Aging and Injury: The latest Evidence

Monday, July 6, 2015 | 0

The workforce has indeed been aging. In contrast to younger age groups, the workforce participation rate of those over 55 is increasing. In 2000, the 10% of lost-time injuries were sustained by workers 55 years old or older. Today, it’s 20%, and the share will continue to grow.

There is no question but that, on average, injuries of workers in their 40s or older involve slower return to work. Yet recent evidence shows that while aging is a yellow flag for workers’ comp professionals, the entire picture is quite nuanced.

Aon coined the term "Ageonomics," publishing in 2014 an impressive series of reports which address a wide range of imperatives for managing productivity and injury risk of older workers. Aon makes the interesting observation that for this cohort of workers an integrated disability risk management approach is particularly valuable. For instance, return to work for older injured workers requires a higher level of attention that should be used for nonoccupational absences as well.

It found “consistently higher average cost for workers’ compensation claims for older claimants across all industry groups.” Workers’ comp claims for 45-54-year-old manufacturing workers were 52% higher than claims for 25-35 year olds. This confirms other reports of higher claims costs. While no one has shown definitely why claims costs are higher, an important contributor is slower physical recovery and more challenges in bringing the worker back to work.

A 2009 article written by Ivan Steenstra and colleagues has tantalizing data on return to work rates by age of worker. Dividing workers out due to low back pain between those under 44 years old and older, the authors reported that about half of each group returned to work at the same pace. However, without an ergonomic intervention, the results diverge when workers remain out of work longer than four months. Five percent of the younger group remained out of work for at least a year, compared to 20% of the older group. With ergonomic intervention, the older group’s RTW success matched that of the younger group.

I asked Michelle Despres, a physical therapist and executive director and national product leader at Align Networks, to describe what a clinician experiences in treating an older injured worker.

She described patients with rotator cuff tears that led to surgery. Align Networks’ data on patients shows that over 72% of its shoulder injuries involving surgery are for workers over 44 years old.

“Shoulder injuries and the aging healing process are more convoluted in a variety of settings, such as truck driving and warehouse workers,” Despres said. “A 35 year old after rotator cuff surgery would ordinarily be back at work full duty in 14 weeks. A patient over 55 will more likely be diabetic and overweight. His or her tensile strength and blood flow are weaker, there is less muscle mass and fatigue will set in earlier. Shoulders are particularly vulnerable for the older worker because their stability is very dependent on muscle, cartilage and ligaments, all of which are affected by aging.” Recovery for this older worker might take twice as long.

Despres cautions that physiology of aging is not destiny. “The older worker can have a strong work ethic, pride and knowledge of the job. Further, starting over in a new job may not be palatable. Research has shown this and this rings true.”

Her point is apt. Talking with Despres and claims professionals and looking at the research, one is struck by how aging may be a useful predictive yellow flag but should be used with care.   

The incidence rate of injuries does not appear to increase with aging beyond the mid-40s. Many older workers recover according to standard duration guidelines. That’s even though personal health care costs of the average American doubles between 35 and 45, and then triples by the late 50s. Automatically upping claims reserves or approving surgery and physical therapy based on a simple computer algorithm will lead to misadventures. 

For better or worse, the workers’ comp professional usually views the older worker through a narrow slit and does not see the whole story. One scholar on aging and ergonomics, Diana Schwerha, writes that “ageist stereotypes are perpetuated that employee productivity declines with age… Such claims are largely misconceptions… Research has emphatically shown that older employees are assets in the workplace.”

Schwerha estimates that ergonomically-sensitive policies by employers can extend productive, satisfying employment by five to 10 years beyond the time when a worker might otherwise want to retire. Despres notes that most soft tissue injuries involve stresses repeated over time, which may be eliminated by straightforward worksite adjustments. 

As we see, average figures about older workers and injuries are misleading. It will be useful for claims payers and employers to share their experience in designing nuanced strategies for this worker population.

Further Reading

Aon, Ageonomics, Enhancing the Workplace for the Aging Worker.

Schwerha D. et al., Integrating ergonomic factors into the decision to retire. Human Resource Management Review, 2011.

Stanford Center on Longevity, The Aging Workforce: a Chartbook of Demographic Shifts, 2013.

Steenstra I. et al., What Works Best for Whom? An Exploratory, Subgroup Analysis in a Randomized, Controlled Trial on the Effectiveness of a Workplace Intervention in Low Back Pain Patients on Return to Work. Spine, 2009 34 (12).