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Older Workers and Disability Management
By Todd McDonald, Graduate Student in Disability Management, University of Northern British Columbia and
Vocational Rehabilitation Consultant WCB of BC
and
Henry G. Harder, Chair, Disability Management Program, University of Northern British Columbia
Employers draw human capital from the general population; and as the population ages, so does the work force. The large number of "baby boomers" born after World War Two are now aging. This means that a large and growing segment of the workforce is middle age or just past middle age. The "baby boom" population surge will have an inescapable impact both on the age distribution in the general workforce and the size of the retired population in the next 30 years. Given the demographic data of an aging workforce and a pending scarcity of workers, employers need to be educated regarding disability management programs structured around older workers. The constant communication to employers through workplace insurance agents (Workers' Compensation Boards, Long-Term Disability Carriers) is that the focus should be on younger workers. However employers who ignore the disability management needs of their older workers due so at their own peril, and lose the ability to retain this vital segment of their workforce. The aging work force brings new challenges in terms of work performance, employee retention and disability costs. The employers who will meet those challenges most successfully are those who begin addressing them now.
First Section: Demographic Review of the Canadian Population and Workforce
Canada has 31.5 million people and the population is expected to reach almost 34.5 million by 2011, to exceed 38 million by 2026, and to be almost 40 million by 2041 (Denton, Feaver, & Spencer, 2000). The median age, just over 26 in 1966, reached 35 by 1996 and is projected to be about 45 by 2041(Denton et al, 2000) life expectancy at birth is 75.7 years for males and 81.4 years for females (Marshal, 2001).
Canada has had the largest post-war "baby boom" in the world, but has since had a "baby bust". Fertility rates measuring live births per couple were above 1.7 until 1993 and have since fallen to under 1.6 by 1997 (Marshal; Statistics Canada, 1999). This "boom-bust" sequence has had marked effects on age distribution. As Denton, Feaver and Spencer (2000) note, until 1971 about two-fifths of the population were "young" (defined as under age 20), but by 1996, that proportion had declined to little more than one-quarter. The reduction in the "young" population was offset by increases in the "working age" population (20 to 64), which rose from just over 50 percent of the total in the early 1960s to 61 percent in 1996, and in the "old" population (65 and older), which increased from less than 8 percent of the total in 1951 to more than 12 percent in 1996.
Without changes in the participation rates of various demographic groups, overall growth in the pool of potential employees would be even more subdued than suggested by the total numbers in the 16 to 64 age group. In Canada, for instance, projection of current workforce participation rates by age and sex suggest that overall participation of men and women in the labor force, which was 65 percent in 2000, will fall to 63 percent by 2010 and to 60 percent by 2020 (Sunter, 2001).
Not only has the absolute numbers of older individuals in Canada been increasing; the number of older individuals relative to the population as a whole has been growing at a steady pace over the past 20 years as well. In 1976 the population share of individuals aged 45 and older was 26.6 percent. By 1996 this proportion had risen to 32.5 percent. As a result of the tracked demographic changes, the growth in the population conventionally considered to be of labor force age-- roughly between 15 to 64 years old-- is now clearly slowing. This group will raise the average working age to 41 by the year 2008, up from 35 in 1980 (Canadian Centre for Occupational Health and Safety, 2001).
National level statistics from the census, and from social and labour force surveys show that as the population ages so does the workforce and this aging workforce has important policy implications for the economic and social well being of the nation. Different forecasts vary in their details, but as Robson (2001) points out, the long lead times in demography permit projections that are broadly reliable. These projections show that, thanks to declining birth rates, growth in the population traditionally considered to be of working age will slow and then essentially cease. The average age of the workforce will rise, as will its average level of education. The proportion of female workers will grow, and people past traditional retirement age will make up a larger share of the labour pool (Robson, 2001).
In Canada in 1976 the population share of individuals aged 45 and older was 26.6 percent, while in 1996 this proportion had risen to 32.5 percent (Denton, Feaver, & Spencer, 2000). The baby boomers group will raise the average working age to 41 by the year 2008, from 35 in 1980 (Statistics Canada, 1999). The C.D. Howe Institute projections show that growth in the age group of 45-64 will account for about 70 percent of the net increase in the working age population by 2010 and all of it by 2020. In addition, growth in the population ages 65 and over, already rapid thanks to the rising life expectancy, is on the verge of accelerating. Not only is the average age of workers within the usual group rising, but the importance of people ages 65 and up as potential employees will increase. This increase comes at the same time that the proportion of workers age 25 to 34 is expected to decrease by 5 percent (Statistics Canada, 1999).
The rate of labour force growth in the early 21st century will be considerably lower than in the recent past. One way to offset the projected fall in labour force growth would be to enact retirement and pension policy changes designed to raise the effective age of retirement. Such a decision would, in turn, magnify the aging of the labour force, by allowing a larger percentage of workers to remain in the workforce longer, thereby raising older workers' overall share of the working population. Therefore it seems inevitable that the Canadian workforce will continue to grow most rapidly in the older age groups, and less rapidly in the younger age groups.
Second Section: Risk for Injury
Data for the calendar years of 1996 to 1998 (Association of Workers' Compensation Boards of Canada, 1999; Human Resources Development Canada, 2000; Statistics Canada, 1999) indicates that workers aged 15 to 24 were most at risk of time-loss injuries, with a time-loss injury incidence rate of 2.93 per 100 workers. This was followed by an incidence rate of 2.59 for 25 to 54 year olds and 1.91 for workers over 55 years old. The main causes of occupational injuries were bodily motion and overexertion. The main types of injury were sprains and strains, and the part of the body most often injured was the back. The data supports that younger workers are more apt to injure themselves while at work however, it is less clear when addressing the susceptibility of older workers to injury.
Older workers tend to have fewer accidents, however, when older workers do get injured, their injuries are often more severe. Older workers, due to the natural processes of aging, are at a higher risk for sustaining soft tissue injuries (sprains and strains) and most especially injuries to the back. They also may take longer to get better. Older workers experience more severe and disabling injuries consequently, average compensation costs per claim increase with age (Association of Workers' Compensation Boards of Canada, 1999).
The length of recovery is a multifaceted variable including issues such as job satisfaction, overall conditioning, family and workplace support, and early intervention. It is also dependent upon the type of injury. Younger workers tend to get more eye or hand injuries, while older workers report more back injuries. In addition, older workers are more likely to sustain fractures and dislocations from falls than are younger workers; while cuts, lacerations, and burns occur more frequently among younger workers. The National Institute for Occupational Health and Safety (NIOHS - United States data) confirms that not only are older workers at a greatly increased risk of work-related injury and fatalities, they are also more susceptible to chronic diseases (National Institute for Occupational Health and Safety, 2001).
Younger workers get injured more often than older workers. However, when older workers do get injured, they take significantly longer to recovery. Between the ages of 19 to 29 the average days lost per workplace injury is less than 11. Between the ages of 50 to 59 the average days lost per workplace injury is 47 (Association of Workers' Compensation Boards of Canada, 1999; Canadian Centre for Occupational Health and Safety, 2001; Statistics Canada, 1999).
Although empirical evidence exists confirming the link between length of disablement and age, as well as age and likelihood of injury, there is little evidence in support of some of the popular myths concerning older workers. These myths must be challenged in order to design effective accident prevention programs. Older workers are often portrayed as frail and unwilling to change, as resistant to learning new skills and, as a barrier to remaining competitive. As Laville (1998) points out, chronological age poorly forecasts a worker"s physical and mental ability. Older workers score high on job skills, loyalty, and reliability (Marshal, 1995; Marshal 2001). They demonstrate low absenteeism, turnover, and the capability to change and adjust. It should be noted, however, that while absenteeism is lower in frequency it is lengthier when it does happen (Canadian Centre for Occupational Health and Safety, 2001). While strength and endurance can decrease with age, the characterization of older workers as weak is simply inaccurate. In most cases, older workers compensate for their decreasing physical strength by working smarter and being more safety conscious. Research has not shown that there is any consistent relationship between aging and performance at work. Rather, the main reasons for poor work performance are: lack of recognition and feeling as if their work isn't valued, not getting along with supervisors, high job stress, and lack of support (Shaw, et al, 2003; Krause, et al, 2001; Amick III, et al, 2000). These variables are clearly not age related. These situations which may lead to poor work performance can be factors at any age. Some studies have noted that older workers work slower and can't easily make quick decisions (Canadian Centre for Occupational Health and Safety, 2001). However, this change is balanced since older workers often tend to be more accurate in their work and make more correct decisions than faster, younger co-workers (Canadian Centre for Occupational Health and Safety, 2001).
Section Three: Physiological and Psychological Consequences of Aging
Our bodies change as we age. Individuals reach full physical maturity or development at around the age of 25 years; then, after a 15 to 25 year period of relative stability, our bodies begin to show signs of aging. Most of these changes are first noticed at ages 40 or 50, but changes can occur as early as 20 or 25. Laville (1998) has outlined several expected deteriorations of physical and cognitive abilities. These were adapted by The Canadian Centre for Occupational Health and Safety (2001). The changes include:
- maximum muscular strength and range of joint movement
- regulation of posture and balance
- sleep regulation
- thermo-regulation (body temperature)
- auditory, and
- changes in cognitive/mental functioning
In general, people lose between 15 to 20 percent of their muscle strength from the ages of 20 to 60 (Canadian Centre for Occupational Health and Safety, 2001). Every person is different and there is a large range of loss between individuals, however, some loss seems largely inevitable. Offsetting the inevitable loss of muscle mass is the fact that most jobs do not require a person to use all of their strength. In the workforce this means that while older employees may still be able to perform the same tasks as younger workers, they may find that they are working closer to their maximum strength level. Also, as we age the body inevitably loses some 'range of motion' and flexibility. As a result, less flexible workers may have problems with situations that require unpredictable or unusual movements.
With aging, people may find it harder to maintain good posture and balance. Accidents that happen as a result of someone losing their balance occur more often with age (Canadian Centre for Occupational Health and Safety, 2001). Work that requires precise adjustments, strong muscular effort (including lifting and carrying), joint movements at extreme angles, or those done on a slippery or unstable surface, will ultimately be affected by increasingly poor posture. This will place older workers at an increased risk due to deficits in this attribute. Unexpected bumps or shocks may cause more serious problems than with younger workers.
Older people, and by extension older workers, may have difficulty regulating sleep as they get older (Canadian Centre for Occupational Health and Safety, 2001). How long a person sleeps, and how well they sleep, can be disrupted by changing work hours or by light and noise. The impact of declining sleep regulation on employees is especially a concern for older shift or night workers. Older workers may find that they need more recovery time between shift changes or extended workdays. In addition to difficulties regulating sleep older workers may find that their bodies are less able to maintain temperatures (Canadian Centre for Occupational Health and Safety, 2001). This change means that older workers may find heat or cold more difficult to deal with than when they were younger. It also means that if they are doing hard manual labour, they may get overheated more easily.
Vision also changes with age. Generally older workers will notice that they cannot see or read from certain distances as well as they used to. This reduction in the "amplitude of accommodation" (the ability to see or adjust focus in certain distance ranges) is normally easily corrected with prescription glasses. Older workers may find that changes also occur in the peripheral visual field, visual acuity, depth perception, and resistance to glare, and light transmission. These changes are normally not noticed by a person unless there is poor lighting or there are sources of glare. Therefore, with accommodations the diminishment of visual strength can be adjusted for. Also, while older workers might notice that they can't see as well when they're reading something when text size is small, or when there is poor contrast between the text and the background, simple accommodations such as brighter lighting (that is suitable for the task) and well laid-out documents which avoid small print are important.
Hearing also diminishes. Older workers may find that they are not able to hear as well at higher frequencies (Canadian Centre for Occupational Health and Safety, 2001). Most often, this change is noticed as the inability to focus in and listen to a particular voice or sound in a noisy environment.
With the inevitable decline in physiological abilities, certain changes in mental capacity also occur. Older workers may not think as quickly and clearly as they once did (Canadian Centre for Occupational Health and Safety, 2001; Laville, 1998). In addition, it may take longer to master new job related skills. Much of the research on cognitive functioning has been completed in laboratory settings (Laville, 1998). As a result of this laboratory based research there is information available on how individuals score on specific tests or tasks, however, there has been little testing to see how these results apply in the "real world" of specific jobs and production orientated workplaces. In particular, at work people naturally develop different habits to match or suit their varied learning and working styles. As Laville (1998) points out, fluid intelligence (such as inductive reasoning, selective attention, 'dual-task' activities, and information processing) declines with age, while verbal tasks and vocabulary (talking and expressing themselves) remain constant or improve. In general, tasks that depend on short-term memory usually take longer. Older workers who tend to depend on the use of experience and expertise when working may find it hard to work with multiple, complex, or confusing stimuli. This means they might find it more difficult to multi-task. They may also find it tricky to work in a busy, hectic environment. With the presence of external stimuli they may be less able to focus attention only on information relevant to the task at hand, especially in "new" situations. This means that there may be so much going on in new situations that they aren't able to quickly and efficiently prioritize what to pay attention to and what to ignore (Canadian Centre for Occupational Health and Safety, 2001).
Employers may find that training requirements are different for older workers. Since, for many older workers, learning is based on previous experience training may need to be more "practically" based. Older workers may find that new skills need to be explained in a way that fits into what they already know. Providing a clear larger picture including justification and the logic behind the information (why you're doing what you're doing) is more important for older workers. In addition employers will likely find that training will take longer than with younger workers. Older workers will likely also benefit from more assistance or practice with implementing new job and employment skills. Importantly, and as Laville (1998) points out, several studies have show that there may not be a difference in how well someone works once the learning curve has been reached. Everyone, at every age, thinks and learns differently.
Section Four: Accommodating Older Workers
One question that can be asked is whether or not aging workers need special accommodations. A well-designed work place benefits everyone. Workstations and job tasks that are matched to the strengths and needs of the individual employee are always best. Employers will undoubtedly find that different conditions for different workers may be needed to meet the needs of any employee, not just one that is older. However, that being said, there are some things older workers may require to work safely and comfortably. These needs are largely the result of the physical and cognitive changes that occur while a person ages.
It seems then that older workers may in fact have physiological and cognitive changes which would place them at increased risk for workplace injuries, and they may also have longer absences from the workplace once injured. An ideal approach to this challenge is the use of ergonomic interventions. Many workplace injuries are the result of doing the same things again and again. Repetitive motion injuries, for example, develop over time. Older workers may report more musculoskeletal injuries since they've had longer for the condition to develop. Increasing numbers of injuries may also be related to the physiological changes associated with aging. However, when anyone, no matter how old they are, is pushed to work harder than they safely can, there is a risk for injury.
Since older workers tend to have more severe injuries when they do happen, it's important to make adjustments to work stations or work patterns to make them as safe as possible. It's also important to make sure a person is suited for a particular task and is safely able to do it. Ergonomic intervention, important in any age group, provides the opportunity to make a disproportionate contribution when effectively applied to the older worker age group.
Section Five: The Argument for Comprehensive Disability Management Programs
When determining the cost effectiveness of providing integrated and comprehensive Disability Management Programs which fully take into account the needs of an older workforce, Disability Management professionals should keep in mind the increased barriers to reintegration that older workers face. The labour market consequences of disability can include job loss, reduced income, earlier retirement, and greater reliance on private and social insurance systems. Robson (2001) in reviewing Workers' Compensation Board data from three US states (California, Washington and Wisconsin) found that older workers suffer proportionately more injuries with permanently disabling consequences. Also, the losses suffered by older workers are greater, on average, than those of younger workers. The data also highlights that injury-related non-employment is higher among older workers and, moreover, that the older workers appear to recover a smaller proportion of their losses from workers' compensation than do other injured workers.
Outside of the social and human costs of disability in older workers, there are real and compelling reasons for employers to implement a comprehensive Disability Management Program. The costs of failures to reintegrate older workers (be it severance, pension bridging, or vocational rehabilitation expenses) can be substantial. In addition, the impending labour shortage will reinforce the benefits of returning injured older workers to meaningful productive employment.
The rational for a comprehensive Disability Management Program is based on three fundamental facts:
- The population and the workforce are aging.
- Older workers, although less likely to get injured, remain disabled for longer periods of time when they are injured.
- Older workers are less able to adapt to displacement by securing alternative employment.
It is clear that older workers are becoming more important to employers. Whereas previously early retirement, medical bridging pensions, and hiring of a younger workforce was an option, organizations must now review their injury prevention and Disability Management Programs with an eye to retaining older workers.
The higher average cost per injury claim for older workers can no longer be managed by layoff or forced retirement. Older workers will play an increasingly important role in the labour force, and employers must take full advantage of their experience and capabilities. Proper design, construction and facility maintenance with older workers in mind; reduction of ergonomic hazards through job task hazard analysis and control; and quality care and follow-up of injuries are critical to effectively managing the aging workforce.
Section Six: Disability Management Solutions
With the need to design a comprehensive disability prevention program, the issue of ergonomics will play an increasingly important role. A key factor in workplace safety is the ability to sustain a safe posture while performing a work task. As has been shown, when we age bone density, muscle mass and strength decline, making it harder to maintain proper body mechanics. There is also a reduction in aerobic capacity, which can lead to increased fatigue in the muscles. Visual acuity and hearing also decrease. The end result of all this is that as workers get older they will have more difficulty performing physical tasks and be more susceptible to injury. In a paper presented to the American Society of Safety Engineers and quoted by Stephen Minter (2002) Vaughn-Miller and R. Wayne Clifton wrote: "A full-service program will include developing transitional and light-duty assignments before injuries occur, based on those types of injuries and the resulting limitations known to exist today in those injuries. It will also include assessments for potential accommodation to reduce the risk factors associated with the tasks of the job." The result will be that workers can return to productive work sooner and that the chances of future injuries are reduced.
Disability Management and accident prevention programs must also adapt a multifaceted approach in order to properly manage workplace risks, treat work-related injuries and control injury claims costs. As the workforce continues to age, the traditional focus on unsafe behaviors and injury frequency may contribute to ineffective management of unsafe ergonomics and ergonomic hazards known to significantly impact older workers. Treatment of injuries by on-site personnel trained in first aid and/or at emergency rooms may adequately address acute injury characteristics of younger workers, yet may fall short in addressing long-term treatment needs of injured older workers.
Employers will have to consider adapting job duties to accommodate age-related conditions such as reduced muscle strength and motion. Older workers may need to avoid heavy lifting or share certain jobs that require strength and flexibility. A job rotation schedule would prevent employees from overworking a certain part of the body, especially important to older workers who may fatigue faster and require a longer recovery time.
Comprehensive fitness initiatives would encourage employees to participate in a home or gym based exercise program. Employers would be wise to consider the implementation of an onsite, supervised fitness program run by physical therapists or trainers who are knowledgeable about the needs of older workers. Employers could also promote fitness through company sponsored sports teams and recreational activities such as company walks. Employers may also consider implementing diagnostic and training programs targeted to prevent specific conditions such as carpal tunnel syndrome and tendonitis. For example, some companies require employees to attend a "back school" as part of their injury prevention program (Canadian Centre for Occupational Health and Safety (2001).
Comprehensive Disability Management Programs will recognize the value of utilizing external health care providers to lecture on wellness topics such as nutrition, weight control, smoking and drinking cessation, and disease prevention. Other topics could focus on coping with age related conditions such as arthritis, incontinence and hearing loss. Although not specific to older workers, a psychologically healthy environment should be the focus of injury prevention programs. The creation of a relaxing work environment to reduce on-the-job stress will result in increased productivity and decreased injury and illness absences. Furniture, paint schemes, music, and employee lounges and dining rooms contribute to a comfortable work place.
Older workers will benefit from the institution of organized stretch and/or walk breaks. The lack of interruption of posture, the tendency to function in one position for days, months, or even years, contributes to prolonged stress on musculoskeletal tissues. All workers need to get up periodically to do simple exercises, stretches and movement in the opposite direction of the long-term stress. Again, older workers stand to reap increased benefits from these interventions.
Although historically hesitant to broach the idea, Disability Management Programs need to ensure job safety by instituting "fit for duty" tests based on tasks involved in a particular job. If any weaknesses are revealed, older workers could get specific training to improve job performance and to prevent workplace injuries.
With an aging workforce employers may opt to choose health plans that permit employees to see practitioners from different disciplines, including physical and occupational therapists. Complementary therapies give workers alternatives to drugs and treatments that may have significant side effects. Complimentary therapies partly address the fact that older workers may react strongly (e.g. drowsiness, confusion, slowed response time) to certain prescription drugs that can affect how well they perform their jobs.
When older workers do get injured the best way to get them back on the job quickly is through a transitional-work program. An effective transitional work program is a program where the injured worker is matched up with defined tasks. As the person's ability to take on more demanding tasks increases, they are moved into the next level of work. This effectively results in work hardening on the job while at the same time freeing up that lighter transitional-duty task for the next injured worker. A full-service program will include developing transitional and light-duty assignments before injuries occur, based on the types of injuries and the resulting limitations known to exist today. It will also include assessments for potential accommodation to reduce the risk factors associated with the tasks of the job. The result will be that workers can return to productive work sooner and that the chances of future injuries are reduced.
It would be a good idea for employers to create and maintain a database that includes not only the essential functions, but also the physical demands of the job. If this is done when an injury occurs, the employer can search by physical demands to see if there is transitional work that the employee is capable of. When injured or ill employees visit the doctor, that transitional-duty information and a letter from the employer can be brought along, promoting the goal of resolving medical issues and keeping the employee at work or returning them to work as soon as appropriate, without unnecessary delays.
Older workers can benefit from flexibility in their work schedules. In making flexible schedules more widely available many employers already appear to be adopting practices that should suit an older workforce. The Conference Board of Canada survey (Robson, 2001) showed that the share of respondents offering flexible arrangements to non-unionized employees rose from 48 percent in 1989 to 88 percent a decade later. Part time work with prorated benefits, available to only 30 percent of respondents in the 1989 survey, was available to 53 percent in 1999.
Section Seven: Discussion and Conclusion
The demographically driven changes in the Canadian workforce are numerous. Three of the most striking results of these changes will be:
- labour that is more scarce,
- labour that is older, and
- a workforce that has a larger proportion of women than in the past.
The most prominent feature of the looming shift in the composition of the working age population is, of course, its increasing age. If employers could simply hire all younger workers they might be able to avoid this problem. The reality, however, is that the previously identified shift in the work force demographics will prohibit that alternative. Between 1998 and 2008 the number of workers 55 or older will increase by approximately 50 percent; the number of workers age 25 to 54 will increase by about 5.5 percent (Minter, 2002).
Prevention of on-the-job injuries must accommodate for the higher costs of injuries suffered by older workers while still managing the more frequent injury characteristics of younger workers. When anyone, no matter how old they are, is pushed to work harder than they safely can, there is a risk for injury. Since older workers tend to have more severe injuries when they do happen, it's important to make adjustments to work stations or work patterns to make them as safe as possible. It's also important to make sure a person is suited for a particular task and is safely able to do it.
At the end of the day, a shrinking labour supply will put a premium on sound business practices that:
- attract and retain people with key knowledge, skills, and aptitudes, and
- ensure that valuable prospective or current employees are not lost due to factors associated with aging.
Innovative hiring, flexible work schedules, appropriate training, imaginative compensation, flexible business structures, new workplace technologies and accommodations, and solid Disability Management practices are key tools for keeping workers of all ages safe, healthy and productive. However, the phenomenon of the aging workforce brings new challenges in terms of work performance and worker retention. The challenge for employers is to begin addressing these issues now.
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Contact
E-Mail: harderh@unbc.ca
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