STUDY 3: RETIREMENT OR CHANGE OF JOB FUNCTION IN NURSING AIDES
Aim of the study
The aim of this study was to analyze retirement among nursing aides, regarding the association between LBP and retirement or other job changes.
Material and methods
In a prospective cohort design the only causes for persons to leave the cohort is death.
A union register is limited, as the registration of persons leaving the union is unsystematic. The retiring persons are probably only partly included in the register, as the follow-up period was longer than the normal period that retiring persons stay in the register (approx. 2 years).
A previous study showed a higher prevalence of LBP among nursing aides who had left the occupation compared to active nursing aides (Jensen et al, 1995). Also the interview data from study 2 pointed towards a tendency that especially nursing aides could have left the job or changed job function during the follow up period: 1) An increasing number of lifting injuries reported per person gave an increasingly low OR as a predictor of long-lasting LBP. It was predominantly cemetery workers and nursing aides who reported only 1-2 lifting injuries per person, giving a notion that persons with several injuries may have left the job. However, in the cemetery workers’ group, the work environment had changed in the same period towards fewer lifts (more cremations and technical lifting devices), so that in this group there may be another explanation of this fact. However, the explanation is not likely to be fewer patient transfers among the nursing aides. 2) A decline at age 45 in the age distribution of the interviewed nursing aides.
The aim of this study was to analyze the issue of retirement or changes in job function among nursing aides. I order to approach this aim, I took a number of steps:
a. Retirement of nursing aides in the DWECS
I analyzed retirement in 1995 of nursing aides identified in the 1990-version of DWECS, and carried out a distribution of the 129 nursing aides identified in the 1990-version of the DWECS on the categories wage earner, sabbatical, unemployed, student, pension/long-term sick-leave or self- employed, and on age groups in a new analysis.
b. A sample of retired health care personnel identified by the union
The union of the nursing aides (FOA) was contacted regarding retirement. As the persons who chose to retire were only seen by the administrative personnel, and retiring persons were not transferred to another register, no simple access to this subgroup existed. But a number of persons had also been seen by the union’s social worker for work related health problems or retirement. The social worker had recorded all these cases during his employment. This sample included 268
persons, of whom 179 persons primarily suffered from musculoskeletal disorders. A large fraction of the remaining persons suffered from mental disorders. In accordance with the union’s wishes, I contacted only the 179 persons, by the means of a mailed questionnaire. This questionnaire was a short version of the interview items plus questions about retirement. As the response rate in this group was only 42 %, and as only 53 % of the respondents were retired, this sample was not useful for the purpose. The sample also included persons with illnesses that could not possibly be viewed as work related.
c. Retirement of nursing aides in the Statistical Register of Transfer Payment linked to the DWECS
The Statistical Register of Transfer Payment is a register conducted by Statistics Denmark that includes persons living on transfer payments. As a part of another PhD-project, the Statistical Register of Transfer Payment, version 1997, had been linked to the DWECS 1995-version (Lund, personal communication, 2000). I selected data on several types of pensions and sick leave for more than 2-3 months to be included in the analyses, whereas sabbatical, maternity leave, and
unemployment were not included. In this linked register I carried out a new analysis of retirement and LBP in the year preceding the interview (categories: yes/no) among nursing aides (94 nursing aides in the DWECS, 1995 version) for this study. The same cross table was analyzed for the total population of the DWECS.
d. Retirement or job changes in a sample of claims of compensation for sudden lifting injuries in nursing personnel
In the NBII a sample of claims of compensation for sudden lifting injuries had been extracted to identify and form subgroups within personnel in health care and children’s day care for descriptive purposes. At the extraction of this sample nursing personnel and personnel in childrens’ day care shared the same code, which meant that I had to exclude claims within childrens’ day care subsequently. The sample included a total of 851 claims.
As claims of compensation for sudden lifting injuries may be dismissed due to the short duration of LBP, a substantial number of claims were dismissed after a short time. A claim may also be
dismissed because the person does not reply to letters. In these claims, very few data would be included. But if there is a possibility that a claim my be recognized, the claim will be handled over a long period (health care personnel is a group of person with a possibility of recognition of the claims), in order to collect the needed data for a decision by the Occupational Diseases Committee. Thus a large amount of data is collected on the person, according to a strict scheme. Whenever there is a possibility that the claim may be recognized, a medical certificate will be taken from a specialist in occupational medicine. This gives a very high quality of data in the claims handled over long time and prepared for the Occupational Diseases Committee. The persons with dismissed claims due to short-lasting LBP may ask for resumption, and this possibility is mentioned in the text of the dismissal (see also appendix 1).
In order to obtain the maximum amount of available data in each claim, I only included claims that were recognized or dismissed (the claim was closed and filed on archive) in the analysis. In this case no more data would be required, unless a resumption of the claim was requested. The same birth dates were used as in the first sample of claims of compensation for sudden lifting injuries, birth dates 05-09 and 24-31. A total of 264 claims were extracted. Of these 47 claims concerned children’s day care, and 40 claims regarded other body regions than the low back in health care personnel. The rest, 177 claims – if data were available – I distributed on the following variables: gender, age, job category, number of patient transfers per day (few/many), years in the job
(few/many), duration of LBP after injury (short/long), and 8 categories of work status after the lifting injury (‘no job change’, ‘lighter functions in same job’, ‘new job’, ‘starting new
training/education’, ‘sick leave’, ‘unemployed’, ‘pension etc.’ and ‘unknown, left previous job ’). A cross-tabulation was carried out, in which these values were dichotomized into either ‘no job
change’ or ‘job changes’ (‘job changes’ included any of the 7 categories of job changes) and distributed on the duration of LBP.
Results
The results of the analyses were as follows: a. Retirement of nursing aides in the DWECS
In the DWECS, 2% (1 person) of nursing aides in the age group 30-39 (35-44 years in 1995), and 23 % (6 persons) of the nursing aides in the age group 40-49 in 1990 (45-54 years in 1995) went on long-term sick leave or pension between 1990 and 1995. Young nursing aides moreover changed category to students, unemployed or on sabbatical (6 persons in the age group 19-29, aged 25-35 in 1995).
b. A sample of retired health care personnel identified by the union
The data from the mailed questionnaire regarding nursing aides identified by their union, FOA, was not analyzed further.
c. Retirement of nursing aides in the Statistical Register of Transfer Payment linked to the DWECS
The cross-tabulation of LBP in the year preceding the interview and retirement among nursing aides in the DWECS, 1995, gave the following results: Among the 94 nursing aides the rate of LBP was similar in the subgroups of the nursing aides in work and retired. Of 87 nursing aides in work 46 (53%) reported LBP and 41 did not report LBP (47%). Out of 7 retired nursing aides, 4 nursing aides (57%) reported LBP and 3 nursing aides (43%) did not report LBP, fischers’ exact test: p=0.7. The same pattern was found in the total population of 5,575 wage earners in the DWECS.
d. Retirement or job changes in a sample of claims of compensation for sudden lifting injuries in nursing personnel
A cross tabulation of duration of LBP after the lifting injury and job changes showed a high association between long-lasting LBP and job changes (fig. 14), (table 10), chi-square: p<0.000. Approximately 50% (46 persons) of persons with LBP of long duration had been through one of the categories of job changes, whereas only 1 person (2%) with LBP of short duration had been through one category of job changes. Most of these types of job changes are compatible with staying in the union membership and job title, and only approx. 1/3 of these changes were retirement or sick- leave.
In addition to this, the interview data in study 2 included a question on changes in job function. This was a question on changes in number of lifts/patient transfers per day, between the time of the injury and the time of the interview. A cross tabulation on chronic LBP for more or less than 30 days in the year preceding the interview and changes in number of daily patient transfers was carried out. An association was found between LBP for more than 30 days in the year preceding the interview and exposure to more/the same number of patient transfers at the time of the last injury, compared to the time of the interview (chi-square: p = 0.05). This indicates a possibility to change level of exposure within the union membership. No such association was found in cemetery workers and automechanics.
Fig. 14. Job status in sample of claims of compensation for sudden lifting injuries in nursing personnel.
Percent of persons on categories (N = 177; 18 missing).
Table 10. Job status dichotomized in ’same job function’ or ‘job changes’, and distributed on duration of
LBP, dichotomized in ’short’ or ’long’. A sample of claims of compensation for sudden lifting injuries in nursing personnel (N = 177; 32 missing).
Short duration Long duration
Same job function 48 (98%) 50 (52%) Job changes 1 (2%) 46 (48%) Total 49 (100%) 96 (100%) ________________________________________________________________________________ Chi-square: p < 0.000. Job status 0 10 20 30 40 50 60 70 80 No job change Lighter funct. I n sam e job New job New training/education Sick leav e
UnemployedPension etc.
Unknow n, l
eft previous j ob
Discussion of methods
A prospective cohort study is the only design that gives easy access to persons who are lost to the follow-up. These persons are included in the study at the baseline and will be identified as persons who have left the job at later follow-ups. In a retrospective cohort design the researchers may have to supply with other sources of data on this issue, as in the present study.
• The analysis in first data set, the DWECS, gave an indication that retirement was found in age groups +45, whereas persons belonging to younger age groups might chose other types of job changes.
• The data from the questionnaire were not valid on retirement.
• Analysis on associations between retirement and LBP in the DWECS on a yes/no-level did not add to the evidence on retirement. A cut-point between minor and major LBP might have shown a different result.
• In the sample of claims of compensation for sudden lifting injuries in nursing personnel there was a tendency towards a possibility of changes of level of exposure within the job title/union. (This tendency was confirmed by results from study 2).
The registers of the union proved very limited with regard to following retiring persons. The union agreed, that subgroups of persons leaving their job may simply terminate their membership (for example persons starting employment in another industry). These persons are only in contact with the administrative personnel of the union and are not registered in any files.
Thus other data sets were studied on the retirement or job changes in nursing aides. The random sample of the Danish population, the DWECS, contains 129 nursing aides in the 1990-version and 94 nursing aides in the 1995-version. This gives a possibility of simple analyses within this data set. The groups are small, but have an advantage in the random distribution. The question on chronic LBP in the DWECS was probably not sufficiently detailed for analyses of occupational groups performing heavy lifting work. A distinction between major and minor LBP was found relevant in studies on return to work in groups with heavy manual work (Krause et Ragland, 1994; Dasinger et al, 2000).
The sample of claims of compensation for sudden lifting injuries is probably not biased within the group of nursing personnel. Bias in reporting this type of injuries moreover occurs between groups. The NBII asks for data according to a strict scheme in the claims of compensation of sudden lifting injuries, which ensures a high and rather similar quality of data in these claims. As the number of claims in nursing personnel was high and many of the claims included a medical certificate, it was possible to show types of job changes in association to a crude categorization of LBP. These results seem reliable within the group.
Conclusion
Analyses of four sets of data on retirement or job changes in nursing personnel was carried out. An association between major LBP and retirement or job changes was found in one data set, in which approx. 1/3 of the nursing personnel seemed to leave their job. There seemed to be a possibility to find lighter functions within the job title/union.