The ageing workforce and its implications for occupational health and safety prevention programs and work-injury compensation systems: A Canadian perspective Peter Smith School of Public Health and Preventive Medicine, Monash University

Acknowledgements This work is supported through grants from WorkSafeBC (RS2009- OG03) and the Canadian Institutes for Health Research (111273). Peter Smith was supported by a New Investigator Award from the Canadian Institutes of Health Research. Access to data sources was made available through the Statistics Canada’s Data Liberation Initiative via the University of Toronto, and through the Statistics Canada Research Data Centre and the University of Toronto.

The Institute for Work & Health Independent, non-profit research institute in Toronto, Canada Majority of funding from the Ontario WSIB ($4.7 million) Plus approx 2.5 million / year from competitive funding agencies Two broad research goals to protect the health of workers by studying the prevention of work-related injury and illness. to improve the health and recovery of injured workers. Staff of 22 scientists from a variety of disciplines Approximately 80 FTE staff in total Governed by a Board of Directors and a Scientific Advisory Committee

Compensation systems in Ontario and British Columbia Lost-time claims (LTCs) After the day if accident/illness, the worker  is absent from work; or  has reduction in earnings (through fewer hours at old job or lower wages doing modified work). No-lost-time-claims (NLTCs) Worker requires health care (arising from work injury or illness), but is not absent from work other than the day of Injury. Also includes modified work for more than seven days at regular pay and hours, even without health care.

Overview  Who are older workers and why should we be interested in them?  Older age and the prevention of work injuries.  Older age and the consequences of work injuries.  Related plans for future research in Victoria

Who are older workers and why should we be interested in them?

Who are older workers? Human Resources and Skill Development Canada = 45 years or older Statistics Canada & European Foundation for the Improvement of Living and Working Conditions = 55 years or older

Workers’ Compensation policy around older workers in Canada Loss of earning benefits  End at age 65 for workers who were less than 63-years-old at the time of injury  Workers who are injured when over the age of 63 are paid loss of earnings for up to two years after the date of injury.  In some provinces (e.g. BC) entitlements may be extended past age 65 Health Care  Is available to workers past age 65, regardless their age at injury Re-employment  Employer’s obligation to re-employ injured workers ends on the date a worker turns 65 years of age

Population Pyramids: Canada (1980, 2000, 2050) Men Women

Population Pyramids: Australia (1980, 2000, 2050) Men Women

CanadaAustralia

Life Expectancy at age 65. Canada: 1991 to yrs 21 yrs

Percent of older persons who are currently working. Canada: 1990 to 2011 Source: Canadian Labour Force Survey

Percent of the employed labour force who are over 50 years of age. Canada: 1990 to 2011 app. 3,6 mill workers app 271,000 workers app. 1,6 mill workers app 98,000 workers Source: Canadian Labour Force Survey

Planned age of retirement for respondents age 45 to 49 years of age: 1991, 2002 and 2007 Shellenberg and Ostrovsky, 2008 These trends will continue and may increase

Retirement plans for 45 to 59 year olds by level of self-rated health. Canada 2007 Shellenberg and Ostrovsky, 2008 And it is not just healthy workers who want to stay in the labour force

Types of employment for workers age 50 and over. Canada: 1996 to 2011 Source: Canadian Labour Force Survey

Number of persons and FTE’s over 50 years of age working in temporary work arrangements and first 6 months of a job. Canada 1996 to 2011 Source: Canadian Labour Force Survey

Summary Older workers are an increasing proportion of the labour force –More older people –More wanting to work –A greater percentage in temporary employment relationships In Canada, 11% of people over the age of 65 are working (up from 6% in 2000) These trends will likely further increase as more workers “choose” not to retire

Older age and the prevention of work injuries?

Age and work injury General assumption that risk of work-related injury declines with age, but that when injuries do occur they are usually more serious

Rates of work injuries per 100 full-time equivalents by age groups. Canada Source: Canadian Community Health Surveys, cycles 2.1 and 3.1

Percent distribution of lost-time claims in Ontario by age: 1991, 1996, 2001 and 2008

Relative change in number of accepted lost-time claims in Ontario: 1996 to 2008 by age group -25%

Percent distribution of time loss claims in Victoria by age: , and Source: WorkSafe Victoria 2008/09 Statistical Summary (available at ww.worksafe.vic.gov.au)

Relative change in number of accepted time loss claims in Victoria: to by age group -12% Source: WorkSafe Victoria 2008/09 Statistical Summary (available at ww.worksafe.vic.gov.au)

Rates of accepted claims per 1,000 full-time-equivalents by age group. British Columbia, 1997 and 2007 Source: Smith et al (in progress)

Rates of claims accepted per 1,000 full-time- equivalents by age group. British Columbia, 2007 Source: Smith et al (in progress)

Rates of wage loss claims per 1,000 full-time-equivalents by age groups. Males only, British Columbia, 2007 Source: Smith et al (in progress)

Rates of wage loss claims per 1,000 full-time-equivalents by age groups. Males working in occupation with equipment: British Columbia, , , Source: Smith et al (in progress)

Rates of serious injuries by age per 1000 persons. WorkSafe BC compensation claims Source: Fan et al, 2011

Rates of disability claims (10 or more days) per 1000 person-years, Victoria 2001 to 2004 Berecki-Gisolf et al 2012

Rates of self-reported time loss work injuries per 1,000 full-time- equivalents. Australia, and (MPHS) Source: Smith et al (in progress)

Summary Compensation boards are dealing with an increasing number of claims from workers over the age of 45 years of age. Older age is not always associated with a reduced risk of injury – relationship differs by gender, occupational exposures and injury type The relationship between age and work injury has changed over time. Differences in injury rates are now less pronounced. In Australia, not all age and gender groups have had reductions in injury risk between and This has changed the relationship between age and work injury.

Aging biological, psychological, social and societal change Chronological age Functional age Societal age Organisational age Kooij et al, J Man Psych, 2008

Thinking outside of chronological age to understand issues related to the aging workforce Functional age: what is the relationship between chronic conditions and work injury and recovery from work injury? Societal age: are older workers treated differently by the health care or compensation system than younger workers, even with the same type of injury? Organisational age: are older workers treated differently in the workplace than younger workers, even with the same type of injury?

Distribution of medically diagnosed chronic conditions among labour force participants by age. Canada 2007 Source: Canadian Community Health Survey, Cycle 4.1

Prevalence of medically diagnosed chronic conditions among labour market participants. Canada: 1994 to % 107% 36% 164% 58% Source: National Population Health Surveys and Canadian Community Health Surveys

A hypothetical example of the relationship between declining worker capacity and occupational physical demands Energy reserve Energy Reserve Occupation with high demands Occupation with moderate demands Occupation with low demands

Questions What is the role that chronic conditions and functional declines associated with age play in the risk of work injury? Palmer et al (2008), OEM, 65,

Chronic conditions and risk of activity limiting injury requiring medical attention. Canada: 2003 – 05. Purple square = women Red square = men Source: Smith et all (in press) JOEM

Chronic conditions and risk of repetitive movement injuries. Canada: 2003 – 05. Purple square = women Red square = men Source: Smith et al (in press) JOEM

Summary  Limited research is currently available on how changes in function, societal or organisational age impact on risk of work injury  Available data in Canada suggests that chronic conditions associated with older age are associated with an increased probability of both acute work injuries and repetitive movement injuries  Statistically significant risk for arthritis and back problems among both men and women.

Older age and the consequences of work injuries?

Percent distribution of types of injuries for lost-time injuries involving falls on the same level. US Data, 2003 Monthly Labour Review, October 2005 Older age is associated with more severe consequences, even after the same event

Percent of severe injuries* after the same event by age group. Ontario 2004 to Lost-time claims *Injuries to bones/nerves/spinal cord/intracranial injuries and multiple injuries

Occupational injury fatality rate by age. US Data, 2007 US Department of Labour, 2008

Physical capacity required to return to work (% of max) by age: hypothetical example using occupational with moderate physical demands Occupation with moderate demands Declining physical function can also influence the ability to return to work

Mean and median days of wage replacement over the first two years. Lost-time claims, Ontario, 1994 and 2004 Hogg-Johnson et al, in preparation

Mean and median health care costs (2002 $’s) over first two years. Lost-time claims. Ontario, 1994 and 2004 Hogg-Johnson et al, in preparation

Adjusted* mean health care over two years. No-lost-time claims: Ontario 1991, 1997, 2006 Smith et al, JOEM, 2011

Median days to first full-return to work by age: WorkSafe Victoria claimants 2001 to Berecki-Gisolf et al 2012

Summary  Older age is associated with more severe consequences even after the same event  In Ontario, age differences in health care costs and time lost from work after a injury are increasing –severity of injury –health care utilisation (both number of treatments and type of treatments)  The relationship between aspects of aging (outside of chronological age) and the consequences of work injury (wage replacement and health care costs) is not known....

Overall Summary What we know  The Canadian labour force is aging  While work after age 65 is not common, it is increasing  Rates of injuries generally decline with age, although not always. This relationship is changing.  Chronic conditions, in particular arthritis and back problems, are associated with increased risk of work injury (acute and repetitive movement) among men and women  Differences in health care expenditures across age groups may be widening  Differences in the duration of wage replacement across age groups may be widening

Overall Summary What we need to know  What specific aspects of aging impact both primary and secondary prevention of work injuries –Are specific chronic conditions associated with more severe injuries? greater health care utilisation, costs or time away from work? Is this morbidity or injury specific? –Is there an interplay between measures of functional age and occupational characteristics in return to work after injury? –Are older workers treated differently (by medical, workplace, compensation) than younger workers even after the same injury?  What happens to workers injured when 63 and older?

57 Planned future work at MonCOEH  The relationship between age and work injury and the consequences of work injury in Victoria using information from the Compensation Research Database (CRD) – Estimating the size of the insured labour force in Victoria across key labour market characteristics (e.g. age, gender, occupation) – Time trends in the relationship between age and different injury outcomes (e.g. health care spending, days off work). – How similar are trends in workers’ compensation claims to trends in self-reported injury?

58 Planned future work at MonCOEH  Developing a framework for occupational health and safety vulnerability (underway – funded through ISCRR)  Understanding individual, workplace and system level influences on return to work in the context of the ageing Victorian labour market. The influence of types of injuries and measures of chronological and functional age (work in progress – funded through ISCRR)

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