Accurate information on the incidence, causes, social, and economic consequences of work-related conditions in older workers is essential to guide public policy. Specific information is needed on effective methods of rehabilitation and re-injury prevention for this segment of the workforce. Unfortunately, little is known about these issues. Our pilot investigation and other studies suggested significant differences between older and younger workers' experience related to occupational injuries and illness. As the number of workers over age 55 will be growing at a rate that is at least twice that of the general workforce, this area will become more important. We conducted a prospective, population-based study of long-term outcomes in older workers with occupationally-related conditions, building on a multifactorial model of influences on outcomes. State law requires notification by employers to the New Hampshire State Department of Labor (NHDOL) of any work-related condition reported by an employee. Using this data, workers over age 55 were contacted 2 - 6 weeks after an occupational injury or illness occurred. They completed a mailed baseline questionnaire, with prospective follow-up at 12 months post initial questionnaire. A comparison younger worker with similar affected body part and gender was selected for each case. We recruited 1500 injured workers over age 55 and as many controls over a 14-month period. Older and younger workers had similar rates of frequent body pains, obesity, having been out of work for more than 2 weeks in the past 5 years because of sickness, or a prior injury to the same body part. However, older workers had slightly higher rates of reporting difficulty doing heavy work on the job. One-third of younger workers reported that their injury was at least moderately severe, and this number was higher for older workers. Older workers actually appeared to have less concerns about return to work than younger workers. Older workers who were out of work had more severe injuries, less job tenure, and were more likely to be receiving a retirement pension. Non-work related illnesses were a factor in preventing return to work only in younger workers. Workers over age 55 were different in several important ways. At least a quarter of them were working in a post-retirement career, and others have much longer job tenure than younger workers. RTW is complicated by pensions and less attachment to a second job / second career. However, older workers had similar length of lost time, frequency of reinjury, and actually had somewhat less negative financial and social consequences of their injuries. These highly comparable outcomes, despite greater injury severity in older workers, suggest that a healthy worker effect is prominent even at these relatively young ages. Practical implications include the importance of tailoring treatment, return to work, and secondary preventive approaches to the unique circumstances of an individual older worker. The negative influences of severity and pre-existing health conditions appear to be less important than strong workplace attachments and RTW support as determinants of outcomes; age by itself is not very important once these factors are taken into account. Better outcomes can be achieved through a road-based approach that includes all factors potentially related to return to work, than by employing a more specific, narrow medical perspective.
Director, Liberty Center for Disability Research; Associate Professor, University of Massachusetts Medical School; 71 Frankland Rd., Hopkinton MA 01748