changes or chronic illnesses or disorders. Thus, the health of older workers is closely connected to their occupational experiences as younger workers.
In addition, the definition of health among older workers shifts as improvements are made in available medical strategies for managing and adapting to the chronic illnesses or disorders that become more frequent with age. Depending on the older worker’s access to health care, the same set of health conditions—e.g., diabetes or heart disease—can represent either a major barrier to employment or a manageable health situation. Similarly, the concept of disability has been changing over the last decades. Here, we follow the model put forth in the National Academies’ Institute of Medicine report, Enabling America (Brandt and Pope, 1997): that disability is not just a result of the functional impairments that workers bring to the workplace, but is also a reflection of the supports available in their physical and social environment, both on and off the job. Workers of any age can remain productively employed despite health problems if the workplace offers compensating accommodations such as elevators, lifting aids, increased lighting, more frequent work breaks, and an accepting management climate. The ability to work safely and productively can also be influenced by community support, such as access to mass transportation that eliminates the need for driving to work, or affordable services and amenities that lessen nonwork time demands, allowing more opportunity for health-promoting activities such as exercise, rest, and medical monitoring. Chapter 8 examines some of these accommodations, on and off the job, as a strategy for meeting the health and safety needs of older workers.
The concept of work is also growing more complex. The “work” often connotes a well-defined, full-time job in a setting where the workers enjoy a variety of employer-provided benefits and are effectively protected by existing fair labor standards and occupational health and safety regulations. While many workplaces do fit this description, a quite different and much more precarious kind of employment also exists, particularly in some small firms and in industries where existing regulations are poorly enforced or for which there are important gaps in legal coverage. Moreover, it is becoming increasingly common for workers to be employed on a contingent basis in short-term contracts and other temporary, nonstandard work commitments less likely to provide supports and legal protections (Barker and Christensen, 1998; Capelli et al., 1997; Houseman and Nakamura, 2001; Wong and Picot, 2001).
Certain subgroups are particularly likely to lack occupational health and safety protections, such as undocumented workers employed in sweat-shops, restaurants, and as domestic servants (GAO, 1988; Hondagneu-Sotelo, 2001). Reliable information about such workers is scarce and hard to obtain. However, they age along with their counterparts who are better positioned in the workforce, and their health and safety needs as older