Influence of physical and psychosocial working conditions for the risk of disability pension among healthy female eldercare workers: Prospective cohort

Work-Related Fear-Avoidance Beliefs and Risk of Low-Back Pain: Prospective Cohort Study Among Healthcare Workers

PURPOSE

Low-back pain (LBP) is a prevalent condition among healthcare workers, negatively affecting well-being and work ability. Research has identified fear-avoidance beliefs, i.e., the belief that physical activities worsen or prolong pain, as a key psychological factor in LBP. Given the physical demands of healthcare work, understanding the link between fear-avoidance and LBP is crucial for effective prevention and management strategies. This study investigated the prospective association between fear-avoidance beliefs and risk of increased LBP intensity and duration in hospital workers.

METHODS

Fear-avoidance beliefs and LBP were assessed in 1933 healthcare workers from 389 departments at 19 hospitals at baseline and 1-year follow-up. Associations between baseline work-related fear-avoidance beliefs (FABW) and LBP intensity and duration at follow-up were analyzed using cumulative logistic regression, adjusting for various factors including age, sex, baseline LBP, education, seniority, patient transfers, psychosocial work environment, and lifestyle.

RESULTS

Moderate and high FABW was associated with higher odds of increased pain intensity (OR: 1.37 [95% CI 1.09-1.73] and 1.85 [95% CI 1.18-2.88], respectively) and prolonged pain duration (OR: 1.37 [95% CI 1.05-1.78] and 2.27 [95% CI 1.50-3.44], respectively). A sensitivity analysis including only female nurses showed similar results, with the high FABW group having significantly higher odds of increased pain intensity (OR 2.95, 95% CI 1.84-4.72) and duration (OR 2.64, 95% CI 1.55-4.49).

CONCLUSIONS

Fear-avoidance beliefs increase the risk of LBP intensity and duration among healthcare workers, emphasizing the need for interventions dealing with psychological aspects of LBP.

Emotional demands at work and risk of disability pension: a nationwide cohort study in Denmark

INTRODUCTION

Working in emotionally demanding jobs is associated with an increased risk of temporarily leaving the labour market due to long-term sickness absence. We tested whether employees working in emotionally demanding jobs are also at higher risk of permanently leaving the labour market due to disability pension compared with employees working in jobs that are not emotionally demanding.

METHODS

We conducted a 10-year cohort study in the workforce in Denmark (n=1 670 825), aged 30-59 years at baseline, by linking job exposure matrices with nationwide registries on social transfer payments and covariates. Using Cox regression, we analysed the risk of disability pension in relation to emotional demands in the full population and sex stratified. Multivariable adjusted models included sex, age, cohabitation, migration background, household disposable income and other work environmental factors (physical workload, influence, possibilities for development and role conflicts).

RESULTS

We identified 67 923 new cases of disability pension during 15 649 743 person-years of follow-up (mean follow-up: 9.4 years). We found an increasing risk of disability pension with higher levels of emotional demands, with HRs of 1.20, 1.23 and 1.73 for medium-low, medium-high and high emotional demands, respectively, compared with low emotional demands in the most adjusted model. There was an exposure-response association in women and a tendency towards an exposure-response association in men.

DISCUSSION

In this nationwide cohort study, we found an increased risk of permanent exit from the labour market due to disability pension in women and men working in emotionally demanding jobs.

The importance of a healthy lifestyle despite chronic pain: Prospective cohort with 11-year register follow-up

The purpose of the study was to investigate to which extent a healthy lifestyle in female healthcare workers with chronic pain contributes to reducing the risk of disability pension. We conducted a prospective cohort study with an 11-year registry follow-up. Overall, 2386 Danish female healthcare workers with chronic pain completed a questionnaire about work and lifestyle (leisure-time physical activity, smoking, and body mass index (BMI)). Data on disability benefit payments were obtained from the Danish Register for Evaluation of Marginalization. Two models (minimally and fully adjusted for different potential confounders) were tested using the Cox proportional hazards model. During the follow-up period, 17.9% of the healthcare workers obtained disability pension. Low levels of leisure time physical activity (reference: moderate level) increased the risk of disability pension in the minimally (Hazard Ratio: 1.38 (95% CI: 1.14-1.69)) and fully adjusted models (Hazard Ratio: 1.27 (95% CI: 1.04-1.56)). Being highly physically active, as opposed to being moderately active, did not confer additional protection. Additionally, a positive association was observed between smoking and disability pension in the minimally adjusted model (Hazard Ratio: 1.27 (95% CI: 1.05-1.54)). BMI was not an influential factor. In female healthcare workers with chronic pain, at least moderate levels of physical activity is a protective factor for disability pension. Effective promotion strategies should be designed for both workplace and non-workplace settings.

Facilitators and barriers for using outdoor areas in the primary work tasks of eldercare workers in nursing homes

BACKGROUND

Eldercare workers in nursing homes report high musculoskeletal disorders, stressful work, and sickness absence. Initiatives that can accommodate these issues are needed. Current studies point out that nature contact may offer a range of human health benefits, potentially promoting healthier work among eldercare workers. Therefore, this study aimed to investigate facilitators and barriers for using outdoor areas as part of the daily work among eldercare workers in Danish nursing homes.

METHODS

In this multiple case study, we collected data from three nursing homes, conducting three semi-structured focus group interviews with eldercare workers and three individual interviews with nursing home managers. Furthermore, we conducted observations of the daily work and mappings of the nursing homes' outdoor environments to gain in-depth knowledge of eldercare workers' and managers' perspectives on using outdoor areas in their daily work. The data was thematically analysed using 'The Behaviour Change Wheel' (BCW), more specifically the COM-B model, as a theoretical foundation for exploring facilitators and barriers for the use of outdoor areas.

RESULTS

Frequently mentioned facilitators were facilities, traditions or repetitive events, positive experiences with residents ('star moments'), and knowledge about the residents. Frequently mentioned barriers were insufficient staffing, hierarchy in the work tasks, professional identity, and lack of ideas.

CONCLUSIONS

The identified facilitators and barriers should be considered when designing initiatives for increased use of outdoor areas or activities of eldercare workers.

TRIAL REGISTRATION

According to the Danish ethics committee (Law of committee, (komitéloven) paragraph 14, Sect. 2), qualitative interviews, which do not include human biological materials, do not need neither approval by ethical and scientific committee or informed consent (The Danish National Centre for Ethics).

Pain Control Beliefs Predict Premature Withdrawal From the Labor Market in Workers With Persistent Pain: Prospective Cohort Study With 11-Year Register Follow-up

While a range of work-related psychosocial factors has been associated with various pain disorders and early retirement, less is known about pain cognitions and their influence on premature exit from the labor market. Therefore, as a primary objective, this study investigates associations between pain control beliefs and risk of disability pension among Danish eldercare workers. In 2005, 2257 female eldercare workers with low-back and/or neck/shoulder pain>90 days within the previous 12 months, replied to a survey and were followed for 11 years in a national register of social transfer payments. Using Cox regression, we estimated the risk of disability pension during follow-up from experiencing different levels of "pain control" and "pain influence," controlling for pain intensity and other relevant confounders. In the fully adjusted model for pain control with "high" as reference, hazard ratios of 1.30 (95% CI 1.03-1.64) and 2.09 (95% CI 1.45-3.01) are observed for "moderate" and "low," respectively, while the metric of pain influence shows hazard ratios of 1.43 (95% CI 1.11-1.87) and 2.10 (1.53-2.89), respectively. Pain control beliefs are associated with disability pension among eldercare workers with persistent pain. These results highlight the importance of evaluating not only bodily manifestations of pain, but also individual pain-related cognitions that may influence the experience of pain. PERSPECTIVE: This article addresses the complex experience of pain within an organizational context. We introduce the metrics of "pain control" and "pain influence" among workers with persistent pain, showing that the psychometric properties of these measures are prospectively associated with premature exit from the labor market.

Combined exposure to heavy physical workload and low job control and the risk of disability pension: A cohort study of employed men and women in Sweden

OBJECTIVE

To investigate the separate and combined effects of overall heavy physical workload (PWL) and low decision authority on all-cause disability pension (DP) or musculoskeletal DP.

METHODS

This study uses a sample of 1,804,242 Swedish workers aged 44-63 at the 2009 baseline. Job Exposure Matrices (JEMs) estimated exposure to PWL and decision authority. Mean JEM values were linked to occupational codes, then split into tertiles and combined. DP cases were taken from register data from 2010 to 2019. Cox regression models estimated sex-specific Hazard Ratios (HR) with 95% confidence intervals (95% CI). The Synergy Index (SI) estimated interaction effects.

RESULTS

Heavy physical workload and low decision authority were associated with an increased risk of DP. Workers with combined exposure to heavy PWL and low decision authority often had greater risks of all-cause DP or musculoskeletal DP than when adding the effects of the single exposures. The results for the SI were above 1 for all-cause DP (men: SI 1.35 95%CI 1.18-1.55, women: SI 1.19 95%CI 1.05-1.35) and musculoskeletal disorder DP (men: SI 1.35 95%CI 1.08-1.69, women: 1.13 95%CI 0.85-1.49). After adjustment, the estimates for SI remained above 1 but were not statistically significant.

CONCLUSION

Heavy physical workload and low decision authority were separately associated with DP. The combination of heavy PWL and low decision authority was often associated with higher risks of DP than would be expected from adding the effects of the single exposures. Increasing decision authority among workers with heavy PWL could help reduce the risk of DP.

Expected reasons for leaving the labour market and loss of paid employment among older workers: prospective cohort study

BACKGROUND

Surveying expected reasons for retirement may be a useful strategy to maintain labor market affiliation. The aim was to investigate the prospective association between self-reported expected reasons for leaving the labour market and subsequent loss of paid employment before the state pension age among older workers.

METHODS

The prospective risk of loss of paid employment before the official state pension age was estimated from expected reasons for leaving the labour market among 10,320 currently employed older workers (50-63 years) from the SeniorWorkingLife study. In 2018, participants replied to 15 randomly ordered questions about expected reasons for leaving the labour market and were in 2020 followed in a national register containing information on labour market participation.

RESULTS

Loss of paid employment before state pension age was predicted by expected reasons related to 'Health, work demands and occupational well-being': 'Poor physical health' (RR 1.47, 95% CI 1.45-1.49), 'Poor mental health' (RR 1.36, 95% CI 1.32-1.40), 'Not being capable of doing the job' (RR 1.20, 95% CI 1.18-1.22), and 'Not thriving at the workplace' (RR 1.14, 95% CI 1.11-1.17). Expected reasons related to the possibility of receiving voluntary early retirement benefits also increased this risk. Expected reasons related to 'Leisure' ('Wish for more self-determination'; 'Wish for more time for hobbies'), 'Economy' ('Economic considerations'; 'Possibility of receiving pension'), and 'Norms' ('Retirement norms'; 'To make space for younger employees') decreased the risk of loss of paid employment before state pension age. Age-stratified analyses revealed that expected reasons related to the domain of 'Health, work demands and occupational well-being' predicted risk of loss of paid employment to a greater extent among workers aged 50-55 compared to those aged 56-63.

CONCLUSIONS

Expected reasons for leaving the labour market predicted actual labour market participation among older workers in Denmark. Expected reasons related to poor physical and mental health, and not being capable of doing the job seem to be stronger PUSH-factors among workers aged 50-55 compared to those aged 56-63. Preventing early labour market detachment should take the worker's expected reasons for leaving into account.

Eldercare's Turnover Intention and Human Resource Approach: A Systematic Review

Eldercare workers' turnover intentions have caused serious concern given their high demand and pivotal role in ensuring elderly individuals' well-being. This systematic review examined the main factors of eldercare employees' turnover intentions with the purpose of identifying gaps and structure a novel human resource (HR) approach framework for eldercare social enterprises through a global literature review and realistic conclusions. A total of 29 publications appeared between 2015 and 2021 were digitally extracted from six databases and are extensively discussed in this review. Resultantly, eldercare workers' turnover intentions were positively impacted by job burnout, low job motivation, and restricted job autonomy. The findings of this study correspond to those of past literature, which highlighted the necessity of thoroughly examining eldercare worker retention practices from an organisational (HR) perspective. Furthermore, the current study outlines the factors influencing eldercare workers' turnover intentions as well as determine proper HR approaches to mitigate employee turnover issues among eldercare workers for organisational sustainability.

Can workplace intervention prolong work life of older workers? A quasi-experimental study

BACKGROUND

We aimed to evaluate the impact of a workplace senior program intervention on early exit from labor market and on the disability retirement among older employees and work-related physical factors associated with it.

METHODS

A total of 259 individuals aged 55 + years participated in the study (107 in intervention and 152 were controls). A questionnaire survey was conducted among Finnish food industry employees between 2003 and 2009 and the intervention "senior program" was provided between 2004 and 2009. The type of pension for the respondents who had retired by 2019 was obtained and dichotomized as statutory vs. early labor market exit. Disability pension was investigated as a separate outcome. Information on work-related factors was obtained from the survey. Cox regression analysis was used to estimate hazard ratios (HR) with their 95% confidence intervals.

RESULTS

Fifty-one employees had early labor market exit. Of them, 70% (n = 36) were control participants. Employees in the senior program worked for longer years (mean years 7.4, 95% CI 6.4-8.1) compared to the control (6.6, 95% CI 6.3-7.5). Sixty percent lower risk of early labor market exit (HR 0.40, 95% CI 0.19-0.84) and disability pension was found among employees in the senior program compared to the control group. Good work ability had a 94% lower risk (0.06, 95% CI 0.01-0.29) of early labor market exit and 85% lower risk (0.15, 95% CI 0.03-0.73) of disability pension compared to poor work ability. Employees with musculoskeletal pain had 4 times higher risk of disability pension compared to those without musculoskeletal pain.

CONCLUSIONS

A workplace senior program intervention prolonged work life and had positive effect on reducing disability pension among older industrial workers.

Can a Healthy Lifestyle Prevent Disability Pension among Female Healthcare Workers with Good and Poor Self-Rated Health? Prospective Cohort Study with 11-Year Register Follow-Up

BACKGROUND

Our purpose was to investigate whether healthy lifestyle habits prevent disability pension among female healthcare workers.

METHODS

We conducted a prospective cohort study with an 11-year register follow-up in which 8159 female healthcare workers from Denmark completed a questionnaire concerning self-rated health, work environment, leisure-time physical activity (LTPA), smoking, and body mass index (BMI). Data on disability benefit payments were obtained from the Danish Register for Evaluation of Marginalization during an 11-year follow-up. Potential confounders included age, occupational education, psychosocial work factors, and physical exertion during work.

RESULTS

Among workers in good health at baseline, smoking, obesity, and low levels of LTPA were risk factors for disability pension during 11-year follow-up. Among workers with poor health, only low levels of physical activity were a risk factor for disability pension.

CONCLUSIONS

This underscores the importance of a healthy lifestyle, specially being physically active, for preventing premature exit from the labor market in female healthcare workers.

Leadership behaviours and health-related early exit from employment: a prospective cohort study of 55 364 employees

Background

Absence of certain leadership behaviours, such as lack of feedback, recognition and involvement in employee development, has been associated with long-term sickness absence. We tested the hypothesis that absence of eight specific behaviours predicts health-related early exit from employment, and investigated differential effects in subgroups to guide future preventive initiatives.

Methods

Using Cox-proportional hazard modelling, we examined the prospective association between absence of leadership behaviours and health-related early exit from employment in a sample of 55 364 employees during 4.3 years follow-up. Leadership behaviours were measured by employee ratings in national surveys from 2012 to 2016. Exit from employment included disability pension and related measures of health-related early exit, retrieved from a national registry.

Results

We identified 510 cases of health-related early exit from employment during follow-up. A high level of absence of leadership behaviours, was associated with an increased risk of exit from employment (hazard ratio: 1.57, 95% CI: 1.31; 1.89). Subgroup analyses showed that the association between absence of leadership behaviours and exit from employment was similar for women and men and across age groups. The association was stronger for employees with high level of education than for employees with medium/low education, and the association was not observed among employees with a prevalent depressive disorder.

Conclusions

Absence of the eight leadership behaviours is a risk factor for health-related early exit from employment in the Danish workforce. More studies are needed to confirm the results.

Employee perception of managers' attitudes towards older workers is associated with risk of loss of paid work before state pension age: prospective cohort study with register follow-up

It is increasingly urgent to retain older workers in the workforce. In the present study, we analysed the prospective associations between employees' perceptions of their managers' attitudes towards older workers, and of having experienced age discrimination in the labour market with the risk of loss of paid work before the state pension age. Questionnaire data from 10,320 currently employed workers aged 50 + on perceptions of managers' attitudes towards older workers and perceived age discrimination were collected at baseline in the SeniorWorkingLife study. Data on labour market affiliation were obtained from national registers at baseline and two-year follow-up. Results show that the perception of negative attitudes was prospectively associated with an increased risk of loss of paid work for three of the five negative attitudes "older workers create conflicts, their qualifications are outdated, and they cannot keep up with the pace and development". Perception of positive attitudes was prospectively associated with a reduced risk of loss of paid work. The perception of age discrimination was prospectively associated with an increased risk of loss of paid work. The results strengthen existing evidence on associations between ageism and labour market attachment, by applying a longitudinal design and including actual change in labour market participation. However, some negative attitudes may be more detrimental to the older workers' labour market participation. Employees' positive perceptions of managers' attitudes reduced the risk. Good relations between employees and managers appear to be important for retaining older workers in the labour market.

The Implication of Physically Demanding and Hazardous Work on Retirement Timing

The need to retain individuals longer in the workforce is acknowledged in many high-income countries. The present study therefore aimed to examine the importance of physically demanding work tasks (PDWT) and physically hazardous work environment (PHWE) in relation to retirement timing among pensionable workers (≥61 years). A particular question was whether PDWT and PHWE increased in importance with age. Six waves (2008-2018) of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were used (n = 5201; 56% women and 44% men; mean age at first survey was 61.0 (SD 2.0) years). Discrete time-event history analysis, stratified by socioeconomic position and gender, showed that among blue-collar workers, PDWT and PHWE were associated with an increased likelihood of retiring within the next two years. With increasing age, high-level PHWE was associated with higher probability of retiring among blue-collar men, whereas heavy PDWT was associated with lower probability of retiring among blue-collar women. Among white-collar workers, having at least some PDWT compared to no PDWT was associated with a lower likelihood of retiring within the next two years. With increasing age, exposure to PHWE was associated with higher probability of retiring among white-collar women. These results suggest that to delay retirements, organizations could offer their older employees, especially blue-collar workers and the oldest white-collar women, alternatives to PDWT and PHWE.

Technical field measurements of muscular workload during stocking activities in supermarkets: cross-sectional study

Multiple studies have reported high prevalence of musculoskeletal disorders among supermarket workers. Technical field measurements can provide important knowledge about ergonomic risk factors for musculoskeletal disorders in the physical working environment, but these measurements are lacking in the supermarket sector. Therefore, using wearable electromyography and synchronous video recording in 75 supermarket workers, this cross-sectional study measured muscular workload during stocking activities in six different types of general store departments and during the thirteen most common work tasks across five different supermarket chains. Our results showed that muscular workload varies, especially for the low-back muscles, across (1) supermarket chains, (2) departments, and (3) specific stocking activities. Highest workloads of the low-back and neck/shoulders were seen in the fruit and vegetables department and during heavy, two-handed lifts of parcels (especially without using technical aids). In conclusion, physical work demands during supermarket stocking activities differ between chains, departments, and work tasks. These results can be used by company representatives and work environment professionals to specifically address and organize the stocking procedures to reduce the muscular workload during supermarket stocking.

Importance of the Working Environment for Early Retirement: Prospective Cohort Study with Register Follow-Up

Background: This study investigates the role of physical work demands and psychosocial work factors for early retirement among older workers. Methods: Data from three Danish surveys on work environment and health among employed older workers (age 55–59) were merged with a national register containing information on labour market participation. Robust Poisson regression modelled the risk ratios (RR) and 95% confidence intervals (CI) for the association between physical and psychosocial work factors and early retirement, that is, not working after the age of 64. Results: Of the 2800 workers, 53% retired early. High physical work demands (RR 1.33, 95% CI 1.19–1.48), poor overall psychosocial working conditions (RR 1.43, 95% CI 1.26–1.61), and access to early retirement benefits (RR 1.79, 95% CI 1.53–2.10) predicted early retirement. Subgroup analyses revealed that poor overall psychosocial working conditions were a stronger predictor for early retirement among workers with seated jobs than those with physically active jobs. Conclusions: High physical work demands and poor psychosocial working conditions are factors that can push older workers out of the labour market prematurely. Poor psychosocial working conditions seem to be a particularly strong push factor among workers with seated work.

Musculoskeletal pain intensity in different body regions and risk of disability pension among female eldercare workers: prospective cohort study with 11-year register follow-up

Background

Musculoskeletal pain is a risk factor for leaving the labour market temporarily and permanently. While the presence of multi-site pain increases the risk of disability pension, we lack detailed knowledge about pain intensity as a risk factor. This study investigated the association between musculoskeletal pain intensity in different body regions and risk of future disability pension among eldercare workers.

Methods

Eight thousand seven hundred thirty-one female eldercare workers replied to a questionnaire on work and health in 2005 and were followed for 11 years in the Danish Register for Evaluation of Marginalization. Time-to-event analyses estimated hazard ratios (HR) for disability pension from pain intensities (0–9 numeric rating scale (NRS)) in the low-back, neck/shoulders, and knees during the previous 3 months. Analyses were mutually adjusted for pain regions, age, education, lifestyle, psychosocial work factors, and physical exertion at work.

Results

During 11-year follow-up, 1035 (11.9%) of the eldercare workers received disability pension. For all body regions among all eldercare workers, dose-response associations were observed between higher pain intensity and risk of disability pension (p < 0.001). The risk for disability pension was increased when reporting “very high” pain levels (≥7 points on the 0–9 NRS) in the low-back (HR 2.19, 95% CI 1.70–2.82), neck/shoulders (HR 2.34, 95% CI 1.88–2.92), and knees (HR 1.89, 95% CI 1.44–2.47). Population attributable risks (PAR) were 15.5, 23.2, and 9.6% for pain > 2 on NRS in the low-back, neck/shoulders, and knees, respectively, indicating that 15.5, 23.2, and 9.6% fewer eldercare workers would likely receive disability pension if the pain intensity was reduced to 2 or less. For workers ≤45 years and > 45 years, PAR was highest for neck/shoulder pain (27.6%) and low-back pain (18.8%), respectively.

Conclusions

The present study found positive dose-response associations between pain intensity in the low-back, neck/shoulders, and knees, and risk of disability pension during 11-year follow-up. Moderate to very high levels of musculoskeletal pain in eldercare workers should, therefore, be considered an early warning sign of involuntary premature exit from the labour market. These findings underscore the importance of preventing, managing, and reducing musculoskeletal pain to ensure a long and healthy working life.

What is giving vitality to continue at work? A qualitative study of older health professionals' vitality sources

BACKGROUND AND AIM

Vitality is described as 'life energy', 'inner strength' and 'inner health resource' and is the essence of health. Especially during the ageing process, it is of fundamental importance that an individual's health resources are strengthened to support work ability. The need for health services increases as the population ages and meanwhile the workforce in health care is also ageing. The aim of the study was to explore what is giving vitality to older workers in health care to continue at work until retirement age and maybe even an extended working life.

INFORMANTS, METHODOLOGY AND METHODS

A qualitative interview study was conducted. A total of 15 people aged 59-65 participated in the study, all of them working in the health care sector. Five participants were administrative personnel and ten were nurses. One man and fourteen women took part in the study. Qualitative content analyses were used.

FINDINGS

The results show that meaningful work, possibilities to use one's knowledge, relationships and work community are promoting vitality. Vitality is affected by work conditions, benefits, personal values and own health.

CONCLUSION

Plans about continuing at work seem to depend on both external and internal reasons. Knowledge of what influences older employees' vitality resources makes it possible to improve their work situation so that vitality and work ability can be maintained by occupational health and employers despite the ageing process.

Self-reported sickness absence and presenteeism as predictors of future disability pension: Cohort study with 11-year register follow-up

Many healthcare workers in eldercare are pushed out of the labor market before the official retirement age due to poor health. Identification of early warnings signs is important to avoid complete loss of work ability. The aim of this study was to investigate to what degree sickness absence and presenteeism increase future risk for disability pension among eldercare workers. A total of 8952 Danish female eldercare workers responded to a survey about work environment and health. They were followed for 11 years in the Danish Register for Evaluation of Marginalization, with time-to-event analyses estimating the hazard ratios (HRs) for disability pension from sickness absence and presenteeism at baseline. Analyses were adjusted for age, education, body mass index, leisure-time physical activity, smoking, physical exertion at work, and psychosocial factors related to the work environment. During the 11-year follow-up, 11.9% participants received disability pension. For the whole cohort, the highest risk for disability pension was observed for the category of >30 days of combined sickness absence and presenteeism at baseline in the fully adjusted model (HR = 7.93 [95%CI 5.20-12.09]). Eldercare workers aged >45 years were at a higher risk for disability pension in all included categories. Sickness absence and presenteeism increased the risk of disability pension among female eldercare workers. These results suggest that organizations would benefit from identifying early warning signs among workers in the prevention of involuntary early retirement.

High physical work demands have worse consequences for older workers: prospective study of long-term sickness absence among 69 117 employees

Objective

This study investigates the role of age for the prospective association between physical work demands and long-term sickness absence (LTSA).

Methods

We followed 69 117 employees of the general working population (Work Environment and Health in Denmark study 2012–2018), without LTSA during the past 52 weeks preceding initial interview, for up to 2 years in the Danish Register for Evaluation of Marginalisation. Self-reported physical work demands were based on a combined ergonomic index including seven different types of exposure during the working day. Using weighted Cox regression analyses controlling for years of age, gender, survey year, education, lifestyle, depressive symptoms and psychosocial work factors, we determined the interaction of age with physical work demands for the risk of LTSA.

Results

During follow-up, 8.4% of the participants developed LTSA. Age and physical work demands interacted (p<0.01). In the fully adjusted model, very high physical work demands were associated with LTSA with HRs of 1.18 (95% CI 0.93 to 1.50), 1.57 (95% CI 1.41 to 1.75) and 2.09 (95% CI 1.81 to 2.41) for 20, 40 and 60 years old (point estimates), respectively. Results remained robust in subgroup analyses including only skilled and unskilled workers and stratified for gender.

Conclusion

The health consequences of high physical work demands increase with age. Workplaces should consider adapting physical work demands to the capacity of workers in different age groups.

Psychosocial determinants of physical activity among workers: an integrative review

Knowledge of the psychosocial determinants of physical activity is critical to informing preventive and therapeutic interventions in the workplace. This study reviewed available evidence on psychosocial factors that have been associated with physical activity among workers. Studies were selected in December 2019 from the Scopus, Web of Science, and PubMed databases, with no date limits, using the following search terms: “physical activity”, “physical exercise”, “psychosocial”, “workers”, and “working-age”. Thirty-nine studies published between 1991 and 2019 were evaluated. The determinants of physical activity investigated among workers were smoking status, stress, psychosocial working conditions, depression, anxiety, social relationships, work ability, job satisfaction, burnout, and self-efficacy. Some consistencies and controversies were observed in the associations among these determinants and physical activity and are discussed, as are suggestions for future studies. The findings of this review may be of interest to physical activity interventions designed to reduce psychosocial risks factors in work environments.

Nation-Wide Dissemination of a Digital Checklist to Improve Work Environment in the Eldercare Sector in Denmark

In this study, we evaluated the dissemination of a digital checklist for improving implementation of work environment initiatives in the Danish eldercare sector. We evaluated the impact of the checklist using the RE-AIM framework. Initiated in 2016, researchers and relevant stakeholders were responsible for disseminating the checklist to all workplaces in the eldercare sector in Denmark through a national campaign. The checklist guided the user to define an action plan to implement, and the checklist covered 11 implementation concept points that should be addressed to reach full implementation of the action in focus. One year after the launch of the campaign almost all municipalities in Denmark had visited the website hosting the checklist (96%), 17% of individual workers within the eldercare responding to a union survey was reached, 4% (n = 199) of all eligible eldercare workplaces in Denmark and 8% of all nursing homes had adopted the checklist. Of the workplaces that used the checklist, 46% typed an action in the checklist. There were 13% of the first time users that used the checklist twice and 29% of the actions were revised (maintenance) after working with the implementation. Finally, the workplaces that had used the checklist showed a higher prioritization of work environment compared to workplaces not using the checklist both at baseline and at follow up. In conclusion, this study employing various strategies, including a 1-year national campaign to disseminate a checklist shows potential to impact implementation of work environment initiatives in the Danish eldercare sector. While dissemination is satisfactory and likely to increase further with time, more efforts is needed to ensure maintenance.

Interaction Effects of Physical and Psychosocial Working Conditions on Risk for Sickness Absence: A Prospective Study of Nurses and Care Assistants in Sweden

Employees in health and social care are often simultaneously exposed to both physical and psychosocial challenges that may increase their risk for sickness absence. The study examines interaction effects of physical and psychosocial work conditions on the future risk for sickness absence among nurses and care assistants in Sweden. The study was based on 14,372 participants in any of the Swedish Work Environment Surveys conducted during the years 1993-2013 with linked register information on background factors and compensated sickness absence. Adjusted hazard ratio (HR), stratified by occupation, and measures of additive interaction effects were estimated. The combinations of high psychosocial job demands and heavy physical work and strenuous postures, respectively, significantly increased the risks for sickness absence among nurses (HR 1.43; CI 1.09-1.88 and HR 1.42; CI 1.16-1.74, respectively), as well as among care assistants (HR 1.51; CI 1.36-1.67 and HR 1.49; CI 1.36-1.63, respectively). The combinations of low job control and both heavy physical work (HR 1.44; CI 1.30-1.60) and strenuous postures (HR 1.42; CI 1.30-1.56) were also associated with excess risk for sickness absence among care assistants. We also found interaction effects among care assistants but not among nurses. The results indicate that the high sickness absence rate among care workers in Sweden can be reduced if the simultaneous exposures of high psychosocial and high physical challenges are avoided. Management policies for reduced time pressure, improved lifting aids, and measures to avoid awkward work postures are recommended. For care assistants, increased influence over work arrangements is likely to lower their sickness absence risk.

Exploring the role of shift work in the self-reported health and wellbeing of long-term and assisted-living professional caregivers in Alberta, Canada

BACKGROUND

Numerous studies have found negative outcomes between shift work and physical, emotional, and mental health. Many professional caregivers are required to work shifts outside of the typical 9 am to 5 pm workday. Here, we explore whether shift work affects the health and wellbeing of long-term care (LTC) and assisted-living (AL) professional caregivers.

METHOD

The Caring for Professional Caregivers research study was conducted across 39 LTC and AL facilities in Alberta, Canada. Of the 1385 questionnaires distributed, 933 surveys (67.4%) were returned completed. After identifying 49 questions that significantly explained variances in the reported health status of caregivers, we examined whether there was a relationship between these questions and reported health status of caregivers working night shifts.

RESULTS

We found significant differences between responses from those working different shifts across six of seven domains, including physical health, health conditions, mental/emotional health, quality of life, and health behaviors. In particular, we found that night shift caregivers were more likely to report incidents of poor heath (i.e., they lacked energy, had regular presences of neck and back pain, regular or infrequent incidents of fatigue or low energy, had difficulty falling asleep, and that they never do exercise) and less likely to report incidents of good health (i.e., did not expect their health to improve, were not satisfied with their health, do not have high self-esteem/were happy, were unhappy with their physical appearance, and do not get a good night's sleep), compared to caregivers working other shifts.

CONCLUSIONS

Our study shows that professional caregivers working the night shift experience poor health status, providing further evidence that night shift workers' health is at risk. In particular, caregivers reported negative evaluations of their physical, mental/emotional health, lower ratings of their quality of life, and negative responses to questions concerning whether they engage in healthy behaviors. Our findings can support healthcare stakeholders outline future policies that ensure caregivers are adequately supported so that they provide quality care.

Psychosocial working conditions, pain, mental disorders, and disability pension

We aimed to investigate associations between psychosocial working conditions and disability pension (DP), and the role of co-existing pain or common mental disorders (CMDs). Survey data collected 1998-2003 on 25,135 Swedish twins born 1935-1958 were linked with national DP register data until 2013. Psychosocial working conditions, pain and CMDs were analyzed by Cox proportional hazards regression models (hazard ratios with 95% confidence intervals). One unit increase in job demands or control was associated with a higher risk for DP due to musculoskeletal disorders. One unit decrease in job demands predicted lower risk of DP due to mental diagnoses. Co-existing pain or CMD played no role for associations of job demands with DP, but pain influenced the associations with DP due to mental diagnoses. To conclude, psychosocial working conditions play different roles for DP depending on the diagnoses.

Risk Factors for Work-Related Musculoskeletal Disorders Among Intensive Care Unit Nurses in China: A Structural Equation Model Approach

PURPOSE

This study explored the direct and indirect effects of risk factors of work-related musculoskeletal disorders (WRMDs) in nurses working in intensive care units (ICUs).

METHODS

A cross-sectional study design was used. ICU nurses from 28 tertiary hospitals in the Hunan and Guangdong provinces participated in a survey conducted via a self-reported online questionnaire. A structural equation model was used to fit the data and to evaluate associations among WRMDs and risk factors.

RESULTS

Valid questionnaire samples were submitted by 984 ICU nurses. The prevalence of WRMDs within the previous year among ICU nurses was 96.8%. A valid structural equation model was constructed, and a good fit was shown: Chi-square value/degrees of freedom = 2.248; comparative fit index = .931; normal fit index = .905; goodness-of-fit index = .978; adjusted goodness-of-fit index = .966; and root mean square error of approximation = .036. All regression coefficients for direct effect reached significant levels (critical ratio > 1.96 and p < .05). In the structural equation model, the occurrence of WRMDs was directly affected by the following: physical factors, risk perception, and job stress. Physical factors and a safe environment indirectly affected WRMDs through risk perception and job stress. The strongest correlations with WRMDs were physical factors.

CONCLUSION

The model provided a new perspective for understanding the associations among physical factors, workplace safety environment, risk perception, job stress, and WRMDs. To improve the practice setting of the ICU, efforts should be made to help prevent WRMDs from physical, psychosocial, and environmental factors.

Work factors facilitating working beyond state pension age: Prospective cohort study with register follow-up

Objectives:

The demographic changes in Europe underline the need for an extension of working lives. This study investigates the importance of physical work demands and psychosocial work factors for working beyond the state pension age (65 years).

Methods:

We combined data from three cohorts of the general working population in Denmark (DWECS 2005 and 2010, and DANES 2008), where actively employed workers aged 55–59 years replied to questionnaires about work environment and were followed until the age of 66 years in the Danish AMRun register of paid employment. Using logistic regression analyses, we calculated prevalence ratios (PR) and 95% confidence intervals (CI) for the association between physical and psychosocial work factors and working beyond state pension age, adjusted for age, sex, cohort, cohabiting, sector, income, vocational education, working hours, lifestyle, and previous sickness absence.

Results:

Of the 2884 workers aged 55–59 years, 1023 (35.5%) worked beyond the state pension age. Higher physical work demands was associated with a lower likelihood (PR 0.69, 95% CI 0.58–0.82) and a good psychosocial work environment was associated with higher likelihood (average of 7 items: PR 1.81, 95% CI 1.49–2.20) of working beyond state pension age. Stratified analyses did not change the overall pattern, ie, a good overall psychosocial work environment – as well as several specific psychosocial factors – increased the likelihood of working beyond state pension age, both for those with physically active and seated work.

Conclusion:

While high physical work demands was a barrier, a good psychosocial work environment seems to facilitate working beyond state pension age, also for those with physically active work.

High physical work demands and working life expectancy in Denmark

Objective

In most European countries, political reforms gradually increase the statutory retirement age to counter the economic costs of a growing elderly population. However, working to a high age may be difficult for people with hard physical labour. We aim to study the impact of high physical work demands on working life expectancy (WLE).

Methods

We combined physical work demands assessed by job exposure matrix (JEM) and longitudinal high-quality national registers (outcome) in 1.6 million Danish workers to estimate WLE and years of sickness absence, unemployment and disability pension. The JEM value for physical work demand is a summarised score of eight ergonomic exposures for 317 occupations groups, sex and age. The WLE was estimated using a multistate proportional hazards model in a 4-year follow-up period.

Results

Individuals with high physical work demands had a significantly lower WLE, than those with low physical work demands, with largest differences seen among women. At age 30 years, women with high physical work demands can expect 3.1 years less working, 11 months more of sickness absence and 16 months more of unemployment than low-exposed women. For 30-year-old men, the corresponding results were 2.0 years, 12 months and 8 months, respectively.

Conclusion

Our findings show that high physical work demands are a marked risk factor for a shortened working life and increased years of sickness absence and unemployment. The results are important when selecting high-risk occupations, and expand the knowledge base for informed political decision making concerning statutory retirement age.

Factors Contributing to Retirement Decisions in Denmark: Comparing Employees Who Expect to Retire before, at, and after the State Pension Age

Aim: Analyse factors affecting retirement decisions comparing employees expecting to retire before, at, and after the state pension age. Methods: In the SeniorWorkingLife cohort, 12,269 workers aged +50 replied to questions about expected retirement age, reasons for leaving, and reasons for staying longer. Results: For all groups, poor health, wish for more leisure, and economy were the most salient expected reasons for retiring. Many would stay longer if there were better possibilities for more leisure time, more work flexibility, and economic benefits. Those expecting to retire before state pension age were more likely to point at desire for more leisure time as expected reason for retiring, and less likely to point at economic reasons, and more likely to point at health and work demands as possible reasons for prolonging working life. Those expecting to retire after state pension age were more likely to point at external factors and recognition from the management. Conclusion: Factors influencing retirement decisions are similar across the groups. Initiatives for better work–life balance, healthy lifestyle, and economic incentives to continue working may help prevent early retirement and motivate prolonging work life beyond retirement. Results also indicate that less strenuous work is particularly relevant to prevent early retirement.

Higher leisure-time physical activity is associated with lower sickness absence: cross-sectional analysis among the general workforce

BACKGROUND

Prevention of sickness absence (SA) is a major public health challenge. Sufficient levels of physical activity may be an important protective factor. In contrast to the North European countries, little is known about physical activity behavior and its influence over SA in South European countries.

METHODS

In the European Health Interview Survey (EHIS) 2014, a total of 9512 Spanish workers aged 17 to 70 (46.5% women) replied to questions about SA (last 12 months) and the frequency of leisure-time physical activity (LTPA). Multiple linear regression adjusted for age, sex, education, occupational class, smoking habits, body mass index, and chronic disease (diabetes, hypertension, neck pain, low back pain, chronic depression and anxiety) was used to assess associations.

RESULTS

The average SA among the participants was 6.9 days (SD=33.3) per year, whereas the prevalence of any SA episode was 22.0%. The prevalence of workers performing high or very high LTPA was 31.0%. In final sex and age-stratified fully adjusted models, the association between LTPA and SA remained significant for women aged 44 to 51 (β=-0.07, 95% CI: -0.42 to -0.03) for SA.

CONCLUSIONS

The results suggest that higher LTPA is associated with lower SA in a particular category of workers, that might benefit from physical activity strategies.

Physical and Psychosocial Work Environmental Risk Factors for Back Injury among Healthcare Workers: Prospective Cohort Study

The incidence of occupational back injury in the healthcare sector remains high despite decades of efforts to reduce such injuries. This prospective cohort study investigated the risk factors for back injury during patient transfer. Healthcare workers (n = 2080) from 314 departments at 17 hospitals in Denmark replied to repeated questionnaires sent every 14 days for one year. Using repeated-measures binomial logistic regression, controlling for education, work, lifestyle, and health, the odds for back injury (i.e., sudden onset episodes) were modeled. On the basis of 482 back injury events, a higher number of patient transfers was an important risk factor, with odds ratio (OR) 3.58 (95% confidence interval (CI) 2.51–5.10) for 1–4 transfers per day, OR 7.60 (5.14–11.22) for 5–8 transfers per day, and OR 8.03 (5.26–12.27) for 9 or more transfers per day (reference: less than 1 per day). The lack of necessary assistive devices was a common phenomenon during back injury events, with the top four lacking devices being sliding sheets (30%), intelligent beds (19%), walking aids (18%), and ceiling lifts (13%). For the psychosocial factors, poor collaboration between and support from colleagues increased the risk for back injury, with OR 3.16 (1.85–5.39). In conclusion, reducing the physical burden in terms of number of daily patient transfers, providing the necessary assistive devices, and cultivating good collaboration between colleagues are important factors in preventing occupational back injuries among healthcare workers.

Association between Psychosocial Working Conditions and Perceived Physical Exertion among Eldercare Workers: A Cross-Sectional Multilevel Analysis of Nursing Homes, Wards and Workers

This cross-sectional multilevel study aims at investigating the associations between psychosocial working conditions of different workplace levels and perceived physical exertion among eldercare workers. Data were obtained from the 'Danish Observational Study of Eldercare work and musculoskeletal disorderS' (DOSES) study, including 536 eldercare workers, nested in 126 wards and 20 nursing homes. Psychosocial working conditions were measured by the Copenhagen Psychosocial Questionnaire (COPSOQ). The physical workload was measured with a self-administered scale (0-10) rating perceived physical exertion. Multilevel linear mixed models were used to determine associations of psychosocial conditions between nursing homes, wards, and workers with physical exertion. Most of the variance in the perceived physical exertion was explained by differences between workers (83%), but some variance was explained by wards (11%) and nursing homes (6%). Workers employed in nursing homes with low influence (p = 0.01) and poor leadership (p = 0.02), and in wards with high quantitative demands (p = 0.03), high work pace (p < 0.001), and low justice (p = 0.01) were at increased risk of reporting higher physical exertion. The strongest associations were found for low influence, low quality of leadership, and high work pace at nursing homes and ward levels. In conclusion, improving specific psychosocial working conditions at nursing home and ward levels may be of particular importance to reduce excessive physical workload in eldercare workers.