Older workers – Age concern

The Government is currently evaluating the responses to its consultation on phasing out the default retirement age. This would mean many more people remaining in their jobs past the age of 65 – a situation, which, says Dr Chris Ide, presents new challenges for employers and practitioners.

“I next met Mr X. He was breathless on exertion, had finger clubbing and bilateral crackles at the base of his lungs. The chest X-ray shows bilateral lower-lobe fibrosis. He undoubtedly has asbestosis, but he begged me not to tell his employer, since he would most likely lose his job and would have difficulty getting another one since he was 75 years of age.” (The italics are mine.)

I began my career in occupational medicine working for the Health and Safety Executive’s Employment Medical Advisory Service, and the above quotation comes from a file that we held on a company that manufactured asbestos lagging. It referred to a visit made by one of my predecessors on 4 September 1954, roughly the time I started primary school.

It seems like only yesterday that the futurologists were predicting that working weeks would be getting shorter and retirements longer. Various factors have since combined to turn these dreams to ashes for many, such that, nowadays, to ensure a reasonable standard of living during retirement, workers will have to remain at the job for longer, and the experience of the employee referred to earlier may become the norm in the not-too-distant future.

Even if the pensions crisis had not happened, it is possible that the protraction of working lives would still have occurred. This would be driven by the changes in the age structure of the population, owing to a drop in the number of children being born. Women in Scotland who were born in 1951 had 2.03 children by the time they reached 44. By comparison, those born 20 years later had produced just 1.65 children. Although childbirth in the late 30s is becoming more common – and so those who are now 38 could still produce more, and up that rate – the falling numbers of children born to women of any age does not suggest that there will be a late catching-up of numbers.¹

We are also told that people are living longer. While this is correct, I have never been really impressed with this argument. There are other models available, but based on Scottish experience, while it is true that life expectancy at birth has greatly increased – a Scottish baby boy born in 1861 had a life expectancy of just 40 years, but by 2009, this had risen to 75, i.e. almost doubling. However, during the same period, life expectancy for a man aged 65 has increased by just six years. For women, the corresponding figures are 44, 80 and seven years (although about half this increase in over-65 life expectancy in both sexes has accrued during the past couple of decades).²

Similar changes are taking place elsewhere – not only in the rest of the UK, but in Europe and much of North America. Thus, it is predicted that in the UK by 2033, those over 60 will comprise about a third of the population.³ Already, there are more workers aged over 50 than under 25 in the UK.⁴ Younger employees may be more attractive, insofar as their qualifications may be more up to date, and they are cheaper, since older members of the workforce are often on the highest wages or salary, but at the present rate of progress, if an employer wants a full workforce, recruiting or retaining older workers may be the only option open.

Reeling in the years

The ageing process affects the body in a number of ways. The ultimate manifestation of senescence – death – begins to make its impact at a very early age. After falling to its lowest levels in the 5 to 14-year-old age group (0.1/1000 per year), the death rate rises inexorably, increasing five-fold in the next decade, and doubling or tripling in each 10-year period thereafter.⁵ Muscle power, as assessed by handgrip strength, starts to fall from the third decade onwards,⁶ as does V02 max (a measure of aerobic fitness),⁷ whereas for lung function, the Grim Reaper’s scythe does not start to swish audibly until the mid-thirties.⁸

With eyesight, the lens becomes less elastic, making accommodation for near vision more difficult. Thus, spectacles (or longer arms) become necessary from the mid-forties onwards. The lens and the vitreous humour behind it also become cloudy, and sometimes cataracts develop. Retinal degeneration may also occur, giving rise to reduced sharpness of vision if it occurs at the macula (or fovea), or visual fields may contract if the periphery of the retina is affected.

Audiometric testing shows that the ageing process is accompanied by loss of hearing acuity, most markedly at the higher frequencies. Joints show degenerative changes, with the development of osteoarthritis, particularly in weight-bearing joints. It is likely that this, together with neural degeneration and thickening skin – particularly in manual workers – is responsible for the loss of manual dexterity.

Various mental changes also occur. While dementia holds the greatest fear, it is rare under the age of 70, and even by 80, four fifths are still unaffected.⁹ A bigger issue is the way in which people approach problem-solving. Older workers tend to rise to the challenge of new situations by applying previously learned strategies, or paradigms, i.e. they bring experience to bear, whereas younger employees are more likely to try to reason the solution from first principles.

Even so, it is difficult to distinguish the extent to which the cohort effect operates – different generations may well have been taught using different techniques, and grow up in a different environment. Witness the effortless speed with which our children or grandchildren manipulate and control the electronic devices that dominate our lives, while we fumble with either paper instruction manuals, or the (so-called) ‘help’ facility, becoming more irate by the minute.

The maturing process

While changes do occur in our faculties as we age, it is a matter of common observation that different people do not necessarily age at the same rate. One of the first problems is to try to define ‘elderly’ or ‘older’ worker. The Employment Equality (Age) Regulations – now subsumed into the Equality Act – do not mention a specific age, except in relation to the national default retirement age of 65 (which has just been the subject of a consultation process – see panel overleaf), but most research and policy work seems to regard 50 as the turning point, although a minority places this age as low as 45!

In some ways, arguing these points is akin to the medieval philosophers who used to debate about the numbers of angels that could dance on the point of a needle, but pragmatic occupational health and safety staff will be bracing themselves to enable the organisations they advise to successfully implement this legislation, and allow older employees to realise their potential.

Older workers are not more prone to work-related accident risks. However, when they do suffer an injury, it is more likely to be severe, and American evidence shows that the fatality rate triples in those over 65, with the highest rates being in construction, agriculture and fishing – sectors already known to have a higher risk of severe and fatal injuries.¹⁰

Older workers may also require longer recuperation from illness and injuries, given that some of them may have been bearing the burden of chronic disease affecting such body components as the heart and blood vessels, lungs, and musculoskeletal systems for many years. Diabetes is becoming more common in line with increasing obesity and has the potential to adversely affect the heart and blood vessels, nerves and eyes. These may cause problems with balance, and affect the body’s ability to regulate temperature in more extreme environments.

Up against time

So, how should occupational health and safety services be gearing themselves up to advise both managers and employees about successful strategies for the employment of those who, according to current thoughts, should have been ‘put out to grass’ with their carriage clocks and retirement cards some years ago?

In a recent review article, McDermott defined the purposes of an occupational health service as promoting the health of workers across the life course by the prevention of work-related diseases, minimising reductions in work performance due to chronic disease, and the promotion of health and workability.¹¹ In fact, according to the authors of this article, there is surprisingly little information available about these topics, with nothing at all regarding the prevention of occupational disease.

It could be argued that preventing work-related diseases among older workers would not be particularly important, since those who were vulnerable to serious occupational disease may well have already been selected out of the workforce, leaving a survivor population.

Against this has to be set the potentially increased vulnerability of older people to a wide variety of workplace hazards. For example, workers with osteoporosis – a bone disorder in which the bones become less dense, and which is rather more common in ageing women than men – are more likely to suffer fractures if they are involved in a fall. Also, some older workers will have changed career direction, thus exposing themselves to hazards for the first time.

Health promotion activities do offer opportunities to help conserve function, and a number of studies cited in McDermott’s article do point to improvements in weight, blood pressure, lipid profiles, and reduction in smoking as a result of endeavours in this area. However, it is less clear how long these changes persist, and the extent to which they translate into improved attendance and productivity at work. In part, this may be because older workers take a different view of their health, some regarding themselves as survivors. Alternatively, they may accept some part of performance decrement as simply a consequence of the ageing process.

However, Murray-Bruce relates an anecdote concerning a survey he carried out involving 100 pensioners.¹² Just one regarded himself as old, and even he qualified that by saying that he was ‘young at heart’!

Safety advisors do need to take common-sense steps to compensate for decrements in performance that will occur as a result of the ageing process. Visual handicaps can be reduced by ensuring that levels of lighting are appropriate for the task in hand, that intrusive glare, etc. is suppressed, and shadows eliminated. Suitable glasses, or other aids to vision should be available. Appropriate hearing protection is just as relevant to older members of staff, and ergonomic adjustments to tools and the availability of lifting appliances, etc. can help offset the functional decline that occurs with ageing. The provision of relevant training and updating in the use of the tools of the job is another ‘must’. Older workers may well have different learning styles, and these need to be acknowledged.

So far, there may have been a tendency to regard older workers as a homogenous group. This is not the case. Men and women may well experience different problems because, despite the gradually increasing penetration of women into jobs that have previously been regarded as male preserves, there is still a tendency for women to be found in jobs that involve caring, or other work such as reception and clerical tasks.

Payne and Doyal argue that this places older women at a disadvantage, since they would be under greater pressure to maintain a youthful appearance.¹³ Furthermore, the interruptions to women’s working lives from bringing up children may mean less opportunity for promotion. In turn, being lower in the pecking order may reduce the possibilities of accommodation and adjustment of tasks, which are available to more senior employees. And, of course, it is still generally the case that women are expected to undertake a disproportionate amount of domestic work and caring for relatives at both ends of the age spectrum.

Ethnicity also raises its head. Granville and Evandrou draw on information from the Office of National Statistics, which shows that, while 80 per cent and 82 per cent of white British and Chinese men, respectively, aged between 40 and 64 are economically active, this proportion falls to 58 per cent among Bangladeshis. Black, Bangladeshi and Chinese men are also more likely to be working on a part-time or casual basis, reflecting their employment in transport, hospitality and catering.¹⁴ As they age, familiarity will probably mean that they stay in those sort of jobs.

I suspect that many of the remedies I have suggested will be easier to adopt in larger organisations, which have established policies and staff who can devote more of their time to dealing with the problems that will inevitably arise. The greatest challenges will probably be in small and medium-sized organisations, where the majority of those in employment are to be found, particularly in the private sector, as well as among the self-employed and sole traders. 

References

1    www.gro-scotland.gov.uk/files2/stats/ve-reftables-09/ve09-t3-7b.pdf
2    www.gro-scotland.gov.uk/files2/stats/life-expectancy-at-scotland-level/table1-le1861-2009-revised-final.pdf (accessed 7 October 2010)
3    www.statistics.gov.uk/cci/nugget.asp?ID=949 (accessed 17 October 2010)
4    Ilmarinen, JE (2001): ‘Ageing workers’, in Occup Environ Med 2001;58:546-52
5    www.gro-scotland.gov.uk/files2/stats/ve-reftables-09/ve09-t5-1.pdf (accessed 15 October 2010)
6    Bohannon RW, Peolsson A, Massey-Westropp N, Desrosiers J, Bear-Lehmann J (2006): ‘Reference values for adult grip strength measured with a Jamar dynamometer: a descriptive meta-analysis’, in Physiotherapy 2006,92;1:11-15
7    http://sportsmedicine.about.com/od/ fitnessevalandassessment/a/Bruce_Protocol.htm (accessed 21 October 2010)
8    Nunn AJ, Gregg I (1989): ‘New regression equation for predicting peak flow in adults’, in Brit Med J 1989; 298(6680):1068-70
9    CRA Clarke In (2007): Neurological Disorders. Clinical Medicine, eds Kumar P, Clark M, 6th Edition, p1254, Elsevier Saunder
10    Laflamme L, Menckel E (1996): ‘Aging and occupational accidents: a review of the literature of the last three decades’, in Safety Science 1996;21:145-161
11    McDermott HJ, Kazi AS, Munir F, Haslam C (2010): ‘Developing occupational health services for active age management’, in Occup Med 2010, 60;3:193-204
12    Murray-Bruce, D (2000): ‘Age and ageing: an overview’, in Occup Med 2000,50;7;471-72
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;   Payne S, Doyal L (2010): ‘Older women, work and health’, in Occup Med 2010, 60;3;172-77
14    Granville G, Evandrou M (2010): ‘Older men, work and health’, in Occup Med 2010, 60;3;178-83

Chris Ide is an occupational physician and regular contributor to SHP.

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