In the UK, the number of workers who are over the age of 50 and still actively working or seeking employment is falling.1 In addition, it is expected that the number of people below the age of 40 in the workforce will also fall over the next 20 years due to changes in population demography. If it is not addressed, the reduction in the size of the workforce, coupled with an ageing population, will have serious implications for the economy.
This article presents the results of research that reviewed current occupational health provision for older workers within the NHS, and reveals worrying gaps in OH advisers’ knowledge on managing the health of older employees.
It has been estimated that the financial cost to the economy of excluding workers between the ages of 50 to 65 could range from £19bn per year2 to £31bn per year.3
In 2003, Humphrey et al undertook a comprehensive study aimed at assessing the reasons why the number of working people over the age of 50 continued to fall in view of the current demographic changes. Significantly, 37% of workers have been forced to retire or leave a job because of ill health or disability. From an occupational health perspective, it is essential we try to reduce this figure to prevent an unnecessary exodus from the workforce.
Other reasons for staying out of work included gaining access to a private pension fund, and women who had not returned to work since having a family.
The government’s response to this issue included the introduction of various initiatives, such as the New Deal 50+, the Age Positive Campaign, and the Age Partnership Group. Yet none of these initiatives give particularly detailed guidance in relation to the OH issues associated with older employees.
The NHS has a workforce where the average age is rising, but no previous research existed that investigated the OH provision for older workers within the NHS. Anecdotal evidence suggested that OH provision and practice for older staff varies widely between organisations.
Research
My comprehensive research study was undertaken to provide the first detailed and comprehensive analysis within the acute NHS, and to provide recommendations for OH benchmarking. The ultimate aim was to promote consistency in OH practice, and to help inform a strategy for evidence-based OH practice for older workers.
All 160 acute NHS trusts in England were approached, and two members from each OH team were asked to complete a questionnaire. A 60% (n=191) response rate was achieved.
Analysis of the questionnaire identified generic and specific issues that were considered to allow the development and improvement of occupational healthcare for older workers, addressing legal, health and safety, and human resources issues.
‘Older workers’
There has been considerable debate as to what constitutes an older worker, yet consistently over the past three to five years, the Department for Work and Pensions and conciliation service Acas have defined them as workers over the age of 50. Disconcertingly, less than in one in 10 (9%, n=16) of those involved in this study could correctly classify an older worker as aged 50 and above. And at least one in three (39%, n=73) classified an older worker as aged 65 and above. This is despite the fact that, in accordance with the Nursing and Midwifery Council’s code of professional conduct (2004), OH advisers are expected to be aware of initiatives and guidance that might affect daily practice and provision of nursing care.
In 2004, the House of Lords recommended that ‘Employers should actively evaluate and instigate the redesign of job tasks and workplaces in order to maximise the opportunity for retention and recruitment of older workers’.4
However, this study indicated that some OH advisers felt the term ‘older workers’ was discriminatory, and that they should be treated the same as all other employees, as their health needs were the same as those of somebody in their 20s or 30s. Consequently, those who are being employed to advise organisations could actually be reinforcing common misconceptions, and potentially putting the health of those they are trying to protect and promote at risk.
Education
Although it might be expected that nurse education would influence practice and provision of OH care in relation to older workers, statistical analysis showed that education and training had had little influence. Potentially, basic concepts about older employees may not be included on the curriculum of OH courses, or may not be accurately conveyed. This is despite guidance from the World Health Organisation (WHO), which advocated in 1993 that ‘experts in occupational healthshould be taught about ageing and work as part of their professional training at the level of both basic education and postgraduate and continuing education’.5
Only one in five (21%, n=40) OH advisers had received some type of training in relation to the OH needs of the older workers, and there was no clear indication about where that training was consistently being provided. For example, training was achieved by personal study, in-house training, external study days and formal OH training.
Interestingly, the number of years’ experience a nurse had was found to be statistically significant, in that these advisers had a greater level of knowledge and understanding of the OH needs associated with older workers. This may be because these advisers are of that age group themselves, and could therefore be likely to be more familiar with these health needs.
Knowledge
The following five statements were taken from the literature review to gauge OH advisers’ (OHAs) knowledge base in relation to older workers:
“There are changes in the ‘average’ human body and brain with increased age, but most of the substantial changes occur well after the normal working ages.”6
“Older workers experience a higher rate of occupational accidents resulting in more fatalities than younger workers.”7
“The rate of occupational non-fatal injury has been shown to decrease with age.”8
“Performance decreases with age in high cognitive function demands but productivity remains the same.”9
“Ageing workers are at higher risk of work-related and occupational diseases.”5
The results indicated that, generally, OHAs in this study do not have a satisfactory level of knowledge, as none were able to correctly respond to the statements given, and only 3% (no=6) of OHAs answered four out of five correctly. Disturbingly, 21% (no=41) of OHAs were unable to answer any statement correctly.
This urgently needs to be addressed to protect the health of employees, and to proactively contribute to government aims of helping more older staff to become employed and remain in work. This lack of knowledge base could be behind some of the reasons why some older employees leave employment, as the organisation is not equipped to deal with health issues when they arise.
Organisational provision
The WHO recommended that all workers over the age of 45 should be offered annual health assessments. Despite this, more than 60% (no=121) of OHAs failed to meet this recommendation, as they do not include this as part of the OH provision for older workers within their organisation. Of the respondents who indicated that these assessments were included within their role, the assessment was predominantly aimed at those aged over 65, and were to be discontinued following the implementation of the age equality regulations in 2006. Yet the evidence base indicates a health assessment may help prevent the dismissal of older workers, as it provides an early forum to identify possible issues. But it also provides a minimalist intervention in relation to older staff while recognising that individual variations are vast, and need to be considered individually.10
OHAs may be reluctant to implement this recommendation in case they are accused of age discrimination. Therefore, the answer may be to offer an assessment to all employees, using the comprehensive Work Ability Index tool.11 This tool aims to assess how good workers are at present, and in the near future, and how able they are to do their job with respect to work demands, health, and mental resources.
Significantly, a poor result using this model was seen to indicate the risk of poor health or work disability within a four-year period. Such tools could then be invaluable in directing OH provision.
Beliefs and attitudes
There is no consensus between OHAs when considering this area. Many believe that within their organisation, the needs of older workers are provided for (35%, no=65), yet a comparative number disagree (30%, no=55).
Ironically, the OHAs within this study also indicated that generally, they felt able to deal with the needs of the older workers within their organisation, as 54% (no=102) indicated that they are able to make recommendations for job redesign and age-adjusted workload. This is alarming, considering the lack of knowledge and evidence base that has been shown by the OHAs in this study.
Conclusions
This study provided the first comprehensive overview of OH provision and practice in relation to older workers within the NHS.
Unfortunately, it indicated a lack of awareness of the literature and evidence surrounding the needs of older workers, and this is reflected in the lack of consistent OH provision and practice provided for these workers. This may also be influenced by the lack of consistent guidelines specific to occupational health from the Department of Health, Department of Work and Pensions and the Health and Safety Executive.
Study recommendations
Education and training: It is recommended that education, training and curriculum development should incorporate the following areas:
Definition of ‘older workers’ as accepted in the UK.
Overview of current and pending legislative issues and their implications for practice.
Critical overview of the current literature base in relation to older staff with a greater emphasis on evidence-based practice.
Use of needs assessment tools in relation to older staff, such as the Work Ability Index Tool.
Health education/promotion/surveillance programmes for older workers.
Trust and local policy: It is recommended that a national policy in relation to older workers is developed, and that all NHS trusts and OH departments ensure they have a comprehensive policy that promotes the health of older workers within the workplace. This policy should be developed in line with The Management of Health and Safety at Work Regulations 1999, and following consultation with employers, staff and interested parties.
This will help to enhance the work environment to suit the needs of the ageing workers. The scope of the policy should incorporate:
Definition of ‘older workers’ as accepted in the UK.
Equal opportunities and HR issues.
Pre-employment assessment.
Fitness-for-work assessments.
Voluntary annual health assessments for staff aged 50 and above.
Return-to-work/rehabilitation assessments.
Provision of a health promotion/education programme.
Definition and supporting statement of age-management practices.
It is also recommended that all NHS trusts/OH departments actively encourage all workers to undertake healthy living and regular exercise to help promote long-term health.
Audit: It is recommended that all OH departments annually audit the provision of OH healthcare to older workers. An audit tool should be developed that can be used across all NHS trusts within the UK to allow for benchmarking and identification of areas of concern. All trusts should be required to use the same tool to provide baseline data that can be used to develop and inform current practice and future requirements.
Audit should be targeted to the following areas:
Occupational injuries in relation to age.
Long-term sickness absence and percentage of successful rehabilitation back to work.
Percentage of successful job amendment programmes.
Number of older workers who have been redeployed.
Number of health issues identified through annual health assessments.
Number of OH advisers who have received training in relation to older workers within the last year.
Further research
Further research is required to find out why OH advisers with 20 to 30 years’ nursing experience have a better understanding of the associated OH needs of older employees.
It is also suggested that the findings of this study should be used to inform practice, and then the study should be repeated. This will provide an opportunity to assess whether the understanding of the issues surrounding older staff has improved, and whether this has had an impact on their OH provision.
This research has demonstrated the complexity and widely varying beliefs and OH practices in relation to older workers within the NHS, and the need to ensure that measures are implemented to promote a high standard of consistent care.
Helen Arnold is an OH adviser at Ashford and St Peter’s Hospitals NHS Trust
References
Yeandle S (2005) Older workers and work-life balance Joseph Rowntree Foundation: York Publishing Services
Cabinet Office, Performance Innovation Unit (2000) Winning the Generation Game: Improving Opportunities for People Aged 50-65 in Work and Community Activity. The Stationary Office: London
Department for work and Pensions (2002) Age Positive: Being Positive about Age Diversity at work A Practical Guide for Business The Stationary Office: London
House of Lords (2004) Government Response to Aspects of the Economics of an Ageing Population The Stationary Office: London
World Health Organisation (1993) Ageing and Working capacity: report of a WHO study group WHO Technical Report Series 835 WHO: Geneva
Warnes T, John A (2005) Facts and misunderstandings about demography and the workforce, Age Partnership Group, Department for Work and Pensions
Agnew J, Suruda A (1993) Age and Fatal Work-Related Falls Human Factors 35(4): 731-736
Arndt V, Rothenbacher D, Daniel U, Zdcenderlain B, Schuberth S, Brenner H (2004) All-cause and cause specific mortality in a cohort of 20,000 construction workers results from a 10 year follow up, Occupational Environmental
Hess TM (2005) Memory and Ageing in Context, Psychological Bulletin 131(3): 383 – 406 Medicine 61: 419 – 425
Chan G, Tan V, Koh D (2000) Ageing and fitness to work, Occupational Medicine 50(7): 483-491
Ilmarinen J (1997) Ageing and Work – coping with strengths and weaknesses, Scandinavian Journal of Work, Environment and Health 23 suppl 1: 3-5
Humphrey A, Coetigan P, Pickering K, Stratford N, Barnee M (2003) Factors Affecting the Labour Market Participation of Older Workers Department of Work and Pensions (2005) Opportunity Age The Stationary Office: London
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Ilmarinen J, Tuomi K, Klockars M (1997) Changes in the Work ability of active employees over an eleven year period,Scandinavian Journal of Work, Environment and Health 23 suppl 1: 49 – 57
Cerella J, Rybash J, Commons M, Hower W (1993) Adult Information Processing, Elsevier
