Worn out workers

By Peter Rousmaniere

Published August 7 2019 by workerscompensation.com

Mark Walls and Kimberly George are on to a good idea. They say we should be aware of how personal predicaments influence recovery from work injury.  In May they said that “social determinants of health [of the injured worker] have a significant impact on the healing process and a worker’s ability to return to work.”[i]

They are referring to the worker’s nutrition, her health fluency, physical living constraints, poverty.  They give a few examples of how a targeted intervention beyond the normal scope of injury benefits can remove a barrier to recovery.

Let’s fit their proposal for broader awareness of the worker’s predicament into the context of worker health and fitness. Personal health behaviors, health complications, and functional capacity cast a shadow over work injury risk. Poor profiles might lead to more injuries; that’s not clear. They certainly lead to longer recovery.

Let’s broaden this even further, to get to what should be a central concern in America today. Most aging workers in physically demanding jobs have to cope with less capacity to perform. But our workforce and retirement systems basically push many to work longer. The have to pretty much to figure out how to adapt on their own. That often involves exiting their career.

The worker’s compensation system, true, is triggered only by a work injury. From the worker’s perspective, especially that of an older worker, her injury may be one incident among many in coping with the job. Aging brings with more medical complications and also reduced physical strength. And, obesity rates have increased by a third since 2000, and some blue collar workforces have the highest rates.[ii]  As a person ages in her job with physical demands, her “tolerance” for the demands goes down.

In 2019, about 400,000 workers 45 years or older will suffer a lost time injury. A share of these injuries will lead to career exits and other major job adjustments.  But perhaps five million workers this old will, without an injury, decide this year that “I can’t do it any more.”

“I can’t do it any more” is how the noted expert on functional capacity, Susan Isernhagen, describes that decisive moment for the worker.

She told me that “a work injury is the top level of knowing you can’t do it any more, because of decreasing strength with age, even if the job does not change.  I may only need 30% of my physical ability at age 30, but use 50% at age 40, and 80% or 90% at age 60.  The threshold of coping with physical demands varies by occupation. For nursing it can be at about 60, for UPS drivers in their 40s, in manufacturing maybe in their 50s.”

She said there is a “great issue of trust and self -image. We don’t research this in the United States.  I have never seen or heard of an employer which had introduced a company-wide plan for graceful transition in or exit of work levels out of concern of worker.”

We need to understand much better the personal response to lower tolerance for job demand.  It is an intimate part of one’s journey through life, filled with career-altering decisions which are shared with family, friends, and co-workers and are invisible to anyone else.

Diminished tolerance is a difficult subject to research. Workers are often not very aware of the burden of diminished tolerance, until all of the sudden, they are.  They may hide diminished tolerance from themselves, they may be ashamed of it, they will not admit it to their employer. Unrecorded adjustments to physical demands, the employer’s probably ambivalent response, a momentous decision to exit a career—these sum nationally to millions of worklife adaptations very year.

These myriad adaptations explain one of the most arresting statistics in occupational injury, which is that the incidence of work injury does not go up among older workers, any may even  decline.  This pattern has been confirmed by researchers since the 1970s.  The older workers have likely cultivated safer work techniques, and perhaps found safer employment. Still, they take longer to recover from injury.  The median lost days of 55- 64 year old injured workers are double the duration for 35-44 year olds.[iii]

We have no idea where these workers go after they discover they can’t do it any more. I find only one published survey of what happens to aging workers. This reported in 2010 that medical and musculoskeletal conditions among roofers are associated with premature departure from the workforce; to what other work was not asked.[iv]

An article published in 2017 said that “Although there is a vast body of research on work participation of older workers, there are only a few high-quality intervention studies aimed at improving work participation in this population.”[v] Yet 55 years and older workers will comprised 25% of the workforce in 2025, compared to 13% in 2000.[vi]

The American employer community is under no mandate to invest in ways to retain older workers. Perhaps in other advanced countries, where the workforce is more regulated and union-management cooperation is more present, are the predicaments of older workers better respected. In America, adaptation to work at an old age is an individual’s virtue, not an employer mandate.

We have little more than anecdotes, but how rich anecdotes they are. The massage therapist with painful hands in her 40s.  The merchant mariner who finds his responses are delayed, only to be diagnosed a year later with cognitive impairment associated with age. The nurse who worked in locked mental health units for decades only to find she could not fully recover psychologically from her last assault. And even Bob Wilson’s father, who at the age of 99 had to close his business due to a fall.

Where is the clear and confident voice advocating on behalf of the older worker?

[i] Out Front Ideas Webinar, The Impact of Social Determinants of Health on your Workforce. May 19 2019

[ii] Gu J et al, Prevalence of Obesity by Occupation Among US Workers. The National Health Interview Survey 2004–2011. J Occup Environ Med. 2014 May

[iii] https://www.bls.gov/iif/soii-chart-data-2017.htm

[iv] Welch L et al, Impact of Musculoskeletal and Medical Conditions on Disability Retirement—A

Longitudinal Study Among Construction Roofers. Am J Ind Med 2010 June.

[v] Steenstra I et al, A systematic review of interventions to promote work participation in older workers. J Safety Res. 2017 Feb

[vi] https://www.bls.gov/careeroutlook/2017/article/older-workers.htm