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Implications of ageing for return to work following injury

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

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Implications of ageing for return to work following injury

  1. 1. Implications of Ageing forReturn to Work Michael Sainsbury
  2. 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. 3. Do older workers require longer periodsof rehabilitation? Are outcomes similar? Average duration of absence (weeks)12 Time off work108 Older workers are off64 work longer20 < 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. 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. 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. 6. General characteristics of ageing (1)Physical ↓ aerobic capacity ↓ muscular strength & endurance ↓ threshold to fatigue ↓ resilience to physical stress ↓ maintenance of healthy tissues & injury healingPhysical work capacity isreduced +++ by inactivity
  7. 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. 8. Tissue Healing (1)Acute Soft Tissue Injury:Grade 1 mild tear / microtrauma & 1-2 weeks recoveryGrade 2 moderate tear & 6-12 weeks recoveryGrade 3 complete rupture & long rehab 4 -12 months + Severity, age, systemic health, job biomechanics & specific injury site will affect healing time
  9. 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. 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. 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. 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. 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. 14. Health Status (4):Diabetes - prevalence rate across Victoria has doubled in the past 5 yearsDiabetes causes metabolic disruption to normal tissue maintenance & healing processes with possibleimpacts (?) for repetitive work tasks & injury recovery
  15. 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 fitnessOA may increase the risk of injury recurrence & impact on risk control based on ‘correct lifting techniques’
  16. 16. Body mechanicsBody mechanics: may vary on the same tasks may change with age & deconditioningFaulty body mechanics may perpetuate MSDs in some individuals & restrict return-to-work
  17. 17. Psychosocial environment Control over pace of work Control over breaks Supervisor support Peer support Role clarity Shift work
  18. 18. Managing the environment to facilitateReturn-to-WorkWhat factors can we influence to create an optimal healing environment for the older worker?
  19. 19. Promote a Healthy Lifestyle  Diet  Management of drug & alcohol consumption  Exercise
  20. 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. 21. Create a Supportive PsychosocialEnvironment 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. 22. Work AbilityWork ability of the older worker: Age Genetic pre-disposition Physiological & psychological changes Health behaviours/lifestyle Experience & skills Match/mismatch with critical job demands
  23. 23. HealthWork Ability functional capacitiesModel 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. 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

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