ERGONOMICS
and
THE AGING WORKFORCE
or
ERGONIGHTMARE
Michael A. Alday, MD, MPH
Medical Director
Regional Occupational Health
As America Ages,
So Does the U.S. Workforce
• 78 million Baby Boomers
(born 1946-1964)
• Boomers comprise 46%
of the U.S. workforce
Source: U.S. Census Bureau,
Bureau of Labor Statistics
SOBERING FACTS ON AGING
• Between 2000 and 2020, the number of
people in the 55 to 64 brackets will increase
by 40%
• Of the 58 million workers in this country,
the median age is now 40.5 years
• The number of workers 45 and older has
doubled since 1950
MORE SOBERING FACTS
• By 2008, it is predicted that there will be
25.2 million workers aged 55 and over
• This is in part due to decreasing retirement
benefits/pensions and delays in social
security entitlements
• Many workers are forced to work longer
because they are part of the “sandwich
generation” --taking care of kids & parents
THE
TSUNAMI TIDALWAVE
OF AGING
THIS IS SHOCKING!!
THE REAL QUESTION IS:
WHO IS GOING TO PAY FOR US BOOMERS??
OLDEST WORKFORCE BY
INDUSTRY(average ages)
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Miners – 36 years old
Construction – 39 years old
Electric Power Industry – 44 years old
Ford Motor Company – 45 years old
Nurses – 48 years old
Doctors – ANCIENT
PROBLEMS WITH AGING
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Eyesight and hearing
Manual dexterity and coordination
Muscular strength(peaks at age 30)
Reduced cognitive function and memory
Chronic medical conditions, i.e. arthritis
More prone to injuries and CTD/RMI’s
(cumulative trauma disorder/repetitive motion injury)
– 37% of all work-related disabilities among older
workers are due to CTD’s/RMI’s
RISK OF FALLING
• Workers over age 64 have a 3X greater risk
of falling(U.S. Dpt of labor)
• Average lost work days for a fall-related
injury:
– >55 – 11 days
– <55 – 6 days
• Older workers are one and a half times
more likely to suffer a fatal fall
A CRUCIAL DISTINCTION
• Total injury rates are actually lower among
older workers
• However, older workers are more likely to
die or take much longer to recuperate from
an injury which adds to the costs
ERGONOMICS: The science of
matching the worker to the work
OSHA and State Worker’s Comp
We’re from the government and
we’re here to help
WHAT IS A CTD/RMI
(Cumulative Trauma Disorder)
(Repetitive Motion Injury)
• A CTD/RMI is a disorder of the muscles,
nerves, tendons, ligaments, joints, cartilage,
blood vessels, or spinal discs from repeated
stressful or awkward motions and/or forces
• Can involve the neck, shoulder, elbow,
forearm, wrist, hand, back, knee, ankle,
foot, and abdomen(hernia related)
SC Worker’s Comp and CTD’s
• As recent as 7 years ago, CTD/RMI’s were
considered diseases as opposed to injuries
and were not covered by W/C
• Today, they are readily accepted as workrelated if there is a clear association with
work and aggravation of symptoms
ERGONOMIC STANDARD
• Proposed standard was set for January 2001
• Goal was to reduce an estimated 1.8 million
workers suffering from work-related
MSD’s(musculoskeletal disorders)
• Was shot down by U.S. Congress due to
meddling into state W/C program(federal
program telling states how to run their W/C
programs and spend their money)
ERGONOMIC STANDARD
• Even with these legal challenges, we will
see this standard reappear in the future
• Designed to match the worker to the
workplace
• Strongly supported by the labor unions
• Even without the standard, it makes good
business sense to implement a program
ONCE A CTD IS REPORTED
• You must investigate and promptly
determine if an CTD is an “incident”
• Employers should request assistance of a
health care professional to make this
determination and to assess the “work
relatedness” of the disorder
BENEFITS OF AN ERGONOMICS
PROGRAM
• Predicted to prevent 4.6 million CTD’s in
first ten years
• $9.1 billion could be saved annually at a
cost of $4.5 billion for employers
• $27,700 savings for each CTD prevented
• Work station fixes can be as little as
$250-500 per station
ERGONOMICS AND CTD/RMI’S
ERGONOMIC FORMULA
Repetition + Position + Force + Time
+ No Rest
= RMI or CTD
UPPER EXTREMITY
PROBLEMS
Tendonitis
Tennis Elbow
Neuropathies
Raynaud’s
Tenosynovitis
Rotator Cuff Strain
Carpal Tunnel Syndrome(CTS)
Ganglion Cysts??
UPPER EXTREMITY
PROBLEMS
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Gradual onset
No history of injury
Dull pain, numbness, tingling
Swelling, bruising may be absent
Gets better with rest
UPPER EXTREMITY
PROBLEMS
• Upper extremity CTD’s are much more common than
back CTD’s and are generally more costly as a group
• Average case going to surgery costs $15-25K
• Indirect costs are up to $50-75K per case
COMMON FACTORS
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Sedentary lifestyle
Repetitive trauma near site
Vibrating or pneumatic tools
Resumption of tasks after inactivity
New tasks
COMMON FACTORS
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Increased production (high repetition)
Awkward & prolonged postures
More common in females(esp. CTS)
Prolonged(>8 hours) shifts and/or overtime
DIAGNOSIS
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Detailed job description is a must!
Strain index
X-rays/MRI’s
Nerve conduction studies
STRAIN INDEX
• Moore-Garg Strain Index
• Based on various risk factors of time,
intensity, and posture
• Scoring:
<3
Between 3-5
Between 5-7
>7
Considered safe
Uncertain risk
Some risk
Considered hazardous
REMEMBER
• Better defined problems (“it hurts here” v. “my
whole arm hurts”) are better associated with true
pathologies and CTD/RMI’s
• Rest and realignment (change the work toward a
less awkward posture)
REMEMBER
• Ratio of muscle (e.g.,tendinitis) to nerve
problems(e.g., carpal tunnel) is usually
5-10 to 1
ERGONOMIC
SOLUTIONS
Look for easy fixes!
• Emphasize adjustment of workstation
(minimize awkward postures)
• Emphasize rotation of tasks (don’t type or
keyboard for 4 hours straight, alternate with
filing, other jobs)
• Use of lifting devices or strict procedures
for lifting heavy objects
Look for easy fixes!
• Consider light and temporary job limitations
or restrictions
• Encourage strength and flexibility building
with emphasis on early rehab/PT
• Expect that they will continue to improve
and reassure them that they will get better
• Braces and ergonomic tools to help with the
workload
What about other ergonomic
solutions?
Worksite visit by the ergonomics team
-- What is the value?
– Very high
– Why?
reinforces employee’s significance, importance,and
the idea that the healthcare system is taking action
What do you look for?
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Method of task accomplishment
Are there physical differences between workers?
Are there workstation or work area differences?
Can force, awkward positions, or prolonged
duration of tasks be reduced?
Pearls……..
• Light or modified duty whenever possible
• Frequent follow-ups are OK
• Be mindful of OSHA 300 recordability rules:
– No prescription meds unless absolutely necessary
– Use elastic splints and supports vs. rigid splints
– Sending home for rest of shift is not recordable
• People who like their jobs do better with less accidents
• If you show that you care about the workers, they will
care about you (remember the golden rule!)
Low Back Pain
The “other” CTD
Significance
• 70% of people will have LBP
• 50% will have a recurrent episode
• #1 disability for men <45
Work Related
• 75% of U.S. back cases are W/C
• Only 25% of cases in Scandinavia
are W/C for the same occupations
• Differences in legal climate?
Cost
• LBP workers’ comp awards up 27 fold
over past 20 years despite improved
safety/work conditions
• 28% of all lost work days due to LBP
• Med cost per case $25-35K
• Total claim cost $150-250K
• Majority have deg. disc disease present
Outcomes
• 50% recover within 2 weeks
• 90% recover within 6 weeks
• 10% are major disability problems
Surgery Outcomes
• Failure rate for industrial cases - 50%
• Failure rate for non-industrial cases -10%
• Poorer outcome
– low income / education level
– job dissatisfaction
– history of previous disability or in the
family (W/C is an inherited disease)
Treatments for early CTD/RMI’s
• Education
– positive expectations
– reassurance that condition will improve
• Provide comfort
• Discuss activity alterations
– avoid irritation
– avoid debilitation
Treat CTD/RMI’s like Combat Stress
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Simple explanations
Avoid diagnostic labeling
Brief rest and modified or transitional duty
Encourage activity
Keep worker at work
Treat CTD’s like combat stress
• Avoid delaying care
• Goal is return to the front lines (work)
• Reinforce the expectation of returning to
work
IN SUMMARY
• The aging workforce will have a dramatic
impact on both W/C and healthcare costs
• Ergonomic issues will always be present
• Involve your occ. health resources early
• Be careful not to create a confrontational
climate with your employees
• Close case management is the key to W/C