COMMENTARY

When It Comes to Work, How Old Is Too Old?

L. Casey Chosewood, MD

May 03, 2011

Editorial Collaboration

Medscape &

In This Article

Keeping Aging Workers on the Job

How can you help older workers continue to work if they must or choose to do so?

Remind yourself that chronological age matters little. One 75-year-old can differ markedly from another. When it comes to work, what matters is functional ability, not the number of candles on a birthday cake.

Ask your patients about work at each encounter. Don't assume that all your patients who are eligible for Social Security and Medicare are retired or sedentary. Ask about full-time, part-time, paid, or volunteer work. Discuss with your patients the potential benefits of work and encourage them to continue to work, if appropriate. Ask about the risk for hazardous exposures, unsafe working conditions, and workplace stressors and demands, and whether and how the employer is addressing these issues with their employees. When assessing risk, consider the cognitive demands of the job and whether the work environment is an appropriate fit for each individual patient.

Consider asking these general questions:

  • Do you have any concerns about your ability to do your job?

  • Are you worried about any workplace exposures or risks on the job?

  • How stressful is your work?

  • Do you believe your job affects your health in any way? and

  • Are there things I can do or that I can suggest to your employer that would make your job easier for you?

Help older workers prevent work-related injury and illness. Older workers are injured less often than their younger colleagues, but when they do get hurt, they heal more slowly and experience greater disability. Advise older workers about balance, stretching, and core-muscle strengthening. Help them manage arthritis and large joint issues as necessary. Print and provide useful arthritis self-management and physical activity resources to your older patients. If older workers are injured, aggressively manage the problem, and try to limit the extent of the injury by pursuing rehabilitation quickly. Consider earlier referrals to occupational health and other specialists than you might with younger workers. You might also wish to advocate for older workers. Many large employers have on-site occupational health, ergonomics, industrial hygiene, and other safety specialists who welcome input from primary care clinicians in preventing injury, addressing nagging symptoms before injury occurs, and transitioning injured workers back to the job.

Provide routine and preventive care for the patient with work in mind. For your older workers, pay attention to limitations (such as impaired hearing or vision) or medications (such as sedatives, pain medication, or neuroleptics) that can impair driving, balance and mobility, and cognition. Optimize all preventive screenings, including vision and hearing, and make early referrals for any concerns. Update immunizations for influenza, tetanus, and pneumococcal infection as needed. Keep work schedules and constraints in mind when planning dosing schedules, daily medical maintenance therapies, and appointments.

Optimize the management of your patient's chronic diseases with an eye toward work. Many of your patients in their 60s and 70s may realistically plan on working another decade or more. With the patient, carefully consider the optimal balance between work and health, especially when making decisions about life-altering interventions, such as joint replacements and other therapeutics targeted at maintaining functional capacity.

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