AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 51:269–280 (2008)

Review

Meeting the Challenges of an Aging Workforce

Michael Silverstein, MD, MPH

Background Demographic, labor market and economic forces are combining to produce
increases in the number and percentage of U.S. workers 55 and older. In some ways these
workers will be our most skilled and productive employees but in others the most
vulnerable.
Methods The literature on aging and work was reviewed, including demographic trends,
physical and cognitive changes, safety and performance, work ability, and retirement
patterns.
Results and Conclusions Older workers have more serious, but less frequent, workplace
injuries and illnesses than younger ones. There is evidence that many of these problems can
be prevented and their consequences reduced by anticipating the physical and cognitive
changes of age. Many employers are aware that such efforts are necessary, but most have
not yet addressed them. There is a need for implementation and evaluative research of
programs and policies with four dimensions: the work environment, work arrangements
and work-life balance, health promotion and disease prevention, and social support.
Employers who establish age-friendly workplaces that promote and support the work
ability of employees as they age may gain in safety, productivity, competitiveness, and
sustainable business practices. Am. J. Ind. Med. 51:269–280, 2008. ß 2008 Wiley-Liss, Inc.

KEY WORDS: aging workforce; work ability; prevention; human factors; older
workers

INTRODUCTION in 1984, rose to 40.3 in 2004 and is expected to reach 41.6 by

2014. The number of those in the workforce who are 55 and
Two simultaneous demographic changes have begun to older will increase by 49% from 2004 to 2014. Their
produce a marked growth in the number and percent of older proportion is also growing, from 11.9% in 1994 to 15.6% in
workers (those 55 and older) in American workplaces. First, 2004 to 21.2% expected in 2014 [Toossi, 2005].
the enormous birth cohort born between 1946 and 1964 has
started to crest past the age of sixty. Second, the twentieth OUR AGING WORKFORCE
century trend toward earlier retirement has reversed and
growing numbers of employees are planning longer working Prior to the passage of the Social Security Act in 1935
careers. As a result, the median age of the civilian labor force work did not typically end with a planned retirement.
(those working or looking for work), which had dropped to 35 Average retirement (meaning the age at which 1/2 of workers
from an initial age cohort remain in the workplace) was age
70 or more for men. After World War II there was a need
Department of Environmental and Occupational Health Sciences, University of Washing- to open the workplace to growing numbers of unemployed
ton School of Public Health and Community Medicine, Seattle,Washington younger workers, particularly veterans. Also retirement
*Correspondence to: Michael Silverstein, Clinical Professor, Department of Environmental
and Occupational Health Sciences, 4225 Roosevelt Way NE, Suite100, Seattle,WA 98105. leisure was becoming a symbol of success. Social security
E-mail: [email protected] and private pension policies were designed to encourage
earlier departures from work. In 1961, for example, Congress
Accepted 3 January 2008
DOI 10.1002/ajim.20569. Published online in Wiley InterScience lowered the age men were eligible for unreduced Social
(www.interscience.wiley.com) Security benefits from 65 to 62. Average retirement dropped

2008 Wiley-Liss, Inc.

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270 Silverstein

from age 70 in 1950 to age 65 in 1970 with age 62 becoming labor and income of large numbers of young workers
the norm by 1985 [Quinn, 2002; Cahill et al., 2005]. supporting the retirement needs of smaller numbers of
Despite this long trend toward earlier retirement since disabled and retired workers and their dependents. In 2005
the 1940s, the 78 million baby boomers born between 1946 for every person 65 and older there were five people aged 20–
and 1964 comprise such a large group that there are more 64 (i.e., an old age dependency ratio of 20%). The Social
workers in their fifties and sixties on the job than ever before. Security Administration estimates that by 2080 this ratio will
As they leave the workforce, whether at age 55, 62, 65 or more than double, to more than 40%, with only 2.5 younger
later, there will also be more retirees than ever before. To people for every older one (Fig. 2). Not only will the number
complete the picture, as these baby boomers age at work and of retirees grow, but their life expectancy and associated
then leave for retirement, they are followed by a substantially duration of retirement is increasing as well. While private
smaller younger generation, the baby bust of 1965–1976 pension systems are theoretically fully funded at the time the
(Fig. 1). commitment is made to provide the future benefit, in fact this
The enormous economic and labor market consequences is often not fully realized. Underfunded pension programs in
of this demographic transformation are becoming clear. In both the private and public sectors are now common, the
the State of Washington, for example, 29% of employed federal assurance program for these pensions is not robust,
workers were 45 or older in 1995. This had grown to 39% by and these pensions may also be jeopardized by these
2005 [Kaglic, 2005]. This growth is not being matched by changing demographics. Although the impact of the growing
younger workers. By 2015 there will be 115,000 more 60- to dependent older population will be somewhat mitigated by
64-year olds and 30,000 fewer 40- to 44-year olds in the lower fertility rates which reduce the numbers of the very
Washington State labor force (those who are either employed young who are also dependent on the working age population
or seeking employment) than there were in 2005 [Bailey, [Burtless, 2005], this will not offset the profound economic
2006]. Nationally, from 2004 to 2014, ‘‘the labor force will consequences of the demographic trends.
continue to age, with the annual growth rate of the 55-and-
older group projected to be 4.1%, four times the rate of STAYING ON THE JOB LONGER
growth of the overall labor force. By contrast, the annual
growth rate of the 25- to 54-year age group will be 0.3%, and As these trends progress—more older workers moving
that of the young age group consisting of 16- to 24-year olds toward retirement with fewer younger replacements—
will be essentially flat’’ [Toossi, 2005]. substantial pressure on our social security and pension funds
As these older workers move into retirement the direct will accompany the anticipated shortages of labor and skills.
impact will be a tighter labor market and a shortage of various Public and private employment policies will almost certainly
skills. According to the International Brotherhood of evolve to encourage workers to stay on the job longer. Other
Electrical Workers by 2010 as many as 60% of today’s factors creating incentives to stay at work longer include the
experienced utility workers will retire [IBEW, 2005]. need for private health insurance until at least the age of 65 in
Similarly, the average age of hospital caregivers today is the face of relentlessly rising health care costs and the
about 45, with 70% of the hospital workforce eligible to retire increasing uncertainty about pension benefits that comes
over the next 20–25 years [Briley and Hutson, 2002]. with the trend from defined benefit private pension plans shift
The indirect, but equally profound, impact of the toward defined contribution programs.
demographic changes will be economic. The integrity of Some of the expected policy changes are already
our federal social security system has depended upon the evident, including the 1978 and 1986 amendments to the

FIGURE 1. Growth of U.S.Workforce 2002 ^2012. FIGURE 2. Oldage dependencyratio (age 65þ/age 20 ^64).
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Protecting the Aging Workforce 271

Age Discrimination in Employment Act of 1967 [ADEA, artery disease), aging brings changes to all parts of the body,
1967] which have largely eliminated mandatory retirement from decline in brain cell connections to decrease in
ages, the gradual increase in the age for full social security muscle mass. Maximum physical strength is at age 20–30,
benefits from 65 to 67, and a relaxation of the social security gradually declining until 40–50 and more quickly thereafter
retirement earnings test so that workers can stay on the job [Millanvoye, 1998]. Bone density, pulmonary oxygen
longer without a loss of benefits. The Pension Protection Act uptake, exercise capacity, visual acuity, resistance to heat
of 2006 has made it easier for senior employees to phase their and cold stress, and many other physiologic functions decline
retirement plans by starting to draw pension income without predictably with age. The prevalence of work-limiting
penalty while they continue to work full or part time past age disabilities increases with age, from 3.4% of workers aged
62 [PPA, 2006]. 18–28 to 13.6% of those greater than 60, according to the
These changes are probably not enough. Business Week 1994 National Health Survey [National Research Council,
magazine, for example, predicts that social security’s normal 2004].
retirement age will incrementally rise to 70 [Coy and Brady, The impacts of age on cognitive function are more
2005]. This, however, is not certain since along with complicated. Some mental processes such as those requiring
predictable political opposition many actuaries assume that spatial abilities, problem solving, and processing of complex
raising the retirement age would result in an increasing stimuli are especially age sensitive. Cross sectional data sets
number of older people applying for Social Security suggest declines in these domains beginning as early as 20–
disability benefits, thus offsetting the possible savings from 30 years old, while the onset is a bit later for longitudinal
the raised retirement age. studies. Performing multiple simultaneous tasks or holding
The impact of these developments is already apparent. multiple items in working memory are examples of these age
While the labor force participation rate among 65-year-old dependent processes. Psychologists distinguish these ‘‘fluid’’
men dropped from 70% in 1940 to only 32% in 1985 functions which involve processing input at the time of
[National Research Council, 2004] this trend shows signs of performance from other ‘‘crystallized’’ cognitive functions
reversing as the incentives for early retirement are beginning which are the cumulative results of earlier processing and are
to soften. From 1985 to 2004 the labor force participation rate better preserved with age. The ‘‘crystallized’’ knowledge of
of 25- to 54-year olds stayed essentially stable (fluctuating word meaning or the ability to retrieve familiar information,
between 82% and 84%) while the rate among 55- to 64-year for example, is relatively age stable. In addition to these
olds increased consistently from 54% to 62% [Toossi, 2005]. crystallized semantic skills, memory for procedural skills
This trend is likely to continue, as signaled by a May, 2005 such as typing, which relies on early learning, is also
Gallup survey showing that the percent of people planning to relatively well maintained with age [National Research
put off retirement until after age 62 had risen from 35% in Council, 2004].
1998 to 55% in 2004. The Bureau of Labor Statistics projects While age-related changes in mental and physical
that the percent of older workers staying on the job will function are inevitable, they do not invariably lead to
continue to rise at least through 2014, even without major incapacity or reduced performance and productivity at work.
changes in social policy such as further increases in full While many older workers with illnesses or limitations leave
social security retirement age. the workforce a considerable number remain on the job.
Seitsamo and Klockars [1997] followed a group of 4,534
Finnish municipal workers over an 11-year period. 37% had
PHYSICAL AND COGNITIVE a self-reported musculoskeletal disorder and 17% had a self-
CHANGES OF AGING reported cardiovascular disease at baseline (with mean age of
50). Prevalence of self-reported musculoskeletal disorders
In some ways older workers are the most skilled and rose to 51% and cardiovascular diseases to 31% at 11 years
productive employees but in others they are the most (with mean age of 61.6). Twenty percent of the cohort
vulnerable. Employers who do not anticipate the physical remained in the same occupation throughout the study period
and cognitive capacities of older workers and who fail to and workers in this subgroup had a prevalence of 45% for
provide the programs and policies needed to support their self-reported musculoskeletal disorders and 23% for self-
productive capacities and minimize their vulnerabilities will reported cardiovascular diseases after 11 years. Forty-five
experience adverse impacts on quality, productivity, work- percent of the cohort had retired due to old age and their
place safety, and workers’ compensation. prevalence of musculoskeletal and cardiovascular diseases
Older workers differ from their younger counterparts in was no different from their counterparts who remained at
several important ways that might have an impact on their work. Disease prevalence was higher, however, among those
safety and health at work. Whether these are normative who had retired due to disability. The fact that many workers
effects of aging (e.g., loss of visual acuity) or age dependent with chronic diseases remain at work is probably because the
increases in various ‘‘abnormal’’ conditions (e.g., coronary health conditions are not severe, the need to work outweighs
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272 Silverstein

other incentives, they have strong social support and coping ships in a study of work injuries by noting that skills and
skills, or their job duties or work environment are modified. experience can compensate for age-related physical and
There are other important reasons that workers, even cognitive declines only when the job demands remain lower
with diminished physical or cognitive function, may than overall work capacity and that this compensation is
continue to work effectively as they age. First, most jobs do not feasible when work organization and working methods
not require performance at full capacity even for older are rigid.
workers, although in general older people work closer to their
physical limits than younger workers. Second, while various SAFETY AND PERFORMANCE
physical and cognitive capabilities decline with age, there is AMONG OLDER WORKERS
great inter-individual variation in these normative trends, it
being ‘‘axiomatic in gerontology that most general physio- Since aging is associated with reduced physical capacity
logical and biological functions in older persons tend to and brain function, we might predict aging to be associated
have greater variation than in younger persons’’ [National with poor performance, particularly because many of the
Research Council, 2004]. Third, older individuals can often functions that decline with age—like the ability to solve
compensate for age-related losses with relatively age stable abstract problems—are strong predictors of initial job
strategies and skills related to their experience and expertise, performance. But, with the exception of certain jobs with
although the relationships are complex and the literature is exceptionally high cognitive demands like air traffic
mixed [Morrow et al., 1994; Meinz and Salthouse, 1998; controllers, most studies have not found an age trend in
Charness et al., 2001]. measures of job performance [Waldman and Avolio, 1986;
Salthouse [1987] notes a ‘‘discrepancy between the McEvoy and Cascio, 1989; Avolio et al., 1990]. Duration
rather pessimistic results of the laboratory and the more tends to be a better predictor of performance than age and
encouraging observations of daily life’’ and offers several variations within age groups tend to exceed the average
possible explanations. First, people sometimes are able to differences between age groups. McEvoy and Cascio [1989]
select into work or other activities as they age that match point out that those who continue to work after normal
their competence. Second, the artificial nature of laboratory retirement age are probably not average workers and that
tests of physical and cognitive capacity may result in low selective retention may partially explain why performance
motivation and high anxiety that result in diminished does not tend to decline with age. Not surprisingly, findings
performance. Third, laboratory tests of cognition may vary depending on the nature of the work. Warr [1994]
measure age-sensitive fluid capacities while daily activities proposes four types of jobs, depending on whether their
are more likely to utilize age-preserved crystallized cogni- physical and cognitive requirements exceed capacities as
tion. Fourth, experience is more of a factor in daily activities workers age and whether performance on the job is enhanced
than in most laboratory settings. with experience. Performance is expected to diminish with
The ability to work successfully with increasing age is age in only those jobs where capacities decrease with age and
thus the integrated result of many factors. For example, older experience provides little advantage (e.g., unskilled manual
typists have been shown to have slower tapping rates and labor or fast paced data processing). In many others where
reaction times, but are able to compensate for declining capacities are maintained with age and experience enhances
motor speed by using experience to scan characters further in performance, the relationship between performance and age
advance than younger, less experienced typists [Salthouse, is expected to be positive. Warr [1994] provides several
1984; Bosman, 1993, 1994]. Similarly, despite significant examples of such ‘‘age enhanced’’ jobs, including mail
age-related declines in the cognitive ability to recall short sorters, shoe leather cutters and sales workers.
musical melodies, at every age those with musical experience In addition to their generally satisfactory performance,
and skills tend to maintain their advantage in musical older workers experience lower overall rates of non-fatal
memory over those with less experience and skill [Meinz and work-related injury and illness compared with younger
Salthouse, 1998; Meinz, 2000]. Based on a comprehensive workers. In the 1988 National Health Interview Survey
review Salthouse [2006] has concluded that while many Supplement on Occupational Health and Safety, men greater
types of cognitive and physical performance are improved at than 50 averaged half the lost workday injury rate of men
all ages with training and practice, this does not appear aged 30–49 [Landen and Hendricks, 1992]. In a review of
to change the rate at which capability declines with age. In 13 studies Laflamme and Menckel [1995] report ‘‘the most
other words training, practice and experience can enhance common finding is that accident frequency tends to decrease
performance at older ages and can often result in older as age increases.’’ The reasons for this positive experience are
workers outperforming younger ones, despite the fact that not fully understood. While experience, skill and maturity of
age-related declines continue at the same rate as they do in older workers may play a role, Rix [2001] notes another
workers with less experience and practice. Laflamme and plausible explanation to be systematic differences in the
Menckel [1995] have summarized these complex relation- exposures to hazards of different age groups. While overall
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Protecting the Aging Workforce 273

injury rates are low, there is evidence that some subgroups of each week. The difference persisted after stratifying by type
older workers with pre-existing problems may be vulnerable of injury and industry. The rate of machinery-related
to higher workplace injury rates and a variety of adverse deaths among males in retail trade was nearly seven times
outcomes. Zwerling et al. [1998a,b] report that poor eyesight greater among older workers and for machinery-related
and hearing is associated with occupational injuries among deaths among males in transportation was nearly nine times
older workers. greater. Agnew and Suruda [1993] also found an increased
Although injury rates are generally low, the impact of rate of fatal falls among workers after the age of 45. This was
workplace injury among older workers has been found particularly noted among falls from lower heights with lower
disproportionately high in most studies [Mitchell, 1988; energy of impact, suggesting that ‘‘once a fall has occurred
Layne and Landen, 1997; Layne and Pollack, 2004]. older workers are more vulnerable to serious injury than
Laflamme and Menckel [1995] note the most common younger counterparts.’’
finding in nine studies reviewed to be that ‘‘age-related There are two likely reasons for the increasing impact of
accident severity tends to increase with age.’’ According to injury with age. First, the types of injuries sustained by older
the Bureau of Labor Statistics, the median duration of workers tend to be more severe; fractures accounting for a
absence from work due to a work injury increases substantially greater percentage of non-fatal injuries among
consistently with age, from 5 days among those less than older workers compared with younger ones, while the
25–12 days for those aged 55 and older [Rogers and percentage of strains and sprains decreases with age. For
Wiatrowski, 2005] (Fig. 3). Laflamme et al. [1996] found example, 20% of injuries to older truck drivers are from
lower injury rates but greater case severity among older male fractures, compared with only 9.3% of injuries to all truck
Swedish iron-ore miners. The literature has not been drivers [Rogers and Wiatrowski, 2005]. Second, for the same
completely consistent, with exceptions including reduced condition older workers experience more severe outcomes,
self-reported adverse outcomes among older workers in the including longer recuperation and lost work time. Fractures
National Health Interview Survey Supplement cited above. from falling to the floor result in a median 35 days for
Also, in a survey of injured New Hampshire workers Pranksy recovery among older workers and 25 days among younger
et al. [2005] found that despite more severe injuries the workers [Bureau of Labor Statistics, 1996]. In a study of fall
workers 55 and older did not have more lost work time or injuries among union carpenters Lipscomb et al. [2003]
other adverse outcomes than the younger workers. In this found age was not associated with the risk of falls from
population older workers reported greater satisfaction and elevations but the mean cost per fall increased fourfold with
fewer residual symptoms than younger workers, possibly age. Whether this is a function of injury severity or medical
related to longer and stronger attachment to their jobs as well care delivery and personnel practices is not clear.
as a healthy worker effect.
While the rates for non-fatal injuries are lower for older MAINTAINING WORK ABILITY,
workers, fatality rates have been higher [Goldberg et al., SAFETY AND HIGH PERFORMANCE
1989; Bell et al., 1990]. Kisner and Pratt [1999] found that IN AN AGING WORKFORCE
workers over 65 had a workplace fatality rate nearly
three times that of those aged 16–64, despite the fact that Since we can reasonably predict growing numbers and
the older workers averaged substantially fewer hours of work percentages of older workers for the next 25 years, we
collectively have a strong interest in ensuring that our
workplaces are hospitable to their needs and capacities so
they may contribute their labor with maximum safety and
productivity. Under current conditions the rate of workplace
injury and illness among these older workers will be lower
than that of their younger counterparts, but the number of
cases will increase substantially and their average severity,
disability, cost and risk of fatality will be high. These adverse
outcomes are likely to outweigh the advantages of relatively
low rates unless we adopt workplace strategies that build
upon the strengths and protect against the vulnerabilities of
workers as they age [Ilmarinen and Rantanen, 1999; Rix,
2001; National Research Council, 2004].
AARP [2002a] has articulated this need as a challenge to
employers to develop programs which match the workplace
FIGURE 3. Median days away from work for non-fatal workplace injuries and environment with the needs and capabilities of older
illnesses, 2003. workers: ‘‘If employers are to reap the benefits of the work
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274 Silverstein

ethic and experience of older workers, they must design the age cohort for both men and women over the period of the
workplace of the future to meet their needs.’’ The concept study. The prevalence of poor work ability increased with
of designing work to match the physical and cognitive age, from 1.7% at age 47, 3.3% at age 51, and 18% at age 58.
capacities of workers applies equally well at all ages and Third, several potentially modifiable variables are
there is some evidence, mostly from the Nordic countries shown to be associated with WAI. Among the group of
and the European Union, suggesting that carefully designed 818 workers noted above, variables associated with
employer programs can provide age friendly working improved WAI over the 11-year study period included
environments that preserve the capacity of employees to decreased repetitive movements, increased satisfaction with
function safely and effectively as they age. supervisor attitude and increased leisure physical exercise
Ilmarinen [2001] and colleagues at the Finnish Institute [Tuomi et al., 1997b]. Variables associated with decline in
of Occupational Health have developed a conceptual model WAI were increased standing at work, decreased satisfaction
of work ability in which an individual’s capacity to perform with restless and noisy workrooms, decreased recognition
job functions successfully is the integrated product of a and esteem at work and decreased leisure time physical
number of self-reported individual and workplace environ- exercise.
mental factors. The critical work ability factors include Fourth, four sets of variables have been associated with
health status and physical impairment, the physical and the preservation or enhancement of WAI over time and
cognitive demands of work, the psychosocial work environ- suggest strategies for intervention: (a) adjustments in physical
ment, and the individual’s general well being and supportive work environment (physical workload, rest/work schedule,
resources. Since 1981, a quantitative Work Ability Index repetitive motion, and regulation of one’s own work and
(WAI), derived from a standardized, self-administered breaks); (b) adjustments in the psychosocial work environ-
employee questionnaire, has been used widely by researchers ment (flexible work schedules, teamwork, age-management
in the Nordic countries and the European Union [Tuomi et al., skills for supervisors); (c) health and lifestyle promotion
1998, 2001; Nielsen, 1999; Kiss et al., 2002; de Zwart et al., (physical exercise, risk factor reduction, occupational health
2002; Camerino et al., 2003]. Using the WAI a cohort of 6257 services); and (d) worker skills and competency building
Finnish municipal employees ranging in age from 44 to 58 [Ilmarinen et al., 1997; Ilmarinen and Rantanen, 1999].
was first evaluated in 1981 [Ilmarinen et al., 1991a]. Five Although these issues have not been explored as actively
thousand five hundred fifty-six were re-evaluated in 1985 and in the U.S. literature, Burkhauser, using data from the 1978
4,534 in 1992, with four principal sets of findings [Nygard Survey of Disability and Work and the 1992 Health and
et al., 1991; Tuomi et al., 1991; Ilmarinen et al., 1991b, 1997; Retirement Study, found that provision of a workplace
Ilmarinen and Tuomi, 1992; Seitsamo and Ilmarinen, 1997; accommodation for an employee with a health impairment
Ilmarinen and Rantanen, 1999; Ilmarinen, 2001; Savinainen slowed withdrawal from the workforce and delayed the time
et al., 2004]. to beginning social security disability payments [Burkhauser
First, the WAI at baseline has been found to be associated et al., 1995, 1999].
with disability pensions and mortality at 4 and 11 years of
follow-up [Ilmarinen et al., 1991b; Tuomi et al., 1997a]. For PROGRAMS AND POLICIES TO MEET THE
example, among a group of municipal workers with poor NEEDS OF AN AGING WORKFORCE
work ability scores in 1981 62.2% had retired on disability
pensions and 11.6% had died in 1992, while the correspond- Several recommendations have been made for the
ing outcomes for those with good work ability were 21% implementation of practical programs consistent with the
disability pension and 3% deceased. Similarly, in a group of evidence summarized above. Four strategic dimensions
construction workers the WAI predicted disability pensions have been suggested, including interventions that focus on
at 4 years of follow-up [Liira et al., 2000]. Scores on the WAI the work environment, the way work and retirement are
also predicted self-reported good health and physical arranged and organized, the health and fitness of the
condition after 5 years of follow-up and were positively individual worker, and the social context of work [Ilmarinen,
associated in cross sectional analysis with self-reported 2001; Moyers and Coleman, 2004; National Research
quality and productivity of work [Tuomi et al., 2001]. Council, 2004] (Fig. 4).
Ilmarinen [2003] has also reported an association between
WAI scores and per person disability and sickness absence The Work Environment
costs.
Second, there is an overall decrease in WAI with age but Injuries and poor job performance are more likely to
with substantial inter-individual variability. Municipal work- occur when work requirements exceed individual capabil-
ers (818) remaining in the same occupation were followed ities, a mismatch potentially more frequent among older
from 1981 to 1992 [Ilmarinen et al., 1997]. WAI in 1981 was workers. The tools of workplace ergonomics and human
not associated with age but declined significantly for each factors engineering, applied to workers of all ages in an aging
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Protecting the Aging Workforce 275

[Whipple et al., 1993; Konrad et al., 1999; Rogers and Mille,

2003]. Measures to compensate for postural instability
include handrails along travel routes, housekeeping to reduce
clutter, slip resistant walking surfaces, repair of uneven or
wet floors, and the use of color contrast between stairway
risers and treads.

Vision

Vision deteriorates with age in several ways, including

normative changes such as the loss of ability to focus on
near objects (presbyopia) as well as age-related pathology
including macular degeneration, glaucoma, and cataracts
[Das, 1999; Quillen, 1999]. As a result older people
experience reduced acuity, loss of accommodation to objects
FIGURE 4. Four strategic dimensions for programs that meet the needs of an aging
at varying distances, diminished color discrimination and
workforce.
depth perception. Five general rules for supporting the vision
of older workers have been suggested, although without a
workforce, can be used to eliminate or modify exposure to great deal of scientific validation [Figueiro, 2001]. These
hazards so that young workers can reach older ages without include general lighting at intensities 50% greater than for
injury or that impaired or limited workers can continue to younger workers, task lighting levels three times greater than
work without further harm [Garg, 1991]. The principles of general levels to help with fine detailed low contrast objects,
‘‘universal design,’’ aimed at products and environments that placement of task lights to the side and in front of the worker
can be used safely and effectively by people of widely to reduce shadows, increased contrast for stair edges and
ranging differences in age, size and other characteristics, are curbs, and high illuminance fluorescent fixtures to enhance
especially useful for creating age-friendly workplaces. These color discrimination.
principles (including equitable use, flexible use, simple and
intuitive design, perceptible information, tolerance for error, Hearing
low physical effort, and size and space provided for approach
and use) are more fully described at http://www.design. Even without noise induced hearing loss, workers after
ncsu.edu/cud/about_ud/udprincipleshtmlformat.html#top. age 50 typically begin to lose higher frequency hearing
The opportunities for safe design are particularly [Irwin, 2000; Seidman et al., 2002; Rosenhall, 2003]. They
applicable to the prevention of work-related musculoskeletal may have difficulty in understanding conversations or
disorders, an Institute of Medicine panel having concluded localizing sounds in space. This is especially important
‘‘that primary and secondary prevention interventions to where audible signals are important for safety or perform-
reduce the incidence, severity and consequences of muscu- ance. In addition to noise reduction, helpful steps include
loskeletal injuries in the workplace are effective when redundant warning signals such as flashing warning lights
properly implemented. . .’’ [National Research Council, or cell phones with vibration, reduced speech rate and
2001]. For example, in a randomized, population based elimination of speech compression on automated systems
clinical trial Loisel et al. [1997] found that workers with such as voice mail, and provision of telephone amplifying
subacute work-related back pain returned to work 2.5 times devices.
faster when modified work was added to the usual regimen
of clinical care. Krause et al. [1998, 2001] concludes that Strength and endurance
modified work programs consistently increase return to work
rates twofold and reduce disability days in half. The general methods of workplace ergonomics to reduce
The principles of ergonomics, human factors and physical stresses on the body, particularly the musculoske-
universal design can be applied to challenges in the areas letal system, are well understood [Hagberg et al., 1995;
of balance, vision, hearing, strength and endurance faced by Cohen et al., 1997; National Research Council, 2001].
workers as they age. Strategies for fitting the workplace to the worker (rather than
the reverse) include substituting mechanical for manual
Balance strength, reducing highly repetitive tasks, allowing adequate
recovery time, reducing static and stressful postures, and job
Many workers above the age of 50 begin to have rotation. As a last choice it may be necessary to provide
problems with balance, risking injuries from trips and falls alternate job assignments and appropriate retraining for
 10970274, 2008, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ajim.20569 by University Of Patras, Wiley Online Library on [19/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
276 Silverstein

workers whose physical capacities are so reduced that even Control, 2003]. These diseases become more common as
modest strength or endurance is impossible and adjustments people age and they cause significant disability and
on the usual job are not feasible. dysfunction long before people die from them. In addition,
other chronic problems that increase in frequency with age
Work Arrangements and but do not typically lead to death, such as arthritis, hearing
Work-Life Balance loss and obesity, are responsible for enormous medical costs
and disability. Medical care costs are nearly two times more
The way relationships at work are designed can have a for employees with cancer, heart disease, or diabetes than for
major impact on the ability of employees to perform safely those without disease and these costs for 65-year olds are
and productively. Important factors include work schedules, four times those of 40-year olds [Centers For Disease
supervisory relationships, decision control, information Control, 2003]. Indirect costs can be even greater than the
transfer, and avenues for conflict resolution. Factors cost of health care—including absenteeism and productivity,
associated with lower injury rates include empowerment of employee turnover and replacement, workers’ compensa-
the workforce, autonomy, delegation of control, good tion, and life insurance benefit costs. Expenditures for
relations between management and workers, low stress, employees just at risk for chronic disease—measured by
low grievance rates and encouragement of long-term blood pressure, body weight, and cholesterol—averaged
commitment of the workforce [Shannon et al., 1997; Hale over 50% more than for those at low risk [Lichiello et al.,
and Hoyden, 1998]. A stressful work organization can 2005]. A number of key clinical services, such as influenza
increase the risk of chronic diseases, such as cardiovascular immunization, colorectal cancer screening, mammography,
disease [Belkic et al., 2004]. A 1999 Swedish study found cholesterol and blood pressure screening and maintaining
increases in self-reported stress and systolic blood pressure three healthy habits—not smoking, eating a healthy diet, and
over a work shift on a traditional auto assembly line but not moderate physical fitness—can prevent or delay disability
with a more flexible assembly operation in small groups with from chronic conditions by as much as 10 years [Centers for
opportunities to alter pace and content of work [Melin et al., Disease Control, 2003; Moyers and Coleman, 2004; U.S.
1999]. Two studies suggest that the impact of job stressors on Preventive Services Task Force, 2006]. Yet most employers
blood pressure levels may be greater among older employees and employees are not taking advantage of most of these cost
[Schnall et al., 1992; Iwasaki et al., 1998]. effective measures [Lichiello et al., 2005; Bondi et al., 2006].
In addition to concerns about the design of work itself, The cognitive changes of aging also deserve individual
many employers and employees are searching for alter- attention at the workplace. For example, older workers
natives to the traditional abrupt transition from full time work process information more slowly than when they were
to full time retirement. There is a growing need for career younger and training methods need to take these changes into
path and retirement options that take into account issues account [National Research Council, 2004]. Fisk et al. [2004]
related to increased longevity, elder care, and the increased have suggested practical guidelines: provide one and a half to
prevalence of chronic illnesses. For example, the Health and two times the training time provided for young adults; allow
Retirement Study, conducted every 2 years by the National for self-paced learning; minimize distractions such as
Institute on Aging and the University of Michigan, ‘‘has background noise; present ‘‘how to’’ information in a step-
consistently shown that three out of every four older workers by-step format; teach spatial tasks using a visual medium;
have said they would prefer to reduce hours gradually rather provide immediate feedback about how to correct mistakes;
than retire abruptly’’ and that older adults are ‘‘increasingly make sure learners are actively involved, for example by
interested in part-time opportunities and other activities to problem solving exercises or hands-on practice; and
stay busy and productive with age’’ [National Institute on minimize demands on working memory using visual cues
Aging, 2007]. A variety of alternative job designs such as and aids such as drop down menus on computer screens.
flexible hours, job sharing, telecommuting or phased retire-
ment may provide more supportive working environments Social Measures
that reduce job stressors and enable safe and productive
performance [Landsbergis, 2003]. A broad range of daily living tasks become more
complex and challenging with aging and these non-work
Individual Measures factors can interfere with successful performance on the job.
For example, older workers may not be able to drive to work
Individual measures are also needed to protect workers, as easily as when they were younger and therefore have
promote their health and build their competencies. Five greater needs for public transportation, car pools or tele-
chronic diseases (heart disease, cancer, stroke, chronic commuting. As workers age, evolving family needs may
obstructive lung disease, and diabetes) cause almost 70% become a significant distraction at work. For example, an
of the deaths in the USA every year [Centers For Disease employee may not be able to function adequately at work
 10970274, 2008, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/ajim.20569 by University Of Patras, Wiley Online Library on [19/12/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Protecting the Aging Workforce 277

without knowing that the home health care needs of an older slow the effects of aging at work. Fourth, while there is strong
spouse are under control. While some of these steps may be evidence to support the implementation of some of the
within the reach of individual employers (e.g., work based interventions discussed in this paper (e.g., ergonomic
car pools or elder care benefits), some must be addressed as measures to prevent musculoskeletal disorders and clinical
broader social services such as improved access to health preventive services to reduce disability from cancer and
care, public transportation, and laws to protect against cardiovascular disease), the evidentiary base for compre-
discrimination. hensive programs and policies (Fig. 4) is sparse and unknown
to most employers. Evaluative research is needed to
CONCLUSION determine the effectiveness of various program designs
together with a substantial effort to disseminate results and
We are beginning to experience profound workplace recommendations to employer and employee organizations.
changes related to the demographic changes of an aging
population. Those employers who do not encourage employ- ACKNOWLEDGMENTS
ees to stay on the job as they age may experience escalating
pension costs as well as a host of expenses associated with The author’s experience as a member of the Institute of
tighter labor markets and shortages of various skills. Those Medicine Committee on the Health and Safety Needs of
who do encourage older employees to remain at work but Older Workers provided the initial stimulation for the work
fail to take steps to support their productive capacities on this article. The author appreciates the opportunity for
and minimize their vulnerabilities may experience adverse interaction with the members of that committee, several of
impacts on quality, productivity, workers’ compensation and whom provided helpful comments on a draft of this article:
other insurance costs. On the other hand employers who David Wegman, Richard Burkhauser, Gary Burtless, Neil
promote and support the work ability of employees as they Charness, Paul Landsbergis, Charles Levenstein, Michael
age may gain in safety, productivity, competitiveness, and Marmot, Carolyn Needleman, Timothy Salthouse, Glorian
sustainable business practices. Sorensen, Emily Spieler, Robert Wallace, Craig Zwerling
A 1998 survey of 400 employers by AARP found that and study director James McGee.
while 55–68% of employers recognized the value of various
programs to address the needs of older workers, only 18–
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