Physical demands and caregiving

Many of us are living and working longer compared with previous generations. In countries such as Australia, older people (>65 years) now represent nearly 16% of the population and is expected to increase to 22% by 2057. This is a result of low birth rates and an increased life expectancy.  Furthermore, an older population necessitates greater needs for caregiving especially as they become more dependent. Remaining at home is generally a preferred option for older adults rather than living in an institutionalized setting.  However, the responsibility of care giving often shifts to “informal caregivers” — typically, family and friends.

Physical demands and caregiving often go hand in hand.

Of the various challenges of home care, activities related to mobility assistance rank as some of the most physically demanding jobs for caregivers.  For example, the risk of injury to the caregiver, particularly to their lower back and shoulders, is commonly caused by helping to stabilize, lift and manoeuvre mobility-impaired people. As a physiotherapist, I treat many clients who have also experienced high levels of physical strain and musculoskeletal discomfort from repetitive lifting and loading of heavy and awkward wheelchairs or walkers.

 

A typical scenario

 

Your mother wants to go shopping to buy her great granddaughter a special graduation gift. Your mother is living at home and employs nursing care services three times a week to help with cleaning and showering. Furthermore, her mobility has declined over the past 6 months, and she uses a 4-wheeled walker to aid her mobility.

You purchased the gift, but the shopping trip was not much fun for anyone. Transferring Mum into and out of the car was tricky.  Your car is low-set, and she needed a lot of assistance.  The walking frame was heavier than you expected (despite it claiming to be “feather- weight”) and you managed to scratch the paint on the back of your car as you heaved it into the boot.  Moreover, you did not have a disabled parking sticker, and this required a long-distance walk to access the shopping mall. This involved numerous seated rests for your Mum throughout the shopping journey.

Upon returning to your car, the automobile in the adjacent parking bay hampered you from fully opening the passenger door. Subsequently, you found yourself leaning and twisting awkwardly to help.  Eventually you succeed, but your back is fraught with a constant dull ache. This highlights the physical demands of caregiving.

 

It is not the load that breaks you.  It’s the way you carry it.

 

The most familiar injury related to the physical demands of caregiving is stress to the lower back (lumbar region). Most often, this occurs when you lift a heavy object while twisting or bending forward.  This was documented in a well-known study (1981) which illustrated how the load on the lower back (lumbar disc) varies with the position of the subject’s body and the performance of various tasks. The pressure on the lumbar disc increased 100% when a standing subject leaned forward and lifted weights.  When rotation – or twisting – occurs while in this position, the pressure on the lumbar discs increased 400%. Causative factors that lead to lower back and shoulder injury and pain occur when we:

  • Lift something that exceeds our strength ability.
  • Lift or support weight while in an unbalanced position (“lifting poorly”).
  • Repeat movements, such as bending from the lower back.
  • Sustain a position for a lengthy duration.
  • Attempt to move in a manner that exceeds our flexibility level.
  • Plan inadequately.
  • Experience pressure to “get things done” quickly.

 

How can you reduce your chance of injury?

TRIP PLANNING

  • Plan the trip and give yourself adequate time. Often, things go wrong when you are rushed. Clear your car’s boot (trunk) so that mobility equipment fits more easily. Engage another person to help with lifting of equipment.  Sharing the load is always more fun!
  • Consider if a wheelchair is more useful than a walker.

CAR TRANSFERS

  • Preparation and planning. Park the car in an accessible place. Avoid parking next to a curb. Park away from other cars to ensure ample room to manoeuvre without having to twist your body.
  • Explain the safest way to get into the car:
    • Position the seat for maximum leg room.
    • Have your passenger place one hand on the dashboard and enter the car backwards.  You may need to squat to help guide your passenger’s legs into the car.
  • Maintain a safe posture throughout. Avoid bending at the lower back. Squat and bend from the hips, keeping the back straight.
  • Place a plastic bag on the car seat to reduce friction. This allows easier movement of the legs and trunk into and out of the car.

WHEELCHAIRS AND WALKERS

  • Preparation and planning. Fold the walker or wheelchair and have the brakes on. Remove loose parts such as footplates on the wheelchair.
  • Maintain a safe posture through the lift. Hold the frame of the chair or walker close to your body. Bend from the knees and hips, not your back, and avoid twisting.
  • Brace your core stabilisers. Prior to lifting, brace (tighten) your core (abdomen and lower back).

INCREASE YOUR STRENGTH

The last component that will help reduce injury to yourself is to improve your strength. Strengthening muscles supporting your knees, hips, lower back and shoulders will protect you from injury and help you to succeed in the physical demands of caregiving. For example, if you are able to squat and lunge properly with good form, you will load your legs rather than your back while lifting and this will help prevent lower back injuries.  Here are some tips to get back fit.

Refer to our previous SimpliMove.health blogs for strengthening exercises that focus on your core, buttocks, legs, arms and shoulders.

Challenge 1 and Challenge 2 are doable and more basic.

Challenge 5 and Challenge 7 are more difficult!

The physical demands of caregiving will always exist, and not every situation is ideal. However, if you plan, lift equipment safely, and keep yourself strong, your experience will be much brighter!

Our next blogs will feature how to safely help someone get out of a chair or off the floor after they have fallen.