Discusses a range of factors impacting the older worker's return to work following injury and strategies to address these.

1. Implications of Ageing for
Return to Work
Michael Sainsbury

2. 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?

3. Do older workers require longer periods
of rehabilitation? Are outcomes similar?
Average duration of absence (weeks)
12
Time off work
10
8 Older workers are off
6
4
work longer
2
0
< 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)
Sustained return to work
100%
Men 55+
80%
60% are somewhat less likely to
40%
20%
RTW
0%
15-24 25-34 35-44 45-54 55-64 65+
Age male female

4. Factors influencing RTW of older workers
Tissue
Specific
Severity & Healing Skills &
Chronicity Rates Experience
of Injury
Age Related Lifestyle &
Physiological Systemic
Changes Health
Status
Older Worker
& Injury Ergonomics
Individual Recovery & Individual
Genetic Body
Attributes Mechanics
Psychosocial Physiology of
Environment Pain
Mental
Well- Being

5. 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

6. 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

7. General characteristics of ageing (2)
Sensory: Mental:
 ↓ vision  ↓ information processing
ability
 ↓ hearing
 ↓ sensory information
 ↓ balance processing
 ↓ motor control
Body control may decline
when off-work for extended
periods

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Health Status (4):
Diabetes - prevalence rate across Victoria has doubled in
the past 5 years
Diabetes causes metabolic disruption to normal tissue
maintenance & healing processes with possible
impacts (?) for repetitive work tasks & injury recovery

15. 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’

16. 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

17. Psychosocial environment
 Control over pace of work
 Control over breaks
 Supervisor support
 Peer support
 Role clarity
 Shift work

18. Managing the environment to facilitate
Return-to-Work
What factors can we influence to create an optimal
healing environment for the older worker?

19. Promote a Healthy Lifestyle
 Diet
 Management of drug
& alcohol consumption
 Exercise

20. 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

21. 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

22. 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

23. Health
Work Ability functional
capacities
Model
Adjustment of Promotion of Adjustment of
physical work work ability psychosocial
environment 45+ work environment
Professional
competence
Good work ability, health
and competence
Good productivity and Good quality of life
quality of work and well-being
Good retirement,
meaningful, successful and
productive “Third Age”
Ilmarinen 2001

24. 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