Date post: | 24-May-2015 |
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Health & Medicine |
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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