Judy Jankovics - Injury treatment - FOCUS SESSION: The Ageing Worker: Facts, Myths and Strategies for Management

THE AGEING WORKER: FACTS, MYTHS AND STRATEGIES FOR MANAGEMENT

Presented by:

Judy Jankovics

Training and Corporate Health Specialist

Content • What is “Ageing”?

• Trends in the Australian workforce

• Facts and Myths about ageing

• What happens when we age

- Physical and psychological changes

- Impact on safety & performance at work

- Risk factors and prevention

• Strategies for managing RTW for an older worker:

- Case Studies

- Considerations and accommodations

• Injury prevention strategies for the organisation:

- Preparing for the future

- Getting the best out of your older workers

What is “Old Age”?

• Recognised in literature as being > 65 years of age

• The excuse / reason given for:

- stiff and painful joints

- dry and itchy skin

- sleep that is un-refreshing

- poor energy levels

- reduced strength

What is “Ageing”? Ageing is a lifelong process – a biological sequence of events that begin at birth and end in death

Many theories:

• Genetic error, wear and tear: result of events that occur randomly and accumulate over time

• Programmed ageing: predetermined by genetics

Commonly accepted that ageing process best explained by the interaction of several mechanisms depending on lifestyle, family history and genetics.

Biological vs Chronological Age • Biological (functional) age is a measure of a

person’s ability, body composition and degree of morbidity.

• Chronological age = actual age

• The gap between biological and chronological age widens as we age

Ageing Across America Pop Quiz • How accurate are your attitudes towards an

understanding of older people?

Facts about older workers:

• They sustain fewer injuries and accidents although

they take longer to recover and RTW if injured

• They are not more absent although they do

take more absence for “genuine” health reasons

• They demonstrate various desirable personality

characteristics: they are more conscientious,

emotionally reliable, stable and agreeable.

*Unum CMO report on ‘inconvenient truths’ about the ageing workforce

Occup Health, 2008, 60(12): 35-36

Australian Ageing Workforce Stats • Population is ageing: longevity increasing and

fertility declining

• People in workforce aged >55 years will increase from 15% in 2009 to 21% by 2050

• 2009 to 2050: 45% growth for 55-59 yr olds; 65% for 60-64 yr olds and >200% for >65 yr olds

What happens when we age?

Loss of Skeletal Muscle Mass

• Part of normal ageing process

• Proportion of body fat generally increases while lean body mass decreases

• Therefore: may escape detection on physical appearance, BMI

Risk factors for Loss of Muscle Mass

• Physical inactivity

• Reduced protein intake

The Implications of Loss of Muscle Mass

• muscle strength (esp. legs) impaired postural stability risk of trips and falls

• muscle power / speed of contraction force generated and response time

• Consider the additional impact of obesity!

Remember: Loss of strength does not necessarily translate to an inability to perform inherent job requirements!

• Older workers may just be working closer to their maximum than younger workers

• Experienced compensations

Changes to other soft tissues (Joints, ligaments, tendons and discs)

• Ligaments, tendons and joints become more rigid in movement likelihood of tears

• Joint cartilage wears down, lubricating joint fluid reduces slower +/- painful movements (degeneration or osteoarthritis)

• Discs become dehydrated,

thin out and/or bulge +/-

osteophyte formation

non specific low back

pain, nerve impingement

and loss of function

Modifiable Risk Factors for Osteoarthritis

• Obesity

• Joint trauma or injury

• Repetitive joint loading tasks

• Joint misalignment

Osteoarthritis is not necessarily present with ageing

The Implications of Soft Tissue Changes

• likelihood of more serious injury

• recovery time following injury

• If you look for something you will find it!!!

• Incident, aggravation or pre-existing condition??

Remember: Nature vs Nurture !!

The older we get, the more different we become!

Loss of Bone Mass (Osteoporosis)

• Bone mass constantly undergoes re-modelling throughout life ie cyclic resorption and renewal

• Ageing resorption and mineral deposition after 40-50 years of age

• Bones become brittle and more likely to fracture

Osteoporosis risk factors • Women 4 x > men

• Reduced calcium intake

• Vitamin D deficiency

• Diet and activity levels

• Factors throughout life

- peak bone mass at 20-30yrs

- affected by diet, calcium

intake, exercise levels and

genetics

• Smoking

Neurological Changes

Chronic Health Conditions

Heart Disease

• Ageing is an independent risk factor for heart disease & stroke (men > women until age 55)

• Ageing arteriosclerosis, stiffer arteries, valves and vessel walls

• systolic blood pressure

• Compromised venous blood return postural hypotension

Main Risk Factors for Heart Disease

• NOT related to ageing

• Modifiable

• Lifestyle choices

2. Type II Diabetes

• Related to insulin resistance

in the cells

• Can go undetected for years

• incidence in older population

Effects of prolonged blood glucose elevation:

• risk of heart disease

• Cataracts and damage to retina

• Foot problems due to poor circulation and nerve damage

• Kidney impairment

• Impaired recovery from injury

Risk Factors for Type II Diabetes

• Overweight and obesity

(esp. abd)

• Waist circumference:

- men > 102cm

- women > 88cm

• Poor diet

• Physical inactivity

• Family history / genetics

• Over 55 years of age

Psychological Changes

Adjustment Disorder: Significant consideration for later in life

Symptoms Include:

• Increased vulnerability to depressive episodes

• Prevalence of triggers for generalised anxiety

Risk factors:

• Change & maladaptive change response

• Ageism

• Trauma, grief & loss

• Challenges to resilience and purposeful ADLS

• Loss of family support, social isolation

Life Balance Challenges with Ageing

• Big Picture - your life journey

Mini Picture -

making each day

meaningful

Balance

Purposeful Work

Mastery in Work & Hobbies

Commitment to Health & Wellbeing

Engagement with Family/

Friends

Functional Happiness &

Pleasure Connection to

Community

Pursuit of Meaning &

Purpose

Exploring Creativity

Pursuit of Learning

Self Actualisation

& Control

The Psychology of “Happiness”

Act:

• Physical activity: walk, garden, dance

• Cognitive activity: read, study, cross words

• Social activity: interact with people, friends

Belong:

• Group participation / join in

• Community events

• Family and friends, partner

Commit:

• Take up / volunteer for a cause

• Learn a new, challenging skill

Psychological Changes

Cognitive Processing

• Greatest 30 and 40 years, decline in 50s / early 60s

• Quality of reasoning and problem-solving remains the same but the speed of mental processing may slow

• Language and the ability to process complex problems improves with age!

Decision Making:

• Come to the same conclusions as younger workers but tend to rely more on prior knowledge and consider more alternatives

You CAN teach an old dog new tricks!!

Strategies for Managing RTW for an

Older Worker Case Study 1: “Sam”

• 68 year old male

• Sustained a lower back strain while working as a

machine operator

• Difficulties experienced with RTW due to the

prolonged standing, repeated bending and

lifting required for pre-injury duties

• History of similar claims in the past with protracted

RTW

Strategies for Managing RTW for an

Older Worker Case Study 1: “Sam”

• What can you do to achieve a successful RTW?

• How would you manage this worker if he

presented with a final certificate for a return to

PIDs today?

• What could you do to try and prevent further

recurrences?

Strategies for Managing RTW for an

Older Worker Case Study 2: “Jack”

• 64 year old male • Sustained a work-related knee injury while

working as a cleaner in a hospital > 3 years ago

• Morbidly obese (BMI 42)

• Work capacity of 4 hours x 3 days, limited standing and walking ability (after several exacerbations)

• Extreme shortness of breath and flushing observed during workplace assessment

• Failed attempt at RTW in driving role due to behavioural difficulties

Strategies for Managing RTW for an

Older Worker Case Study 2: “Jack”

• What are the barriers to RTW / work capacity?

• What can you do to manage this?

• What should the employer have done?

Considerations & Accommodations:

• Identify personal risk factors as early as possible

• Allow more time for gradual RTW

• Consider stage of life / priorities

• Use government and community services where appropriate

• Modify the workplace to extend work longevity:

- raise / lower working heights

- equipment provision

• Change nature of PID / redeploy to more suitable role

• PREVENTION!!!

Injury Prevention Strategies for the

Organisation

“ Need to adopt workplace strategies that build

upon the strengths and protect against the

vulnerabilities of workers as they age”

(Silverstein 2008)

Assessment and Analysis:

Current Workforce:

• Workforce demographics

• Areas of skills and experience

• Make predictions about future age of workforce and any training or up-skilling needs

• Review illness and injury statistics with regard to ageing factor

• Review opportunity for progression of job roles to more “suitable” tasks as workers age

May direct recruitment selection, opportunities for flexible work arrangements, social engagement

Assessment & Analysis

Further Assessment:

• Health status

• Policy review

• Employee focus groups, surveys

• Risk assessment

• Workplace assessment

Interventions / Implementations • Job dictionaries / review of job descriptions

Education / Training:

- Manual handling, H&W,

Courses

• Workplace modifications

• H&W environment

• Fitness for work Ax

• RTW planning for non

work-related conditions

• Onsite physio

• Flexible work arrangements (gradual retirement)

Aim: Healthy Ageing Workforce

Questions