HEALTH AND SAFFTY NEEDS OF OLDER WORKERS

Committee on the Health and Safety Needs of Older Workers

David H. Wegman and James P. McGee, Editors

Board on Behavioral, Cognitive, and Sensory Sciences

Division of Behavioral and Social Sciences and Education

NATIONAL RESEARCH COUNCIL AND INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
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HEALTH AND SAFETY NEEDS OF OLDER WORKERS Committee on the Health and Safety Needs of Older Workers David H. Wegman and James P. McGee, Editors Board on Behavioral, Cognitive, and Sensory Sciences Division of Behavioral and Social Sciences and Education

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the Na- tional Academy of Sciences, the National Academy of Engineering, and the Institute of Medi- cine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. 200-1999-00023 between the National Academy of Sciences and the National Institutes of Health. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessar- ily reflect the views of the organizations or agencies that provided support for the project. Library of Congress Cataloging-in-Publication Data Health and safety needs of older workers / Committee on the Health and Safety Needs of Older Workers ; David H. Wegman and James P. McGee, editors. p. ; cm. Includes bibliographical references and index. ISBN 0-309-09111-X (hardcover) 1. Aged—Employment—Health aspects—United States. 2. Age and employment—United States. 3. Industrial hygiene—United States. [DNLM: 1. Occupational Diseases—prevention & control—United States. 2. Age Factors— United States. 3. Occupational Health—United States. WA 440 H4346 2004] I. Wegman, David H. II. McGee, J. (James), 1950- III. National Research Council (U.S.). Committee on the Health and Safety Needs of Older Workers. IV. Institute of Medicine (U.S.) RC963.6.A43H435 2004 363.11′00973—dc22 2004007008 Additional copies of this report are available from National Academies Press, 500 Fifth Street, NW, Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. Printed in the United States of America. Copyright 2004 by the National Academy of Sciences. All rights reserved. Suggested citation: National Research Council and the Institute of Medicine. (2004). Health and Safety Needs of Older Workers. Committee on the Health and Safety Needs of Older Workers. D.H. Wegman and J.P. McGee, editors. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engi- neers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is presi- dent of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON THE HEALTH AND SAFETY NEEDS OF OLDER WORKERS DAVID H. WEGMAN (Chair), School of Health and Environment, University of Massachusetts, Lowell RICHARD V. BURKHAUSER, College of Human Ecology, Cornell University GARY BURTLESS, The Brookings Institution, Washington, DC NEIL CHARNESS, Department of Psychology, Florida State University PAUL LANDSBERGIS, Department of Community and Preventive Medicine, Mount Sinai School of Medicine CHARLES LEVENSTEIN, Department of Work Environment, University of Massachusetts, Lowell MICHAEL MARMOT, International Centre for Health and Society, University College London CAROLYN NEEDLEMAN, Graduate School of Social Work and Social Research, Bryn Mawr College TIMOTHY A. SALTHOUSE, Department of Psychology, University of Virginia MICHAEL SILVERSTEIN, Department of Labor and Industries, Washington State GLORIAN SORENSEN, Dana-Farber Cancer Institute, Harvard University EMILY A. SPIELER, School of Law, Northeastern University ROBERT B. WALLACE, Department of Epidemiology and Internal Medicine, University of Iowa Colleges of Public Health and Medicine CRAIG ZWERLING, Department of Occupational and Environmental Health, College of Public Health, University of Iowa JAMES P. McGEE, Study Director JESSICA G. MARTINEZ, Senior Project Assistant v

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BOARD ON BEHAVIORAL, COGNITIVE, AND SENSORY SCIENCES ANNE PETERSEN (Chair), W.K. Kellogg Foundation, Battle Creek, Michigan LINDA MARIE BURTON, Center for Human Development and Family Research, Pennsylvania State University STEPHEN J. CECI, Department of Human Development, Cornell University EUGENE K. EMORY, Department of Psychology, Emory University ROCHEL GELMAN, Center for Cognitive Science, Rutgers University ANTHONY W. JACKSON, Asia Society, Los Angeles PETER LENNIE, Center for Neural Science, New York University MARCIA C. LINN, Graduate School of Education, University of California at Berkeley ELISSA L. NEWPORT, Department of Brain and Cognitive Sciences, University of Rochester MICHAEL L. RUTTER, Institute of Psychiatry, University of London ARNOLD SAMEROFF, Center for Human Growth and Development, University of Michigan JAMES W. STIGLER, Department of Psychology, University of California at Los Angeles WILLIAM A. YOST, Office of Research and the Graduate School, Loyola University, Chicago CHRISTINE R. HARTEL, Board Director vi

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Contents Preface xi Executive Summary 1 1 Introduction 13 The Charge to the Committee, 14 The Need for Research, 14 The Aging Workforce: A Moving Target, 15 The Life Course Perspective, 18 The Study and the Report, 24 Note on Data Tables in Appendixes, 25 2 Demographic Characteristics of the Older Workforce 26 Demographic Trends of Older Persons, 26 Demographic Trends of Older Workers, 32 Health and Job Characteristics Among Older Workers, 53 3 The Role of the Changing Labor Market and the Changing Nature of Work in Older Workers’ Work Experiences and Health Outcomes 56 Changes in the Labor Market, 56 The Changing Nature of Work, 61 vii

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viii CONTENTS 4 The Social and Economic Context of Work for Older Persons 73 Socioeconomic Position, 74 Gender, 83 Race and Ethnicity, 87 Age Discrimination, 90 The Nature of Work, 91 Unpaid Work Roles, 92 Work and the Wider Context, 94 5 Physical and Cognitive Differences Between Older and Younger Workers 95 Well-Being of Older Workers and Changes with Age, 96 Mental Health Issues for the Older Worker, 107 Psychological Characteristics of Older Workers, 112 6 Effects of Workplace Exposures on Older Workers 123 Effects of Chemical, Physical, and Biological Exposures, 123 Impairments, Injuries, and Illnesses or Disorders Among Older Workers, 131 Health Effects of Work Organization, 136 High-Risk Jobs for Older Workers, 146 Efforts to Assess Burden of Occupational Diseases, 147 7 Programs and Policies Related to the Older Workforce and Safe Work 149 Legally Mandated Interventions, 149 The Legal Context, 150 Specific Areas of Legal Intervention, 153 Wage and Benefit Protection to Enable Workers to Exit Risky Work, 165 8 Interventions For Older Workers 174 Job Design and Redesign, 177 Issues in Training for Worker Health and Safety, 186 Health Promotion and Disease and Illness or Disorder Prevention for Older Workers, 198 Employee Assistance Programs, 207 Accommodations for Workers with Impairments and Return-to-Work Programs, 214 9 Conclusions and Recommendations 219 Key Conclusions and Recommendations, 219 Additional Conclusions and Recommendations, 227

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ix CONTENTS References 231 Appendixes *A Epidemiological and Demographic Tables 279 *B Estimated Survival Functions for Men and Women 283 C Biographical Sketches of Committee Members and Staff 285 Index 291 *Appendix A and B are not printed in this volume but are available online. Go to http:// www.nap.edu and search for Health and Safety Needs of Older Workers.

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Preface Age to me means nothing. I can’t get old; I’m working. I was old when I was twenty-one and out of work. As long as you’re working, you stay young. George Burns (1896–1996) In the past decade there has been a great deal of attention directed to the impact of population aging on all of our futures. Much of this attention has been devoted to such issues as the consequences of an aging population to our economy, the viability of the Social Security pension system, and long-term care issues related to survival well after retirement. There has been much less attention directed to the older worker and the interaction between work and the aging process. The aging of the workforce raises several issues, among them concern about the age-related impact of work on health. Some of these issues are unique to older adults, and some apply to all age groups. Regardless, public health and medical scientists will need to answer the following questions to improve understanding of the impact of work and aging: • How does aging affect health and working capacity? • How does working affect aging and the rate of aging? • In what ways are aging workers more susceptible to occupational diseases than younger workers? • Does working exacerbate the development of age-related diseases? • Can changes due to aging be decelerated or reversed? xi

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xii PREFACE As understanding in these areas improves, there will be second-order questions in need of answers in order to select, prioritize, and guide inter- ventions: • How does work need to be remodeled to suit aging workers? • What remediable work factors cause health deterioration and thus hasten aging? • What social support is needed for aging workers to maintain work- ing capacity? Despite the importance of these questions, the answers are incomplete, and the knowledge base is limited. In fact there is no commonly agreed-on definition of “older” worker. Research efforts in the United States tend to focus on those 55 and older with particular attention to the work factors that predict early or disability retirement. In Europe the age group of inter- est has been somewhat broader, with studies frequently directed at workers age 45 or older. The choice of a starting age for attention should be selected as “young” enough that intervention efforts can be expected to make a difference during the working life. Recognizing the importance of the health and safety needs of older workers, the U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention, the National Institute on Aging, and the Archstone Foundation requested that the National Research Council and the Institute of Medicine convene a committee to consider relevant areas of science and policy. The Committee on the Health and Safety Needs of Older Workers was charged to (1) define and understand the size, compo- sition, and other dimensions of the older adult workforce over the next 20 to 30 years, including the changing nature of work and its implications for workers over the age of 50; (2) identify the range of policy and research issues that should be addressed over the coming decade regarding the health and safety of older workers, including the effects, if any, of inappropriate working conditions on working capacities and occupational injuries and the effects of longer working lifetimes on health; and (3) identify relation- ships between retirement patterns and these characteristics of the older adult workforce and of their jobs. This report presents the committee’s findings, conclusions, and recommendations. In addition, the Environmental Protection Agency (EPA) requested that the committee conduct a workshop on differential effects of environmental hazards on older persons. The workshop, held December 5–6, 2002, brought together numerous experts with the goal of contributing to the formulation of a research and practice agenda that will help guide the EPA’s new initiative in susceptibility of older workers to environmental hazards.

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xiii PREFACE Many individuals supported the work of the committee in various ways. The committee is grateful for the continuing support of the represen- tatives of the organizations sponsoring this effort: in particular, Mary Ellen Kullman Courtright, at the Archstone Foundation; James Grosch, at the Centers for Disease Control and Prevention’s National Institute of Occupa- tional Safety and Health; Rosemary Sokas, currently at the University of Illinois at Chicago and formerly at the National Institute of Occupational Safety and Health; Richard Suzman, at the National Institute on Aging; and Kathleen Sykes, at the Environmental Protection Agency. Several individuals have made contributions to the committee’s think- ing and have provided very useful information that contributed to the formulation of our report. Janet Holtzblatt, at the U.S. Department of the Treasury, provided summary data on the relationship between age and Earned Income Tax Credit filing. John Ruser, at the Bureau of Labor Statistics, provided and pointed the way to important data on occupational health. David Williams, at the University of Michigan, contributed data and narrative on the topic of the health of minority elderly. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with proce- dures approved by the National Research Council’s Report Review Com- mittee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Jeremiah A. Barondess, New York Academy of Medicine; Leslie I. Boden, School of Public Health, Bos- ton University; Stefan Gravenstein (with Paul Aravich, Madeline Dunstan, and Maximilliane Szinovacz), Glennan Center for Geriatrics and Gerontol- ogy, Department of Medicine, Eastern Virginia Medical School; Franklin E. Mirer, Health and Safety Department, International Union, United Auto Workers, Detroit; Gary Rischitelli, Center for Research on Occupational and Environmental Toxicology, Oregon Health and Science University; Eve Spangler, Sociology Department, Boston College; and Stephen R. Zoloth, Bouve College of Health Sciences, Northeastern University. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Mark R. Cullen, Yale University School of Medicine. Appointed by the National Research Coun- cil, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures

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xiv PREFACE and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. This report is the collective product of the entire committee, and each member took an active role in drafting sections of chapters, leading discus- sions, and reading and commenting on successive drafts. Each member of the committee has contributed to the formulation of the committee’s con- clusions and recommendations, which reflect the consensus of the commit- tee. We commend their tireless and diligent efforts, which have resulted in, we believe, a successful response to the very challenging charge presented to them. Staff at the National Research Council and the Institute of Medicine made important contributions to our work in many ways. We thank An- drew Pope and Frederick Manning of the staff of the Institute of Medicine, for their work in designing and launching the study. We express our appre- ciation to Christine Hartel, director of the Center for Studies of Behavior and Development, for her valuable insight, guidance, and support. We offer major thanks to Jessica Gonzalez Martinez, the committee’s project assis- tant, who was indispensable in organizing meetings, arranging travel, com- piling agenda materials, conducting extensive outreach with the interested community, copyediting and formatting the report, and managing the ex- change of documentation among the committee members. We wish also to thank Christine Covington Chen, Deborah Johnson, Wendy Keenan, and Allison Shoup for their skillful support during the workshop. We are in- debted to Laura Schenone, who improved the report by the application of her editing skills, and to the team of Christine McShane, Eugenia Grohman, and Kirsten Sampson Snyder, who artfully shepherded the report through all of its phases of editing and review. David H. Wegman, Chair James P. McGee, Study Director Committee on the Health and Safety Needs of Older Workers

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HEALTH AND SAFETY NEEDS OF OLDER WORKERS

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