–E.B. White
The graying of the American workforce is generating health and safety concerns that require insight, innovation, and definitive action on the part of employers, payers, and medical professionals.
Life expectancy is increasing, medical technology is advancing and birth rates are declining. Meanwhile, many members of the baby boom generation are facing the harsh reality that retirement at the traditional age of 65 is no longer economically feasible.
In short, a complex set of age-related issues has been placed squarely on the doorstep of employers and the occupational health professionals who advise them.
“One of the challenges is that while older workers generally have fewer workplace injuries, their injuries often are more costly to treat, and they tend to be away almost twice as long as their younger co-workers,” said David Deitz, M.D., national medical director at Liberty Mutual, a leading workers’ compensation insurance carrier.
In 2006, the city of Decatur, Illinois’ Risk Management Department did a study that showed the cost of work injury was double for workers 45 and up, reports David Fletcher, M.D., medical director of SafeWorks Illinois, which operates an occupational medicine clinic in Decatur. Data from the U.S. Bureau of Labor Statistics show the median lost-time duration for a work-related injury experienced by a worker under 25 is five days, compared to 12 days for workers 55 and older.
“For example, shoulder problems, particularly rotator cuff injuries, are a relatively common occurrence among older workers, in part because of diminished blood supply, increased bone spur size and increased incidence of degenerative-related tears,” Dr. Fletcher said. He noted that shoulder complaints often require surgery and extensive post-operative rehabilitation in order for patients to regain range of motion and strength. Because of the extent and nature of their injuries, older workers often have permanent work restrictions; some require vocational rehabilitation.
Determining Cause
One significant anticipated consequence associated with the aging workforce is the growing number of employees who may attempt to use the workers’ compensation system to treat their age-related medical complaints. This likelihood hands occupational health physicians the challenging task of rendering opinions on compensability.
“It’s no wonder that employers and clinicians find it difficult to determine if an injury is work-related or not,” said Susan Isernhagen, a physical therapist and chief operating officer for DSI Work Solutions Inc., Duluth, Minn., where she and her husband, Dennis Isernhagen, specialize in functional capacity assessments and return-to-work programs.
Lean muscle mass deteriorates by 40 percent between the ages of 30 and 80. Nerves, reflexes and coordination slow down and place older workers at a disadvantage, particularly with new tasks. In well-established tasks, speed and accuracy don’t diminish, but older workers are only as industrious as the body allows, she said. Osteoarthritis, cumulative trauma and aging are all intertwined. Hip and knee arthritis, for example, is present in 28 percent of people over 55 and in 39 percent of those over 65, making it difficult to determine if a worker’s arthritis is the result of aging, occupational demands or both, she wrote in an article published in Healthy Aging: Age Management Medicine for Physicians (Merion Publications, ©2007).
In the two years since that article was published, Ms. Isernhagen has become even more convinced that many employers, workers and the attorneys who represent them in workers’ compensation cases are placing an incorrect emphasis on causation. She believes efforts “to prove something that can’t be proven” only serve to create suspicion, fomet litigious work environments and escalate costs.
“More attention needs to be paid to prevention,” she said in a recent VISIONS interview. “And, we aren’t taking minor problems seriously enough. The best money spent is when you first encounter a problem. When an injured worker is treated effectively and fully and their condition is not allowed to develop into something worse, that is when we are doing a good job. Occupational medicine specialists can help design a preventive exercise routine to stall future exacerbations and prevent similar cases in co-workers.”
Ms. Isernhagen suggests the following to achieve the best possible outcome: “Treat workers in a functional way so they can stay healthy or get back to work. Get injured workers moving toward becoming ‘workable’ as an alternative to becoming embroiled in litigation over the cause. This should always be the goal, no matter what the problem.”
What is Normal?
When one reaches a certain age, one begins to experience aging changes that – given an inappropriate attitude – would be considered “pathological” rather than “normal,” Ms. Isernhagen said.
“That is why I talk to employers about normal changes, because everyone gets them and they shouldn’t be considered pathological,” she explained.
“One of the problems in the workplace is that few recognize ‘normal’ as opposed to ‘pathology.’ A worker may need intervention for their hearing or eyesight, and that would be expected. But our society doesn’t consider musculoskeletal problems normal. They feel like they are sick, and that is not normal.”
She offers an illustration: A younger worker injures his shoulder and needs surgery; that is pathology and has nothing to do with aging. On the other hand, a 45-year-old worker who has a 40 percent chance of experiencing some age-related changes, such as a frayed rotator cuff, may be exacerbating these normal changes while doing his job.
In both cases, if the United States had universal health coverage, it wouldn’t matter what caused the shoulder injury: it would simply be repaired and the patient would most likely return to work. Instead, the system requires evidence of work-relatedness in order to determine whether the case should be covered under group health or workers’ compensation insurance. This contributes to a climate in which employers, patients, payers and providers are compelled to argue about the “gray areas.” The situation is complicated by the rules of apportionment, which vary among states, thus increasing pressure on medical professionals who are asked to determine cause.
“I tell employers to take care of the worker first and not be so concerned about what insurance bucket it falls in,” Ms. Isernhagen said. “I say, ‘Don’t pressure the medical professional or the patient,’ but it probably often falls on deaf ears.
“The medical provider has got to disregard the pressure, and not become a pawn in this argument. Each patient deserves an individual evaluation of their status so the provider can make their best estimate about cause. If the provider believes it could be both from aging and stressors from home and work, they need to say the causation is mixed. If they know the person has a severe underlying condition and the work problem didn’t really cause it, they need to say so and not consider themselves a vehicle of the patient or whoever is paying the bill.”
‘Old,’ Not ‘Same’
Occupational medicine providers know it is inadvisable to put all workers over a certain age (55 is the typical cut-off) together in a basket labeled “older.” People age at different rates. Some may have chronic health conditions that affect their productivity, while others are exceptionally healthy and fit. In addition, reasons for working past “a certain age” can be as varied as personalities and life circumstances.
Changes that are likely for most older workers include visual diminution, loss of hearing, increased blood pressure, and a decrease in peak strength and aerobic capacity. Effects that can vary depending on the person include changes in one’s ability to reason, think and remember, excessive weight gain and chronic illness, said Glenn Pransky, M.D., director of the Liberty Mutual Center for Disability Research in Hopkinton, Mass.
In a New Hampshire study of 1,540 injured workers over 55, Liberty Mutual researchers identified three broad categories of older employees:
- “Healthy survivors” who are still successfully working in their first career after 40 or more years.
- Post-retirement workers who have started new careers.
- Workers who want to retire but are “trapped” in the workplace by financial constraints, health problems and insurance benefit needs.
“It is possible to reduce the risk of injury in each of these groups by tailoring jobs to older workers, matching workers to job demands, modifying jobs and workplaces, and encouraging wellness.” However, “not all older workers are the same,” Dr. Pransky noted.
For example, post-retirement workers who take unfamiliar jobs are at risk of injury when there is a mismatch between their duties and their capabilities. By comparison, “trapped” workers tend to have a relatively low level of education, lower than average income, and more chronic health problems that can become a factor in case management and claims resolution. Dr. Pransky advises employers to:
- Develop wellness programs that include age-related information on diet and exercise.
- Modify training techniques while recognizing that some older employees may need more repetition than younger colleagues when learning new tasks and responsibilities;
- Tailor jobs by decreasing the manual handling of heavy loads and ensuring a comfortable working posture.
- Pay particular attention to marginal job performance, which can be an indicator of an impending work-related injury.
- Acknowledge the value and self-esteem older workers associate with their jobs by communicating early and often following an injury.
- Find alternate duties to permit an early return to work. In concurrence with Ms. Isernhagen on the benefits of a preventive approach, Dr. Pransky advises employers and occupational health professionals to assess worker capabilities as a strategy for getting a handle on potential exposures before an injury occurs.
Gray Tsunami
Employers are recognizing that hiring and retaining older workers carries both rewards and risks. “There is enough of a critical mass at this point where employers have an interest in investing in the aging worker,” said William Gingold, Ph.D., of the University of Illinois, College of Medicine, who is a specialist in senior issues. “The best thing employers can do is enhance the work environment. They should do things that allow the aging worker to have high productivity and high performance.”
Employers have to weigh the positives associated with employing older workers (e.g., accountability, productivity, experience) against the negatives (e.g., higher injury treatment and general health care costs, the need for workplace accommodations). A better balance can be achieved to a great extent by creating ergonomically correct and age-friendly work environments, Dr. Fletcher says. He cites simple improvements such as:
- Stair handrails and visual contrast on stairwells;
- Improved office lighting, acoustics and signage for those whose hearing and eyesight are declining;
- Periodic training on safe lifting, correct sitting postures, etc.;
- Wellness and nutritional education programs, particularly for those with chronic diseases that can impair work abilities;
- Exercise and stretching programs.
Adding to the list, Ms. Isernhagen proposes the use of assistive devices such as ramps to allow workers to push products up an incline instead of lifting them; removing slip, trip and fall hazards; and alternating work environments to sidestep any problems arising from excessive repetition.
“By employing older workers, employers can tap into a workforce that is experienced and dependable,” Dr. Fletcher said. “However, employers need to be prepared to address the challenges an aging workforce brings. When employers create age-friendly work environments, they support the work ability and health status of older workers and reap benefits in terms of improved safety, productivity and competitiveness.”
References & Resources
1. Boomers Face Stark Choices in Bleak Economy; John W. Schoen, MSNBC, March 11, 2009, ww.msnbc.msn.com/id/29535417/from/ET.
2. Health and Safety Needs of Older Workers; D Wegman, J McGee, eds.; National Academies Press, 2004.
3. Capitalizing on an Aging Workforce: www.pmagroup.com
4. The Work Ability Index; J Ilmarinen; Occupational Medicine, 2007:57:160.
5. Institute on Aging: www.IOAging.org
