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June 5, 2015

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An age-old question

Brain aging and memory loss due to Dementia and Alzheimer's disease with the medical icon of a group of color changing autumn fa

As the population ages, workplaces will need to adapt to this potentially seismic change. Chris Ide shares his thoughts on the challenges facing employers and offers some solutions.

I spent 11 years working for the Health and Safety Executive and soon found that nothing was ever discarded. When I was preparing to visit a company that had previously manufactured asbestos lagging, I looked through HSE’s files, and found a note describing a visit made by one of my predecessors, dated 4 September 1953.

The note read, “I next met Mr X. He was breathless on exertion, (the note then lists signs of illness detected on physical and x-ray examination of the chest). He undoubtedly has asbestosis, yet he begged me not to tell his employer since he would almost certainly lose his job, and would have difficulty getting another one since he was 75 years of age”.

Because it coincided with the ages at which the state pension was payable, until comparatively recently, the default retirement age was set at 60 or 65 years of age, although a few, for example, mental health workers, police and firefighters, could retire earlier – between 50 and 55.

However, the age at which the state pension becomes payable has been raised to 66 for those born from December 1953, and will rise further in the years to come to 68 in 2045. [1] Changes have already occurred in many of the other pension schemes, which has resulted in full payment being deferred until 55, or even older.

Many of the concerns about the ageing population tend to involve the potential problems posed by the rising numbers and proportions of the very elderly, i.e., those over 80 years, with their multiple pathologies and impairments and the resultant burdens on health and social care systems.

I doubt these will impact greatly on the workplace since for the reasonably foreseeable future most of those seeking to remain in work will be in the 55-75 year old category. They represent a survivor population, since the ‘healthy worker effect’ will have removed the most severely disabled.

Furthermore, the decline in the general incidence of heart disease – the most common killer of middle aged men, in particular – over the past three decades has meant that people have been arriving at late middle age in a better state of health than ever before. The downsides to this optimism is that these gains have not been generally experienced across all social classes, and I worry that the rising epidemic of obesity, particularly if accompanied by a parallel increase in type 2 (maturity onset) diabetes, could undermine much of these improvements.

The ageing process involves loss of physical and mental faculties no matter how one measures prowess, whether by tests of strength, lung function, auditory/visual acuity, or mental agility. We seem to have peaked by our early-mid twenties, and thereafter, it’s downhill all the way, with the pace increasing from the mid-thirties onwards. In fact, the most extreme manifestation of senescence – death – starts to become more common with the advent of adolescence, particularly in males. [2]

For safety advisors, the most pressing matter will be rates of fatal and other injuries in older workers. The message is mixed, with some studies reporting somewhat raised rates [3], but with others showing little, if any, difference. The authors of an overview published by HSE considered that these differences might be at least partially explained by the differing workplace environments in which the subjects worked. [4]

In order to adapt the workplace environment to better accommodate the needs of older workers, it is important to consider in more detail the physical and mental changes that occur as a result of the ageing process, while remembering that the elderly are not a homogenous population. I expect that most of us will know of sprightly 80-year-olds, while some individuals in their fifties will appear a good 30 years older. There is a considerable variation between individuals in the rates at which the various changes occur.

Based on my experience of problems for which my advice has been sought, the five most common categories are:

1. Sensory changes

The most important changes occur in the eyes and ears. Ocular changes include a stiffening of the lens, which makes focussing on near objects rather more difficult (presbyopia). Also, the lens becomes more ‘crystalline’ with the tendency to develop cataracts and the jelly-like vitreous humour between the lens and the retina becomes tinged and discoloured.

Collectively, these changes result in light being scattered within the eye and difficulties with colour and night vision. Hence, the importance of brighter lighting (but without glare). The sense of hearing undergoes a well-known reduction (presbyacusis) as the years progress. This is most marked at higher frequencies, but it gradually involves the lower ones as well. In addition, other age-associated disease processes, such as otosclerosis, may contribute.

While otosclerosis and cataracts can usually be effectively treated with surgical techniques, presbyacusis is not. Hence, the importance of striving to reduce noise levels, which will not only reduce background noise, and make communication easier, but will also protect the hearing of the young and middle aged.

2. Musculoskeletal changes

These arise from a combination of loss of muscle tissue and bone mass, which tends to be more marked in females, because they often have less of both to begin with, although in fact the rate at which this occurs varies both between and within each sex. This loss of tissue can give rise to stiffness and reduced flexibility. It may well be possible to mitigate some of these problems by giving consideration to workstation design and layout.

3. Cardiovascular changes

The heart muscle and arterial walls become stiffer, reducing the efficiency of the heart, and leading to loss of stamina. This, in combination with the slowness imposed by the musculoskeletal symptoms, can really slow employees down. However, comparatively few jobs require workers to maintain sustained strenuous activities throughout the working day. Where it is not possible to allocate older employees to less physically demanding work, the use of manual handling aids may be usefully explored.

Older people sometimes need to be reminded that exercise is just as beneficial for them as for the young and middle-aged, and will derive benefit from this, particularly if broken up by rest breaks that allow recovery.

4. Mental changes

This is possibly the elephant in the room, and feared by everyone. However, the dreaded senile dementia affects about 1.5 per cent of those aged 65-69, although this rises to almost 20 per cent twenty years later. [5]

More common are changes in the way in which people cope with completely new problems. Older workers tend to draw on ‘Crystalline’ intelligence, which brings accumulated experience to bear. While this is perfectly adequate for analysis of situations that arise from familiar problems, they may be at a disadvantage when completely original thought is required, and it is necessary to start right from first principles, in other words, ‘Thinking outside the envelope’. This is best served by the ‘Fluid’ intelligence, which tends to be more prevalent in younger people.

The way in which older employees learn, with outcomes just as successful as for younger people, is also relevant. On a purely anecdotal basis, my late father developed an interest in computing. He enrolled in a class at a Liverpool further education college. In 1998, he was one of 11 per cent of candidates to be awarded a distinction in RSA examinations in spreadsheet manipulations and word processing. He was 81.

With regards to dementia, this is sometimes a difficult diagnosis to make, and which may have grave implications for the individual. The disease process tends to gradually involve increasingly broad functions starting with impairment of sophisticated intellectual capabilities, before extending to neglect of appearance and personal hygiene, for example. Safety advisors should not attempt diagnosis (and even occupational physicians should think twice), since these symptoms and signs can be the result of a number of diseases, some of which, like depression and underactive thyroid, are eminently treatable.

However, this should not stop concerns being raised, and functional evidence being gathered, since independent testimony of day-to-day function is extremely valuable to those whose duty it is to try to make the diagnosis.

5. Medication

Older people have multiple morbidities and disease risk factors, and well-meaning medics tend to try to sort these problems by prescribing various medicines, a trend which seems to be extending to much younger ages. It’s not unusual for an employee to present in my clinic with a referral to the effect that, “Mr/Ms Bloggs is taking A/B/C/D/E/F. I’ve Googled them, they have these side effects. Is he/she safe?” My first reaction is often: “Well, what’s he/she going to be like without them?” This is followed by, “I can’t find any mention of performance issues here”. Based on experience gained with road traffic collisions, all medical causes are responsible for just over one per cent of accidents. [6]

That said, I remember during my days with Strathclyde Fire and Rescue Service writing to GPs and specialists to the effect that, “Mr McBloggs is a firefighter… I met him today… his commander asked for my advice because of concerns re: Mr McB’s performance over the past few weeks/months, where he has been…” I then go on to add, “As you know, he is currently taking drug x which, according to the British National Formulary, has such and such as a side effect. I wonder if it might be feasible to stop this, and change it for… drug y, assuming that no worse harm would occur as a result of this amendment?”

To sum up, retaining and recruiting older people into the workforce will present some problems, but safety advisors should consider that steps taken by them which are ideally ‘individual, innovative and inexpensive’ [7] to enable older employees to remain safely at work will maximise their contributions and may also likely be of benefit to younger and middle-aged workers as well.

Chris Ide is retired and has a background in occupational medicine


  7. Goodall HN, Evans JG. The older worker. In: Fitness for work 5th. Edn 2013. Eds Palmer KT, Brown B, Hobson J Oxford University Press Ch 26 525- 551.

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In this episode  of the Safety & Health Podcast, ‘Burnout, stress and being human’, Heather Beach is joined by Stacy Thomson to discuss burnout, perfectionism and how to deal with burnout as an individual, as management and as an organisation.

We provide an insight on how to tackle burnout and why mental health is such a taboo subject, particularly in the workplace.


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