1. The Health Issues of an Ageing Workforce Dr Shane Tellam Consultant Occupational Physician Occupational Health South West Ltd

2. Aims To understand the demographics To understand the demographics To consider the health issues of ageing To consider the health issues of ageing To consider the impact on work capability and the possible need for adjustments To consider the impact on work capability and the possible need for adjustments To consider the possible legal aspects To consider the possible legal aspects

3. Demographics

4. Demographics The UK population is projected to continue ageing with the average (median) age rising from 39.7 years in 2010 to 39.9 years in 2020 and 42.2 by 2035 (Office for National Statistics 2011a). The UK population is projected to continue ageing with the average (median) age rising from 39.7 years in 2010 to 39.9 years in 2020 and 42.2 by 2035 (Office for National Statistics 2011a).

5. Demographics 3x number of people aged 90+ by 2035 3x number of people aged 90+ by 2035 4x age 95+ by 2035 4x age 95+ by 2035 Age 100+ is projected to rise from 13,000 in 2010 to 110,000 by 2035 Age 100+ is projected to rise from 13,000 in 2010 to 110,000 by 2035 (Office for National Statistics 2011a)

6. Key Facts We are running out of workers : We are running out of workers : current employer plans suggest that we will need to fill 13.5 million job vacancies in the next ten years, but only 7 million young people will leave school and college (UKCES 2010/GADa).

7. Key Facts Immigration will not fill the gap : Immigration will not fill the gap : current net immigration is around 200,000 people per year (ONS 2011b) and the Government is committed to reducing this.

8. Key Facts Older people are the main untapped source of labour : Older people are the main untapped source of labour : unlike migrants, they already live here, and their numbers are growing. By 2020, 36% of the working population will be over 50 (Government Actuary’s Department).

9. Key Facts People are living and keeping fit for longer : People are living and keeping fit for longer : most of today’s 65- year-olds will live beyond 80, and some will live beyond 110 (Government Actuary’s Department).

10. Key Facts : whether retirement is paid for through occupational or state pensions, the money to pay for it comes from the current workforce. In 2008, there was a ratio of adults under and over pensionable age of 3.2. By 2033 this will be 2.8 (ONS 2009). The dependency ratio is deteriorating : whether retirement is paid for through occupational or state pensions, the money to pay for it comes from the current workforce. In 2008, there was a ratio of adults under and over pensionable age of 3.2. By 2033 this will be 2.8 (ONS 2009).

11. Key Facts More and more people want to work longer if the conditions are right : surveys regularly show that most older workers would work longer if they enjoy their work and could work more flexibly (McNair et al 2004). More and more people want to work longer if the conditions are right : surveys regularly show that most older workers would work longer if they enjoy their work and could work more flexibly (McNair et al 2004).

12. Key Facts The proportion of older workers aged 55 and above planning to work beyond the state pension age is 54%, according to a recent survey (CIPD 2010b). The proportion of older workers aged 55 and above planning to work beyond the state pension age is 54%, according to a recent survey (CIPD 2010b).

13. Common Age Related Health Problems Heart conditions (hypertension, vascular disease, congestive heart failure, high blood pressure and coronary artery disease) Heart conditions (hypertension, vascular disease, congestive heart failure, high blood pressure and coronary artery disease) Dementia, including Alzheimer's disease Dementia, including Alzheimer's disease Depression Depression Incontinence (urine and stool) Incontinence (urine and stool) Arthritis Arthritis Osteoporosis Osteoporosis Diabetes Diabetes Breathing problems Breathing problems Frequent falls, which can lead to fractures Frequent falls, which can lead to fractures Parkinson's disease Parkinson's disease Cancer Cancer Eye problems (cataracts, glaucoma, Macular Degeneration) Eye problems (cataracts, glaucoma, Macular Degeneration)

14. Cardiovascular High blood pressure High blood pressure High cholesterol High cholesterol Reduced cardio respiratory fitness Reduced cardio respiratory fitness Obesity Obesity Increased risk of ischaemic heart disease and stroke Increased risk of ischaemic heart disease and stroke

15. Diabetes Certain factors can increase the risk of developing type 2 diabetes (which is most common in older people). Certain factors can increase the risk of developing type 2 diabetes (which is most common in older people).type 2 diabetestype 2 diabetes Over 80 percent of people with type 2 diabetes are overweight. The more overweight you are, with a body mass index (BMI) of 25 or more, the greater your risk of diabetes. Over 80 percent of people with type 2 diabetes are overweight. The more overweight you are, with a body mass index (BMI) of 25 or more, the greater your risk of diabetes.

16. Diabetes Physical inactivity has been shown to contribute to diabetes. Physical inactivity has been shown to contribute to diabetes. Impaired Glucose Tolerance (IGT) Impaired Glucose Tolerance (IGT) African Americans, American Indians, Alaskan Natives, Asian Americans, Pacific Islanders and Latinos are at higher risk for developing Type 2 diabetes. African Americans, American Indians, Alaskan Natives, Asian Americans, Pacific Islanders and Latinos are at higher risk for developing Type 2 diabetes. Age - Approximately 18.4% of Americans over age 65 have type 2 diabetes. Age - Approximately 18.4% of Americans over age 65 have type 2 diabetes.

17. Musculoskeletal Arthritic conditions: OA, Rheumatoid, Gout Arthritic conditions: OA, Rheumatoid, Gout Lasting joint pain and tenderness Lasting joint pain and tenderness Joint swelling Joint swelling Joint stiffness Joint stiffness Problems using or moving a joint normally Problems using or moving a joint normally Reduced functional capability and exertion tolerance Reduced functional capability and exertion tolerance

18. Cognitive Ability Cognitive decline is a deterioration in cognitive function. There is a normal process of age related cognitive decline across the life-span characterised by increasing difficulties with memory (new learning) speed of infomation processing, language and other cognitive functions. This normal process of age related decline. Cognitive decline is a deterioration in cognitive function. There is a normal process of age related cognitive decline across the life-span characterised by increasing difficulties with memory (new learning) speed of infomation processing, language and other cognitive functions. This normal process of age related decline.memoryspeedlanguagememoryspeedlanguage

19. Cognitive decline mild cognitive impairment increases with age. The prevalence is 10% in those aged 70-79 years and 25% in those aged 80-89 years. mild cognitive impairment increases with age. The prevalence is 10% in those aged 70-79 years and 25% in those aged 80-89 years. cerebrovascular disease, Lewy body dementia, Parkinson's disease, fronto- temporal dementias (alcohol related),Alzheimer's disease, or no specific underlying pathology (Dementia). cerebrovascular disease, Lewy body dementia, Parkinson's disease, fronto- temporal dementias (alcohol related),Alzheimer's disease, or no specific underlying pathology (Dementia).

20. Vision There are four major age-related eye diseases There are four major age-related eye diseases glaucoma, cataracts, age-related macular degeneration and diabetic retinopathy glaucoma, cataracts, age-related macular degeneration and diabetic retinopathy By age 65, 1-in-3 people have some form of vision-impairing eye disease. By age 65, 1-in-3 people have some form of vision-impairing eye disease. Presbyopia - the lens of the eye loses its ability to focus Presbyopia - the lens of the eye loses its ability to focus

21. Hearing Presbycusis-is the loss of hearing that gradually occurs in most individuals as they grow older. Presbycusis-is the loss of hearing that gradually occurs in most individuals as they grow older. Tinnitus-common in older people. Tinnitus-common in older people. Sensorineural-damage to the inner ear or the auditory nerve. This type of hearing loss is permanent. Sensorineural-damage to the inner ear or the auditory nerve. This type of hearing loss is permanent. Conductive-when sound waves cannot reach the inner ear e.g. Earwax, fluid, or a punctured eardrum. Treatable. Conductive-when sound waves cannot reach the inner ear e.g. Earwax, fluid, or a punctured eardrum. Treatable.

22. Other Ageing Effects A slowed reaction time, which is especially important when judging if a person can drive. A slowed reaction time, which is especially important when judging if a person can drive. Thinner skin, which can lead to breakdowns and wounds that don't heal quickly Thinner skin, which can lead to breakdowns and wounds that don't heal quickly A weakened immune system A weakened immune system Diminished sense of taste or smell, especially for smokers, which can lead to diminished appetite and dehydration Diminished sense of taste or smell, especially for smokers, which can lead to diminished appetite and dehydration

23. Legal Equality Act 2010 Equality Act 2010 Disability discrimination – need to consider reasonable adjustments Disability discrimination – need to consider reasonable adjustments Age discrimination Age discrimination Forced retirement Forced retirement

24. Employers Flexible working Flexible working Part-time working Part-time working Adjustments Adjustments Redeployment Redeployment

25. Why continue Studies of older people show clearly that those who stay in work are healthier and often happier than those who retire early (Waddell and Burton 2006, Black 2008). Studies of older people show clearly that those who stay in work are healthier and often happier than those who retire early (Waddell and Burton 2006, Black 2008).