Pressed for Time: Physiological Indicators of Care Aides’ Mental Workload in Response to Simulated Pressures in Long-Term Care Homes

Background Mental workload is an important indicator of an individual's interaction with task demands. Care aides in long-term care (LTC) settings frequently report excessive demands imposed on their daily work due to challenging resident behaviours and organizational expectations. Understanding mental workload in these contexts is key to predicting staff strain and guiding support strategies. Methods Twenty-eight care aides from six LTC homes in New Brunswick, Canada, participated in a simulated care scenario involving common challenges encountered when completing resident care. Two physiological markers of mental workload, namely heart rate variability (HRV) and pupil dilation, were continuously measured across five experimental stages, each designed to elicit different cognitive and emotional demands. Hierarchical mixed-effects models assessed the impact of demographic variables and experimental stages on mental workload. Results Mental workload increased significantly, as indicated by decreased HRV and increased pupil diameter, when the care aide was required navigate impossible requests made by the resident. Contrary to expectations, resistance to care, verbal aggression, direct time pressure, and intervention by a supervisor did not significantly influence physiological correlates of mental workload. Conclusion These findings suggest that creative problem-solving, such as responding to impossible resident demands, may be more mentally taxing than expected stressors like aggression or time pressure. To manage mental workload, staff should be prepared and supported to adapt creatively under pressure. Further efforts should be made to understand the relationship between increased mental workload and cumulative stress in care aides.