Preventing and recognizing burnout and compassion fatigue when working with older adults

While all health service providers (HSP) are vulnerable to the impacts of burnout and compassion fatigue, those working with older adults have unique stresses that may make them at greater risk.1,2,3 HSP caring for older adults are managing a heavy workload, often with staff shortages and a lack of social support or recognition.3,4

Additionally, many older adults have declining physical and mental health that requires a lot of support to meet their needs.1,4 With COVID-19, older adults’ needs are even greater as they are at a greater risk of experiencing severe illness and longer periods of social isolation.5,6

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What is burnout?

Burnout is a state of physical, emotional and mental exhaustion related to continued stress at work.7,8 Burnout can lead to other health implications, such as headaches, digestive disorders, anxiety or depression.4 It is often a slow process that happens in stages:9

  1. Mental and physical exhaustion by one’s work
  2. Indifference and cynicism towards clients and work
  3. A feeling of professional failure and helplessness
  4. A feeling of personal failure and self-hatred
  5. Complete burnout: feeling numb and performing tasks without commitment.

Before experiencing complete burnout, HSP may experience “presenteeism.” Presenteeism is when you are physically at work, but are unable to perform at your normal capacity.10 This may be due to physical or mental illness or other reasons, such as perceived lack of support at work, work-life conflict or stress. Presenteeism has been associated with poorer physical health and mental well-being.11

What is compassion fatigue?

Compassion fatigue is the cost of witnessing and absorbing others’ pain and suffering at work.12,13,14 It is important to address as it can lead to mental health problems, such as posttraumatic stress disorder (PTSD), anxiety or depression.13

While burnout can affect any profession, compassion fatigue is experienced by those in caring professions who are exposed to the traumatic experiences of the people in their care.2,8 Compassion fatigue can emerge suddenly and result in a sense of helplessness.12 It can be hard to spot the signs.8

handbook iconCompassion fatigue can also affect nonpaid caregivers, such as family members and friends.

The Regional Geriatric Programs of Ontario developed the Caregiver Strategies Handbook as a resource for caregivers.

What are some of the signs and symptoms of compassion fatigue?11, 15

  • Feeling irritable, anxious, overwhelmed or detached
  • Difficulty focusing or making decisions
  • Headaches
  • Sleeping problems
  • Nausea
  • Depression
  • Increase use of alcohol or other substances

clipboard iconThe Professional Quality of Life Scale (PROQOL) is a validated self-administered assessment tool that measures burnout and compassion fatigue for people who work in helping professions.16 It is a screening tool that is designed to understand how one is feeling, as experienced over the last 30 days.

Note: The PROQOL should not be used as a diagnostic tool. If you have concerns based on your scores, you should discuss them with a physical or mental health professional.

How can I avoid burnout and compassion fatigue?

  1. Practise self-care14, 16
    • Get enough sleep
    • Exercise regularly
    • Eat healthy foods
    • Schedule time for the activities that bring you joy
    • Practise mindfulness
    • Set SMART (specific, measurable, achievable, realistic and timely) self-care goals
  2. Set boundaries
    • Work towards establishing a work-life balance8,9
    • Set emotional boundaries – balancing compassion with professional distance14
    • Recognize boundaries may change over time14
    • If possible, limit your caseload or end the workday with a positive activity17
    • Limit friends and family’s expectations for you to solve their problems since you work in a helping profession 17
  3. Lean on your support system17
    • Connect with your coworkers or supervisor
    • Ask for support from your friends and family
  4. Seek help
    • Be aware of the signs and symptoms of burnout and compassion fatigue9
    • Use formal supports, such as your family doctors or employee assistance program (EAP), which many employers provide for free, confidential support
    • The Government of Ontario has provided a list of supports for HSP during COVID-19

people iconAgency leadership and managers have an important role to play in building a supportive work environment through policies and procedures and promoting available resources.2,6,7 For example, creating manageable workloads, improving coordination among teams, supporting self-care activities, engaging team members in decision making, providing recognition, and offering flexible schedules, enough time off and professional development opportunities.2,3,4,7

References

  1. Leon, A.M., Altholz, J.A.S. & Dziegielewski, S.F. (1999) Compassion fatigue. Journal of Gerontological Social Work, 32 (1), 43–62, https://doi.org/10.1300/J083v32n01_04
  2. Kolthoff, K.L. & Hickman, S.E. (2017). Compassion fatigue among nurses working with older adults. Geriatric Nursing, 38 (1), 06e109
  3. Rouxel, G., Michinov, E. & Dodeler, V. (2016). The influence of work characteristics, emotional display rules and affectivity on burnout and job satisfaction: A survey among geriatric care workers. International Journal of Nursing Studies, 62, 81–89
  4. Sanchez, S., Mahmoudi, R., Moronne, I., Camonin, D. & Novella, J.L. (2015). Burnout in the field of geriatric medicine: Review of the literature. European Geriatric Medicine, 6, 175–183
  5. Centres for Disease Control and Prevention. (2019). People who are at higher risk for severe illness. Available: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-.... Accessed June 10, 2020.
  6. Public Health Ontario. (2020). How to protect yourself from COVID-19: Older adults and people with chronic medical conditions or weakened immune systems. Available: https://www.publichealthontario.ca/-/media/documents/ncov/factsheet/2020.... Accessed June 10, 2020.
  7. Maslach, C. (2003). Job burnout: New directions in research and intervention. Current Directions in Psychological Science, 12 (5), 189–192. https://doi.org/10.1111/1467-8721.01258.
  8. Cetrano, G. Tedeschi, F., Rabbi, L., Gosetti, G., Lora, A., Lamonaca, D. et al. (2017). How are compassion fatigue, burnout, and compassion satisfaction affected by quality of working life? Findings from a survey of mental health staff in Italy. BMC Health Services Research, 17, 755.
  9. Spinetta, J.J., Jankovic, M., Ben Arush, M.W., Eden, T., Epelman, C., Greenberg, M.L. et al. (2000). Guidelines for the recognition, prevention, and remediation of burnout in health care professionals participating in the care of children with cancer: Report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology. Medical and Pediatric Oncology, 35 (2), 122–125.
  10. Lui, J., Andres, E. B. & Johnston, J. M. (2018). Presenteeism exposures and outcomes amongst hospital doctors and nurses: a systematic review. BMC health services research, 18 (1), 985.
  11. Aboagye, E., Björklund, C., Gustafsson, K., Hagberg, J., Aronsson, G., Marklund, S., Leineweber, C. & Bergström, G. (2019). Exhaustion and impaired work performance in the workplace. Journal of Occupational and Environmental Medicine, 61 (11), e438.
  12. Figley, C.R. (1995) Brunner/Mazel Psychological Stress Series: No 23, Compassion Fatigue: Coping with Secondary Traumatic Stress disorder in those who treat the traumatized. New York: Brunner/Mazel.
  13. Cocker, F. & Joss, N. (2016). Compassion fatigue among healthcare, emergency and community service workers: A systematic review. International Journal of Environmental Research and Public Health, 13 (6), 618.
  14. Centre for Addiction and Mental Health. Is there a cost to protecting, caring for and saving others? Beware of compassion fatigue. Available: https://www.camh.ca/en/camh-news-and-stories/is-there-a-cost-to-protecti.... Accessed June 2, 2020.
  15. Pfifferling, J.H. & Gilley, K. (2000). Overcoming compassion fatigue. Family Practice Management, 7 (4), 39-44. Available: http://www.aafp.org/fpm/2000/0400/p39.html. Accessed June 2, 2020.
  16. Stamm, B.H. (2010). The Concise ProQOL Manual. Available: https://proqol.org/uploads/ProQOLManual.pdf. Accessed June 10, 2020.
  17. Stamm, B.H. (1999). Quick-Guide Suggestions Prevention/Intervention with the Negative Effects of Caregiving. Available: https://proqol.org/Handouts.html. Accessed June 3, 2020.