Implications of Ageing for Return to Work

Michael Sainsbury

Introduction

Return-to-work of our increasingly older workforce is a significant challenge

Do older workers generally require longer to recover from injury?

What factors may influence the older worker’s recovery from injury?

How can we create an optimal healing environment for the older worker?

Do older workers require longer periods of rehabilitation? Are outcomes similar?Average duration of absence (weeks)

0

2

4

6

8

10

12

< 20 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

Sustained return to work (% of workers in employment 14 -19 months post injury)

0%

20%

40%

60%

80%

100%

15-24 25-34 35-44 45-54 55-64 65+ Age male female

Time off work Older workers are off work longer

Sustained return to work Men 55+ are somewhat less likely to RTW

Factors influencing RTW of older workers

Severity & Chronicity of Injury

Age Related Physiological

Changes

Individual Genetic

Attributes

Psychosocial Environment

Mental Well- Being

Physiology of Pain

Ergonomics & Individual

Body Mechanics

Lifestyle & Systemic

Health Status

Skills & Experience

Tissue Specific Healing Rates

Older Worker & Injury

Recovery

Age-related changes in functional capacity

Age-related changes are specific to each individual

Genetic disposition

Lifestyle & health behaviours

History of hazardous exposures

Individual body mechanics

Age-related functional changes are a product of individual factors & not simply chronological age

General characteristics of ageing (1)Physical ↓ aerobic capacity ↓ muscular strength &

endurance ↓ threshold to fatigue ↓ resilience to physical

stress ↓ maintenance of healthy

tissues & injury healing

Physical work capacity is reduced +++ by inactivity

General characteristics of ageing (2)Sensory:

↓ vision

↓ hearing

↓ balance

Mental:

↓ information processing ability

↓ sensory information processing

↓ motor control

Body control may decline when off-work for extended

periods

Tissue Healing (1)

Acute Soft Tissue Injury:

Grade 1

mild tear / microtrauma & 1-2 weeks recovery

Grade 2

moderate tear & 6-12 weeks recovery

Grade 3

complete rupture & long rehab 4 -12 months +

Severity, age, systemic health, job biomechanics & specific injury site will affect healing time

Tissue Healing (2)

Chronic MSDs & Occupational Overuse Syndromes

Tissue irritation due to excessive load-bearing

Inflammatory & repair processes co-exist

Chronicity dictates the time & extent of recovery

Difficult to predict prognosis. Early intervention is crucial.

Physiotherapy may assist in acute flare-ups

Tissue Healing (3)

Muscle - well vascularised & short duration

Tendon - less vascularised & moderate duration

Ligament - poorly vascularised & longer duration

Intervertebral disc – extended duration & capacity for repair unclear

Healing rate is related to the specific tissue type

Health Status – a snapshot

Workforce reflects the broader health status of the Australian population

Systemic health of injured workers will interface with the

rehabilitation process.

Return-to-Work process should recognise the systemic health status of the workforce

Health Status (2)

Body Weight:

Dietary over-consumption & physical inactivity has increased the weight of Australians;

In the 50-59 yr age group, 24% men & 30% women are obese.

High proportion of workers are substantially overweight with ↑ risk of disease & biomechanical

impacts

Health Status (3)

Cardiovascular Health

CHD, stroke, heart failure, hypertension & peripheral vascular disease affects 750,000 Victorians

Cardiovascular illness causes reduced work capacity, lower fatigue threshold, increased injury risk &

increased susceptibility to de-conditioning when injured

Diabetes - prevalence rate across Victoria has doubled in the past 5 years

Health Status (4):

Diabetes causes metabolic disruption to normal tissue maintenance & healing processes with possible

impacts (?) for repetitive work tasks & injury recovery

Health Status (5)

Osteoarthritis ~11% of workforce have

osteoarthritis OA may create abnormal

stresses on adjacent body segments

OA may reduce weightbearing exercise & lead to reduced fitness

OA may increase the risk of injury recurrence & impact on risk control based on ‘correct lifting techniques’

Body mechanics

Body mechanics:

may vary on the same tasks

may change with age & deconditioning

Faulty body mechanics may perpetuate MSDs in some individuals & restrict return-to-work

Psychosocial environment

Control over pace of work

Control over breaks

Supervisor support

Peer support

Role clarity

Shift work

Managing the environment to facilitate Return-to-Work

What factors can we influence to create an optimal healing environment for the older worker?

Promote a Healthy Lifestyle

Diet

Management of drug & alcohol consumption

Exercise

Job Ergonomics & Body Mechanics

Manual handling risk management

Suitable duties to match functional capacity

Improve body mechanics

Improve general & specific fitness

Fit the task to the worker and correct faulty body mechanics

Create a Supportive Psychosocial Environment at the Workplace Supervisor support

Peer support

Control over tasks etc

Flexibility

Shift work

Minimise the stress response to maintain positive mental well being & prevent adverse physiological

affects on healing tissues

Work Ability

Work ability of the older worker: Age

Genetic pre-disposition

Physiological & psychological

changes

Health behaviours/lifestyle

Experience & skills

Match/mismatch with critical job demands

Work Ability Model

Good work ability, health and competence

Good productivity and quality of work

Good quality of life and well-being

Good retirement, meaningful, successful and

productive “Third Age”

Professional competence

Health functional capacities

Adjustment of physical work environment

Adjustment of psychosocial work environment

Ilmarinen 2001

Promotion of work ability

45+

Conclusion

Return-to-Work of our older workers remains a challenge

Older worker health reflects exposure to occupational hazards & individual health behaviors

Young worker OHS is a high priority to prevent deteriorating health with advancing age

OHS management should promote health & wellness in a broad context