This
essay was the notes for the PowerPoint CQU presentation with my study partner in
August 2012. Growing older myself has increased my thoughts from years ago. The
government does not seem to seriously think about old age, but flicks it off
Old Age
is not a Work-Related Illness
July 2012
In May 2009
the Government announced in the Federal Budget that the pension age would
gradually be increased to 67 by 2023. That, along with the financial crises in
global markets, is now seeing an unprecedented number of baby boomers either
remaining in work or returning to work.
Australia’s
population is ageing faster than we can keep up with it. The statistics are
scary. 47A 2004 Treasury report noted that while there were more than 5 working
age people to support each person over 65 in 2002, by 2042 25% of the entire
population will be over the age of 65 and there will only be 2.5 working age
people supporting each one of them.
To
accommodate this phenomenon, Governments have to look carefully towards the
future to try to develop policies which will integrate rather than alienate an
elderly population. They would do well to start by looking at worker’s
compensation schemes and the potential for wide scale misuse to provide medical
treatment of the kind that was never the intention of the schemes.
While
Australia was reasonably well placed in 2005 at 13th in the OECD for
participation rates of workers over 55, COAG noted in 2006 that more people
needed to enter or rejoin the workforce to avoid laying the burden on a
shrinking number of people. Three years later the Bureau of Statistics reported
that in 2007 only 40% of people aged 45 and older worked in paid employment.
The growing
numbers of older people in the workforce is presenting a new challenge in the
management of workplace health and safety.
The Safety Rehabilitation and Compensation Commission in 2009 suggested
that older workers have more accidents, and, according to Berecki-Gisolf et al
in a 2012 paper produced for Work Cover Victoria, “A consequence of an ageing
workforce is an expected overall increase in time off work due to work-related
injury or disease.”
The National
Occupational Health and Safety Commission in 2004 clearly defined “occupational
injuries” and “occupational diseases”, but these definitions don’t appear to
have made it into the various States’ Worker’s Compensation legislation in the
same form. The Queensland Workers’ Compensation and Rehabilitation Act 2003
defines an injury as “personal injury arising out of, or in the course of,
employment if the employment is a significant contributing factor to the
injury”, and also includes aggravation of an injury, disease or medical
condition “if the aggravation arises out of, or in the course of, employment
and the employment is a significant contributing factor to the aggravation”.
What
confounds and confuses the matter of “aggravation” is section 32(4), which says
“to remove any doubt, it is declared that an aggravation mentioned in the
provision is an injury only to the extent of the effects of the aggravation.”
Over the last
several decades society has developed an understanding regarding the
relationship between sedentary lifestyle and many chronic degenerative
disorders. Woolf-May (2006) echoes the finding of many large epidemiological
studies that found physical activity can reduce an individual’s risk of
developing many of the following degenerative disorders that are often
associated with the aging process.
Physiological
& Biochemical
Onset of
Arthritis
Onset of
Osteoporosis
Decrease in
Cardiac index
Decrease in
nerve conduction velocity
Decrease in
acuity of senses
Cardiorespiratory
Decrease in
VO2 uptake
Increase in
cardiovascular disease
Increase in
hypertension
Muscular
Decrease in
strength
Decrease in
size of muscle fibres
Decrease in
Fast twitch fibres
Others
Susceptibility
to anxiety
Increase in
reaction and movement times
Roy Shephard
(1997 p.61) associated aging with progressive increase in body fat content, a
decrease in lean muscle mass, atrophy of skeletal muscles, a loss of bone
mineral and often a restriction of joint mobility. Aging is inevitable; however
the rate of decline can be significantly inhibited by the physical activity
level of individuals.
Berecki-Gisolf’s
analysis of Victorian worker’s compensation claims identified that both the
incidence and duration of work disability increased with age, and “50- to
54-year old persons had on average 5.7 times as many WorkSafe-covered
compensated workdays as 15- to 19-year olds”.
Of concern,
then, for older workers, employers and Work Cover is the natural progressive
degeneration of age-related and pre-existing conditions, such as arthritis
or osteoporosis and musculoskeletal conditions, asthma, cancer, cardiovascular
disease, diabetes, injury, mental health and obesity which are the 8 National
Health Priority Areas. Not mentioned as an NHPA is
hearing loss, which in many jurisdictions has accounted for an increase in
claims. In the SA study “there was a
strong and positive relationship between degree of hearing loss and average
cost per claim. The median lump sum claim was $7,778 and of hearing aids was
$5,860.”
WorkCover routinely accepts claims as “aggravation of
a pre-existing condition”, but while the cover under legislation is to the extent
of the aggravation that is almost impossible, in many instances, to
identify let alone to treat.
The
definition in the legislation, rather than the NOHSC definition, of
“occupational injuries” and “occupational diseases”, leaves the door wide open
for claims that an aggravation of a pre-existing condition happened at work,
even when the circumstances of the condition are such that an aggravation could
have happened at any time, any place. I would not think that the intention
of worker’s compensation was ever to provide medical treatment for age related
conditions.
Cardiorespiratory
- VO2 max is a widely
used index for cardio-pulmonary fitness. It is calculated by using the Fick
equation of Co x a-vo2 difference. Authors Taylor & Johnson describe a
linear reduction between the ages of 30-65yrs. Suggesting that sedentary
individuals Vo2 max declines at a rate of 10% per decade after the age of
25yrs.
Diabetes –
In regards to type II
Diabetes age is a primary factor. It is recommended that individuals over the
age of 45yrs should have annual check-ups for the disease. A second and ever increasing
factor for type II diabetes is obesity. Taylor & Johnson state that the
number of people with Type II diabetes in the unhealthy weight range is double
that of the population without diabetes.
Obesity - McAdle, Katch and Katch (2007, 845) associate
obesity with hypertension, elevated blood sugar, postmenopausal breast cancer.
Being overweight or obese increases an individual’s risk of musculoskeletal
problems, complications from osteoarthritis. The increased weight causes joint
pain, reduction in mobility and inefficiency in body movement, and is a primary
risk factor for cardiovascular disease.
The American
College of Sport Medicine sets out a risk stratification based on the presence
or absence of the CAD risk factors set out below. The risk factors are a group
of clinically relevant thresholds that should be considered collectively when
making decisions about the level of medical clearance required for exercise
testing and prescription. The following was taken from the ASCM (2006 p.22) Table
2-2 Coronary Artery Disease Risk Threshold for use with the ACSM Risk
Stratification.
Family
History - Myocardial infarction, coronary revascularization, or
sudden death before 55 years of age in father or other male first-degree
relative (i.e. brother or son), or before 65 years of age in mother or other
female first-degree relative (i.e. sister or daughter)
Cigarette smoking - Current
cigarette smoker or those who quit within the previous six months
Hypertension - Systolic blood
pressure of >140 mmHg or diastolic >90 mmHg, confirmed by
measurements on at least two separate occasions, or on antihypertensive
medication
Dyslipidemia - Total serum
cholesterol of >200 mg/dL or HDL or, 40 mg/dL, or on lipid-lowering
medication. If LDL is available, use
>130 mg/dL rather than total cholesterol of >200 mg/dL
Fasting Glucose - Fasting blood
glucose of >110 mg/dL confirmed by measurements on at least two
separate occasions.
Obesity - Body mass
index of >30 kg/m2, or waist girth of >40 inches (102 cm) in men
and >35 inches (89 cm) in women.
Sedentary Lifestyle - Persons not
participating in a regular exercise program or meeting the minimal physical
activity recommendations from the US Surgeon General’s report.
The risk
stratification is used with the ACSM Pre-Participant screening algorithm for an
individual that scores a moderate risk the ACSM TABLE 2-1 (2006 p.20)
recommends “Medical examination and exercise testing prior to initiation of
vigorous training.” According to Woolf-May this would equal daily accumulation
of 30 min or more of physical activity greater than 60% Vo2max. However the
ACSM suggests between 80-90% of Max Heart Rate.
World
Health Report (WHO
2002) indicated that 60% of the world’s population are not active enough to
benefit their health.
According to
Kate Woolf–May in her Book for Exercise Prescription, “A Guide for health,
sport and exercise professional” (2006 p.3), the US and UK governments now
recommend the daily accumulation of 30 min or more of moderate-intensity
physical activity.(40-60% Vo2max) for most health adults this is equivalent to
a brisk walk around 4.8-6.4 k/hour.
The medical
profession has a tendency to medicalise everyday conditions, and worker’s
compensation makes it easy for that to happen. All a worker needs to say is it
“happened at work”. So person with a degenerative back condition, scoliosis for
instance, may claim they felt a twinge when doing their normal work, and their
condition worsens until they require time off. What the medical professionals
fail to make clear is that exactly the same result could have come about from
something as simple as bending to feed the cat at home.
Low et al
(2006) noted “Research in the United States has shown that physicians’
recommendations about limiting activity and work after musculoskeletal injury
are often influenced by patients’ requests. It is likely that the situation is
no different in Australia.”
The recent
changes to the NSW Work Cover legislation included removing stroke and heart
attack as compensable claims unless there was a definitive and significant
connection to work. The authors of those
changes argued that coverage for strokes and heart attacks, which were not
normally associated with workplace injuries, was not consistent with the principles
of workers’ compensation. “It has been suggested this would provide a closer
connection between work, health and safety responsibilities and workers
compensation premiums through eliminating workers compensation costs arising in
circumstances over which employers have limited control.”
Barnett et al
(2008), undertaking research for the South Australia WorkCover Corporation,
pointed out that because heart and lung capacity tends to decline with age, the
tasks undertaken by older workers may need to be revised to take account of
lower speed, intolerance of extremes of temperature and increased recovery time
after physical exertion.
S M Hangai et
al (2008) concluded in the study of “Factors associated with lumbar
intervertebral disc degeneration in the elderly” that aging, cardiovascular risk
factors, particular physical lifting and sports activity were associated with
disc degeneration. Participants in the study were aged between 51-86 years old.
Another study
by Michele C. Battie et al (2008) The
Twin Spine Study: Contributions to a changing view of disc degeneration
found “Among the most significant findings were a substantial influence of
heredity on lumbar disc degeneration”, noting surprisingly little disc
degeneration associated with occupational and leisure time physical loading and
factors such as BMI, muscle strength and smoking having a greater effect. No
evidence was found to suggest exposure to whole body vibration through
motorised vehicle leads to accelerated disc degeneration.
As noted in a
submission in response to the Australian Law Reform Commission Issues Paper 41,
the country needs to break down the barriers and get mature workers into the
workforce, not “inadvertently create disincentives for employers to employ
them”.
Workers
compensation legislation, in its present form, is neither equitable nor
sustainable long term unless changes reflect a moving away from acceptance of
degenerative and age related claims for everyday conditions and a return to the
original intention of the scheme.
References
Abhayaratna, J. and Lattimore, R. 2006. Workforce Participation Rates — How
Does Australia Compare?, Productivity
Commission Staff Working Paper, Canberra
Ai Group. 20 June 2012. Submission in response to the ALRC Issues Paper 41,
Grey Areas – Barriers to Work in Commonwealth Laws
Albert, W.A. and M, J, Michel. 2008. Physiology of Exercise and Healthy
Aging. United States of America: Human Kinetics.
American College of Sport Medicine [ACSM]. 2006. Guidelines for
Exercise Testing and Prescription. Seventh Edition. USA: Lippincott
Williams & Wilkins.
Australian Bureau of Statistics. 2009. Australian Social Trends 4102.0
Barnett, K., Spoehr, J. & Parnis, E. July 2008. Ageing and
capacity to work: research findings, The Australian Institute for Social
Research, prepared for The South Australian WorkCover Corporation
Battie, M. C., T. Videman, J. Kaprio, L. E. Gibbons, K. Gill, H. Manninen, J.
Saarela, L. Peltonen. 2009. The Twin Spine Study: Contributions to a changing
view of disc degeneration. The Spine Journal (9): 47-59.
Berecki-Gisolf, J., Clay, F.J., Collie, A., McClure, R.J. 2012. Insights
from Workers’ Compensation claim records - Full article published in J
Occup Environ Med. 54(3):318–27
Commonwealth of Australia. 12 May 2004.
Budget Overview, p23
Commonwealth of Australia. 2004. Australia’s Demographic Changes
Exploring the Impact of an Ageing Workforce on the South Australian
Workers’ Compensation Scheme: Chapter 3
Hangai, M., K. Kaneoka, S. Kuno, S. Hinotsu, M. Sakane, N. Mamizuka, S. Sakai
and N. Ochiai. 2008. Factors associated with lumbar intervertebral disc
degeneration in the elderly. The Spine Journal (8):732-740.
Low, John MBBS, GradDipOHS, FAFOM Lai; Roger, MBBS, GradDipOHS and Connaughton;
Peter MBBCh, LRCP&SI, FAFOM,CIME. December 2006. Back injuries: Getting
injured workers back to work, Australian Family Physician Vol. 35, No. 12
McArdle, W, D,.F,I, Katch and V, L, Katch 2007. Exercise Physiology: Energy,
Nutrition & Human Performance. Sixth Edition. USA: Lippincott Williams
& Wilkins.
NSW Workers Compensation Scheme. 2012.
Issues Paper
Safety Rehabilitation and Compensation Commission. December 2009. Compendium
of OHS and Workers’ Compensation Statistics
Shephard, R,J. 1997. Aging, Physical Activity, and Health. United States
of America: Human Kinetics.
Woolf-May, K.2006. Exercise Prescription, Physiological Foundations: A Guide
for health, sport and exercise professionals. Philadelphia, USA: Elsevier.
Workers’ Compensation and Rehabilitation Act 2003
