Frances Reynolds & Alex Farrow Brunel University London Project funded by IOSH

Post-retirement age workers and health and safety:How does working over age 60 affect safety on the job? Frances Reynolds & Alex Farrow Brunel University London Project funded by IOSH

Does working into the 60s (and beyond) pose any health and safety risks? • IOSH funded a 3-phase project to find out: • Existing evidence concerning the health benefits and health risks of working beyond 60 (systematic review) • Motivations for working beyond 60/65 and perceptions of workplace hazards and discomforts (interview study) • Experiences and attitudes regarding safety at work across different age groups (survey)

Background • People are being expected to work for longer before retiring • The Office for National Statistics (ONS) reported that 1.4 million people were working beyond State pension age (SPA) (ONS 2012) • Men in highly skilled jobs are more likely to work beyond SPA – and women in low skilled jobs • Current figures show 73% of employees expect to work beyond 65 (up from 67% in 2016 and 61% in 2015) • SPA rising from 67 to 68 between 2037 and 2039 http://www.thisismoney.co.uk/money/pensions/article-2414016/Number-65-74-year-olds-work-doubles.html http://www.adrdaily.com/uk-lags-jobs-older-workers/

Why are people retiring later? • ONS reported the following key reasons (in 2012): • the ending of compulsory retirement age (and rising age of payment of State pension) • increased life expectancy • increases in flexible working patterns • economic pressures – reduced savings interest/annuity rates – and rising livings costs Vera Rubin, discoverer of dark matter; continued her research into astronomy until her death in 2016, aged 88

Further motives for late-life working • There is limited evidence about psychological / social motives for continuing to work beyond SPA. • These include1: • enjoying the content of work and using job-related skills. • preserving routines and keeping busy • making a worthwhile contribution • social contact Dr William Frankland, immunologist and expert in allergy, still working at 105 (pictured with Princess Anne).

Reasons for working beyond SPA (IOSH study) 1. Financial security Maintaining a satisfying lifestyle On-going support of dependents 2. Active control over health Keeping physically active Maintaining mental alertness and vitality Work obligations and routines help resist ‘‘giving in’’ to illness, laziness and low mood Work as a distraction from pain and other health problems 3. Later life as a time for maintaining identity and continuing personal development Learning and change Challenge and achievement Social connectedness and affirmation Resisting ageist stereotypes Preserving personal and professional identity Colin Pillinger, 70, planetary scientist Eileen Kramer, 100, performing in Sydney earlier this year

Health concerns of older workers • Two thirds of 55-64s (compared to 53% of 25-34s) are concerned that poor health will limit their ability to work beyond 65* • In addition to disease, typical age-related changes in functioning include: • difficulties in tasks requiring divided attention • slower information processing speeds • worsening visual acuity in low light • hearing loss (2-3.5% loss per year) • increased susceptibility to back pain • reduced muscle mass, strength, flexibility, standing tolerance Barbara Knickerbocker-Beskind O.T., prosthetics designer, continues as designer of adapted equipment for elderly and visually impaired, at 91 http://www.bbc.co.uk/news/magazine-33626980 *Canada Life Group Insurance survey 2017

Review of evidence about health and safety among over 60s at work • What are the health benefits of continuing to work beyond retirement age? • Are there any safety aspects (hazards, accidents, risks, ill-health) associated with later life working? • These are NOT straightforward questions to ask of published evidence

Health benefits of working into later life: overview of evidence • Workers aged over 60 typically have good physical and functional health • Does this simply reflect the ‘healthy worker effect’ and self-selection? • Work itself may not benefit health – but could be one facet of a positive psychosocial context. • Older workers are more likely to have working spouses, more education, and better financial status – and be working part-time. • Choice over lifestyle may be a key determinant of subjective well-being.

Is working beyond SPA good for health? • Our study (of 40 interviewees) found that working into later life helped participants to flourish – a state of emotional vitality • They framed their later years as a period of opportunity rather than decline, and a time to apply and further develop their work-related expertise rather than withdraw wholly into leisure and family activities • Only poor health (of self or partner) was seen as a significant future threat to continuing in work • BUT note that few participants felt ‘obliged’ to work – they enjoyed high levels of choice/ control; 75% worked part-time • The findings may not generalise to older workers who have less choice through delays in pension entitlements Stephanie Kwolek: Inventor of Kevlar. Earned the Lemelson-MIT Lifetime Achievement Award in 1999, at age of 76.

Are older workers more susceptible to injury at work? Review of published evidence • The search for evidence was complicated: • Varying definitions of ‘older’ worker (e.g. >50, even >40) • Studies of workers which included a wide age range rarely reported any analysis on workers older than SPA • Very little focused enquiry into safety issues affecting workers beyond 65 (or even 60) • Findings vary by industry

Occupational injuries among the over 60s • Several studies have noted that the oldest groups studied (usually 60-64) tend to have fewer work-related injuries (and/or make fewer compensation claims for work-related injuries) – for example: • Irish construction workers2 • US carpenters3 • Canadian cooks and food service workers4 • Canadian blue collar workers 5 – older workers had worse hearing loss but fewer accidents • US hospital employees6 Rick Stein; aged 70; celebrity chef and restaurateur

Example of findings from US National Surveillance data of treatment for work-related injuries in hospital emergency departments From: A COMPENDIUM OF NIOSH CONSTRUCTION RESEARCH 2003; Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health

Occupational injuries tend to be more severe among older workers (>60) • Swedish iron ore miners7– the oldest group (55-65) had fewer accidents but more severe injuries leading to more days sickness absence • A rare study8 including ≥65s reported US survey data that noted increasing absences due to injury with age (18 days per year among the ≥65s – 5 days in the 20-24 group). • Workers aged ≥65 were more vulnerable to injury linked with driving/transportation – and more susceptible to fractures. • This study8noted that injuries were not only associated with hazardous occupations – in retail sales, the ≥65s had the highest rate of same-level falls

Rate of falls at work (by age and sex): Canadian data The middle age-groups (e.g. 35-44 years) had higher rates of strains/sprains and severe musculoskeletal injuries. Older workers had higher rates of fractures and severe falls - BUT lower rates of contact injuries compared to younger workers9 University of British Columbia Partnership for Work, Health & Safety; surveillance data from workers’ compensation claims.

Occupational injuries may have worse outcomes for >60s • A relatively early study in 1988 10 reported that ≥65s suffer higher rates of permanent disability and fatality from incidents at work (especially in manufacturing, transportation, craftworking) • BUT the study notes that disability rates vary across States in the US – with Arkansas, Wisconsin and Idaho reporting a greater incidence of job-related injury • Disparity may be linked with more manufacturing and service industries in these States OR different compensation policies/ definitions of disability

Occupational fatalities • Fatal workplace accident data from the US11 found that workers aged ≥65 had 13.7 fatalities/ 100,000 workers – compared with 5.1/100,000 among younger workers. • The oldest group were more susceptible to machine-related deaths. http://www.straitstimes.com/singapore/manpower/wage-subsidy-for-older-workers-to-be-extended

Recent fatal injury figures (USA data) *In 2014, USA data from the Census of Fatal Occupational Injuries reported that ≥65s are most vulnerable to fatal accidents at work. 40% of (all) deaths were a result of transportation accidents; 17% a result of falls. Large proportion of those affected were of Latino origin – linked with unsafe jobs, job insecurity and no training. Agriculture, mining, transportation and construction have the most fatal injuries

Which factors protect workers aged ≥60 from injury? • The ‘healthy worker effect’: the oldest group might remain at work because they have better physical and cognitive functioning? • Greater job experience: may lead to compensatory strategies (e.g. to maintain driving safety 12) • Changed work roles: the oldest group (in studies reporting positive outcomes) may have been promoted (or demoted) into less hazardous jobs (e.g. mentoring/ consultancy) • BUT injury and mortality data provide limited insights into the specific environmental events and human errors which lead up to the incidents being recorded – we lack narrative data about the trajectory of such incidents.

Older workers’ perspectives on safety and risk at work • Our interview study found that older workers perceived few risks at work: • “I can’t really think of anything that really affects me at all, I mean sitting about too long [at a computer] is not a good thing. But I am not by any means overweight … I keep myself fit, I’ve just come in from the gym as it happens half an hour ago. No, the safety issue is never a consideration” (Joseph, running his own recruitment business full-time, 78). Most participants were office-based and part-time

Older workers’ perspectives on safety and risk at work “Sometimes, at the end of the day, I’m getting a bit mentally tired, I can feel myself making a few silly errors ...but I think it happens to everybody, doesn’t it?” (Christopher, 70, part-time hospital worker). • The main hazard thought to relate to age was tiredness • Most work-related ‘hazards’ were thought to affect people of all ages: • Prolonged sitting at computers • Lifting heavy items • Driving • Lone working and clients’ negative behaviour • Pace of change “They’re the same things that would apply to anybody. I don’t feel they’re particularly more difficult for me than other people” (Ben; 76, part-time locum GP)

Strategies to cope with hazardous aspects of work: Interview study “It is a given [in all the veterinary practices attended] that Graham doesn’t operate” (because of arthritis), Graham, 68, locum vet. • Adapt to age-related changes • Reduce hours and driving commitments • Apply work expertise (including from previous careers) • Be assertive • Exercise authority and status • Use supportive company policies and practices “I always feel it’s part of my job actually [to advocate safe practices]. Hospitals are highly pressurised now, you can get people who … let’s put it this way, overstate their authority if you like. And if you’ve got young people onboard, they will accept it as normal and I know it isn’t normal and I will not let them suffer under that regime” (Christopher, part-time hospital worker, 70).

How safe is later life working? Summary of published evidence • The over-60s were shown in most published studies to have lower accident and injury rates compared with younger workers, although they were more seriously affected when accidents did occur and took more sickness days off. • Over-60s were more likely to suffer fractures in workplace accidents (increasing the likelihood of retirement). • Over-60s (especially over-65s) were more likely to suffer fatalities at work – but there is little information about the events leading to such severe consequences • Manufacturing, transportation, construction, agriculture all posed larger risks – but also falls were noted in retail • Factors such as work-related hearing loss may affect workers over 60, and increase risk of accidents.

Summary (continued) • We found no robust evidence that work patterns including shiftwork, or overtime (unless excessive), affect the safety of the 60+ worker, more than any other worker. • The over- 60s typically seem to be able to apply protective or compensatory strategies to maintain safe working practices (e.g. when driving). • Education, work experience and expertise have important protective effects on the 60+ worker, maintaining skills and cognitive resources (e.g. study of flight simulator training among pilots aged 40-6913 ; accident rates among pilots are better predicted by qualification age than actual age14).

What did the interview study add? • The older people valued maintaining their occupational identity and vitality, and saw later life as a time for further development • Work was part of a self-chosen lifestyle – mostly part-time • We recognise that the sample was relatively advantaged – and tended to be office-based • Interviewees were suspicious about ageist attitudes and disliked the focus on ‘health and safety’ as it implied incompetence

What did the interview study add? Further understanding of: • Perceived ‘hazards and discomforts’ of later life working – thought to be shared widely with workers of all ages • Strategies for adapting to stress and age-related change at work – but largely at an individual level (not organisational), linked with older people’s expertise, authority and assertiveness “When someone buys a bag of compost, I say ‘Can you put it in the car yourself?’ And they say ‘Yes I can do that’, and I say ‘Well, you look stronger than me, a bit younger than me!’” (Eric, 80, owner of a horticultural business, works full-time).

Limitations of published evidence • There are very few studies of workers aged over-65, and relatively few report on the over-60s • Existing studies of over-60s focus on objective accident rates, fatalities and days lost from injury rather than narratives about unfolding events or health and safety perceptions, experiences and coping strategies. • A few studies gather retrospective memories from older workers (e.g. of workplace noise exposure) which are hard to validate • Older workers’ own experiences of safety and risk-taking behaviour at work, the circumstances leading to incidents and near-misses, and their suggestions for improving safety, are not directly examined.

Limitations of published evidence • Opinions of managers/ employers predominate • Many recommendations – e.g. for skid-resistant flooring, shallow-angle stairs, and larger screen displays – are not based on consultation with older workers • There are very few longitudinal studies to trace age-related changes in the work performance, safety and adaptation of workers into their 60s and 70s. • Socio-cultural change is affecting later life working – so existing evidence may offer inadequate future guidance

What more do we need to know? • How do older workers’ health problems and responsibilities outside of work affect work capabilities and performance? (e.g. declines in concentration, strength, fitness may mean that older people are working closer to their limits)? Job demands. Increased pace. Insufficient training. Sensorimotor loss. Health problems. Caring responsibilities. Cognitive resources. Fitness Expertise. Support at work and at home.

How do health problems affect safety? • One recent study 15 noted that arthritis could be one factor increasing risk of falls among older women at a chemical plant % people with arthritis by age - Canadian Community Health Survey 2010 Neck and back painalso increases in a similar pattern

Average Annual Age-Specific Incidence Rates of Stroke (First-ever and Recurrent) Per 100,000 Population in the United States in 1996 by Sex. What may be the role of stroke or transient ischaemic attack (TIA) in fatal accidents in the workplace? See publication16

Many older people at work are affected by cancer and its treatment – with unknown effects on safety Average Number of New Cases of all cancers (excluding melanoma) per Year and Age-Specific Incidence Rates per 100,000 Population, UK

Unpaid care provision: by age and sex in England (UK Census figures 2011) How does the burden of care affect safety at work? Despite the huge burden of caregivingby older people, there is a “breathtaking lack of awareness” by the government – Professor Alan Walker, Director of the New Dynamics of Ageing programme

Improving safety at work for the over-60s • Consult with older workers about their experiences and needs17 • ‘People still think it will be frowned upon if you admit you are having problems, especially if it’s something that is not going to get better but related to age decline’ (Group Health and Safety Manager, Arts & Entertainment) 17, p10

Improving safety at work for the over-60s • Enhance older worker’s ability to do the job safely: • Introduce non-stigmatising, discreet ways for older workers to discuss changing abilities, health and social circumstances • Offer hearing and sight tests that are relevant to work demands • Offer education and develop opportunities to increase fitness and strength • Provide a choice of flexible/ part-time working that can accommodate older workers’ health and caring issues • Provide training to maintain work skills and cope with change – and on-going safety training

Improving safety at work for the over-60s • Organisational change: • Implement age-awareness training for managers (or more widely) • Use ergonomic designs that promote age-friendly workplaces • Offer rest/quiet areas for brief periods of respite and recuperation • Consider job design that increases self-pacing (and reduces external pacing) and reduces physicality of roles, where possible All the above strategies enhance the experience of workers of all ages, so avoiding discrimination

Conclusion • Workers of ≥60 have good safety records in terms of injuries and claims – but suffer more severe injuries (e.g. fractures) and fatalities when incidents occur • There is little evidence about what leads up to severe injury/ fatality at work • Published evidence largely relies on data from workers who are choosing to remain in work in their 60s and beyond and may not generalise to the changing profile of workers who are obliged to work for longer • Workplaces need to take into account attributes of older people such as reduced reaction times, loss of core strength, and possible distraction by health problems, bereavement and caring responsibilities – and capitalise on expertise • Designing age-friendly working environments benefits the health and safety of all workers

“In societies where mature workers are respected and where their wisdom is respected, everybody benefits”*. Sydney Prior (photographed aged 95 in 2009) worked at B&Q until shortly before his death in 2012 * Deepak Chopra, philosopher

Publications from the IOSH-funded study • Farrow, A. & Reynolds, F. (2012). Health and safety of the older worker (In-depth review). Occupational Medicine, 62 (1), 4-11. • Reynolds, F.., Farrow, A. & Blank, A. (2012). "'Otherwise it would be nothing but cruises': Exploring the subjective benefits of working beyond 65". International Journal of Ageing and Later Life, 7 (1), 79-106. • Reynolds, F., Farrow, A., & Blank, A. (2013). Working beyond 65: A qualitative study of perceived hazards and discomforts at work. Work: A Journal of Prevention, Assessment and Rehabilitation, 46(3), 313-323.

References 1. Smeaton D, McKay S. (2003). Working after State Pension Age: Quantitative Analysis. Leeds: HMSO, Department of Work and Pensions. 2. Brenner, H., Ahern, W. (2000). Sickness absence and early retirement on health grounds in the construction industry in Ireland. Occupational and Environmental Medicine, 57, 615–620. 3. Lipscomb, HJ, Cameron, W, Sylverstein, B. (2008). Incident and recurrent back injuries among union carpenters. Occupational and Environmental Medicine, 65, 827–834. 4. Alamgir, H, Swinkels, H, Yu, S, Yassi, A. (2007). Occupational Injury. American Journal of Industrial Medicine, 50, 528–535. 5. Picard, M., Girard, S. A., Simard, M., Larocque, R., Leroux, T., & Turcotte, F. (2008). Association of work-related accidents with noise exposure in the workplace and noise-induced hearing loss based on the experience of some 240,000 person-years of observation. Accident Analysis & Prevention, 40(5), 1644-1652. 6. Horwitz, I. B., & McCall, B. P. (2004). The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers’ compensation data. Occupational Medicine, 54(8), 556-563.

References 7. Laflamme, L., Menckel, E., & Lundholm, L. (1996). The age-related risk of occupational accidents: the case of Swedish iron-ore miners. Accident Analysis & Prevention, 28(3), 349-357. 8. Rogers, E., & Wiatrowksi, W. J. (2005). Injuries, illnesses, and fatalities among older workers. Monthly Labor Review, 128, 24-30. 9. Fan, J., McLeod, C. B., & Koehoorn, M. (2012). Descriptive epidemiology of serious work-related injuries in British Columbia, Canada. PloS One, 7(6), e38750. 10. Mitchell, O. S. (1988). The relation of age to workplace injuries. Monthly Labor Review, 111, 8-13. 11. Kisner, S. M., & Pratt, S. G. (1999). Occupational injury fatalities among older workers in the United States, 1980–1994. American Journal of Industrial Medicine, 36(S1), 24-25. 12. Llaneras, R. E., Swezey, R. W., Brock, J. F., Rogers, W. C., & Van Cott, H. P. (1998). Enhancing the safe driving performance of older commercial vehicle drivers. International Journal of Industrial Ergonomics, 22(3), 217-245.

References 13. Taylor, J. L., Kennedy, Q., Noda, A., & Yesavage, J. A. (2007). Pilot age and expertise predict flight simulator performance A 3-year longitudinal study. Neurology, 68(9), 648-654. 14. Li, G., Baker, S. P., Lamb, M. W., Grabowski, J. G., & Rebok, G. W. (2002). Human factors in aviation crashes involving older pilots. Aviation, Space, and Environmental Medicine, 73(2), 134-138. 15. Swaen, G., Burns, C. J., Collins, J. J., Bodner, K. M., Dizor, J. F., Craun, B. A., & Bonner, E. M. (2014). Slips, trips and falls at a chemical manufacturing company. Occupational Medicine, 64(2), 120-125. 16. Williams, G. R. (2001). Incidence and characteristics of total stroke in the United States. BMC Neurology, 1: 2 Access via http://www.biomedcentral.com/1471-2377/1/2. 17. Drake, C., Haslam, R., & Haslam, C. (2017). Facilitators and barriers to the protection and promotion of the health and safety of older workers. Policy and Practice in Health and Safety, 15(1), 4-18.

For further information • Please email frances.reynolds@brunel.ac.uk

Frances Reynolds & Alex Farrow Brunel University London Project funded by IOSH