An Aging Workforce Calls for Modernized Management and Ergonomic Practices

The aging of the workforce is gradually reshaping the sanitation and institutional cleaning sector. A recent systematic review published in Frontiers in Public Health focused specifically on musculoskeletal disorders (MSDs) among hospital cleaning workers aged 50 and over. The following is a summary of its findings.

This analysis, based on 11 international studies, highlights a concerning reality — but one that is, above all, modifiable through adapted management, improved work organization, and sound ergonomic practices.

A High Prevalence of Musculoskeletal Disorders Among Cleaning Workers

Among workers aged 50 and over, MSD prevalence ranges from 49.1% to 68.96%, depending on the measurement window (7-day or 12-month recall periods).

The most frequently affected body regions are:

•       the lower back

•       the upper back

•       the shoulders

•       the knees.

These findings are consistent with international data on MSDs in physically demanding occupations, including both commercial cleaning and institutional janitorial work.

The article notes, however, that age alone does not fully account for the elevated MSD risk. The authors observe contradictory findings across studies: some show increased risk with age, while others suggest a protective effect linked to accumulated professional experience. This may be partly attributable to the “healthy worker effect” — the tendency for the most physically compromised individuals to exit the workforce earlier, leaving a comparatively healthier cohort in active employment.

The Physical Demands of Institutional Cleaning

Cleaning in institutional and healthcare settings involves specific physical constraints. Staff are regularly required to perform:

•       handling of operating tables and heavy carts

•       floor cleaning

•       waste collection and transport

•       repeated forward-bending postures

•       prolonged periods of standing.

The most demanding tasks — floor washing and the handling of large equipment — impose significant biomechanical loads.

The authors classify cleaning tasks into five broad categories:

•       surface and equipment cleaning

•       patient-area work

•       floor maintenance

•       handling and moving objects.

Awkward postures, repetitive movements, and manual handling of loads are among the primary determinants of MSD risk in cleaning workers.

Individual and Psychosocial Risk Factors

Beyond physical demands, several individual and psychosocial factors influence MSD incidence:

•       age-related physiological decline

•       reduced muscular strength

•       insufficient recovery time

•       occupational stress

•       inadequate posture.

The study identifies a relationship between insufficient recovery and elevated MSD risk, suggesting a dose-response effect between cumulative fatigue and musculoskeletal pain.

Occupational stress also plays a meaningful role. Healthcare environments are characterized by:

•       a sustained work pace

•       irregular scheduling

•       a level of social recognition for cleaning work that is sometimes limited.

The Central Role of Organizational and Technological Factors

One of the review’s most significant contributions is its integration of the Person–Environment Fit model. Under this conceptual framework, MSDs occur when work demands exceed individual capacity within an inadequate organizational environment.

Organizational risk factors identified in the literature include:

•       low work autonomy

•       effort–reward imbalance

•       insufficient communication

•       absence of ergonomic training

•       prolonged task repetition without rotation.

Conversely, positive organizational conditions are associated with better musculoskeletal health outcomes.

Technological factors also carry significant weight. Equipment improvements — adjustable-length handles, ergonomic waste containers, mechanical assists — reduce extreme postures and excessive load. Structured ergonomic training and adequate supervision are identified as effective preventive levers for MSD risk in cleaning teams.

Adapting Practices for an Aging Workforce

The authors conclude that sustaining the long-term employment of experienced workers requires the adaptation of tasks and work environments. Workforce aging in the cleaning sector should not be viewed as an individual problem, but as an organizational signal: work systems can evolve.

For cleaning companies, this means:

•       rotating physically demanding tasks

•       strategically planning rest breaks

•       investing in ergonomic equipment

•       providing ongoing training in safe handling and posture

•       improving communication between management and frontline staff.

Modernizing management practices and ergonomic approaches thus represents not only a measure for preventing MSDs, but a sustainable performance strategy.

The scientific message is clear: the challenge is not the age of the workers, but the intelligent alignment between work demands and human capacity. Your organizations need these experienced workers — and they need work environments designed to keep them.

Source: Musculoskeletal Disorders Among Hospital Cleaning Workers Aged 50 and Over: A Systematic Review. Frontiers in Public Health, 2025. DOI: 10.3389/fpubh.2025.1711097