Ageing and municipalities in change

Transcription

1 Ageing and municipalities in change Tuula Oksanen, MD, PhD, Docent Director, Renewal of Occupational Health and Safety Nordic Research Conference on Safety , Helsinki, Finland Outline Demographic change Ageing populations Ageing employees Additional challenges 1

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3 Global Aging: Which countries are the oldest? Source: CIA World Finnish Institute of Occupational Health Factbook Ageing populations => Changes in the need of municipal services 3

4 Changes in dependency ratio in Finland index Children and the elderly / per worker Age > 65 yrs < 15 yrs Changes in the demand of services Costs Social welfare services Daycare for children Nursing homes Home services for the elderly Skilled nursing facilities Health care Specialised health care Primary health care Education Kindergarten Primary school High school Vocational school Univ of applied sciences Ministry of Finance, Finland 4

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6 Ageing populations => ageing municipal employees The Finnish Public Sector Study includes employees from 1 towns 6 hospital districts 1-Town study PI Professor Jussi Vahtera Oulu Hospital personnel study - PI Professor Mika Kivimäki Pohjois-Pohjanmaan shp 2% of the public sector employees in Finland Virrat Nokia Naantali Raisio Turku Tampere Valkeakoski Vantaa Espoo Varsinais- Suomen shp Vaasan shp Pirkanmaan shp Kanta-Hämeen shp HUS (Jorvi, Hyks) 6

7 Data collection phases Survey 2-1Town (N=32 299, 67%) -Hospitals (N=16 299, 67%) Total Survey 24-1Town (N=32 322, 65%) -Hospitals (N=15 879, 69%) Total Survey 28-1Town (N=38 727, 7%) - Hospitals (N=14 53, 72%) Total Survey 212-1Town -(N=39 194, 69%) -Hospitals (N=13 861, 71%) Total Respond/ survey Response rate% DOCTORS Teachers Special teachers Social workers NURSES Practical NURSES CLEANERS Retirement intentions ( >55 year old) %

8 High job demands, low control % Organizational injustice %

9 Work load exceeds own tolerance % Long working hours?! 9

10 The IPD-Work Consortium et. al. Working more than 54 hours / week is associated with a 29% increase in type 2 diabetes among employees in the low socioeconomic status group 1

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12 Experiencing violence at work School helper Special education teacher Practical nurse Kindergarten teacher Nurse Source: 1Town Study, FIOH, 212 Experience of violence at work: physical assaults by throwing items %

13 Experience of physical violence at work: kicking % Experience of violence at work: being threatened with a weapon %

14 Resources Employee health and safety Patient health and safety 14

15 Overcrowding in hospital wards 1 In hospitals, overcrowding and excess staff workload has been widely recognised as a serious problem for both patients and staff. Overcrowding has been associated with increased hospital infections and patient mortality (Cunningham et al. Br J Nurs 26; Tarnow-Mordi et al. Lancet 2; Sprivulis et al. Med J Aust 26) as well as staff burnout and job dissatisfaction (Aiken et al. JAMA 22) Overcrowding can be indicated as excess bed occupancy. Overcrowding in hospital wards 2 Participating hospitals routinely collect monthly figures on bed occupancy for each ward according to a standard procedure. Bed occupancy %= Sum of in-patient days Beds available Beds available: number of beds x the number of days the ward is in use The day of admission but not the day of discharge for each person is included in the numerator. The rate above which a hospital ward is considered overcrowded is usually defined as > 85%. 15

16 Overcrowding in hospital wards 3 Timing of exposure changes continuously over time. A fixed time window would lead to inaccurate exposure estimate loss of power (a short time lag between exposure and treatment seeking likely) Solution: Monthly excess bed occupancy rates treated as time-dependent exposures that may change in value over the period of observation Measurement of overcrowding Excess occupancy: bed occupancy <85% coded as % bed occupancy >85% coded as XX%-85% Antidepressant treatment = no 1 = yes Monthly bed occupancy Excess occupancy 18/6=3 (18+3)/6=8 (18+3)/6=8 3/6=5 (3+35)/6=11 (3+35+4)/6=12 ( )/6=

17 Overcrowding and antidepressant treatment among staff (n=734) Virtanen, Kivimäki, Oksanen Finnish Institute et of Occupational al. Am Health J Psychiatry 28 Overcrowding and new onset sickness absence due to depression among staff Adjusted risk2 (HR) 1,8 1,6 1,4 1,2 1,8,6, ( ) 1.44 (.9-2.3) Overcrowding Ylikuormitus 1.95 ( ) ei <=5% >5<=1% >1%* -> no association with other causes Virtanen, Batty, Pentti, Vahtera, Oksanen et al. J Clin Psychiatry, 21 17

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19 Overcrowding in psychiatric wards and physical assaults on staff Adjusted risk (OR) 3,5 3 2,5 2 1, ( ) 3.4 ( ) 2.76 ( ) 1,5 Ylikuormitus Overcrowding ei <=5% >5<=1% >1%* -> no association on ward property Virtanen, Vahtera, Batty Oksanen Finnish Institute et al. of Brit Occupational J Psychiatry, Health

20 Solutions? 2

21 4677 public sector employees At work in 25 and who reached their old age pensionable date between in Were alive and either retired due to old age or were employed for over six months beyond their individual pensionable age between During employment responded to at least one survey between 2-28 Mean age 59.8 years, 73% women Altogether 832 participants (18%) extended their employment by more than 6 months beyond their pensionable age. Predictors of voluntary extension of work career in the prospective Finnish Public Sector Study -> The strongest predictor was opportunity to control work time N=4677 employees who reached statutory pensionable age between 25-11; Outcome was voluntary extension of employment >6 months (multivariable adjusted models) Virtanen M, Oksanen T, Batty GD, et al., Plos One

22 Good work time control enhanced longer work career also among employees with psychological symptoms Virtanen, Oksanen, Batty et al., Plos One

23 Thank you for your attention! 23