Diabetes, men, drugs, and dementia – why occupational health faces a challenging future

The RCN/SOM conference heard that dementia and cognitive decline is becoming a growing issue in the workplace, along with a range of other workplace health challenges, as our working population ages

Between tackling the challenges of rising rates diabetes, men’s ill health, drugs and alcohol, and working-age dementia, occupational health practitioners are going to have their work cut out over the coming years, the Royal College of Nursing and SOM occupational health conference heard recently. Nic Paton listened in.

The prevention of type 2 diabetes; managing men’s health; drugs and alcohol; and the growing issue of dementia/cognitive decline in the workplace – all these topics, most OH practitioners would probably concede, either already are or will continue to be major workplace health challenges.

To that end, November’s Royal College of Nursing/SOM (Society of Occupational Medicine) occupational health nursing conference and exhibition was both topical and relevant. Alongside a series of morning keynote presentations, these four issues were the focus of the afternoon’s breakout sessions and, to conclude the day, a panel discussion then brought all four presenters together on one stage.

The discussion was chaired by Mandy Murphy, deputy head of the National School of Occupational Health, who opened the proceedings by asking all four panel members to give a brief synopsis of their session and what had been discussed, before questions were taken from the audience.

OH as an influencer of change

Shan Eastcott, specialist nurse practitioner in occupational health at Partners in Health, who had been presenting on the prevention of type 2 diabetes in the workplace, said: “As occupational health advisers, we are in a good position to try and influence change in this area; not for us to actually do the hands-on work, but to get companies to work with us to motivate people to change behaviour and to try and maintain that change, and to just make some small changes to their ongoing health.”

Professor Alan White, emeritus professor of men’s health at Leeds Beckett University, then explained how he had spoken on the challenges associated with occupational health working more effectively with men around health and wellbeing. “Men are easy, men are straightforward”, he joked to laughter from the floor. “We had a good discussion about how men might be a little bit more challenging than we thought. We tried to take it back to where boys come from and the physiological, sociological and cultural differences between boys and girls, and issues around socialisation.”

Helen Parsons, service manager in the Department of Occupational Health and Wellbeing at King’s College Hospital in London, had talked about drugs and alcohol in the workplace. “We discussed what you can look out for as an OH practitioner in spotting someone with a drug and alcohol problem; the need for a robust workplace policy on both general drug and alcohol but possibly if you are going to have testing; and why it is important to have a good, solid, testing policy,” she explained.

Finally, Dr Karla Greenberg, clinical director at March on Stress, had run a session on managing dementia/cognitive decline in the workplace against the backdrop of our ageing working population. For OH practitioners, she emphasised, it was important to have “a high index of suspicion” when assessing or evaluating a patient who may be exhibiting symptoms of cognitive decline.

“There is this real crossover between depression and dementia and cognitive change. If you have people who you are seeing with work-related stress and depression who are also over 50/55, it is important to be having an index of suspicion around dementia, particularly for those who aren’t improving or getting better with treatment,” she explained.

“Also, it is about thinking about your assessments and how you can have dementia in your mind when you are assessing older workers; potentially having a key question that you always ask routinely as part of those assessments,” Dr Greenberg added.

Her session had looked at some of the assessment tools you can use in this context but also the importance of recognising what she described as “the mark of impairment”. As she put it: “That is a really challenging area because these are a group of people who, 10% a year, will go on to develop dementia but who are aren’t generally monitored and supported outside, in the world of the NHS. But, in the occupational setting, monitoring them and keeping eyes open for those signs of progression could potentially be really key.”

Growing focus on wellbeing

The first question from the floor was to Professor White who was asked, if he were to deliver an event around men’s health in the workplace, what would he focus it upon? As his questioner pointed out, when she had posed the same question to male employees in her organisation, it had led to surprising results. “They came back with ‘the menopause’; I kid you not. One, it was to enable them to have a better understanding of it in the workplace and what their colleagues were going through but also two, quote/unquote, ‘to make life more bearable at home’,” she said, again to laughter.

“It just shows how much ignorance and stigma there still exists around a whole raft of women’s issues, and that we need to be doing much more work within the workforce to help them,” answered Professor White. “It also shows that a lot of female managers are much better at speaking to men about mental health problems than male managers. So, a lot of men need to have experienced mental health first aid, which I think is something nearly everyone should be given the opportunity to do.

“Working with men around health is often complicated; it is about working with men around things that build their camaraderie, get them together to do things, and then, on the side, you have health conversations,” he explained. “It is about perhaps making it more appealing to men on a social level; making it an opportunity to get together and then have, as part of that, some very useful brief interventions along the way.”

Mandy Murphy then asked the panellists whether they were seeing improving wellbeing coming up the agenda with employers or organisations they were working with. “Have you specifically noticed anything different or improving around that for each of your subject areas in terms of a shift in our perceptions and in terms of embracing and engaging with it?” she asked.

“From the point of view of the older worker, I think we’re very much near the beginning of that journey,” said Dr Greenberg. “I think in the last couple of years it’s become something people are much more aware of and talking about. It is something that seems to be on the agenda now, which it wasn’t before. But I think there is still a long way to go, and I really think that older workforce part hasn’t really been fully grasped yet.”

“I think in general terms people know that alcohol or drugs are not good. But when it comes to supporting people at work, the things that we generally rely on, like health promotion days and EAPs, there is no definite, demonstrable effect on drug and alcohol usage,” agreed Helen Parsons.

“We know that too much alcohol and illicit drugs are not good for us, but that is often about where it starts and finishes. That was why I wanted to start a conversation around what people felt we could do, what policies there are and what support is out there, because everybody is doing something different,” she added.

Breaking down taboos and tackling stigma

For Professor White, simply continuing to break down taboos and stigma around men’s health, getting more men to open up and discuss health issues, was the continuing challenge. “There is certainly a great deal more known now about men’s health than there was, and it is part of a dialogue. But every time we’re turning a corner, we’re finding other issues. I think the more we work together on a gender basis as we try to do things, to recognise where services need to be focused in on what’s needed for men/what’s needed for women, the better it will be.”

“With regard to diabetes in the workplace, there aren’t many places that I know that do specific schemes,” said Shan Eastcott. “Organisations concentrate more on the general health and wellbeing of their individuals, their employees. I’ve seen an increase in employee assistance programmes where people have access to reduced gym memberships; or they’ve introduced schemes with insurance companies where they do mini health checks on-site. Some organisations do walking clubs; they encourage socialisation, set up groups and clubs, to get people of a like mind to try and motivate them, which are all plus points. Others, do fresh fruit Fridays, or offer fruit on a daily basis where people are on lower wages, so at least they get something healthy to eat. But it is not just about diabetes, it is about looking at the person in general.”

At this point, Helen Donovan, RCN professional lead for public health, pointed out from the floor that the college has two potentially useful publications available, on dementia and on the menopause in the workplace.

The next question was from an OH practitioner working in the retail industry who asked Dr Greenberg whether she knew of specific research looking at the health effects of working into older life.

“The research evidence currently is quite poor and quite mixed,” Dr Greenberg conceded. “Around mental health there are some research studies that show the positive effects of working; there are some research studies showing positive effects of retirement. So there are really mixed results at the moment. There are things going on, but the pool of evidence from a research point of view is still really small,” she explained.

“Redundancy and retirement are critical points, certainly in men’s health,” agreed Professor White. “The preparation that is required, as so many people fall out of work and then fall over. We are able to prepare people for going out into the wide world, but retirement much less so. Redundancy is a different thing again; it can be a brutal process. The more you are able to deliver support so that people, once they are out of the workplace, can still have access to support, the better it is.”

How to spread the OH message

As the discussion drew to a conclusion, Mandy Murphy asked the panellists to consider what one thing occupational health practitioners could do to help spread the message in terms of their specific areas of interest (in other words alcohol and drugs, men’s health, cognitive decline, and diabetes)?

“Just keep pushing the boundaries; just keep plugging away, keep your voice going, keep being heard. Don’t get demotivated. Just keep going,” said Shan Eastcott.

“I’d say recognise that gender is a protected characteristic within equality legislation, and we should be meeting the needs of men, women and trans within the workplace; that is the legal position,” said Professor White.

“We should not be frightened of incorporating different strategies for men, for women, for trans, to ensure that we are not going back to ‘oh we’re going to be sexist if we do this for the women’ or ‘everyone is treating equally’ when, actually, that is a nonsense. We of course have to be equitable, which means provision is focused where it is needed. But if we need male-focused weight loss services, for example, then they need to be male focused. Or if female-focused, then female focused. We need to be thinking about ‘what is the need?’,” he added.

“For me, it is around that reducing stigma message with an ageing workforce,” emphasised Dr Greenberg. “There are going to be people in the workforce with cognitive change and, actually, we need to be reducing the stigma around it – that people with cognitive change can still be supported in the workplace – which I think many organisations and colleagues think is impossible. So, for me, it is about gradually reducing that stigma; that is my important message.”

“I’d say ‘start a conversation’,” urged Helen Parsons. “Drugs and alcohol are a bit of a taboo subject. Typically in organisations I have worked with, the first thing that happens is ‘oh we think he’s drinking, can you talk to him as an occupational health nurse?’. But then there is no policy, there is no back-up, there are no support mechanisms in place to start the conversation with employees.

“So, talk about it. And encourage people to come forward. Because if you do that, they will,” she concluded.

Participants

  • Shan Eastcott, specialist nurse practitioner in occupational health, Partners
    in Health
  • Dr Karla Greenberg, clinical director, March on Stress
  • Mandy Murphy, deputy head, National School of Occupational Health (chair)
  • Helen Parsons, service manager, Department of Occupational Health and Wellbeing, King’s College Hospital, NHS Foundation Trust
  • Professor Alan White, emeritus professor of men’s health, Leeds Beckett University

References
“Dementia in the workplace”, RCN 2018, https://www.rcn.org.uk/professional-development/publications/pub-007088

“The menopause and work: guidance for RCN representatives”, RCN 2016, https://www.rcn.org.uk/professional-development/publications/pub-005467

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