4Ageing, musculoskeletal health and work
Introduction
In Europe, the proportion of people aged >65 years is expected by 2050 to represent 30% of the population; worldwide, the support ratio (of adults of working age to those aged >65 and <15 years) is projected to be only one-third of that in 1950 [1]. Therefore, in most countries, an economic imperative exists to encourage people to remain in productive work to older ages. Governments have responded by developing policies to encourage labour force participation in later life by, for example, delaying the age at which people can draw state pension benefits, abolishing the ‘default’ retirement age, and legislating against workplace age and disability discrimination.
The delayed availability of pension benefits as well as improved population health has led to many older individuals recognising the financial need and opportunity to remain in the workforce longer. A steady rise in those working beyond traditional retirement age has been observed [2], [3].
This changing age profile in employment brings with it potential pros and cons. It is feasible that work at older ages can benefit health [4]; on the other hand, it may be challenging for those with serious health limitations. In this chapter, we consider the relation between work and health at older ages, focussing particularly on musculoskeletal health, and a number of associated questions:
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How feasible is work, for those with chronic musculoskeletal disorders (MSDs)?
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Is work beneficial for people with chronic MSDs?
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How limited in employment are affected patients? How often does poor musculoskeletal health prevent their working?
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What interventions can increase work productivity in people with chronic MSDs?
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What are the predictors of work disability due to MSDs?
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Where affected individuals wish to work for longer, or feel they need to, what can be done to support them?
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What role can health-care professionals and managers play in extending gainful employment?
We first review the pattern of musculoskeletal complaints in later middle age; then consider what is known about their impact on employment; finally, we review potential interventions, including what clinicians can do to support older workers with MSDs. Gaps in research are highlighted.
To inform the review, searches were performed in Medline and Google Scholar, as well as a hand search of recent volumes of two journals of occupational medicine and three journals of rheumatology (details available on request).
Section snippets
Regional pain
Musculoskeletal symptoms are common in older middle life. In a survey of adults aged ≥50 years from North Staffordshire [5], back pain in the previous 4 weeks affected about one in three people aged 50–59 years. Similar proportions reported knee or shoulder pain, while a fifth to a quarter reported pains in the hip, neck, distal upper limbs or feet. Almost two-thirds of those affected experienced moderate to extreme interference with their work and household duties.
Age is a major risk factor
The impact of MSDs on work participation at older ages
In this review, health-related ‘work participation’ encompasses various employment-related outcomes, ranging from usual paid work at one extreme to health-related job loss at the other. This last event may take the form of early retirement on health grounds or, in some countries, entitlement to a state-funded disability pension; in between the extremes, patients may remain at work with amended or restricted duties, or diminished productivity (sometimes called ‘presenteeism’); or they may be
The modifying effect of work activity
Manual employment is clearly associated with risk of disability pension from an MSD. Thus, among 3674 people in the nationally representative Health Survey 2000 in Finland, disability retirement attributed to MSDs was approximately three to six times higher in manual as compared with non-manual occupations [56]. Adjustment for physical working conditions attenuated the socio-economic gradient by almost two-thirds, indicating that these drive much of the relationship.
The authors further explored
Is work at older ages good for musculoskeletal health?
Work at older ages may carry physical benefits, such as maintained muscle strength and mobility, and psychological benefits, such as sustained motivation and sense of purpose, social engagement and mental activity [4]. On the other hand, older workers may struggle with the demands of work [4], while planned normal retirement can carry benefits of its own [61], [62]. A trade-off exists therefore between opposing influences on health. Where does the balance lie?
An influential best evidence
Promoting work participation in older people with MSDs
In reporting higher rates of work disability and job loss in manual workers with MSDs, some authors have called for improved working conditions, to combat socio-economic differentials [56]. Others have exhorted doctors to increase their efforts to treat or prevent underlying health problems [70]. Such calls assume a predominantly biomedical relationship between working with an MSD and employment: physical stressors aggravate or cause injured and diseased tissues, which in turn render work
Summary and pointers for practice
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MSDs are very common; their prevalence generally rises in older people
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At older ages, they have a considerable impact on patients' employment prospects
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Factors that influence job retention at this stage include the type of MSD, its severity and treatment, the presence of comorbid illness, people's attitudes to work and retirement and the work environment's demands
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Interventions to optimise symptom control and provide a more flexible adaptive work environment can substantially improve older
Gaps in research
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The health risks and benefits of work at older ages require further elaboration, especially in workers with major joint disease
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Interventions to extend working life are underdeveloped and under-tested. Because the population is ageing and patients are likely to work for longer, this gap in knowledge is urgent to fill, in relation to MSDs and many other chronic diseases of ageing
Funding
This work has been undertaken under the auspices of the Arthritis UK MRC Centre for Musculoskeletal Health & Work. KTP also wishes to acknowledge core-funding support from the Medical Research Council.
Conflict of interest
None.
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