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August/September 2002


Older Does Not Equal Obsolete

By Meri Goehring, PT, MHS, GCS
In today’s world of corporate downsizing, mergers, and acquisitions, and manufacturing plants relocating to other countries, job security is under assault. The older worker, although protected by law from age discrimination, is still vulnerable. Older workers may be of value to an employer in improving or maintaining productivity, but they are not often valued for their wealth of experience, maturity, or humanity.

If someone or something can accomplish a task as well or nearly as well, but in a more cost-effective manner, the older worker may be expendable. If the older adult looses a job and needs to look for work, available alternative employment may be demeaning and/or difficult to find. Financial problems, insecurities, and personal and interpersonal challenges hinder coping strategies.

When older workers experience a musculoskeletal disorder, workers’ compensation and Social Security disability demand quantification of any pathology. Many older workers injured on the job can spend months or years in disability determination. Physical therapists can play a key role in the prevention of injury and health promotion for older workers. However, PTs must value the older worker and understand the complexities of musculoskeletal problems and the associated psychosocial issues.

The unemployed older worker needs to remain active for physical as well as mental health. Physical therapists working with other health care professionals should make certain that older workers are provided with job assistance, training, and psychosocial assistance, when necessary, to assure that they remain productive members of society.

NUMBERS TELL A STORY

The number of workers worldwide between the ages of 45 and 64 is expected to rise from 32.1% in 1990 to 42.3% in 2020.1 In the United States, it is predicted that between the years of 1990 and 2005, the number of working men 55 to 64 years of age will increase by 43% and that the number of working women in the same age group will increase by 65%.2 The Bureau of Labor Statistics projections of moderate growth estimate 22.1 million Americans age 55 years and older in the workforce by the year 2006. This will represent 20% of the projected workforce.3,4 Therefore, the labor market and the whole economy are facing an aging labor force.

Even though this trend is growing, most employers do not generally look for older employees. Yet older adults often keep or seek employment due to financial need. Nearly six in 10 workers in the private sector reach retirement age without a defined benefit pension from their lifelong work according to the US Labor Department. Many older adults work because of costly health insurance premiums and prescription drug costs. Physical therapists can provide important information on injury prevention and conditioning to keep these older adults viable in the workforce.

UNDERSTANDING THE BIG PICTURE

When gathering intake information from a client receiving physical therapy evaluation and treatment, special circumstances unique to the older worker must be considered. Older workers often care for aging parents5 or they may be guardians of their grandchildren. These factors can cause considerable mental as well as physical stress. During corporate downsizing, older workers tend to experience higher mental stress compared to younger workers.6 Older workers may not adjust well to night work or longer shift work.7,8 Older workers may also have visual, auditory, or musculoskeletal impairments that make injury more likely.9

Knowing the causes of injury, the sources of injury, and the types of injuries that occur in the older worker will help the physical therapist better prepare for prevention and treatment strategies. In two large studies of nonfatal work-related injuries to workers 55 years of age or older, injury caused by “contact with objects” is the most common, which includes being struck by or against objects. Injury due to falls was the second most common type of injury in older workers, followed closely by bodily reaction, including overexertion incidents or contact with caustic or harmful substances. The sources of injury, from most to least common, are: machinery; structures and surfaces, such as floors and stairs; nonpowered hand tools; injuries sustained directly from other persons; and motorized vehicles. The location of injury, listed from most to least common are: hands and fingers; shoulder and arm, head and neck; and back, trunk, and hip injuries. The nature of injury, not including falls, from most to least common, include: lacerations, contusions, abrasions, and hematomas followed by sprains and strains. Sprains and strains are the most common type of injury involving the back, trunk, and hip.10,11

Fractures and dislocations occurring in older working adults were the fourth most common injury in one study and the second most common in another.10-12 These types of injuries are certainly more severe. It is interesting to note that older women workers have a higher proportion of fracture injuries due to falls, as compared to other workers.11-13 Physical therapists have good justification for including a fall prevention program when working with older women employees. Poor sight and hearing are also associated with increased injuries and falls in the working elderly.14 Therefore, it is important for the physical therapist to include vision and hearing screens as part of the overall evaluation. The physical therapist also needs to know that older working adults who sustain injury are more likely to have chronic disability than younger injured workers.15 Therefore, rehabilitation efforts to return the injured older worker to the fullest possible capacity are important to prevent progression of a simple injury to a chronic disability.

The type of occupation is the strongest predictor of occupational injuries. Physical therapists can target prevention training if the occupation is known to pose significant risks to older workers. When all occupations are compared, the service industry has the highest total number of injuries, whereas the highest number of injuries in any one industry occurs in the agriculture, forestry, and fishing industry, which are grouped together.10,11 More than 55% of service industry injury occurs in health-related services.11 Therefore, it is extremely important to target prevention training to older workers in health-related services.

EXERCISE AND ERGONOMICS ARE CRUCIAL

When providing physical therapy evaluations and treatments, exercise and ergonomics are imperative. Exercise is a key component of prevention and treatment of work-related injury in the older adult. In January 2000, the Journal of the American Academy of Orthopaedic Surgeons stated, “Physicians caring for middle-aged and older patients frequently overlook the importance of regular physical activity.”16

Physical therapists, as movement specialists, need to play a leadership role in instructing and encouraging older adults to become more active. Employers, physicians, and insurance agencies need to value the importance of physical therapy provided on a long-term basis in the prevention and treatment of injury to the older working adult.

Ergonomics is the science of fitting the task to the worker. To succeed in injury prevention to the older worker, there must be a better match between job demands and worker capabilities as the workforce ages. Many employers are concerned that screening, education, and focused attention on workplace pain will cause an increase in workers’ compensation claims. A study done in Wichita, Kan, demonstrated that when the employer implemented an individual risk-screening program and employee education/awareness campaign, there was no increase in the incidence of work-related musculoskeletal pain, claims, or costs.17 Physical therapists are well trained to be leaders in developing and performing screening processes including a written plan for data collection, analysis, and response to abnormal levels of injury to the older worker.

To properly treat musculoskeletal injuries of working older adults, physical therapists should understand when, how, and why most work injuries occur. Physical therapists can provide the most important information regarding musculoskeletal performance and should actively participate in employee health, screening, and prevention activities. They can assist an employer in carefully matching the employee to the job, and with reassessment and training of older employees. There is no conclusive research that shows the older worker has less physical work capacity.

Physical exercise is a powerful intervention that can reduce frequency of falls and injuries. There is a need for development of distinct fall prevention programs specific to the older population in the workforce. Efforts should be made to minimize fall hazards in all occupational sectors, particularly those using many women.

More attention must be paid to the sensory impairments of the older worker, especially in vision and hearing with job modifications as needed. Motor learning theory tells us that older adults may need different forms of safety training emphasizing task analysis and repeated practice. Physical therapists should also become skilled at assessing the readiness of older adults to learn. Certain stages of grief or stress, cultural beliefs, language, and education of the older adult can affect learning. Older adults may be the most ready to hear information regarding health, fitness, and strengthening when they begin physical therapy evaluation and treatment of a musculoskeletal problem sustained from an on-the-job injury.

With an aging work force, physical therapists can position themselves to be vital members the health care team in the workplace. Physical therapy that provides prevention and proper treatment of work-related injury has the potential to set these workers free.

References
  1. DeZwart BC, MH Frings-Dresen, FJ van Dijk. Physical workload and the aging worker: a review of the literature. Int Arch Occup Environ Health. 1995;68(1):1-12.
  2. Chan G, Tan V, Koh D. Ageing and fitness to work. Occup Med. 2000;50:483-491.
  3. Wolff H. Demographic change—a challenge for all involved in the labor market. Z Gerontol Geriatr. 2000;33(4):251-255.
  4. Panel on Musculoskeletal Disorders and the Workplace, Commission on Behavioral and Social Sciences and Education, National Research Council. Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities. Washington, DC: National Academy Press; 2001.
  5. Rands G. Working people who also care for the elderly. Int J Geriatr Psychiatry. 1997; 12(1):39-44.
  6. Reissman DB, Orris P, Lacey R, Hartman DE. Downsizing, role demands, and job stress. J Occup Environ Med. 1999;41(4):289-293.
  7. Reid K, D Dawson. Comparing performance on a simulated 12 hour shift rotation in young and older subjects. Occup Environ Med. 2001;58(1):58-62.
  8. Yasukouchi H, Wada S, Urasaki E, Yokota A. Effects of night work on the cognitive function in young and elderly subjects with specific reference to the auditory P300. J UOEH. 1995;17(4):229-246.
  9. Zwerling C, Whitten PS, Davis CS, Sprince NL. Occupational injuries among older workers with visual, auditory, and other impairments. A validation study. J Occup Environ Med. 1998;40(8):720-733.
  10. Castillo D, Rodriguez R. Follow-back study of oldest workers with emergency department-treated injuries. Am J Ind Med. 1997;31(5):609-618.
  11. Layne LA, Landen DD. A descriptive analysis of nonfatal occupational injuries to older workers, using a national probability sample of hospital emergency departments. J Occup Environ Med. 1997;39(9):855-865.
  12. Islam SS, Biswas RS, Nambiar AM, et al. Incidence and risk of work-related fracture injuries: experience of a state-managed workers’ compensation system. J Occup Environ Med. 2001;43(2):140-146.
  13. McNamee R, Kemmlert K, Lundholm L, Cherry NM. Injuries after falls at work in the United Kingdom and Sweden with special reference to fractures in women over 45. Occup Environ Med. 1997;54(11):785-792.
  14. Zwerling C, Whitten PS, Davis CS, Sprince NL. Occupational injuries among older workers with disabilities: a prospective cohort study of the Health and Retirement Survey, 1992 to 1994. Am J Public Health. 1998;88(11):1691-1695.
  15. Turner JA, Franklin G, Turk DC. Predictors of chronic disability in injured workers: a systematic literature synthesis. Am J Ind Med. 2000;38(6):707-722.
  16. Galloway MT, Jokl P. Aging successfully: the importance of physical activity in maintaining health and function. J Am Acad Orthop Surg. 2000;8(1):37-44.
  17. Melhorn JM. The impact of workplace screening on the occurrence of cumulative trauma disorders and workers’ compensation claims. J Occup Environ Med. 1999;41(2):84-92.
  18. Hadler NM. Plaint of the aged worker. J Occup Environ Med. 1997;39(12):1141-1143.
Meri Goehring, PT, MHS, GCS, is a faculty member in the Department of Physical Therapy at Northern Illinois University, DeKalb, Ill, and is board certified by the American Physical Therapy Association as a geriatric clinical specialist.

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