Dealing with ageing
What's one of the biggest challenges facing the NHS today? Age. And not just the issue of how best to respond to the vastly increased demands of an ageing population, but also for the staff they depend on.
Pension changes have already been introduced, with the ageing population as one of the major drivers. Anaesthetists starting in their jobs today will have to work until they are at least 68 to receive their pension in full. Eight years longer than currently expected.
Problems faced by older workers
The effects of ageing are inevitable, unfortunately none of us can avoid them - no matter how hard we try. However, the rate that we are affected really varies for all of us. A one-size retirement strategy can't fit all. Some of us might take these extra years in our stride, for others it might be a strain that takes a big impact on our health and pose a risk to patients.
Age-related physical health problems
The incidence of many chronic conditions (e.g. musculoskeletal problems and cataracts), and of acute illness (e.g. ischaemic heart disease) increases with age, as does a reduction in visual acuity, hearing loss and some aspects of cognitive function.
Some health problems (e.g. hypothyroidism), are not always easy to spot and may go unrecognised by both the individual and their colleagues until well advanced.
Quality of sleep worsens with age and sleep becomes shorter
Tiredness has an effect on older doctors' performance and mood. Being on-call can be highly disruptive to sleep, even when not called out. There is a decrease in the capacity to adapt to shift work with increasing age. Older workers' cognitive performance may be more impaired during night work but they may be less aware of their degree of impairment.
Mental health issues
Decreased job satisfaction, irritability, burnout, anxiety, depression and fatigue are more common in older practitioners. These, combined with fear of failure and challenges to self-esteem, can impact on the decision to retire.
Risk of errors
Older anaesthetists may be slower at recognising and managing new situations, but can be quick to respond when they are not tired and are able to draw on previous experience. Older practitioners may rely heavily on previous experience, intuitively recognising patterns and making 'routinised' automatic rapid responses to developing situations without employing conscious analysis and reasoning.
As physicians age, they are perhaps more likely to make errors from placing undue weight on first impressions.
Positive steps forward for an ageing workforce
Create job plans for older doctors
Over time, older anaesthetists' work patterns will need adjustments. Changes made should play to the individual's strengths and ensure continued involvement in their department to ensure continued job satisfaction and a sense of being valued by colleagues.
Appropriate job planning might include:
- Daytime weekend work instead of overnight on-call
- Flexible working
- Shorter hours
- Less isolated working
- Less demanding/stressful lists
A change of role might be appropriate for some, perhaps involving pre-operative assessment clinic work, undergraduate or postgraduate education, clinical governance or other non-clinical roles.
Keeping patient safety a priority
There's been an increasing amount of evidence showing some older anaesthetists may have a reduced clinical performance that can be adverse to patient safety. So it's important to:
- Accept that older anaesthetists may need enhanced monitoring of their workplace performance
- Introduce a process to confirm competence within the individual's job plan before problems arise
The path towards eventual retirement (whenever that is) needs active management. Waiting passively for an adverse event to signal professional failure is definitely not the way forward.
Have annual appraisals tailored specifically to the older practitioner, which allow a genuine two-way interchange of information both to optimise the anaesthetist's job plan and to maximise patient safety.
We need to accept and recognise that our performance will gradually slow down with age. We shouldn't be ashamed, but self-aware and proactive in addressing concerns they we might have. We have a responsibility to demonstrate insight into the potential impacts of ageing, and to ensure our health remains compatible with their job requirements.
Older anaesthetists should comply with reasonable requests from their department with respect to their planned duties. If changes are needed, it is vital that the clinical director ensures the older anaesthetist understands the reasons for change, and that their perspective is taken into account in decision-making.