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Table 5 Challenges reported that span work settings and particular tasks

From: Beyond 50. challenges at work for older nurses and allied health workers in rural Australia: a thematic analysis of focus group discussions

Challenges impacted by age-related factors Reported reasons why each is more difficult
1. Dealing with mental demands of work Age-related factors:
In particular: ▪ Memory and recall not as good as when younger
▪ Dealing with the paperwork ▪ Added stresses affect cognitive function
▪ Remembering things ▪ More difficult to concentrate for long periods and with distractions
- Passwords ▪ Mental fatigue leads to tiredness
   - Clients names Exacerbated by:
   - Where "lists are" ▪ Constant changes in work systems
▪ Emails and other required reading ▪ More hats to wear - roles, variety of tasks and multi-tasking
▪ Keeping mind on task ▪ Information overload
▪ Managing stress and burn-out    - Increased emails, required reading, amount of reading within tasks
     - "Too many meetings"
  ▪ Stress and expectation to have "stuff in your head"
     - New information and passwords (see computers)
     - Client expectations to remember their names
  ▪ Pressure of meeting several demands at once
  ▪ Longer term impacts - always stretched, physical and emotional stress, less happy, less tolerant etc.
2. Meeting the physical demands of workload as an older health worker Age-related factors:
  ▪ Musculo-skeletal changes - increased pain, stiffness
  ▪ General tiredness and fatigue - especially after lunch, end of day, focusing for long periods
  ▪ Reduced fitness and endurance - reduced energy levels and loss of weight (or gain)
  ▪ Slower physically - takes longer to do things, including routine tasks, can't walk as quickly
  Exacerbated by:
  ▪ A sense there is more to do, but not enough time to do everything, or do it well
  ▪ "Patients (and populous) are older, heavier- and so are we"
  ▪ Sicker, more dependent and debilitated patients
3. Coping with change Age related factors:
These may be: ▪ Subdued mental reflexes/agility
▪ Procedural ▪ Need more time to assimilate knowledge/change
▪ Organisational ▪ Less/lack of adaptability
In particular:  
▪ Role changes Exacerbated by/resistance to change due to:
▪ Coping with change both cognitively and emotionally ▪ "Constant change" referring to the many changes in the health service over the past 15 years eg. in systems, procedures, roles
Coping with sudden change ▪ Change often associated with increased paperwork requirements, new computer programmes
  ▪ Less tolerance for supposedly 'new things' and "reinventing wheels"
  ▪ Experience of older workers not valued, "people don't ask us (about the change), the opportunity is not provided"
  ▪ Casual workers - don't always know about changes
  ▪ In contrast, participants also noted that some workers refuse to change or learn - "doggedness")
4. Dealing with emotional impacts of attachment, loss and awareness of own ageing and mortality Age related factors:
In particular: ▪ Confronted by ageing process in clients, colleagues
▪ Emotional stress after episodes in acute care ▪ Death of older people affects us more as we age - closer to own age"
▪ Death of older people, who are often well-known to workers ▪ Dealing with ageing in clients and own ageing/mortality
▪ Loss, grief associated with colleagues leaving ▪ Slower recovery from physical and emotional stress
Coming to work with younger colleagues ▪ Difficulty sleeping
  Exacerbated by:
  ▪ Patients are becoming peers, bonds formed over any years - "Now you know them, they're not just a patient"
  ▪ No debriefing available
5. Dealing with emotional impacts of not achieving personal standards and goals Age related factors:
Including: ▪ Self-awareness that things take longer/workload
▪ A sense of change from total patient care to something less, with lower standards Exacerbated by:
▪ Lack of time to achieve higher standards of care ▪ Difficulty saying no to physical work required (ethic)
▪ Less job satisfaction: ▪ Lack of time to achieve high standards leading to feelings of 'guilt, frustration, lack of pride, poor job satisfaction'
  ▪ Seeming lack of understanding by higher executives of encroachment of administrative work on clinical time
  ▪ Declining work conditions over the years - shared offices, technology, work cultural changes, more stimulation
6. Emotional impacts of not meeting/fulfilling expectations of others Age related factors:
Including : ▪ Less able to cope with stress and changing roles (see above)
▪ Patients expectations Exacerbated by:
▪ Organisational expectations relating to workload and workforce: ▪ Nature of job - increasingly stressful and changing roles at a time of life when less able to cope
▪ Peer expectations - supporting other staff and being the "stable" staff member ▪ High expectations of clients for complete recovery and short recovery times mismatched with staff perspective - leading to tension/stress
  ▪ High organisational expectations relating to workload
     - Sense that required documentation is largely driven by fear/risk of litigation
     - Workforce issues - recruitment in rural areas, getting harder
  ▪ Supporting other staff - exhausting
     - "Others revolve, rotate around you and you have to take on more of the support/responsibility role"
7. Balancing work/family life commitments Age -related factors:
Including: ▪ Own health issues - need for health appointments, specialists
▪ Juggling work, family and sharing time with all family members ▪ Coping with the many facets of life and still keeping your mind on the job
▪ Time to fulfil all commitments ▪ Less energy, slower, more weary, yet seemingly more tasks to do
▪ No time for self - to look after yourself ▪ Wisdom - desire for balance of work and family life
  Generational factors:
  ▪ Main carer role in family -
     - Ageing parents
     - Looking after husband, older parents, growing children, adult children needing help eg. minding grandchildren
     - Going home to do more physical work
  Exacerbated by:
  ▪ Other shift workers in family
  ▪ Split days off
  ▪ Distances to travel to see family
  ▪ "More to do (family), less time to do it",
  ▪ Assumptions by organisation and younger colleagues that older workers don't have family commitments
8. Staying engaged and positive in spite of difficulties Age related factors:
Including: ▪ Less capable of dealing with the increased physical/emotional workload posed by demanding patients (see above)
▪ Maintaining tolerance for attitudes and behaviours of patients, organisation and younger workers    - On the one hand, tolerance often lower for rudeness of people - "get to an age where you say - hang on, you can't speak to me like that"
▪ Maintaining tolerance for attitudes and behaviours of patients, organisation and younger workers ▪ In contrast: wisdom and tolerance gained through experience
     - "As you get older, you realise you can't fix things... you can only do so much"
  ▪ Sensitivities and the "psychology of ageism"
     - More sensitive to criticism when older
     - Negative thinking/spin from others and from self eg. "I'm too old"
  ▪ Tiredness dealing with difficult situations eg. confrontation associated with "dealing with destructive and undermining behaviours - would rather avoid it"
  Exacerbated by:-
  ▪ Attitudes and behaviours of patients, organisation, younger workers
  ▪ Interpersonal communication
     - Communication with younger workers difficult - language used, seem "less compassionate", seem to "only half listen"
     - In contrast: "Not in our team, we work well and communicate well," (need to) "beware of generalising"