B.C. Matthews Hall
University of Waterloo
200 University Ave. West
Waterloo, Ontario, Canada N2L 3G1
519-888-4567, ext. 45513
Authors: Dwayne Van Eerd, Ivan Steenstra, Kim Cullen, Emma Irvin
The global population is aging with a projection that one in five people will be over the age of 60 by 20501. The Canadian population aged 65 and over is expected to double over the next 25 years2. The Canadian workforce is also aging with a large proportion of workers (42.4%) in the 45 to 64 age group in 20113 and the average age of labor market participant predicted to continue to rise until 20314. However, it appears that very few Canadian companies have addressed the impact of an aging workforce on occupational health.
Musculoskeletal disorders (MSD) are a burden to all industrial sectors. They present with pain and symptoms such as numbness and tingling. These symptoms may be warning signs of current or impending MSD, such as peripheral nerve entrapments, peripheral enthesopathies, and many other non-specific musculoskeletal pain disorders such as low back pain5. There are concerns that MSD maybe more prevalent and costly among older workers, although the evidence supporting these concerns is not consistent. However, it would seem prudent for workplaces to consider strategies for healthy aging to address an aging workforce regardless.
The World Health Organization (WHO) recently released their World Report on Ageing and Health which defines healthy aging as “the process of developing and maintaining the functional ability that enables well-being in older age”6. The WHO report provides a framework for healthy aging6. As part of the framework there are proposed strategies for creating age friendly environments that we propose can be adapted and applied to workplaces. The strategies include: i) combating ageism; ii) enabling autonomy, and iii) supporting healthy aging in policy. We suggest that these strategies are valuable for workplaces and by extension MSD and show some supporting research for each of them below.
As part of a scoping review of the literature we present some recent research addressing the WHO strategies and how they may apply to workplaces. We also drew on recent searches for larger ongoing systematic reviews carried out by a team of Institute for Work & Health researchers as part of the prevention review program7, including: aging and return to work8, return to work9 and upper extremity MSD prevention10. Overall, we note that there is a lack of literature evaluating interventions or strategies related to older workers and MSD.
There is much discussion by the Canadian government, the media and the scientific community about ageism in the workplace 1,13,14,15,16,17. One important aspect of ageism is the suggestion of decline in productivity of older workers 11,18,19. While there is a biological plausibility along with support from studies showing reduced physical and cognitive6 capabilities among older persons, the problem lies in whether these reductions in capabilities translate to decreased productivity (or a decreased ability to do one’s work tasks20). Burtless 18 contends that, in fact, older workers may be more productive than their younger counterparts. The link between work ability and aging has been explored since the late 1990s and is complex, encompassing: health/function, education/competence, values/attitudes/motivation, work demands, work community/management/work environment 20,21,22). Although, there are few studies that have explored the link between MSD and aging such as those by Whalin 23,24 and Monteiro 25; it seems there is a growing body of evidence calling this link between aging and MSD into question. Pransky 26 suggests older workers recover from injury more quickly than younger workers. Smith 27 found older workers did not have a higher rate of MSD but they had longer duration of disability, likely due to co-morbid conditions. Smith 28 also found no association between age and the probability of a lost time claim. Guest 29 showed older workers did not sustain more injuries than younger workers in construction jobs. Research on physical demands reveals older workers are not impacted as much as 25-45 year olds 30, nor do older workers consider physical demands as a reason for earlier exit from their jobs 19. More research regarding MSD and aging is required so workplaces/employers can better develop retaining, recruiting and hiring policies regarding older workers. Specific research on fatigue and recovery 31,32,33 should be a priority.
There are studies addressing the impact of autonomy on MSD in older workers. Some studies show benefits when older workers are involved in creating solutions for MSD hazards (among other hazards) 34,35. In addition there are many studies that support increased autonomy for older workers to maintain productivity and assist them in working longer 36,37,38,39. Key approaches related to autonomy include flexible work arrangements and idiosyncratic deals (I-deals) 40,41 . Studies have shown that older workers with more control over their jobs stay at work longer 36,37,38,42. Leijten 43 noted a lack of autonomy resulted in job change that might have been avoided. While not specific to MSD, Bal and colleagues 44 report I-deals are most useful in retaining older workers. The main challenge for enabling autonomy at work is likely related to workplace policies which are usually designed to cover all workers; the I-deal approach could be potentially useful for older workers with MSD.
Supporting policies for healthy aging
The perception that older workers can do less, get injured more and require more resources is unfounded but impacts on workplace policies and practices 11,13. Workplace policies can provide support for healthy aging and older workers. Research examining workplace policies on aging workers show inconsistency regarding support for healthy aging 44,45,46,47. Policies that address ageism 45,47,48,49,50 and those that support autonomy33,35,3839,41,44 are important as noted above. Workplace policies supporting accommodation and development 20,46,51 may be the most useful to address MSD in older workers as they can lead to innovative interventions and programs such as participatory and problem solving approaches 34,35,52, ergonomics 20,53,54 and health promotion approaches 20,55,56. Perhaps the greatest challenge to workplace policy is the heterogeneity among older workers 1,6. Bal 44 suggests that the heterogeneity of older workers is greater than that of younger workers and considers I-deals a key aspect of workplace policy to support healthy aging.
An aging population and workforce is a reality. The link between aging and MSD is not clear and specific research related to strategies to reduce MSD suggests that age is but one of many factors to address. However, current research suggests that supporting healthy aging will be beneficial for productivity as well as society. The results of our scoping review of the literature suggest there are feasible approaches to maintain older workers in the workforce which can be applied to MSD and potentially other health conditions. We suggest that adopting (or adapting) strategies such as those of the WHO are important for workplaces to consider.
- The population is aging globally with a concomittant aging in the available workforce
- A WHO Ageing and Health framework released in 2015 provides strategies for creating environments that support healthy aging that can be adapted for workplaces:
- Combatting ageism: there is inconclusive evidence that MSD are more prevalent in older workers or that older workers are less productive yet these attitudes prevail
- Enabling autonomy: it is clear that increased autonomy can support older workers work longer
- Supporting healthy aging in policies: workplace policies that support accommodation and development are needed
- More research on fatigue and recovery in older workers should be a priority
Implications for the prevention of MSD
It is of the authors’ opinions that the strategies related to creating age friendly environments described by the WHO extend to workplaces. There is little scientific research on solutions for older workers with MSD. However the literature on older workers provides some practical support and direction for workplace solutions that reflect the WHO strategies. Specific research evaluating the implementation of strategies for aging workers is required.
- UN (2012) Ageing in the Twenty-First Century: A Celebration and A Challenge. United Nations Population Fund (UNFPA), New York, and HelpAge International, London
- Statistics Canada. (2010). Estimates of population, by age group and sex for July 1, Canada, provinces and territories, annual (CANSIM Table 051-0001). Ottawa: ON.
- Human Resources & Skills Development Canada. (2011) National occupational classification career handbook. Ottawa, ON: Government of Canada.
- Martel L, Malenfant EC, Morency JD, Lebel A, Bélanger A, Bastien N. (2012) Projected trends to 2031 for the Canadian labour force. http://www.statcan.gc.ca/pub/11-010-x/2011008/part-partie3-eng.htm
- HagbergM, Silverstein B, Wells R, et al. (1995) Work related musculoskeletal disorders (WMSDs): a reference book for prevention. London: Taylor & Francis.
- WHO (2015) World Report on Ageing and Health WHO Press, World Health Organization, Geneva.
- Irvin E, Van Eerd D, Amick BC, Brewer S. (2010). Introduction to Special Section: Systematic Reviews for Prevention and Management of Musculoskeletal Disorders. Journal of Occupational Rehabilitation, 20(2), 123–126.
- Steenstra I, Cullen K, Irvin E, Van Eerd D, Alavinia M, Beaton D, Geary J, Gignac M, Gross D, Mahood Q, MacDonald S, Puts M, Scott-Marshall H, Yazdani A. (2016) A systematic review of interventions to promote work participation in older workers. Journal of Safety Research (submitted).
- Cullen K, Irvin E, Collie A, Palagyi A, Clay F, Gensby U, Jennings P, Hogg-Johnson S, Kristman V, Laberge M, Mckenzie D, Ruseckaite R, Sheppard D, Shourie S, Steenstra I, Van Eerd D, Amick BC. (2016) Workplace-based interventions for improving return to work after musculoskeletal, pain related and mental health conditions: An updated systematic review. Journal of Occupational Rehabilitation (submitted).
- Van Eerd D, Munhall C, Irvin E, Rempel D, Brewer S, van der Beek AJ, Dennerlein JT, Tullar J, Skivington K, Pinion C, Amick B. (2016a) Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence. Occupational and Environmental Medicine Jan;73(1):62-70.
- Lagacé M, Nahon-Serfaty I, Laplante J. (2015) Canadian government's framing of ageing at work and older workers: Echoing positive ageing models. Work. Aug 7;52(3):597-604. doi: 10.3233/WOR-152114.
- Kagan SH, Melendez-Torres GJ. (2015) Ageism in nursing. J Nurs Manag. Jul;23(5):644-50. doi: 10.1111/jonm.12191.
- Malinen S, Johnston L. (2013) Workplace ageism: discovering hidden bias. Exp Aging Res. 39(4):445-65. doi: 10.1080/0361073X.2013.808111.
- Anderson KA, Richardson VE, Fields NL, and Harootyan RA. (2013) Inclusion or exclusion? Exploring barriers to employment for low-income older adults. J Gerontol.Soc Work. 56(4):318-334.
- Desmette D and Gaillard M. (2008) When a "worker" becomes an "older worker": The effects of age-related social identity on attitudes towards retirement and work. Career Development International, 13(2): 168-185.
- Dixon J. (2012) Communicating (St) ageism: Exploring Stereotypes of Age and Sexuality in the Workplace. Research on aging. 34(6):654-669.
- Iweins C, Desmette D, and Yzerbyt V. (2012) Ageism at Work: what Happens to Older Workers Who Benefit from Preferential Treatment? Psychologica Belgica. 52(4):327-349.
- Burtless G. (2013) The impact of population aging and delayed retirement on workforce productivity. Chestnut Hill (MA): Center for Retirement Research at Boston College; (http://crr.bc.edu/working-papers/the-impact-of-population-aging-anddelayed-retirement-on-workforce-productivity/, accessed 10 July 2015).
- Barros C, Carnide F, Cunha L, Santos M, Silva C. (2015) Will I be able to do my work at 60? An analysis of working conditions that hinder active ageing. Work. 51(3):579-90.
- Ilmarinen JE. (2001) Aging Workers. Occupational and Environmental Medicine. 58: 546
- Ilmarinen JE. (2006) The ageing workforce—challenges for occupational health. Occupational Medicine. 56(6); 362-364.
- Ilmarinen J. (2009) Work ability—a comprehensive concept for occupational health research and prevention. Scand J Work Environ Health. 35(1);1-5
- Whalin C, Ekberg K, Persson J, Bernfort L, Öberg B. (2012) Association between clinical and work-related interventions and return-to-work for patients with musculoskeletal or mental disorders. J Rehabil Med 44; 355–362
- Whalin C, Ekberg K, Persson J, Bernfort L, Öberg B. (2013) Evaluation of Self-Reported Work Ability and Usefulness of Interventions Among Sick-Listed Patients. J Occup Rehabil 23;32–43
- Monteiro MS, Alexandre NMC, Ilmarinen J, Rodrigues CM. (2009) Work Ability and Musculoskeletal Disorders Among Workers From a Public Health Institution. International Journal of Occupational Safety and Ergonomics (JOSE)15( 3); 319–324.
- Pransky, G. S., et al. (2005) "Outcomes in work-related injuries: a comparison of older and younger workers." Am.J Ind.Med 47.2: 104-12.
- Smith P, Bielecky A, Ibrahim S, Mustard C, Saunders R, Beaton D, Koehoorn M, McLeod C, Scott-Marshall H, Hogg-Johnson S. (2014a) Impact of pre-existing chronic conditions on age differences in sickness absence after a musculoskeletal work injury: a path analysis approach. Scand J Work Environ Health. 40(2):167-175. doi:10.5271/sjweh.3397
- Smith P et al. (2015) The Relationship Between Worker, Occupational and Workplace Characteristics. American Journal Of Industrial Medicine. 58:402–410.
- Guest M, Boggess MM, Viljoen DA, Duke JM, Culvern CN. (2014) Age-related injury and compensation claim rates in heavy industry. Occup Med (Lond). Mar;64(2):95-103. doi: 10.1093/occmed/kqt166.
- Smith PM, Berecki-Gisolf J. (2014b) Age, occupational demands and the risk of serious work injury. Occupational Medicine. Aug 28. doi:10.1093/occmed/kqu125
- Riethmeister V, Brouwer S, van der Klink J, Bültmann U. (2016) Work, eat and sleep: towards a healthy ageing at work program offshore. BMC Public Health.16(1):134.
- Clendon J, Walker L. (2016) The juxtaposition of ageing and nursing: the challenges and enablers of continuing to work in the latter stages of a nursing career. J Adv Nurs. Jan 18. doi: 10.1111/jan.12896.
- Bos JT, Donders NCGM, Schouteten RLJ, and Van der Gulden JWJ. (2013) Age as a moderator in the relationship between work-related characteristics, job dissatisfaction and need for recovery. Ergonomics. 56(6):992-1005.
- Steenstra IA, Knol DL, Bongers PM, Anema JR, van Mechelen W, de Vet HC. (2009). What works best for whom? An exploratory, subgroup analysis in a randomized, controlled trial on the effectiveness of a workplace intervention in low back pain patients on return to work. Spine, 34(12), 1243-9.
- Koolhaas W, Groothoff JW, de Boer MR, van der Klink JJ, Brouwer S. (2015) Effectiveness of a problem-solving based intervention to prolong the working life of ageing workers. BMC Public Health. 2015 Feb 4;15:76. doi: 10.1186/s12889- 015-1410-5.
- Ng TWH and Feldman DC. (2015) The Moderating Effects of Age in the Relationships of Job Autonomy to Work Outcomes. Work Aging and Retirement. 1(1):64-78.
- Vantilborgh T, Dries N, de Vos A, and Bal PM. (2015) The psychological contracts of older employees. In Bal, P. Kooij, DTAM, Rousseau DM. (Eds.) Aging Workers and the Employee-Employer Relationship. Switzerland: Springer. DOI 10.1007/978-3-319-08007-9_7
- Binnewies C, Ohly S, and Niessen C. (2008) Age and creativity at work - The interplay between job resources, age and idea creativity. Journal of Managerial Psychology. 23(4):438-457.
- Leijten FRM, van den Heuvel SG, van der Beek AJ, Ybema JF, Robroek SJW, and Burdorf A. (2015) Associations of Work-Related Factors and Work Engagement with Mental and Physical Health: A 1-Year Follow-up Study Among Older Workers. Journal of Occupational Rehabilitation. 25(1):86-95.
- Clendon J, Walker L. (2015) Nurses aged over 50 and their perceptions of flexible working. J Nurs Manag. Jun 28. doi: 10.1111/jonm.12325.
- Atkinson C and Sandiford P. (2016) An exploration of older worker flexible working arrangements in smaller firms. Human Resource Management Journal, 26(1): 12–28.
- Schreurs B, Van den Broeck A, Notelaers G, van der Heijden B, and De Witte H. (2012) The relationship between job demands, job resources, strain, and work enjoyment: a matter of age? Gedrag & Organisatie. 25(1):5-27.
- Leijten F, van den Heuvel S, Geuskens G, Ybema JF, de Wind A, Burdorf A, Robroek S. (2013) How do older employees with health problems remain productive at work?: a qualitative study. J Occup Rehabil. 2013 Mar;23(1):115-24. doi: 10.1007/s10926-012-9390-0.
- Bal PM and Jansen PGW. (2015) Idiosyncratic deals for older workers: Increased heterogeneity among older workers enhance the need for I-deals. In Bal, P. Kooij, DTAM, Rousseau DM. (Eds.) Aging Workers and the Employee-Employer Relationship. Switzerland: Springer. DOI 10.1007/978-3-319-08007-9_8.
- Nilsson K. (2016) Conceptualisation of ageing in relation to factors of importance for extending working life - a review. Scand J Public Health. 2016 Mar 14. pii: 1403494816636265.
- van Dalen HP, Henkens K, Wang M. (2015) Recharging or Retiring Older Workers? Uncovering the Age-Based Strategies of European Employers. Gerontologist. Oct;55(5):814-24. doi: 10.1093/geront/gnu048.
- Timmons JC, Hall AC, Fesko SL, Migliore A. (2011) Retaining the older workforce: social policy considerations for the universally designed workplace. J Aging Soc Policy. Apr;23(2):119-40. doi: 10.1080/08959420.2011.551623.
- Bonnet-Belfais M, Cholat JF, Bouchard D, Goulfier C, Casselle A, Schram J. (2014) How to integrate the aging of employees into occupational health policies: the approach of a French company. Work. 49(2):205-14. doi: 10.3233/WOR-131651.
- Schermuly CC, Deller J, and Busch V. (2014) A research note on age discrimination and the desire to retire: the mediating effect of psychological empowerment. Res Aging. 36(3):382-393.
- Hertel G, van der Heijden BIJM, de Lange AH, and Deller J. (2013) Facilitating age diversity in organizations-Part I: Challenging popular misbeliefs. Journal of Managerial Psychology. 28(7/8): 729-740.
- Findsen B. (2015) Older Workers' Learning Within Organizations: Issues and Challenges. Educational Gerontology. 2015; 41(8):582-589. Doi 10.1080/03601277.2015.1011582
- Van Eerd D, Cole DC, Steenstra IA. (2016b) Chapter 16: Participatory ergonomics for return to work. In: Schultz, IZ., Gatchel, RJ., editors. Handbook of return to work: from research to practice. New York: Springer; p. 289-305.
- Stedmon AW, Howells H, Wilson JR, Dianat I. (2012) Ergonomics/Human Factors Needs of an Ageing Workforce in the Manufacturing Sector. Health Promotion Perspectives 2(2); 112-125.
- Gonzalez I, Morer P. (2016) Ergonomics for the inclusion of older workers in the knowledge workforce and a guidance tool for designers. Appl Ergon. Mar;53 Pt A:131-42. doi: 10.1016/j.apergo.2015.09.002.
- Pitt-Catsouphes M, James JB, Matz-Costa C. (2015) Workplace-based health and wellness programs: the intersection of aging, work, and health. Gerontologist. Apr;55(2):262-70. doi: 10.1093/geront/gnu114.
- Hughes SL, Seymour RB, Campbell RT, Shaw JW, Fabiyi C, Sokas R. (2011) Comparison of two health-promotion programs for older workers. Am J Public Health. May;101(5):883-90. doi: 10.2105/AJPH.2010.300082.
Last updated: 2016
Disclaimer: Position papers are funded by the Centre of Research Expertise for the Prevention of Musculoskeletal Disorders, which receives funding through a grant provided by the Ontario Ministry of Labour. The views expressed are those of the authors and do not necessarily reflect those of the Centre nor of the Province.