1. The Ageing Workforce
Dr Robin ‘Sid’ O’Toole
Occupational Physician

2. Scope Australia’s Ageing workforce Effect of Ageing
Body and Soul
Workplace
Prevention versus Accommodation

3. Ageing Oz 2007 2056 (projected) Population ≅ 21million
Proportion ≥ 65yrs ≅ 13%
Proportion yrs ≅ 67%
2056 (projected)
Population ≅ 35.5 million
Proportion ≥ 65yrs ≅ 23%
Proportion yrs ≅ 60%

4. Dependency Ratio 2007 Dependency Ratio = 48 2056 Dependency Ratio = 65
Increase in ratio is expected to commence from 2015.
The dependency ratio is a marker of the percentage of the population that is required to ‘carry’ the remainder. It is meant to reflect the Percentage of the population that is at an age which could be expected to work and provide for the remainder; the ‘dependents’ if you will.
It is NOT an accurate measure, purely an indication as can be seen by how it is calculated:
((No people <15) + (No people ≥65) / No people aged 15 ⇒ 65) x 100
A Dependency Ratio of 100 means that there is 1 person of working age per dependent. A score of 25 means that there are 4 people of working age per dependent. A score of 110 means that there are more dependents than people of working age.
Does not take into consideration illness, welfare or unemployment rates. Assumes all workers retire aged 65. Does not consider teens and young adults undertaking education. Assumes all work commences at aged 15.
I think of it as a ‘best case’ scenario. If everyone were expected to start work at 15 and retire at 65 and never get sick in between, then the best case scenario is we would have ‘X’ percentage of the population able to provide for the population.

5. Life Expectancy In 1970 In 2010 In 2050 ♀ - 74.5 years ♂ - 67.8 years
This in itself shows that the trend is for a further life expectancy growth of only four years for each sex over the coming 40 years. Whilst this may not seem much compared to the 10 and 13 year increase for males and females respectively over the previous forty years, it needs to be put into context.
In the 70s, with retirement age being 60-65, men lived on average only 2.8 years beyond that. The hypothesised reasons behind this are well documented and include a greater physicality in their job taking its toll, poorer health in general and loss of a sense of purpose. It also could be because they were home a lot more and really just wanted to fall of the perch.
However, this really meant that there was only a small amount of time for them to be dependent upon social services after they had stopped contributing through their taxes etc into the government coffers that had to pay for these services.

6. Quick Summary 75 95 57 years 37 years 58 years
Enter the Workforce at 18
Leave at 65
Die aged 84
Contributed to Dependency for 47 years
Been Dependent for 47 years 75 95
57 years
58 years
37 years

7. Decreasing Dependency
Can't start earlier
Exploitation and Fair Work legislation
Best to get people to work longer
Less time that they are dependent
Earn more as you get older therefore more tax revenue.

8. Effect of Ageing - Body ↓ muscle strength and balance
↓ aerobic capacity and endurance
↓ Joint mobility – flexibility and posture
↑ reaction time
↓ Hearing/vision
Altered Sleep Pattern
Increased potential for chronic disease
Generalisations
Please note that these are generalisations. We all remember Cliff Young and see Today/Tonight and ACA when they trot out 90 year old Masters Games legends. These are exceptions, and they are not the norm.
We are an organism that has evolved from pond scum to what we are today. We have evolved physically by the weak dying out against the strong. This is so when it comes to age as well. We are living in bodies that have been designed to live ~40 years. The fact we live longer is due to changes in diet, sanitation and healthcare, not further evolution of the physical body itself. Therefore we need to expect that as things get older they break down. They degenerate. Weaker cells give way whilst the stronger ones stay on.
Muscles lose bulk and the decline in the nervous system means less of the muscle cells receive input. This effects strength. Increased ‘muck’ in the balance organs and altered firing of nerves in the peripheries give us disturbances in balance. Joints fill with debris of degeneration and lose the lubrication supplied by the lost cartilage.
Loss of fluid in the brain leads to atrophy - it shrinks - and the messages can’t get through as well.
The eyes are an extension of the brain and they are a victim of fluid loss also, though in the case of age related vision loss, it is actually the loss of fluid in the lens and cilliary muscle decline that makes it harder to see things up close. In addition, Macular Degeneration and other illnesses such as diabetes, glaucoma and cataracts further contribute to the extent of this problem. In particular there is a loss in Visual Acuity, Accommodation, depth perception and Colour discrimination.
Hearing decreases secondary to age (presbycusis) and also from NIHL.

9. Effects of Ageing - Soul
Slower mental processes (NB Quality may be the same)
Ingrained perceptions
Rigidity
As we touched on previously, the brain is not what it used to be, and messages take longer to get through. Therefore it may take longer to think of answers to solutions.
THIS DOESN”T MEAN that the answer is a lesser quality though.
Can’t teach an old dog new tricks. As we age we enjoy the comfort of consistency and pattern. We do not accommodate to change very well and this is due in part to our experience giving us ingrained perceptions and rigidity in thought processes. We also don’t have the energy to change as our physical and mental tolerance has reduced.

10. Effect of Ageing - Workplace

11. Effect of Ageing - Workplace
Physical Effects of Ageing
↑ risk of trips, slips and falls
↓ tolerance to shift work
Particular significance c.f. night shift
↓ ability maintain intensity of effort
↓ Ability to work in extremes of temperature
↑ Time to train on new practices.
Decreased muscle strength, and co-ordination/balance lead to increase in slips trips and falls. Shuffling, poorer vision and less attention as a consequence of exertion are also potential contributors.
There are physical changes that affect your tolerance to shift work as circadian rhythms change as well as the sleep architecture.

12. Effect of Ageing - Workplace
Injury rates are less
Injury more severe
Result of Injury longer to resolve
Injury healing time only slightly longer
De-conditioning is a major contributor
Premature retirement
Injury costs more (up to ~ 2x)
Decreased muscle strength, and co-ordination/balance lead to increase in slips trips and falls. Shuffling, poorer vision and less attention as a consequence of exertion are also potential contributors.
There are physical changes that affect your tolerance to shift work as circadian rhythms change as well as the sleep architecture.

13. But….. Older Workers are; More happy with their post injury outcome
Have better adaptation
Corporate knowledge
Adaptation: Old age and cunning outwits youth and enthusiasm every time!!!

14. Job Lock
Worker feels locked into their job and unable to securely seek further employment
What is Job lock?
Job lock is when a worker feels trapped, or ‘locked’ into their job out of fear of loss of remuneration or benefit. This phenomenon is seen mainly in countries like the US where there health insurance is generally tied to their employer. The employee fears that if they seek other employment, then they will lose their health insurance. This may be appeased somewhat with the new Health Insurance reform seen in the US. This is, however, a concern for Qantas as it is a self insurer, and as such the healthcare for its workers can potentially be better, or at least more expeditious, than the rest of WorkCover.
The other side of the job lock phenomenon, particularly amongst older workers is the sense of having to work because they can’t AFFORD to retire. This is seen in Australia (and Qantas) and will become an increasing problem as cost of living increases outstrip earnings in Superannuation and other such concerns arise.
This phenomenon is further exacerbated by the type of worker you have - low skilled and (generally) poorly educated. Once they have been working here a few years, then they lose their currency in any other skills that they have and become dependent.

15. Prevention vs Accommodation

16. Prevention Alter the population Alter Employment Strategies
Only employ young
Only employ for set period of time (contract)
Strict Pre-employment Physical Standards
Maintenance of Physical Standards
Change the population that you source your employees from. It’s a bit difficult to swap 21 million people over for a new group of people. You have to source from workers from your own population. The only other option is for the Federal Government to annex NZ, Samoa, PNG and other island nations to provide a greater pool of physically strong people. This sounds bizarre, however both the USA and the UK do exactly this with their Defence Forces.
Alter employment strategies. This speaks for itself. By only employing young people and limiting the time which they are employed for on a strict contractual basis you can avoid the problem of having older workers. What, though, do you do when everyone else has the same idea and the year old bracket is one of the smallest population pools? You have to pay exorbitantly high wages to attract them. Turnover will be exceptionally high, and there MAY NOT BE the next generation coming through in numbers large enough to sustain this.
Strict Pre-employment Physical Standards. These must adhere with guidelines provided in the Industrial Relations Act, but more importantly they must not breach the Anti-Discrimination Act of No easy task. The pre-employment MUST be representative of the job that is being examined for, therefore a task analysis must be done first.
Maintenance of Physical Standards. We have spoken about how the body declines with age. Regular physical examination is required in a number of employment groups to check that they are capable of maintaining the level of function that is required from a Safety point of view; Military, pilots, ships captains, truck drivers etc. A similar system can be put in place in here. Qantas already has a Functional Assessment component of its pre-employment medical for Airports staff. This is therefore the baseline standard. IF QANTAS can argue that this standard was put in place as a safety measure, then it can also be argued that this standard must be maintained as a safety measure, and regular testing to assess compliance with this standard can be put in place. The legal nightmare of what happens when this standard IS NOT met, then ensues.

17. Accommodation Workplace Changes Management Physical
Accommodating is the only option, and this is for a number of reasons.
1. People cannot be turfed out just because they are old and therefore add a burden of risk
2. People will HAVE to keep working longer to support themselves and the rest of society
3. Older workers will make up the bulk of the workforce, so best to make changes now when it is cheaper to do so.
There is a need for changes in the workplace, both physical and managerial.

18. General approach People are lazy
Organisations / Governments are lazier
Prefer to be given something that they can approve and take credit for than to actually develop it
Gross Generalisation, but generalisations are generally true!

19. Workplace Management Changes
Accept there is a problem
Apply resources to assess extent
Create defined mission statements
Create Protocols / Procedures
Assess your progress
Adapt
Accepting that there is a problem is more than stating so. Acceptance also involves taking ownership of the problem and committing to change it.
This is best represented by application of resources to the problem. Everything costs money. Sad but true. In the aviation industry everything from the napkins in your on-flight meal to the fuel costs money, and it keeps costing more and more. Expedience is the key here, and the sooner there is allocation of resources, the cheaper it will be.
Defined mission statements. You are one of the biggest companies in Australia. You are held is esteem by the community - so capitalise on this. Make bold statements about taking care of your workers so that they can have good quality LIVES, not just good quality work life when they work for you. State you are going to actively seek ways to lessen the impact of work on people as they age so that you may offer them the opportunity to work until they WANT to retire. Achieving this will allow you to then offer work to older people. Strong statements - but with wriggle room in them.
Create the protocols, and be rigid. Just because the governing legislation does not provide specifics regarding safe weights - doesn’t mean that you can’t for example. Protocols regarding:
Manual Handling, pre-employment standards, maintenance of those standards and how this is measured, COA should worker fail to maintain standards. Maximum weights in baggage.
This can be tricky because there a number of key stakeholders involved in this, and each has an agenda. That is why you start with these key stakeholders and give them an active role in development of these protocols. Advertise loud and long beforehand that you WANT their involvement as they have the same duty of care and want the same outcome - healthy workers.

20. Need for rigid protocols
Current level
Maintain Current Job
Reduced Level
Someone else’s Job
Injured Worker
Lateral Integration
Vacant job
When a worker is injured there are three main outcomes regarding Long term post injury management.
1. Maintain current Job
2. Lateral Integration
3. Injury Retirement.
These are obviously in order of preference.
Each of these categories then has its own options as can be seen.
Whilst most are self explanatory, the two (reduced level and someone else’s job) are the difficult ones that require a very supportive workforce. These are possible, but must be backed up by documentation!!!!!
The sticking point here is the way in which organisations set up their job tasking
Injury Retirement

21. Random Company X Job Task Analysis
Show up
Drink coffee
Talk to mates
Lift heavy things
Clean toilets
Drive trucks
Mop floor
Juggle cats
Shave widgets
Everyone must be able to do Everything
Guise of Cross Training
Can they safely perform all tasks?
Fitness for duty assessment
Ask an OP.
Functional Capacity Examination
Here we see how organisations set up their job tasking.
How do we know if a worker is capable of performing the tasks? It must be done by using objective measures. The best objective measure that we have is a Functional Capacity Examination.
FCE’s must be based upon the job that needs to be done and the capabilities required of the person doing it. It should therefore be identical to a well prepared Pre-employment medical.

22. Functional Capacity Evaluation
Pass
Current level
Injured Worker
FCE
Current Job
Reduced Level
Someone else’s Job
Lateral Integration
Fail
So let's now replace the injured worker with the older worker.
Periodic functional examinations to assess capacity.
We still have the problem of this area though.
Vacant job
Injury Retirement

23. Need for rigid protocols
Pass
Current level
Older Worker
Injured Worker
FCE
Current Job
Reduced Level
Someone else’s Job
Lateral Integration
Fail
So let's now replace the injured worker with the older worker.
Periodic functional examinations to assess capacity.
We still have the problem of this area though.
Vacant job
Injury Retirement

24. Discrimination You can’t be seen to discriminate.
You supposedly can’t kick a 25 year old guy out of a job that they are doing that is easier than what the 60 year old is doing if they are equally qualified for the job. This is the elephant in the room
QLD anti-discrimination act. There are provisions for POSITIVE discrimination based upon age - Senior’s cards, cheap movies and public transport for kids etc.

25. Need for rigid protocols
Pass
Current level
Older Worker
ALL Workers
FCE
Current Job
Reduced Level
Someone else’s Job
Lateral Integration
Fail
So to overcome that, we swap out older workers and replace with ALL workers
Vacant job
Injury Retirement

26. Periodic Health Examination
Age
Periodic Health Exam
Functional Exam
If indicated 40
Both
5 yearly 50
52 & 54
Yes
55 +
Yearly
Every 2-5 years
Periodic Health Examination can be as simple as a tick and flick questionnaire that is paired with directed questioning in line with RACGP guidelines for the patient’s age. Adding in 5yr CVD risk calculations and a physical examination that is based upon the roles that the person undertakes.
This should fall in line with (ESPECIALLY the FCE) the pre-employment medical.
This way you are checking if the worker is STILL able to SAFELY complete the inherent requirements of their job, much like you were assessing for the same condition BEFORE they were employed.
It is also a way of identifying areas of weakness that can be worked on to prevent injuries. Provides an opportunity to pick up the little niggles that older workers carry and put into place rehab whilst still in the workplace.

27. But Confronting Needs to be sold to the workforce
Argued that it is a company’s DoC to do this.

28. Protocols Must cover off on Workplace Rehabilitation
Failures
Reasonable accommodation
Workplace Rehabilitation
Change the Job Task Analysis
These must be rigid and cover off on what we do if they worker fails and include reasonable accommodation to comply with the Act.
Also should mention workplace rehabilitation to show that all efforts are made before failure.
Allow more flexibility in the jobs. Create jobs especially for older workers

29. Workplace Physical Changes
MHE
Technology
Worker advice
Worker
We can also change the physicality of the work being done.
We can use better technology and education on the use of MHE
We can make the worker stronger.

30. What about the Insurer? Must decide Injury versus
Exacerbation/Aggravation versus
Normal Ageing Process

31. Decision requires
Knowledgable specialists practicing Evidence Base Assessment
Seriously!

32. But…. My workforce aren’t performing a physical task
A fitness for duty assessment isn’t necessarily a physical test.
Cognitive assessments
Psychological assessments
Assessment of effects of Chronic Disease

33. Take home messages We’re getting older, and having to work longer
Proportion of those available for recruitment islessening
Stuck having to employ older people
Need to take care of those we’ve got

34. Take home messages