variety of age-related changes, such as declines in vision, hearing, and physical strength and capacity, as well as approaches that address work-related musculoskeletal disorders that are anticipated to be an important problem for aging workers. There also is evidence for the effectiveness of a limited number of interventions to address cardiovascular disease by improving work organization and job design, and by reducing job stressors. Many effective interventions also involve changing the social climate in the workplace (e.g., empowering workers), training for better work practices (e.g., ergonomic interventions to improve body posture for bending and lifting), improving physical fitness with exercise, and substituting machine work for human exertion. Training is another potent intervention and seems particularly relevant for older workers, as they are likely to be the most distant from their initial professional and job training. Access to training, however, is often too limited.
Health promotion efforts now have received the greatest attention in workplaces within large organizations; smaller organizations have typically paid far less attention to health promotion efforts. Although many of these efforts focus on preventing common diseases that are not uniquely caused by work, mitigating hazardous aspects of the work environment is an important example of health promotion. Attention to general health promotion programs is as relevant for older as for younger workers and may result in greater decrements in preventable disease rates per unit of resource expenditure for older workers, in part because chronic disease rates are higher at older ages. General health promotion programs directed at workers appear to be more effective when tied to environmental controls in the workplace.
Accommodations for workers with impairments and return-to-work programs are important interventions for older workers, who are more likely to bring impairments into the workplace and to be out of work longer than their younger colleagues after an injury at work. Modified work programs have been clearly shown to facilitate the return to work of workers with temporary or permanent impairments.
Factors known to result in shortening the duration of disability consistently include medical and vocational rehabilitation interventions, organizational-level employer factors, and employer- and insurer-based disability prevention and disability management interventions. However, several challenges must be overcome before researchers can establish which interventions are most effective. Multidisciplinary teams are needed to address the social/behavioral, biomedical, and analytic issues in the research. Researchers need to agree on the best outcome variables to use in return-to-work studies, and the methodological quality of research needs to be improved. For example, survival models can be used to improve efficiency, and hierar-