Aging populations: impact on
compensation schemes
Ian Cameron
Rehabilitation Studies Unit
University of Sydney, and Royal Rehabilitation Centre Sydney
Second Australasian Compensation Health Form
Auckland, 8 November 2012
A Health Perspective
Summary
Examples – effects of injuries on older people
The Ageing Population
Conceptual approaches to ageing (and beware of
age, period and cohort effects)
The ageing driver and the ageing worker (briefly)
2
The Rehabilitation Studies Unit is supported by grants from the NSW Motor
Accidents Authority, and the NSW Lifetime Care and Support Authority
Ian Cameron’s salary is supported by an Australian National Health and Medical
Research Council Practitioner Fellowship
3
http://www.crash.lshtm
.ac.uk/Risk%20calcula
tor/index.html
The MRC CRASH
Trial Collaborators.
Predicting outcome
after traumatic brain
injury: practical
prognostic models
based on large cohort
of international
patients. BMJ 2008
doi:10.1136/bmj.3946
1.643438.252007
http://www.crash.lshtm.ac.uk/Risk calculator/index.htmlhttp://www.crash.lshtm.ac.uk/Risk calculator/index.htmlhttp://www.crash.lshtm.ac.uk/Risk calculator/index.html
4
http://www.crash.lshtm.a
c.uk/Risk%20calculator/i
ndex.html
http://www.crash.lshtm.ac.uk/Risk calculator/index.htmlhttp://www.crash.lshtm.ac.uk/Risk calculator/index.htmlhttp://www.crash.lshtm.ac.uk/Risk calculator/index.html
5
http://www.crash.lsht
m.ac.uk/Risk%20cal
culator/index.html
http://www.crash.lshtm.ac.uk/Risk calculator/index.htmlhttp://www.crash.lshtm.ac.uk/Risk calculator/index.htmlhttp://www.crash.lshtm.ac.uk/Risk calculator/index.html
Traumatic brain injury outcomes by increasing age
Why this difference? o Physiological changes
o Comorbidities / multimorbidity
o ? Other factors – psycho-social determinants
Between the ages of less than 40 years and 80 years o15 x increase in mortality
o 8 x increase in disability (dead, vegetative or severe
disability on Glasgow Outcome Scale)
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Whiplash outcomes – age effects
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Kamper et al. Course and prognostic factors of whiplash: a systematic
review and meta-analysis. Pain 138 (2008) 617–629.
Systematic review – 38 cohort studies
Some effect of older age, but it appears to be limited
Whiplash outcomes by increasing age
Why this difference? o Physiological changes
o Comorbidities / multimorbidity
o ? Other factors – psycho-social determinants
Some studies (far from all) detect worse outcome for older people o The effect, if present, does not appear to be large
8
Effect of Age – general injury example
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New Zealand Prospective Outcomes of Injury Study (POIS)
N = 2856, Status 3 months after injury, adjusted for pre injury health status
Langley et al. Health and Quality of Life Outcomes 2011, 9:68
http://www.hqlo.com/content/9/1/68
Older age is associated with poorer health related quality
of life in the mobility, self care and pain / discomfort
domains
Conclusion 1
Older age does have a negative effect on
health, disability and recovery
However, this varies with injury type (and
severity)
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How is the population changing?
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http://www.abs.gov.au/websitedbs/d3310114.nsf/home/Population%20Pyramid%20
-%20Australia Australian Bureau of Statistics
Many more older people – especially over the age of 80 who are women
http://www.abs.gov.au/websitedbs/d3310114.nsf/home/Population Pyramid - Australiahttp://www.abs.gov.au/websitedbs/d3310114.nsf/home/Population Pyramid - Australiahttp://www.abs.gov.au/websitedbs/d3310114.nsf/home/Population Pyramid - Australia
Disability Prevalence by Age
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Prevalence of disability at age 70 – approx 50%
Aust Bureau of Statistics. Disability, Ageing and Carers. 4430.0 2009
Health related quality of life changes with ageing
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Dal Grande et al. Health related quality of life by South Australian Regions ..
http://www.publications.health.sa.gov.au/cgi/viewcontent.cgi?article=1055&context=pop
Psychological health is maintained with ageing
http://www.publications.health.sa.gov.au/cgi/viewcontent.cgi?article=1055&context=pop
Conclusion 2
In the next few decades, there will be a lot
more older people, especially very old women
There is also an increase in “younger old”
people
Disability is very common in older people
Health related quality of life shows varying
changes according to domain
o Psychological health is stable (or improved)
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Conceptual approaches multimorbidity
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At age 65 two thirds of the population have
more than one chronic health condition
Barnett et al. Lancet 2012 DOI:10.1016/S0140-6736(12)60240-2
Conceptual approaches – compression of morbidity
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Compression of morbibidity is not
happening
Compression of disability might be
happening
Conceptual approaches - frailty
Frailty is a state of reduced physiological reserves in
the domains of physical ability, cognition and health.
It increases an individual’s vulnerability to adverse
outcomes, including functional dependence,
institutionalisation, and death.
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Rockwood 2000
Conceptual approaches - ageing in context
Age effect, changes with ageing of the
population ie more older people
Cohort effect, ie an 80 year old today is
different to an 80 year old 20 years ago
Period effect, ie a factor affecting all the
population such as the cost of petrol and the
GFC
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Age, cohort and period effects
Modelling age, cohort and period effects
Aging effects, ie more older people
Cohort effects, ie an 80 year old today is different to an 80 year old 20
years ago
Period effects, ie a factor affecting all the population such as the cost of
petrol and the GFC
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“... age, period and cohort all have significant
independent effects. ... Simple extrapolation
produces higher estimates than modelling which
considers these three factors.”
Langley, Samaranayaka and Begg. Age, period and cohort effects on the
incidence of motorcyclist casualties in traffic crashes. Inj Prev 2012: June 30,
2012 10.1136/injuryprev-2012-040345
Conclusion 3
Older people are more complex than younger
people
Many older people have multiple health
conditions
Older people are operating closer to their
limits
Cohort and period effects mean assumptions
based solely on an ageing population will be
wrong
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Ageing in the context of compensation schemes
Older driver – age 70 and 75 years
- Older drivers overall fewer crashes than other age groups
- Drive shorter distances, restrict driving if uncertain
- In a crash have greater risk of serious injury or death
- Some medical conditions (esp nervous system) and medicines increase
crash risk.
Older passengers and pedestrians – health problems relatively common
Current issues
- Assessments for re-licensing
- Driving and dementia
- Social importance of driving
21
http://www.vicroads.vic.gov.au/Home/SafetyAndRules/SaferDrivers/FamilyandFriends/
TheAgeingDriver.htm Vic Roads
http://www.vicroads.vic.gov.au/Home/SafetyAndRules/SaferDrivers/FamilyandFriends/TheAgeingDriver.htmhttp://www.vicroads.vic.gov.au/Home/SafetyAndRules/SaferDrivers/FamilyandFriends/TheAgeingDriver.htm
Ageing in the context of compensation schemes
Older worker – age 45 or 55 years
- Tend to have fewer injuries
- But if injured, injuries often more severe and have longer
duration
- Different spectrum of injury, esp back injury
Current issues
- What is a reasonable and fair retirement age? 70 years or
less?
- Should older workers be looking for work, or on government
disability benefits?
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Canadian Centre for Occupational Health and Safety.
http://www.ccohs.ca/oshanswers/psychosocial/aging_workers.html
http://www.ccohs.ca/oshanswers/psychosocial/aging_workers.html
Conclusion 4
Older drivers / passengers / pedestrians are
different to younger road users
Older workers are different to younger
workers
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Executive Summary
There are real differences in older people
The New Zealand and Australian populations are ageing - this is already having effects on compensation schemes
o more older people with injuries
o older people have recovery complexities
Older people in the future are not the same as older people in the past – beware of assumptions and stereotyping
► Realignments in compensation schemes are needed
›
What realignments are needed?
Education and information – all stakeholders
Accept that recovery may be slower and less complete
Consider pre-injury health and disability status (they are
important predictors)
Don’t blame all ongoing problems on pre-injury factors –
adopt the approach “how would the person have been but for
the injury”
Accept that older people probably will have more severe
impairments given similar injury severities
Build on the psychological strengths of older people –
experience, resilience and wisdom
Implications for compensation schemes with ageing populations
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