is better to resort to some form of technical assistance.
• Residents with mobility problems, such as Parkinson's, arthritis, hemiplegia, etc.
• Large demonstrations: bariatric persons, bedridden persons, etc.
The most common assistive devices for the mobilization and transfer are the cranes. It may sometimes seem to move residents to walk or chair wheel is faster than doing it in crane, but if he or the assistant is trained in its use, will soon notice that it is less tiring and your back does not suffer the exertion to which it is subjected.
Currently, the cranes of the old people's homes are mobile (with wheels), electric (with battery) and have a variable number of accessories (straps, harnesses) suitable for different uses.
transfers and demonstrations for using two types of cranes, lifting and standing. Conclusions
As seen throughout the preceding pages, to address the prevention of musculoskeletal disorders in the group of geriatric assistants, requires an impact on various factors related to the workplace.
Achieving this objective involves the implementation of actions that require the involvement of several institutions and agents related to the job. The makers of residential institutions (public or private), public administration, from the point of view and preventive work, social partners and, of course, the affected community itself must actively work together to achieve, by design appropriate strategies, reducing the impact of musculoskeletal disorders in this group and thus contribute to improving their quality of life.
2 Ministry of Labour and Social Affairs, National Institute of Occupational Safety and Health at Work (2007): VI National Survey of Working Conditions, www.mtas.es / Insh / survey
3 The data kindly provided by the Department of Occupational Health and Safety the Department of Social Action and Citizenship, for the year 2006.
4 Refer http://osha.europa.eu/topics/msd
5 Source: Service Occupational Health and Safety at the Department of Social Action and Citizenship (Generalitat de Catalunya).
6 L. Simó-C. Perez: "Strategies training for preventing the risk of musculoskeletal injury in the group of geriatric assistants, occupational hazard. Journal of occupational risk prevention, No. 19 (November 2007), pp.28-33.
7 See L. Simó et alia: per Manual to prevention of musculoskeletal injuries risc of Senior Citizens in residences. Protocol of transferències i mobilitzacions (Department of Social Action and Citizenship, Barcelona, \u200b\u200b2007), which collects, graphically and abundance of examples, the protocols for most common operations in nursing homes.
Responsible Service Department Vicepresidència
PRL (Generalitat de Catalunya)
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