Ergonomics and the aging workforce
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ERGONOMICS and THE AGING WORKFORCE. or ERGONIGHTMARE Michael A. Alday, MD, MPH Medical Director Regional Occupational Health. As America Ages, So Does the U.S. Workforce • 78 million Baby Boomers (born 1946-1964) • Boomers comprise 46% of the U.S. workforce

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ERGONOMICS and THE AGING WORKFORCE

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ERGONOMICS and THE AGING WORKFORCE

or

ERGONIGHTMARE

Michael A. Alday, MD, MPH

Medical Director

Regional Occupational Health


As America Ages,

So Does the U.S. Workforce

• 78 million Baby Boomers

(born 1946-1964)

• Boomers comprise 46%

of the U.S. workforce

Source: U.S. Census Bureau,

Bureau of Labor Statistics


SOBERING FACTS ON AGING

  • Between 2000 and 2020, the number of people in the 55 to 64 brackets will increase by 40%

  • Of the 58 million workers in this country, the median age is now 40.5 years

  • The number of workers 45 and older has doubled since 1950


MORE SOBERING FACTS

  • By 2008, it is predicted that there will be 25.2 million workers aged 55 and over

  • This is in part due to decreasing retirement benefits/pensions and delays in social security entitlements

  • Many workers are forced to work longer because they are part of the “sandwich generation” --taking care of kids & parents


THETSUNAMI TIDALWAVE OF AGING

THIS IS SHOCKING!!

THE REAL QUESTION IS:

WHO IS GOING TO PAY FOR US BOOMERS??


OLDEST WORKFORCE BY INDUSTRY(average ages)

  • Miners – 36 years old

  • Construction – 39 years old

  • Electric Power Industry – 44 years old

  • Ford Motor Company – 45 years old

  • Nurses – 48 years old

  • Doctors – ANCIENT


PROBLEMS WITH AGING

  • Eyesight and hearing

  • Manual dexterity and coordination

  • Muscular strength(peaks at age 30)

  • Reduced cognitive function and memory

  • Chronic medical conditions, i.e. arthritis

  • More prone to injuries and CTD/RMI’s

    (cumulative trauma disorder/repetitive motion injury)

    • 37% of all work-related disabilities among older workers are due to CTD’s/RMI’s


RISK OF FALLING

  • Workers over age 64 have a 3X greater risk of falling(U.S. Dpt of labor)

  • Average lost work days for a fall-related injury:

    • >55 – 11 days

    • <55 – 6 days

  • Older workers are one and a half times more likely to suffer a fatal fall


A CRUCIAL DISTINCTION

  • Total injury rates are actually lower among older workers

  • However, older workers are more likely to die or take much longer to recuperate from an injury which adds to the costs


ERGONOMICS: The science of matching the worker to the work


OSHA and State Worker’s Comp

We’re from the government and we’re here to help


WHAT IS A CTD/RMI(Cumulative Trauma Disorder)(Repetitive Motion Injury)

  • A CTD/RMI is a disorder of the muscles, nerves, tendons, ligaments, joints, cartilage, blood vessels, or spinal discs from repeated stressful or awkward motions and/or forces

  • Can involve the neck, shoulder, elbow, forearm, wrist, hand, back, knee, ankle, foot, and abdomen(hernia related)


SC Worker’s Comp and CTD’s

  • As recent as 7 years ago, CTD/RMI’s were considered diseases as opposed to injuries and were not covered by W/C

  • Today, they are readily accepted as work-related if there is a clear association with work and aggravation of symptoms


ERGONOMIC STANDARD

  • Proposed standard was set for January 2001

  • Goal was to reduce an estimated 1.8 million workers suffering from work-related MSD’s(musculoskeletal disorders)

  • Was shot down by U.S. Congress due to meddling into state W/C program(federal program telling states how to run their W/C programs and spend their money)


ERGONOMIC STANDARD

  • Even with these legal challenges, we will see this standard reappear in the future

  • Designed to match the worker to the workplace

  • Strongly supported by the labor unions

  • Even without the standard, it makes good business sense to implement a program


ONCE A CTD IS REPORTED

  • You must investigate and promptly determine if an CTD is an “incident”

  • Employers should request assistance of a health care professional to make this determination and to assess the “work relatedness” of the disorder


BENEFITS OF AN ERGONOMICS PROGRAM

  • Predicted to prevent 4.6 million CTD’s in first ten years

  • $9.1 billion could be saved annually at a cost of $4.5 billion for employers

  • $27,700 savings for each CTD prevented

  • Work station fixes can be as little as $250-500 per station


ERGONOMICS AND CTD/RMI’S


ERGONOMIC FORMULA

Repetition + Position + Force + Time + No Rest

= RMI or CTD


UPPER EXTREMITY PROBLEMS

Tendonitis Tenosynovitis

Tennis Elbow Rotator Cuff Strain

Neuropathies Carpal Tunnel Syndrome(CTS)

Raynaud’s Ganglion Cysts??


UPPER EXTREMITY PROBLEMS

  • Gradual onset

  • No history of injury

  • Dull pain, numbness, tingling

  • Swelling, bruising may be absent

  • Gets better with rest


UPPER EXTREMITY PROBLEMS

  • Upper extremity CTD’s are much more common than back CTD’s and are generally more costly as a group

  • Average case going to surgery costs $15-25K

  • Indirect costs are up to $50-75K per case


COMMON FACTORS

  • Sedentary lifestyle

  • Repetitive trauma near site

  • Vibrating or pneumatic tools

  • Resumption of tasks after inactivity

  • New tasks


COMMON FACTORS

  • Increased production (high repetition)

  • Awkward & prolonged postures

  • More common in females(esp. CTS)

  • Prolonged(>8 hours) shifts and/or overtime


DIAGNOSIS

  • Detailed job description is a must!

  • Strain index

  • X-rays/MRI’s

  • Nerve conduction studies


STRAIN INDEX

  • Moore-Garg Strain Index

  • Based on various risk factors of time, intensity, and posture

  • Scoring:

    <3 Considered safe

    Between 3-5 Uncertain risk

    Between 5-7 Some risk

    >7 Considered hazardous


REMEMBER

  • Better defined problems (“it hurts here” v. “my whole arm hurts”) are better associated with true pathologies and CTD/RMI’s

  • Rest and realignment (change the work toward a less awkward posture)


REMEMBER

  • Ratio of muscle (e.g.,tendinitis) to nerve problems(e.g., carpal tunnel) is usually

    5-10 to 1


ERGONOMICSOLUTIONS


Look for easy fixes!

  • Emphasize adjustment of workstation (minimize awkward postures)

  • Emphasize rotation of tasks (don’t type or keyboard for 4 hours straight, alternate with filing, other jobs)

  • Use of lifting devices or strict procedures for lifting heavy objects


Look for easy fixes!

  • Consider light and temporary job limitations or restrictions

  • Encourage strength and flexibility building with emphasis on early rehab/PT

  • Expect that they will continue to improve and reassure them that they will get better

  • Braces and ergonomic tools to help with the workload


What about other ergonomic solutions?

Worksite visit by the ergonomics team

-- What is the value?

  • Very high

  • Why?

    reinforces employee’s significance, importance,and the idea that the healthcare system is taking action


What do you look for?

  • Method of task accomplishment

  • Are there physical differences between workers?

  • Are there workstation or work area differences?

  • Can force, awkward positions, or prolonged duration of tasks be reduced?


Pearls……..

  • Light or modified duty whenever possible

  • Frequent follow-ups are OK

  • Be mindful of OSHA 300 recordability rules:

    • No prescription meds unless absolutely necessary

    • Use elastic splints and supports vs. rigid splints

    • Sending home for rest of shift is not recordable

  • People who like their jobs do better with less accidents

  • If you show that you care about the workers, they will care about you (remember the golden rule!)


Low Back Pain

The “other” CTD


Significance

  • 70% of people will have LBP

  • 50% will have a recurrent episode

  • #1 disability for men <45


Work Related

  • 75% of U.S. back cases are W/C

  • Only 25% of cases in Scandinavia are W/C for the same occupations

  • Differences in legal climate?


Cost

  • LBP workers’ comp awards up 27 fold over past 20 years despite improved safety/work conditions

  • 28% of all lost work days due to LBP

  • Med cost per case $25-35K

  • Total claim cost $150-250K

  • Majority have deg. disc disease present


Outcomes

  • 50% recover within 2 weeks

  • 90% recover within 6 weeks

  • 10% are major disability problems


Surgery Outcomes

  • Failure rate for industrial cases - 50%

  • Failure rate for non-industrial cases -10%

  • Poorer outcome

    • low income / education level

    • job dissatisfaction

    • history of previous disability or in the family (W/C is an inherited disease)


Treatments for early CTD/RMI’s

  • Education

    • positive expectations

    • reassurance that condition will improve

  • Provide comfort

  • Discuss activity alterations

    • avoid irritation

    • avoid debilitation


Treat CTD/RMI’s like Combat Stress

  • Simple explanations

  • Avoid diagnostic labeling

  • Brief rest and modified or transitional duty

  • Encourage activity

  • Keep worker at work


Treat CTD’s like combat stress

  • Avoid delaying care

  • Goal is return to the front lines (work)

  • Reinforce the expectation of returning to work


IN SUMMARY

  • The aging workforce will have a dramatic impact on both W/C and healthcare costs

  • Ergonomic issues will always be present

  • Involve your occ. health resources early

  • Be careful not to create a confrontational climate with your employees

  • Close case management is the key to W/C


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