Revista nº 807

Ranchal-Sánchez et al. Progressive ageing of hospital working population Actualidad Médica · Número 807 · Mayo/Agosto 2019 Páginas 92 a 97 · 95 · social assistance (15.88%), physicians (12.37%), administrative staff (9.02%), junior physicians (6.17%), technical specialists (4.62%), maintenance professionals (2.99%), coordinators (0.26%) and managers (0.42%). Table 3 compares the total population of the hospital staff reflected in the 2006 annual reports with the data obtained in 2007, grouped by age bracket and sex. The 41 to 50 age bracket is the most predominant in the 2006 report while in 2017 it is the 51 to 60 bracket. We observe in both sexes a progression in terms of the predominant age brackets towards older age brackets; after a decade the working population over 50 (57.16%) has already overtaking those under 50 despite the numbers in the age bracket from 50 to retirement age being lower. In the 2006 report, of the 5,043 persons making up the working population, less than a third (30.85%) were over 50. In the 2006 report, 4 nurses retired past 65. Not one did so according to the data registered in 2017. With respect to sex, the percentage of women has increased in the total population of the hospital over the last decade, going from 70.37% in the 2006 report to 73.47% in 2017. DISCUSSION The working population pyramid obtained is a reflection of the contemporary demographic situation in the general Spanish population (2), reaffirming the forecasts for 2025 in Andalusia (10). The ageing of the hospital's staff is an example of what is happening on the international level (11). Facts such as the decrease in birth and mortality rates in the working population may have influenced this ageing, along with other factors, among them the adjustment measures taking during the recent recession. The Spanish Administration, where healthcare and education account for the majority of the 3.3 million public employees, saw the number of public servants over 60 surpass the number of those aged under 30 in 2016 (12). Thus, 17% of the working population of Spain are employed in the public sector, compared to 21% in the OECD, with more than half the public service belonging to the country's autonomous communities (12). The working population pyramid obtained reveals the low percentage of young people. The increase shown in the results for the 25 to 30 age bracket in the total population of the hospital is basically due to the contracting of junior specialist physician staff who predominantly come under this age bracket (13). In contrast with the low percentage of nurses among the younger population, a notable situation, as a “snapshot” of what might be occurring in the hospitals of the Spanish National Health System. The reality is that the main access route of new nursing graduates to join the National Health System is the specialist internal resident exam. It is a significant challenge considering the low number of places offered and the high number of nursing graduates who present for the annual national examination. Moreover, the duration of the residency for nursing specialists (just two years) and the lack of correlation between the working and category and the actual specialisation in the majority of cases makes workplace insertion very difficult for young specialist nurses in National Health System hospitals (14). Many of them are forced to emigrate to other countries which then benefit from their experience and the cost of their training, reinforcing the ageing of the population at home further. It is even more ironic as an ageing population requires more and better nursing care. Other factors may have influenced the drop of in the 31 to 35 age bracket. Among them the temporary nature of the current access contracts and systems to Spanish public service which generally penalise young people with lower seniority. It would seem desirable that with an ageing working population, measures would be introduced to allow for greater flexibility of access. In particular in relation to those centres with lower National Health System demand (local hospitals, rural health centres, etc.). On the other hand, the narrowing of the 61 to 65 age bracket indicates that a percentage of hospital staff do not retire at the legal age of 65 in Spain. No nurse did so over 65. One must ask the reasons why staff in general and nurses in particular retire early. The literature suggests that capacity to work is affected as staff grows older (15) with older people needing longer periods to recover from health problems than young people (15). The majority of nurses claim to be most affected by musculoskeletal conditions (11,17,18) pathologies which begin to emerge in their 40s and 50s (11). In terms of sex, the pyramid is asymmetrical with clear female predominance in the hospital population, which is even more pronounced in nursing. Almost three quarters of the staff are women, as are almost 84% of all nurses. Furthermore, female predominance in the working population of the hospital has increased compared to the data in the 2006 report. As the saying goes, one can’t see the wood for the trees. The data obtained in the nursing population pyramid might also reveal a practical application for the early detection of possible damage on a collective level in terms of sex. Specifically, the drop off of female nurses in the 51 to 55 age bracket is notable. Given that this does not occur with male nurses nor for the total hospital population in the same age bracket, it interrupts the progressive growth of the working population in the age brackets immediately below (figure 2). Its detection obliges us to plan the monitoring of individual health, including the application of a capacity to work survey (19), and adequate monitoring of nurses in this age bracket. It would also force us to engage in the necessary coordination with the Human Resources department to analyse the situation and pinpoint the causes in order to propose preventive and corrective measures. Several circumstances might be involved in the narrowing of age brackets detected. On the one hand, it may be due to internal mobility in the health systems, such as the transfer of specialised services (hospitals) to primary care (health centres) periodic mobility tenders. It would be useful, therefore, to compare the primary care nursing population pyramid for the same city. On the other hand, it may be influenced by temporary incapacity processes due to certain pathologies that would cause departure from the company. It would be necessary to also analyse the working conditions AGE (years) Number of men: 2017 Number of men: 2006 Number of women 2017 Number of women 2006 Total by section 2017 Total by section 2006 report < 30 121 124 192 189 313 313 31-40 162 262 482 702 644 964 41-50 311 635 1067 1575 1378 2210 51-60 663 414 1782 958 2445 1372 61-65 173 57 477 119 650 176 <65 16 2 4 6 20 8 Total 1446 1494 4004 3549 5450 5043 Table 3. Comparison by age brackets of the total hospital population in 2017 with the publication of the 2006 report.