Old age and work

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 13^th 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