1 The ageing workforce and its implications for occupational health and safety prevention programs and work-injury compensation systems: A Canadian perspective Peter Smith School of Public Health and Preventive Medicine, Monash University
2 Acknowledgements This work is supported through grants from WorkSafeBC (RS2009- OG03) and the Canadian Institutes for Health Research (111273). Peter Smith was supported by a New Investigator Award from the Canadian Institutes of Health Research. Access to data sources was made available through the Statistics Canada s Data Liberation Initiative via the University of Toronto, and through the Statistics Canada Research Data Centre and the University of Toronto.
3 The Institute for Work & Health Independent, non-profit research institute in Toronto, Canada Majority of funding from the Ontario WSIB ($4.7 million) Plus approx 2.5 million / year from competitive funding agencies Two broad research goals to protect the health of workers by studying the prevention of work-related injury and illness. to improve the health and recovery of injured workers. Staff of 22 scientists from a variety of disciplines Approximately 80 FTE staff in total Governed by a Board of Directors and a Scientific Advisory Committee
4 Compensation systems in Ontario and British Columbia Lost-time claims (LTCs) After the day if accident/illness, the worker is absent from work; or has reduction in earnings (through fewer hours at old job or lower wages doing modified work). No-lost-time-claims (NLTCs) Worker requires health care (arising from work injury or illness), but is not absent from work other than the day of Injury. Also includes modified work for more than seven days at regular pay and hours, even without health care.
5 Overview Who are older workers and why should we be interested in them? Older age and the prevention of work injuries. Older age and the consequences of work injuries. Related plans for future research in Victoria
6 Who are older workers and why should we be interested in them?
7 Who are older workers? Human Resources and Skill Development Canada = 45 years or older Statistics Canada & European Foundation for the Improvement of Living and Working Conditions = 55 years or older
8 Workers Compensation policy around older workers in Canada Loss of earning benefits End at age 65 for workers who were less than 63-years-old at the time of injury Workers who are injured when over the age of 63 are paid loss of earnings for up to two years after the date of injury. In some provinces (e.g. BC) entitlements may be extended past age 65 Health Care Is available to workers past age 65, regardless their age at injury Re-employment Employer s obligation to re-employ injured workers ends on the date a worker turns 65 years of age
9 Population Pyramids: Canada (1980, 2000, 2050) Men Women
10 Population Pyramids: Australia (1980, 2000, 2050) Men Women
11 Canada Australia
12 Life Expectancy at age 65. Canada: 1991 to yrs 18 yrs
13 Percent of older persons who are currently working. Canada: 1990 to % 70% 60% 50% 40% 30% 20% 10% 0% to 64 years 65+ years 55 to 59 years (A) 60 to 64 years (A) 65+ yrs (A) Source: Canadian Labour Force Survey
14 Percent of the employed labour force who are over 50 years of age. Canada: 1990 to % 25% 20% 65+ years 50 to 64 years app 98,000 workers app 271,000 workers 15% 10% 5% 0% app. 1,6 mill workers app. 3,6 mill workers Source: Canadian Labour Force Survey
15 These trends will continue and may increase Planned age of retirement for respondents age 45 to 49 years of age: 1991, 2002 and % 35% 30% 25% 34% 32% 30% % 26% 26% 20% 15% 22% 20% 20% 20% 22% 21% 10% 5% 0% Before yrs 65 or older Don't know Shellenberg and Ostrovsky, 2008
16 And it is not just healthy workers who want to stay in the labour force 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Retirement plans for 45 to 59 year olds by level of self-rated health. Canada % 32% 78% 26% 35% 71% 33% Don't know when will retire Plan to retire at 65 or older Expect adequate income 58% 45% 46% 39% Excellent Very good Good Fair or Poor 50% Shellenberg and Ostrovsky, 2008
17 Types of employment for workers age 50 and over. Canada: 1996 to 2011 Source: Canadian Labour Force Survey
18 Number of persons and FTE s over 50 years of age working in temporary work arrangements and first 6 months of a job. Canada 1996 to , , , , , , ,000 50,000 0 Temp (Pers) Temp (FTE) LT 6 mnths (Pers) LT 6 mnths (FTE) Source: Canadian Labour Force Survey
19 Summary Older workers are an increasing proportion of the labour force More older people More wanting to work A greater percentage in temporary employment relationships In Canada, 11% of people over the age of 65 are working (up from 6% in 2000) These trends will likely further increase as more workers choose not to retire
20 Older age and the prevention of work injuries?
21 Age and work injury General assumption that risk of work-related injury declines with age, but that when injuries do occur they are usually more serious
22 Rates of work injuries per 100 full-time equivalents by age groups. Canada to 24 yrs 25 to 34 yrs 35 to 44 yrs 45 to 54 yrs 55+ yrs Activity Limiting Req Med Att Men Women Source: Canadian Community Health Surveys, cycles 2.1 and 3.1
23 Percent distribution of lost-time claims in Ontario by age: 1991, 1996, 2001 and % 30% 25% 20% 15% 10% 5% 0% 15 to to to to to
24 -25% Relative change in number of accepted lost-time claims in Ontario: 1996 to 2008 by age group
25 Percent distribution of time loss claims in Victoria by age: , and % 14% 12% 10% 8% 6% 4% 2% 0% Source: WorkSafe Victoria 2008/09 Statistical Summary (available at ww.worksafe.vic.gov.au)
26 Relative change in number of accepted time loss claims in Victoria: to by age group -12% Source: WorkSafe Victoria 2008/09 Statistical Summary (available at ww.worksafe.vic.gov.au)
27 Rates of accepted claims per 1,000 full-time-equivalents by age group. British Columbia, 1997 and to 24 yrs 25 to 34 yrs 35 to 44 yrs 45 to 54 yrs 55+ yrs Men 1997 Women 1997 Men 2007 Women 2007 Source: Smith et al (in progress)
28 Rates of claims accepted per 1,000 full-timeequivalents by age group. British Columbia, to 24 yrs 25 to 34 yrs 35 to 44 yrs 45 to 54 yrs 55+ yrs Men (all) Women (all) Men (TL) Women (TL) Source: Smith et al (in progress)
29 Rates of wage loss claims per 1,000 full-time-equivalents by age groups. Males only, British Columbia, to 24 yrs 25 to 34 yrs 35 to 44 yrs 45 to 54 yrs 55+ yrs Men Noise Equipment Source: Smith et al (in progress)
30 Rates of wage loss claims per 1,000 full-time-equivalents by age groups. Males working in occupation with equipment: British Columbia, , , All Bone trauma Open wounds Muscular Trauma Source: Smith et al (in progress)
31 Rates of serious injuries by age per 1000 persons. WorkSafe BC compensation claims to 24 yrs 25 to 34 yrs 35 to 44 yrs 45 to 54 yrs 55 to 64 yrs 65+ yrs Men Women Men (fractures) Women (fractures) Source: Fan et al, 2011
32 Rates of disability claims (10 or more days) per 1000 person-years, Victoria 2001 to 2004 Berecki-Gisolf et al 2012
33 Rates of self-reported time loss work injuries per 1,000 full-timeequivalents. Australia, and (MPHS) to 24 yrs 25 to 34 yrs 35 to 44 yrs 45 to 54 yrs 55+ yrs Men Women Men Women Source: Smith et al (in progress)
34 Summary Compensation boards are dealing with an increasing number of claims from workers over the age of 45 years of age. Older age is not always associated with a reduced risk of injury relationship differs by gender, occupational exposures and injury type The relationship between age and work injury has changed over time. Differences in injury rates are now less pronounced. In Australia, not all age and gender groups have had reductions in injury risk between and This has changed the relationship between age and work injury.
35 Aging biological, psychological, social and societal change Chronological age Functional age Societal age Organisational age Kooij et al, J Man Psych, 2008
36 Thinking outside of chronological age to understand issues related to the aging workforce Functional age: what is the relationship between chronic conditions and work injury and recovery from work injury? Societal age: are older workers treated differently by the health care or compensation system than younger workers, even with the same type of injury? Organisational age: are older workers treated differently in the workplace than younger workers, even with the same type of injury?
37 Distribution of medically diagnosed chronic conditions among labour force participants by age. Canada % 30.0% Less than 50 yrs 50+ years 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Asthma Athritis Back Probs High BP Diabetes CVD 1 CC 2+ CC Source: Canadian Community Health Survey, Cycle 4.1
38 Prevalence of medically diagnosed chronic conditions among labour market participants. Canada: 1994 to % 107% 36% 164% 58% Source: National Population Health Surveys and Canadian Community Health Surveys
39 A hypothetical example of the relationship between declining worker capacity and occupational physical demands Energy reserve Occupation with high demands Energy Reserve Occupation with moderate demands Occupation with low demands
40 Questions What is the role that chronic conditions and functional declines associated with age play in the risk of work injury? Palmer et al (2008), OEM, 65,
42 Chronic conditions and risk of activity limiting injury requiring medical attention. Canada: Purple square = women Red square = men Arthritis High BP CVD Diabetes Back Probs Source: Smith et all (in press) JOEM
43 Chronic conditions and risk of repetitive movement injuries. Canada: Purple square = women Red square = men Source: Smith et al (in press) JOEM
44 Summary Limited research is currently available on how changes in function, societal or organisational age impact on risk of work injury Available data in Canada suggests that chronic conditions associated with older age are associated with an increased probability of both acute work injuries and repetitive movement injuries Statistically significant risk for arthritis and back problems among both men and women.
45 Older age and the consequences of work injuries?
46 Older age is associated with more severe consequences, even after the same event Percent distribution of types of injuries for lost-time injuries involving falls on the same level. US Data, 2003 Monthly Labour Review, October 2005
47 Percent of severe injuries* after the same event by age group. Ontario 2004 to Lost-time claims *Injuries to bones/nerves/spinal cord/intracranial injuries and multiple injuries
48 Occupational injury fatality rate by age. US Data, 2007 US Department of Labour, 2008
49 Declining physical function can also influence the ability to return to work Physical capacity required to return to work (% of max) by age: hypothetical example using occupational with moderate physical demands 100% % 80% 70% % of max to RTW Physical Capacity 75% 81% 88% % 50% 55% 58% 58% 60% 63% 66% 69% % 30% Occupation with moderate demands % 20 10% 10 0%
50 Mean and median days of wage replacement over the first two years. Lost-time claims, Ontario, 1994 and to to to to to (mean) 2004 (mean) 1994 (med) 2004 (med) Hogg-Johnson et al, in preparation
51 $2,000 Mean and median health care costs (2002 $ s) over first two years. Lost-time claims. Ontario, 1994 and 2004 $1,800 $1,600 $1,400 $1, to to to to to $1,000 $800 $600 $400 $200 $ (mean) 2004 (mean) 1994 (med) 2004 (med) Hogg-Johnson et al, in preparation
52 Adjusted* mean health care over two years. No-lost-time claims: Ontario 1991, 1997, 2006 $600 $500 $400 $300 $200 $100 $ yrs yrs yrs yrs 55+ yrs Smith et al, JOEM, 2011
53 Median days to first full-return to work by age: WorkSafe Victoria claimants 2001 to Berecki-Gisolf et al 2012
54 Summary Older age is associated with more severe consequences even after the same event In Ontario, age differences in health care costs and time lost from work after a injury are increasing severity of injury health care utilisation (both number of treatments and type of treatments) The relationship between aspects of aging (outside of chronological age) and the consequences of work injury (wage replacement and health care costs) is not known...
55 Overall Summary What we know The Canadian labour force is aging While work after age 65 is not common, it is increasing Rates of injuries generally decline with age, although not always. This relationship is changing. Chronic conditions, in particular arthritis and back problems, are associated with increased risk of work injury (acute and repetitive movement) among men and women Differences in health care expenditures across age groups may be widening Differences in the duration of wage replacement across age groups may be widening
56 Overall Summary What we need to know What specific aspects of aging impact both primary and secondary prevention of work injuries Are specific chronic conditions associated with more severe injuries? greater health care utilisation, costs or time away from work? Is this morbidity or injury specific? Is there an interplay between measures of functional age and occupational characteristics in return to work after injury? Are older workers treated differently (by medical, workplace, compensation) than younger workers even after the same injury? What happens to workers injured when 63 and older?
57 Planned future work at MonCOEH The relationship between age and work injury and the consequences of work injury in Victoria using information from the Compensation Research Database (CRD) Estimating the size of the insured labour force in Victoria across key labour market characteristics (e.g. age, gender, occupation) Time trends in the relationship between age and different injury outcomes (e.g. health care spending, days off work). How similar are trends in workers compensation claims to trends in self-reported injury? 57
58 Planned future work at MonCOEH Developing a framework for occupational health and safety vulnerability (underway funded through ISCRR) Understanding individual, workplace and system level influences on return to work in the context of the ageing Victorian labour market. The influence of types of injuries and measures of chronological and functional age (work in progress funded through ISCRR) 58
59 For more information or to get a copy of this presentation Peter Smith Senior Research Fellow School of Population Health and Preventive Medicine Ph: