ERGONOMICS and THE AGING WORKFORCE or ERGONIGHTMARE Michael A. Alday, MD, MPH Medical Director Regional Occupational Health.

ERGONOMICS and

THE AGING WORKFORCEor

ERGONIGHTMARE

Michael A. Alday, MD, MPHMedical Director

Regional Occupational Health

As America Ages,So Does the U.S. Workforce

• 78 million Baby Boomers(born 1946-1964)

• Boomers comprise 46%of the U.S. workforce

Source: U.S. Census Bureau, Bureau of Labor Statistics

SOBERING FACTS ON AGING

• Between 2000 and 2020, the number of people in the 55 to 64 brackets will increase by 40%

• Of the 58 million workers in this country, the median age is now 40.5 years

• The number of workers 45 and older has doubled since 1950

MORE SOBERING FACTS

• By 2008, it is predicted that there will be 25.2 million workers aged 55 and over

• This is in part due to decreasing retirement benefits/pensions and delays in social security entitlements

• Many workers are forced to work longer because they are part of the “sandwich generation” --taking care of kids & parents

THETSUNAMI TIDALWAVE

OF AGING

THIS IS SHOCKING!!

THE REAL QUESTION IS:

WHO IS GOING TO PAY FOR US BOOMERS??

OLDEST WORKFORCE BY INDUSTRY(average ages)

• Miners – 36 years old

• Construction – 39 years old

• Electric Power Industry – 44 years old

• Ford Motor Company – 45 years old

• Nurses – 48 years old

• Doctors – ANCIENT

PROBLEMS WITH AGING• Eyesight and hearing• Manual dexterity and coordination• Muscular strength(peaks at age 30)• Reduced cognitive function and memory• Chronic medical conditions, i.e. arthritis• More prone to injuries and CTD/RMI’s

(cumulative trauma disorder/repetitive motion injury)

– 37% of all work-related disabilities among older workers are due to CTD’s/RMI’s

RISK OF FALLING

• Workers over age 64 have a 3X greater risk of falling(U.S. Dpt of labor)

• Average lost work days for a fall-related injury:– >55 – 11 days – <55 – 6 days

• Older workers are one and a half times more likely to suffer a fatal fall

A CRUCIAL DISTINCTION

• Total injury rates are actually lower among older workers

• However, older workers are more likely to die or take much longer to recuperate from an injury which adds to the costs

ERGONOMICS: The science of matching the worker to the work

OSHA and State Worker’s Comp

We’re from the government and we’re here to help

WHAT IS A CTD/RMI(Cumulative Trauma Disorder)

(Repetitive Motion Injury)

• A CTD/RMI is a disorder of the muscles, nerves, tendons, ligaments, joints, cartilage, blood vessels, or spinal discs from repeated stressful or awkward motions and/or forces

• Can involve the neck, shoulder, elbow, forearm, wrist, hand, back, knee, ankle, foot, and abdomen(hernia related)

SC Worker’s Comp and CTD’s

• As recent as 7 years ago, CTD/RMI’s were considered diseases as opposed to injuries and were not covered by W/C

• Today, they are readily accepted as work-related if there is a clear association with work and aggravation of symptoms

ERGONOMIC STANDARD

• Proposed standard was set for January 2001• Goal was to reduce an estimated 1.8 million

workers suffering from work-related MSD’s(musculoskeletal disorders)

• Was shot down by U.S. Congress due to meddling into state W/C program(federal program telling states how to run their W/C programs and spend their money)

ERGONOMIC STANDARD

• Even with these legal challenges, we will see this standard reappear in the future

• Designed to match the worker to the workplace

• Strongly supported by the labor unions

• Even without the standard, it makes good business sense to implement a program

ONCE A CTD IS REPORTED

• You must investigate and promptly determine if an CTD is an “incident”

• Employers should request assistance of a health care professional to make this determination and to assess the “work relatedness” of the disorder

BENEFITS OF AN ERGONOMICS PROGRAM

• Predicted to prevent 4.6 million CTD’s in first ten years

• $9.1 billion could be saved annually at a cost of $4.5 billion for employers

• $27,700 savings for each CTD prevented

• Work station fixes can be as little as $250-500 per station

ERGONOMICS AND CTD/RMI’S

ERGONOMIC FORMULA

Repetition + Position + Force + Time + No Rest

= RMI or CTD

UPPER EXTREMITY PROBLEMS

Tendonitis Tenosynovitis

Tennis Elbow Rotator Cuff Strain

Neuropathies Carpal Tunnel Syndrome(CTS)

Raynaud’s Ganglion Cysts??

UPPER EXTREMITY PROBLEMS

• Gradual onset

• No history of injury

• Dull pain, numbness, tingling

• Swelling, bruising may be absent

• Gets better with rest

UPPER EXTREMITY PROBLEMS

• Upper extremity CTD’s are much more common than back CTD’s and are generally more costly as a group

• Average case going to surgery costs $15-25K• Indirect costs are up to $50-75K per case

COMMON FACTORS

• Sedentary lifestyle

• Repetitive trauma near site

• Vibrating or pneumatic tools

• Resumption of tasks after inactivity

• New tasks

COMMON FACTORS

• Increased production (high repetition)

• Awkward & prolonged postures

• More common in females(esp. CTS)

• Prolonged(>8 hours) shifts and/or overtime

DIAGNOSIS

• Detailed job description is a must!

• Strain index

• X-rays/MRI’s

• Nerve conduction studies

STRAIN INDEX

• Moore-Garg Strain Index• Based on various risk factors of time,

intensity, and posture• Scoring:

<3 Considered safeBetween 3-5 Uncertain riskBetween 5-7 Some risk >7 Considered hazardous

REMEMBER

• Better defined problems (“it hurts here” v. “my whole arm hurts”) are better associated with true pathologies and CTD/RMI’s

• Rest and realignment (change the work toward a less awkward posture)

REMEMBER

• Ratio of muscle (e.g.,tendinitis) to nerve problems(e.g., carpal tunnel) is usually

5-10 to 1

ERGONOMICSOLUTIONS

Look for easy fixes!

• Emphasize adjustment of workstation (minimize awkward postures)

• Emphasize rotation of tasks (don’t type or keyboard for 4 hours straight, alternate with filing, other jobs)

• Use of lifting devices or strict procedures for lifting heavy objects

Look for easy fixes!

• Consider light and temporary job limitations or restrictions

• Encourage strength and flexibility building with emphasis on early rehab/PT

• Expect that they will continue to improve and reassure them that they will get better

• Braces and ergonomic tools to help with the workload

What about other ergonomic solutions?

Worksite visit by the ergonomics team

-- What is the value?– Very high– Why?

reinforces employee’s significance, importance,and the idea that the healthcare system is taking action

What do you look for?

• Method of task accomplishment• Are there physical differences between workers?• Are there workstation or work area differences?

• Can force, awkward positions, or prolonged duration of tasks be reduced?

Pearls……..

• Light or modified duty whenever possible• Frequent follow-ups are OK• Be mindful of OSHA 300 recordability rules:

– No prescription meds unless absolutely necessary

– Use elastic splints and supports vs. rigid splints

– Sending home for rest of shift is not recordable

• People who like their jobs do better with less accidents• If you show that you care about the workers, they will care

about you (remember the golden rule!)

Low Back Pain

The “other” CTD

Significance

• 70% of people will have LBP

• 50% will have a recurrent episode

• #1 disability for men <45

Work Related

• 75% of U.S. back cases are W/C

• Only 25% of cases in Scandinavia are W/C for the same occupations

• Differences in legal climate?

Cost

• LBP workers’ comp awards up 27 fold over past 20 years despite improved safety/work conditions

• 28% of all lost work days due to LBP• Med cost per case $25-35K• Total claim cost $150-250K• Majority have deg. disc disease present

Outcomes

• 50% recover within 2 weeks

• 90% recover within 6 weeks• 10% are major disability problems

Surgery Outcomes

• Failure rate for industrial cases - 50%

• Failure rate for non-industrial cases -10%

• Poorer outcome

– low income / education level

– job dissatisfaction

– history of previous disability or in the family (W/C is an inherited disease)

Treatments for early CTD/RMI’s

• Education

– positive expectations

– reassurance that condition will improve

• Provide comfort

• Discuss activity alterations

– avoid irritation

– avoid debilitation

Treat CTD/RMI’s like Combat Stress

• Simple explanations

• Avoid diagnostic labeling

• Brief rest and modified or transitional duty

• Encourage activity

• Keep worker at work

Treat CTD’s like combat stress

• Avoid delaying care

• Goal is return to the front lines (work)

• Reinforce the expectation of returning to work

IN SUMMARY

• The aging workforce will have a dramatic impact on both W/C and healthcare costs

• Ergonomic issues will always be present

• Involve your occ. health resources early

• Be careful not to create a confrontational climate with your employees

• Close case management is the key to W/C