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2 Human Factors Problems Associated With Aging When identifying human factors problems relevant to aging, an initiad step rs to define and characterize the subpopulation of interest. Typically, the "agent are defined as all persons 65 years old and over, with further Extinctions made between the ~young- old~ (65-74 yeam old) and the "old-old~ (85 years old and over). However, this characterization of the older population is grossly oversimplified. Aging is continuous and it does not start suddenly at age 65. Moreover, the changes in physiological and psychological functioning that often accompany aging are by no means uniform in their onset, aIld the social, psychological, and physical changes associated with advancing age are unevenly distributed among the elderly. Therefore, using chronological age to characterize or predict an older person's behavioral and functional capacities Is likely to prove inadequate. Many gerontology researchers have suggested that new methods are needed that more accurately describe a person's condition, capabilities, and maturational trajectory. We support the objectives of separating the functional characteristics of interest from the uncertain statistical predictor variable of age and of avoiding the stigma of age labels. On the other hand, we would not favor the development and use of any single omnibus measure of "functional age" as has sometimes been suggested. Essentially, such a measure would be derived by identifying variables related to age, measuring performance levels for these variables, and combining the measures into a composite index using some form of multivariate analysis. This type of measure 7

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8 HUMAN FACTORS RESEARCH NEEDS FOR AN AGING POPULATION would have many of the faults that chronological age has as a mea- sure, hiding the large amounts of variability and lack of correlation among different manifestations of age-related changes. By contrasts a functional assessment battery that retained the distinctions between different abilities would be valuable. Of special interest would be research to discoverer predictive relationships between deficits in one function and another as a guide to possible prophylactic strategies. For the purpose of formulating research, development, and policy goals, the significant fact is that many changes in capabilities are closely related to aging by links involving biological factors, social customs, or the benefits and deficits inherent in longevity. These changes alter performance and, in quantitative and qualitative ways, the nature of an "optimally environment. However, we strongly urge that the large variability among older individuals be kept in clear focus. We do not want to produce behavioral or design prescriptions for the "house of ~ 70 year old." Rather, we would like to say, for example, that, for a given age distribution ~ a population, bathtubs of a particular design would be beneficial. It would be better still to specify a design that will serve everyone well irrespective of age (Fozard, 1981~. The subsequent sections of this report will consider some data on the characteristics and needs of our aging population. ,, _ ~ , DEMOGRAPHICS, ECOLOGY, AND SOClO[OGY In order to provide a more complete picture of the subpopu- lation of interest, this section presents information regarding the living patterns of older adults. The tables presented here describe salient demographic characteristics of the older adult population of the United States. These characteristics include information regard- ing the projected age structure of the older population through the year 2050, the living arrangements of older adults, and their work and retirement patterns. Table 1 shows the age distribution of older people in the United States as projected through the year 2050 (Myers, 1985~. As shown in the table, the number of older people living in the United States will continue to increase over the next several decades. Until the year 2000, the number of older persons is expected to increase across all age categories, but the gain will be particularly large for persons aged 80 years old and over. Generally, there is a progressive sex imbalance in the older population, with an increasing proportion of females at

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H~4N FACTORS PROBLEMS ASSOC7lATE:W WIT7I AGING TABLE 1 Projected Numbers of People 65+ Years in the United States (in thousande) Year Population Group 1980 2000 2025 2050 Number/aged population 25,708 35,036 58,636 67,060 Percent/total population 11.3 lS.1 19.5 21.1 Ages--number 65-69 8,805 9,110 18,314 16,591 70-74 6,843 8,583 13,774 13,431 75-79 4,815 7,242 11,103 11,352 80-84 2,972 4,965 6,767 9,624 85+ 2,274 5,136 7,678 16,063 Ages-percent 100.0 100.0 100.0 100.0 65-69 34.2 26.0 31.2 24.7 70-74 26.6 24.S 25.2 20.0 75-79 18.7 20.7 18.9 16.9 80-84 11.6 14.2 11.5 14.4 85+ 8.8 14.6 13.1 24.0 Source: Adapted from Myers (1985:Table 43. 9 older ages. The sex ratio for people aged 65-70 in the year 2050 is estimated at three males for every four females. Among people 80 years old and over, there will be two femades for every male (Myers, 1985). In addition, the aged population itself is growing older. In 1900 the average life expectancy of people aged 65 was an additional 11.9 years, ~ compared with an additional 17.0 years in 1983. By the year 2000 those aged 75~4 wiD constitute about one-third of elderly persons and those 85 and over win represent about 15 percent (Office Of Technology Assessment, 1985~. This means that there win be a greater number of very old persons living ~ the United States. The growth in the number of people in the oldest age brackets has signif- icant implication for human factors engineering because people in older age groups typically have greater problems maintaining func- tional independence and warrant more environmental and service support. Table 2 presents data regarding the living arrangements of older people. It shows that most older adults live in a household either

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10 HUMAN FACTOR ARCH NEWS FOR AN AGING POPULATION TABLE 2 Living Arrangements of the Population Aged 65 and Over, by Age and Sex; United States, 1970 and 1981 (percent distribution) Year and Male Ages Living Arrangement 65+ 65-74 75+ Female Ages 65+ 65-74 75+ 1970: In households 95.5% 96.4% 93.796 95.0% 97.6% 91.156 Living alone 14.1 11.3 19.1 33.8 31.6 37.0 Spouse present 69.9 75.2 60.4 33.9 43.5 19.1 With someone else 11.5 9.9 14.2 27.4 22.4 35.0 Not in households 4.5 3.6 6.3 5.0 2.4 8.9 Total 100.0 100.() 100.0 100.0 100.0 100.0 1981: In households Living alone Spouse present With someone else Not in households Total 96.2 97.9 92.9 93.8 97.8 88.3 13.8 11.1 19.0 38.8 34.2 45.1 74.1 79.0 64.S 35.5 47.3 19.3 8.3 7.8 9.1 19.4 16.2 23.8 3.8 2.1 7.1 6.3 2.2 11.7 100.0 100.0 100.0 100.0 100.0 100.0 Source: Office of Technology Assessment (1985:Table 25~. alone or with a spouse. In the older age group (75~) the likelihood of living alone increases, especially for women. ~ fact, the proportion of elderly women living alone has markedly increased since 1970. In general, the number of older people living in nursing homes has increased since 1960. In 1983, 5 percent of persons age 65 years old and older lived In nursing homes as compared with approximately 3 percent in 1960. However, this increase is largely due to the increased number of the old-old cohort. It is anticipated that by the year 2020 there will be 3 million elderly persons in nursing homes, more than half of whom will be age 85 and over. Also, the proportion of institutionalized elderly has decreased for the young- old and increased mnong the old-old. These trends are expected to persist through the next decade. However, the most dramatic trend projected is the increased number of females living alone. With respect to housing, the majority of older adults own their own homes. In 1980, among the 16.5 million elderly households, about 12.3 million were owner occupied and only 4.2 million were renter occupied. It is expected that the number of elderly owned

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BUJ~IN FACTORS PROBLEMS ASSOCL4TED WITH AGING 11 households will continue to increase (Office of Technology Assess meet, 1985~. This is due to the growth in the elderly population and to the fact that older people are less likely to move than younger people. The growth ~ households maintained by older persons un- derscores the need to attend to the housing problems of the elderly. These problems arise from the fact that older people tend to live in housing that ~ older than that occupied by younger people (Lawson, 19853. As ~ result, housing deficiencies, such as broken stairs or poor electrical wiring, are more common in elderly households. While the disrepair found in the homes of many older people is attributable to the fact that they live in older homes, the problem persists because their incomes are often not sufficient to cover the cost of repairs. This is not surprising in view of the fact that approximately 15 percent of the elderly live below the poverty line, a figure that doubles among older women living alone (Office of Technology Assessment, 1985~. Data also medicate that there is an increasing trend among older people to live ~ the suburbs of major cities. Because suburban areas tend to have less accessible public transportation and older people generally find driving progressively difficult, it may be that greater attention should be paid to the mobility problems commonly experienced by the elderly in order to enhance their functional inde- pendence. Regarding employment status, as shown In Table 3, the labor force participation rates of older adults are declining. Since 1950 the proportion of older men In the work force has declined. In 1950 men aged 65 years old and over represented 45 percent of the work force as compared with 18 percent in 1982. A similar pattern is observed for men aged 55 64 (BeD and MarcIsy, 1987~. Factors that may have contributed to this decline include increased availability of early retirement options, changes In health or attitudes about health and work, forced retirements, age discrimination, psycholog- ical "burnout, skill obsolescence, and increased desire for leisure. Howe crer, hypotheses about the changing male work patterns have not yet been substantiated. The labor force participation rate for women over 65 has declined only slightly, from 6 percent in 1950 to 5 percent in 1984. However, for women aged 55 64, participation in the work force has increased to around 41 percent (Robinson, Coberly, and Paul, 1985~. The types of jobs held by older adults are shown in Table 4. Most older people, especially women, tend to be concentrated in the

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12 HUMAN FACTORS RESEARCH NEEDS FOR AN AGING POPULATION TABLE 3 Labor Force Participation Rates by Age and Sex Through 1995 (percent) Population Actual Group 1981 Estimated Projected 1985 1990 1995 Total 106,393 (thousands) Men 114,985 122,375 127,542 16-24 12.2 10.9 9.2 8.3 25-54 36.4 36.5 37.7 38.2 55-64 6.7 6.2 5.4 5.1 65+ 1.7 1.6 1.S 1.3 55+ 8.4 7.8 6.9 6.4 Women 16-24 10.7 10.3 9.2 8.8 25-54 26.8 29.3 32.2 33.7 55-64 4.4 4.1 3.6 3.5 65+ 1.1 1.0 1.0 1.0 55+ 5.5 5.1 4.6 4.5 Both sexes 16-24 22.9 21.3 18.5 17.1 25-54 63.2 65.8 70.0 72.0 55-64 11.0 10.S 9.1 8.6 65+ 2.8 2.6 2.5 2.3 55+ 13.8 12.9 11.6 10.9 Source: Adapted from Robinson, Coberly, and Paul (1985:T~ble 1~. service sector. Eighteen percent of employed men over 65 are in man- agement, 15 percent are engaged in professional technical work, and 13 percent are in service occupations. The pattern for female workers is different. Employed women, aged 45 64 (40 percent) and 65 years old and over (25 percent) tend to be ~ clerical occupations (Office of Technology Assessment, 1985~. This suggests that large num- bers of older workers wiD be affected by developments in computers, communications, and other expanding office technologies. Overall, it ~ clear Tom the data that work and living situations vary considerably as a function of age and that the shifting distribu- tion of the population will consequently create major changes in the distribution of life-styles among the old. The important questions for our purposes, however, are how these changes are reflected in the everyday adaptive demands on individuab; the ways in which individuals are, or are not, able to meet these demands; and the

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HUAf4NFACTORSPROBLEI~SASSOCIATEIDWITHAGING TABLE 4 Industry Distribution of Employed Men and Women Aged 45+, 1980 (percent) Men Women Industry 45-54 55-59 60-64 65+ 45-54 55-59 60-64 65 Mining 1 1 1 1 0.3 0.2 -- -- Construction 10 9 8 6 1 ~ 1 -- Manufacturing 29 29 28 12 19 18 17 9 Durable 20 19 18 7 9 9 8 3 Nondurable 9 10 10 5 10 9 9 6 Transportation 10 10 8 4 3 3 3 1 Trade 15 15 16 21 20 19 21 26 Wholesale 5 5 5 5 2 2 2 2 Retail 10 10 11 16 18 17 19 24 Financing/~nsurance real estate 5 5 5 7 8 ~ 6 6 Services 18 18 20 30 40 40 41 42 Public administration 8 7 6 5 5 6 4 3 Agriculture 4 5 ~ 14 1 1 2 2 Private household ~ 3 4 5 11 Source: Office of Technology Assessment (1985:Table E-1~. 13 requirements and opportunities for improvements based on human factors research. A good deal is known about the incidence of vari- ous diseases and medical disabilities and a certain a~nount about the "normals changes in functional abilities that come with age; we wiD present examples of such data shortly. But we also need to know about the distribution of demands for various capabilities, and here is where the data are weakest. Ne~rerthele=, some useful evidence is available. We will review some highlights of this knowledge in the categories of home activities, work activities, transportation and communication, safety and security, =d leisure. HOM1: ACTIVITIES Examination of the home activities of older people is a good starting point in our discussion in that (~) an increasing number of older people live atone at home; (2) older people spend the majority of their time at home, with a large portion of this time allocated to personal daily living activities; (3) older people frequently report difficulty completing home activities; and (4) there is some detailed -

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14 HUMAN FACTORS RESEARCH NEEDS FOR AN AGING POP UNCTION knowledge available regarding the demands associated with home tasks and the problems older people have in meeting these demands. To some extent this knowledge can be generalized to other domains. Household behaviors are complex ~d involve a number of physio- logical and psychologicad subprocesses that are corn to factors in most task performance. In this context it is useful to d~t~gu~h between basic activi- ties of daily living (ADL) and instrumental activities of daily living (IADL), as this categorization is frequently used in the literature. Basic activities of daily living include bathing, dreming, toiletting, transferring, continence, and feeding. Instrumental activities, which reflect the capacity to adapt to one's environment, include such tasks as shopping, housework and yardwork, handling money, and driving (Katz, Ford, Moskowitz, Jackson, and Jaffee, 1963~. Table 5 presents summary data reflecting the amount of time older people spend perfortn~ng various household tasks. Because we do not have nationally representative data on how older people allocate their tone to different activities, these data are limited to a restricted range of activities and are based on a small s~nple of people. Studies of day-t>day patterns of time use have tended to omit the elderly or have focused on their leisure activities. Moss and Lawton (1982) collected tim~budget data from small selected samples `>f independent (n = 426) and nonindependent (n = 1643 elderly people. Their data give a more detailed picture of how older people allocate their time to various daily living activities (Table 63. The data also indicate that older people allocate ~ large portion of their tune to home tasks, to the extent that 82 percent of ~] waking- tune behaviors occur in the home. About one-third of the day is devoted to basic activities of daily living. Comparison of the time budgets of the independent and nonindepenclent samples indicate that the latter group's activities are heavily weighted toward personal care ~d away from instrumental activities. The major difference ill. discretionary behaviors between these groups ~ the higher level of "inacti~rity~ among the impaired (I,awton, 1987~. It is reasonable to ask whether the Ieve] of inactivity among the nonindependent elderly would be reduced if the task demands of certain instrumental activities were reduced. In general, data regarding activity frequency are useful in sug- gest~ng activities and activity groups that should be investigated. However, while such data represent a good starting point, they do not provide sufficient detail to target specific areas for human factors

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HUMAN FACTOR PROBLEMS ASSOCIATE WITH AGING TABLE 5 Time Spent Performing Within-Home Activities Among a Sample of Elderly People Percentage Median Hours who Engaged Spent by All Behavior in Behavior Engaged Eating, cooking 99 2.5 Pemonai care 97 1.0 Television 70 3.0 Housework 67 2.0 Reading 61 1.0 Napping, idleness 56 2.O Radio, records 17 1.5 Handiwork 15 2.0 Entertaining 9 2.5 Writing 8 1.S Crafts, collection 1 2.0 Source: Beyer and Woods (1963) as cited in Lawton (19773. 15 research. The kind of information that can better help research ef- forts derives from knowing what types of home activities are difficult for older people to perform and what difficulties they encounter when performing them. It is essential to understand the environmental d sign issues that interact with these difficulties. It is reasonably well established that older people often have difficulty performing home tasks such as cooking and cleaning. Such difficulties may be reflected in the high rate of home accidents among people 65 and over, which account for approximately 43 percent of aD home fatalities. The most common causes of accidental injury for older people are (1) falls on stairways, floors, and bathtubs; (2) burns/scalds from cooking, hot water, and fires, and (3) poisoning from gases and vapors (Sterm, Barrett, and Alexander, 1985~. The reasons for the high frequency of such accidents are complex but likely include the fact that older people spend a majority of their time at home; age-related changes in functional abilities make it more diffiluit to complete home tasks; and the demands of the home environment are often substantive in that the homes of the elderly tend to be older than those of younger people, are more likely to be difficult to operate and maintain, and are more often in need of repair. The high rate of home accidents among the elderly pouts to the need for a detailed understanding of the etiology -of these accidents (Lawson and Brody, 1969~.

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16 HUMAN FACTORS RESI£ARC!I NEEDS FOR AN AGING POPULATION TABLE 6 Mean Minutes Reported in Selected Activities in 24-Hour Day Activity Impaired Independent Community Residents Residents Obligatory Activities Personal and health care 53 71 Eating 77 77 Shopping 22 13 lIousework/home maintenance 68 38 Cooking 69 45 Helping others 10 7 Social agency 2 9 Discretionary Activities Family interaction 58 51 Social interaction (nonfamily) 54 59 Religious activity, excluding services 10 7 Reading 59 52 Radio 28 33 Television 205 210 Recreation and hobbies 44 32 Rest and relaxation 128 200 Gap (unaccounted time) 24 31 Sleeping 456 452 Environmental Context (waking houre) In home or yard 790 8S8 Mean age 75.2 79.0 Percentage female 54 77 Number 426 164 Source: Moss and Lawton (1982~. To date, the study of accidents in older populations h" been hugely epidern~olog~cal. A more refined and efficient approach to these problems would be possible with greater knowledge of the proximal causes of incidents and their relative frequencies. However, the effect of contributors to such accidents could be reduced with currently available methods. For example, housing can be designed to minimize the number of trips up and down stairs for people who spend most of their time indoors. In addition, the fictional requirements associated with home tasks need to be examined and compared with data on the capabilities of older adults In order to determine why they are difficult for the elderly. Many researchers

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HUA~4N FACTORS PROBLE:MSASSOCIAT~D WITlIAGING 17 have suggested that an older person's inability to function ~ various settings can be linked to disparities between demands generated by the design and structure of the environment and the capacity of the older individual to meet those demands (e.g., Lawton, 1977~. A recent study (Czaja, Drury, Hammond, Brill, and I,ofti, 1987) identified consumer products and environments that are hazardous to people aged 55 and over and conducted a human factors analysis of the most hazardous products. This allowed the difficulties inherent in the human-product-enviromnent interface to be identified and also highlighted possible intervention strategies. For example, scalding accidents ~ bathrooms or showers occur when the person operates the wrong water control, operates a control in the wrong direction, or ~ unable to react quickly enough or with enough force when the water suddenly increases in temperature. These results permit identification of possible intervention strategies, such ~ changing the design of water controls to incorporate better labeling, lower force requirements, standard layouts, and automatically regulated water temperature. Unfortunately, detailed data of this type are limited. The only data available on competence leveb of the elderly with respect to home activities are restricted to ADL and lADL activities, which is understandable smce these activities are critical to functional inch pendence. Tm addition, the data that are available generally report only the frequency with which older people have problems perform- ing certain tasks, although there are limited data on the types of problems encountered. Regarding the first issue, the best data come from a national sample studied in the Health Interview Survey (Na- tional Center for Health Statistics, 1987~. In this survey questions were asked in dichotomous frames of reference: whether or not the respondent experiences difficulty ~ perfor~rung a task and whether the respondent receiver help with the task. Table 7 shows the preva- lence of ADL impairments as weD as similar rates for a group of skies thought to be especially relevant to work. The tasks that are most problematic for older adults are bathing, transferring, shopping, meal preparation, and housework (National Center for Health Statistics, 1987; Dawson, Hendershot, and Fulton, 1987~. The sample also re- ports difficulty walking, reaching, maintaining postures for extended periods, and carrying heavy objects. These results are consistent with those of Czaja, Clark, Weber, and Faletti (1988~. In their study self-report data from a small sample (n = 250) of independent elderly

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48 HEN FACTOR ~S=RC~ ==S FOR ~ AGING POP UNWON Poisanmg Ingestion of toxic dosages of medication now ranks among the three most prevalent home accidents. Only a portion of there oc- cu~Tences in adults ~d older children me accidentsI, with many attributable to unintentional self-pomon~g. The elderly are apt to be taking several highly potent drugs, to be physiologically ~ensi- tive to their effects and their interaction with other drugs, to have disabilities, and to live in an environment conducive to medication error. Labeling, lighting, and dose/inter~ral management have been suggested as predisposing factors. Fa~letti (1984) has suggested that medication management ~ a fruitful area for the application of hu- man factors technology, ~ Creaky demonstrated ~ devices such as audible reminder systems and self-stable containers designed for the older hand and eye. Accidental Injuries to ElderI~r Pati~ts Accidental injuries to elderly patients pose a growing problem for hospital, nursing homes, and other residential care facilities (New- man, 1985~. FaDs and fires are especially severe problems. The Aetna Life and Casualty Company (1981) reported that between 1976 ~d 1981 falls were a factor in 20 percent of all claims filed against their insured hospit ads; 75 percent of the fans occurred ~ patients' rooms. Unique health/safety problems and solutions exist for the dementia patient. The high incidence of mental decline and confusion among the institutionalized elderly powts to a critical role for technology. For example, a passive alarm system (Ambul~m) that signals when a patient a - umes a seated position on the edge of the bed h" been tested and found successful ~ reducing accidents and decreasing the need for restraint In confused patients. The limited research on older patients who fan or experience other accidental injuries has been largely anecdotal, and little human factors research has been done for any age in the medicad setting. The frequency of accidents and high accident fatalities for older people at home and in i~titaltional environments provide a com- pelling target for human factors research in this area. To date, studies of the elderly have been descnptive. They offer some gen- eral insight into the environmental features of accident scenarios and some general guidelines for home and building modifications. For example, limited work has been done on the cause of fails and on the development of intervention strategies. However, little is known

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HUMAN FACTORS PROBLEMS ASSOOlAT~ WITH AGING 49 about the specific mechanisms that produce fads ~ the elderly. It is clear that many factors interact to increase the risk of falling among older people, but a better understanding of the causal nature of this problem ~ needed before effective methods of intervention can be developed. Human factors reteach in this area has focused prunar- fly on the design of stairs and railings (e.g., Archea, Collins, and Stahl, 1979; Pam, 1984) and the work of Alessi, Brill, and associates (1978) provides an amemment of the safety environment of stairs. Using data available from the Consumer Products Safety Commis- sion and the National Bureau of Standards, Alessi et al. identified 12 stair accident scenarios involving about 82 percent of Al cases. Table 9 presents a summary of their findings. Types 1 (overstepping) and 7 (Ioss of balance) were the only ones significantly related to older persons. In a farther aneurysm of their NEISS data, Czaja and Drury (1986) developed 8 detailed analysis of six of the most hazardous products for persons over 55. In p~ticul=, they reported on a detailed human factors analysis of bathtubs/showers. The most frequent causes of in- jury were slips, fans, and strikes aghast objects. The primary tasks associated with these accidents were getting into the tub/shower, washing, and getting out of the tub/shower. Dazzlers and loss of balance were experienced Frequently. Scaldings from hot water in the tub/shower were the second major type of accident. Extension of detailed environmental analyses, such ~ the Czaja et al. (1986) ~d Alessi et al. (1978) studies, neecIs to be focused on the elderly add applied to other specific hazardous areas in the home and cornmu- nity. Planek (1982) asserts that successes in home accident control have occurred in narrowly defined, aIld therefore, more manageable problem areas. nIustrations of this pout are drug-conta~ner design, prevention of refrigerator suffocation, and flame-retardant sleepwear for children. The example of studies on fads (Archea, Carson, Mar- gulp, and Carson, 1978), the design of stairs (Alessi et al., 1978), and the analysis of NElSS home accident data (Czaja et al., 1986) might serve as models for specific product/accident analysis =d for evaluation of other product/environment categories. Work ~v~ronment The ratio of workers aged 45 =d over to the general working population has Secreted steadily during the last 30 yews. This may account in part for the lack of pressure to evaluate safety or accident

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50 LUMEN FACTOR ITCH IS FOR ~ AGNG POPUM~ON TABLE 9 Types of Stairway Accidents Percontage Stair Cause or Event Aeadents Victims Misjudged tread depth while 19.0 descending Obstructed view while descending 10.9 Descending: caught heel on 9.0 nosing; ascending: foot did not clear nosing Climbed store or descended 6.S in Darlene" Foot placed on nosing; carpet 6.5 elf" Wet or icy stab Lost balance: handrail inadequate Distracted by change of visual (or other) environment Adult women in a hurry; the elderly; persons with poor eyesight; persons under the influence of alcohol or other drugs (medicatione) Adult women carrying children or objeeb, often in dark unable to activate light switch Adult women in high heels children ascending Anyone: often unfamiliar places Anyone S.7 Anyone S.7. Anyone, but Specially elderly and disabled S.0 Anyone Treads too shallow d.2 People with large feet, heavy shoes, or, in extremes, most adults Irregular treacle or rmere or S.8 Anyone any iregulanty Small flight (1 or 2 neer) in 2.9 Anyone unusual place griddle of Rays Objects on stairs 2.9 Anyone Source: Jones, Smith, and Small (19793.

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HUMAN FACTORS PROBINGS ASSOCIATED WITH AGING 51 prevention for this age group. Whether occupational safety and age are seen as a high-prionty research issue for the future may depend on how we define the older worker. The National Commission for Employment Policy kiss identified older workers as persons 45 years of age and older. About 30 minion people, 45 64, are currently employed, and this figure is expected to grow to 45 nonillion by the year 2000. At the same time a decrease in the inflow of younger workers may compel older employees to remain longer in high-risk tasks. Morrison (1984) argues that the older m~le-aged worker wiD be the dominant labor force mue In the coming yea=. While a great deal of research on occupational accidents has been done, some of it in the area of human factors safety, studies ~d descriptive data on the oilier m~e-agecI employee and the elderly employee are limited. In general, the age-related injury pattern at work parallels that In other environments; as age increases, the frequency of injury decreases "d severity increases, with falls being an especially severe threat to the older worker (Root, 1981~. The study by Root, based on approximately ~ minion worker compensation records, found that injury rates dropped regularly until age 64 and more sharply for persons over 65. ~ general, thin trend was independent of the kind of industry ~n~rol~red. Relative to occupational accidents, we need to know the specific jobs, task demands, equipment, "d environmental features present when the older worker is mvol~red. Unfortunately, information is not readily available for the older population. ~ the Czaja et al. (1986) study of NElSS data, industrial equipment was among the 49 most hazardous products for persons over 55 "d "non g the top 10 most hazardous for persons 55~4. Ginger, Dispenziere, and Emenberg (1984) hypothesized that a speed job (sewing machine operator) versus a skis job (quality control examiner) would-~fluence the accident rates of older workers (mean age—57), but no differences were found. It h" been suggested that older workers hare fewer acciclents that result from carelessness or poor judgment and more accidents that result from berg le" successful at escaping hazards. Recently, Shahani (1987), ~ analyzing 7,131 incidents at Shed Oil, found that accidents tended to decre~e until about age 51 Ad then increased. This age-related pattern was similar across different families of jobs up to age 60, but at the older ages (61+) the accident rate was a function of the kind of job.

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52 HUMAN FACTORS RESEARCH NEEDS FOR AN AGING POPULATION Unique kmds of occupational accidents associated with the el- derly are those experienced by the family or human services care- giver. For example, while most heavy lifting has been engineered out of other jobs, this is not the case in the human services industry. This industry is reported to have the highest percentage of overexertion injuries of any major industry (62 percent of work injuries), a sizable proportion of which could Groove care of the elderly (National Insti- tute for Occupational Safety add Health, 19813. The prevalence of low back pain has been shown to be significant in the nursing prm fession. Of similar concern are overexertion injuries ~d other safety problems for individual family caregivers, who therrmelves may be aging, under strew, and tenth little opportunity for relief. Basic shifts In nationad employment patterns have token place in the last 30 years. These include rapid growth in white-color jobs (professional, technical, managerial, and service); a proportionate decline in blue-collar jobs; increased numbers of women (inCluding older women); and increased participation of specific ethnic groups. A parallel change has been occurring in new work technologies, such as numerical control, robotics, flexible manufacturing, and computer- a~ded design. It ~ not clear what these changes In technology and the composition of the work force may mean for safety Dues ~ an aging population. Transportation ]5nv~onment The maintenance of independence and quality of life for older persons is heavily dependent on access to adequate transportation. Loss of personal transportation and inadequate public transporta- tion, or a transportation handicap, lead to an increased requirement for family and public support for the elderly. Automobile safety h" been studied extensively and has involved research on the elderly driver. There are some 12 million to 15 mil- lion licensed drivers over age 65 an increase of 25 percent in the I=t 10 years, with the sharpest rise among drivers over 69, up 68 percent (National Research Council, 1988~. There is some bin against the older driver as a safety hazard, but data supporting this attitude can be challenged (Jones and Pecl`, 1985~. A number of studies have attempted to relate vision and other functional capabilities of the older driver to their accident characteristics. However, the strength and consistency of this relationship, except in extreme cases, has not been sufficient for use In making licensing Sections. Attempts to

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HUA~4N FACTORS PROBLEMS ASSOCIlAT~ WITH AGING 53 extend the accident/functional capability relationships to human fac- tors design criteria for the driving environment (roadways, markings, signs, give sources, lighting, intersections, controls, dashboards, and restraints) have been limited. ~ heavy traffic areas the danger of walking may rival that of driving. In general, pedestrian accidents intone the very young, the inexperienced, the old, the physically disabled, and the intoxicated (W~ler, 19783. The very young ~d the old tover 70) (Todd Ed Walker 1980) are the major victims and suffer most of the fatalities. The principal danger is In cro - mg traffic. The best means of achiev- ing pedestrian safety would be physical separation of vehicular and pedestrian traffic; however, short of thm, temporal measure separate tion and better design features of the crowing space would constitute substantial ~mpro~remente. Better design of signal lights and crossing points (e.g., curbs, signs, crossing make, and dimensions) are exam- pies of such unpro~rements. The potential impact of environmental design ~ shown by the observed decrease In pedestrian accidents associated with zebra-striped crossings and diagonal parking. Security Environment for Older Abuts Anecdotal and survey data suggest that there are three major areas of security concern for the elderly, their families and the larger community. These are (~) emergency access to fire, police, and health assistance; (2) security from the fear and victimization of crune; ~d (3) wanting and assistance In the case of natural disasters. Particularly vulnerable are the elderly living alone and those with a significant dmability. The latter represents about half of all persom over 65. Kelens and Griffithe (1983) reviewed evidence that suggests security ~ directly linked to the older person's mental and physical health. Security systen~ using new technology to provide access to emer- gency services are in use particularly among the elderly. These new Reprices include personad emergency alarms; remote monitoring gym terns for marital signs; and small tracking devices to detect wandering, a special problem of the Alzhe~mer'~ patient. Human factors has an important role in the development and dissemination of such technology. Crone and the fear of crime are topics of growing attention in social gerontology. While victimization of the elderly occurs less frequently than is the case for younger people, fear of crime may

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54 HUAfAN FACTORS RIESEIARC~ NEWS FOR AN AGING POPULATION well be greater among the elderly (Yin, 1985). Especially vulnerable is the older woman living alone ~ art urban apartment or public housing who depends on public transportation (AIson, 1986~. While this aspect of security ~ predominately one of socis! and community policy, there is ample support ~ the literature for the fact that environmental design (lighting, high-rme apartmente) and security (surveillance policy) reduce crime. New technology ~ being applied to this Rue that wiD require human factors interface design and user-accept~ce studies. A trend ~ the field of dmaster reteach hen been to focus on subgroups with different degrees of vuInerabilit~r and limited ability to cope with emergency situations mclud~g the elderly (Tierney, Petak, and Hahn, 1987; Kilijanek and Drabek, 1979~. Research has been primarily concerned with sociological and postdisaster events, such as the ability to cope with the lom suffered. Other research has studied the behavior of the disabled and the elderly ~ hospi- tals, nursing homes, and residential care facilities after fires (Archea, 1979~. However, the focus of research has prmcipaDy been on rescue rather than on self-help and environmental design. General Ismes in Hem In Factors lleseard~ Related to Safety and Security and Aging A sizable body of literature has focused attention on the unpor- tance of safety Rues for the older person and clearly demonstrates the potential role that human factors might play in the design of safer environments. However, the same information base reveals a large gap between the empirical data available and the data needed for human factors applications. There is sufficient epidemiological detail on accidents and on un- safe and insecure environments of the older population upon which to base reteach prionties, hypotheses, and design activities. In addition, data do exist (e.g., from the National Center for Health Statistic, the National Accident Sampling System, state agencies, and the open literature), but none of these sources provide sufficiently detailed information on person and task characteristics, environmen- tal features and demands, ~d product features. Research yielding substantial epidem~ological detail will be necessary to direct and just tify hypotheses generation or human factors design (Miller, Recht, and Green, 1969; Planek, 1982; National Research Council, 1985a). A prerequisite for human factors design activity is information

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H~4N FACTORS PROBLEMS ASSOCLAT}ED WITH AGING 55

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56 HUMAN FACTORS RESEARCH NEEDS FOR AN AGING POPULATION medicine, gerontology, architecture, safety, and eIlgineer~g. Relax tively little research ~ this area can be clearly identified with the field of human factors. A search of the lot 30 years of the Journal of Human Factors produced only 17 articles specifically related to aging, only a few of which dealt directly with issues of safety; none that focused on security were found. Considering the effectiveness of environmental design in accident prevention (Robertson, 1975; Reilly, Kurke, ~d Bukenma~er, 1980) relative to the effectiveness of tragic laws or Denver training (Lund and Williams, 1984; McKnight, Simone, and Weidman, 1982), Tuitional research in this area would seem warranted. LEISURE ACTIVITIES The topic of leisure is closely related to the topics of work and retirement. This ~ because adult leisure activity ~ primarily con- centrated in the retirement period. Given the increasing longevity of persons reaching age 65 and the declining employment rate among older people, the number of potential years of leisure activity is grow- ing. This creates a need to ensure that the po~tretirement leisure years are satisfying and meaningful. A common problem associated with aging is adjustment to the substitution of leisure for work (Myers, Manton, and Bacellar, l986~. Several investigators (e.g., Gordon, Gaits, and Scott, 1976) have shows that older people find leisure less satisfying than work and that, for those older persons who do seek out leisure activities, recre- ation programs have not kept pace with their demands in quality or quantity. Because future generations of older adults will be healthier, better educated, az,6 more affluent (Burru~Barnrnel and Bammel, 1985), it will be essential to provide meaningful and varied leisure ser- vices. In order for human factors specialists to make contributions in this area, basic information is needed regarding current leisure patterns of older people. Such knowledge will permit identification Of ways in which human factors efforts can improve lemure options for older people (Kahne, 1987~. Current information about aging and leisure is limited. This is partially due to lack of consensus regarding the definition of the term ~lemure.~ Although the common definition of leisure has been "nonwork-related activities," more recently, Unobligated or ~dis- cretionary" time have been proposed. These differences in the oper- ational definitions of the term make it difficult to draw conclusions

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lIUMAN FACTORS PROBLEMS ASSOCIATED WITH AGING 57 from inventory stuclies of adult lemure behavior. Although these did ferences are noted in reports on the most popular activities among the elderly, which seem to include TV viewing, visiting friends, write ing letters, and dowg jobs at home, the majority of lemure activities take place within the home and are m~ividual pursuits (Moss and Lawton, 1982~. It is known that engagement in physical activities declines with age, and this decline is especially significant for women. Data suggest that 60 percent of people over 60 are physically unfit (Bu~Tu~B=nmel and Bal}unel, 1985~. This is an important finding since lack of physical activity accelerates the onset and progression of many ages related deficits and diseases. Possible human factors research in this area might include finding ways to increase the participation of older adults in physical activities. This might involve, for example, redesign of sports athletic equipment or identifying which types of activities are most suitable for older people in terms of activity demands and adult capabilities. As IsmAhola (1980) points out, it is important for older adults to be able to make alterations or substitutions within activities so that they can continue to enjoy a broad leisure repertoire. This goal can be realized by changing the intensity of participation within an activity, by altering the focus of participation, or by adopting new forms of leisure pursuits. Such results are predicated on an under- st8Dding of what types of problems older people encounter when attempting leisure pursuits and identifying strategies to circumvent those problems. Currently, there are only limited data regarding the reasons older people choose to participate in one type of leisure activity as opposed to another ~d what types of obstacles they encounter. McAvoy (1979) conducted a surrey of people aged 65 years and over and found that lack of ability was the most important problem cited as preventing participation in preferred activities. This suggests that the demands of many leisure pursuits pore obstacles for older adults and that activities need to be structured to lemen demands or activities need to be identified that are equally satefying but less demanding. Lack of companionship, restricted mcome, and problems with transportation are also mentioned in the literature as being ~ignifi- cant obstacles to participation in leisure activities. This suggests a need to identify ways in which leisure activities can be made more readily available to persons in older age groups. At.

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58 GUAM FACTOR ITCH IS FOR ~ AGOG POPUM"ON ~ 8u~y, the forgoing human factors reteach is warranted within the area of leisure "d recreation: (1) data regarding current leisure patterns of older adults, including types of activities pursued, frequency of participation in activities, and reams for choice of activities; (2) task-analytic information identifying specific types of problems older adults encounter when sttempt~g to engage ~ recross ational activities; and (3) identification of strategies to modify the time and location structure of activities, equipment, or requirements of lemure events so that they are more accemible to older adults.