The ageing workforce: a workplace health and wellbeing challenge

Employers need to develop age-neutral approaches to workplace health and wellbeing to ensure that their practices do not discriminate against older workers.

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Key points Employers are being encouraged by the government to recruit from among the long-term sick and to help those with ongoing health conditions stay in employment up to, and beyond, their normal retirement age. Employers need to focus on developing policies and practices to enable workers to continue in employment, in jobs backed by health and wellbeing support. Changes to pension schemes will make it harder for employers to use early retirement as a way of managing ill health among the growing numbers of employees staying on up to retirement age. Although the risk of certain diseases and work-related conditions rises with age, it is important not to make assumptions about the capability of workers on the basis of age. Medical assessments should be used throughout working life to assess the capacity of all workers, as part of ongoing performance management. Occupational health professionals have an important part to play in managing the health of older workers, for example, in conducting fitness-for-work assessments, designing phased return-to-work plans, and phased retirement or "step-down" arrangements.

The proportion of the population aged between 50 and 69 is projected to rise by 17% by 2016. Government policy is to extend the number of people working up to and beyond their normal retirement age to minimise the economic and social impact of this demographic trend, but many people currently leave the workforce because of ill health well before state pension age. If the government policy drive succeeds, and growing numbers of this age group return to work, some will bring with them ongoing health conditions that need managing, with potentially significant implications for employers' workplace health policies and practices.

Some older employees face complex health risks at work, often simply because they have been economically active for 30 or 40 years and may have developed long-term health conditions such as musculoskeletal disorders (MSDs) and mental health problems as a result of prolonged exposure to workplace hazards. However, it is important not to make general assumptions about the fitness for work of older people from the statistics on the prevalence of ill health - a fi t 55-year-old may have higher capacity for certain work than a 25-year-old colleague. A range of myths and perceptions have grown up around older workers - for example, they are less able to acquire new skills and take more sick leave - which need to be challenged.

According to The Work Foundation¹, organisations should be exploring how they respond to the health needs of an ageing workforce, taking age-neutral policies and practice beyond recruitment, selection and promotion. It suggests that employers will need to think about the details of motivating and managing older workers, which will include ensuring the jobs they fill are "good" jobs, backed by health, wellbeing and workplace support.

This article examines the implications of the ageing workforce for key areas of workplace health and wellbeing, including health promotion, fitness for work, job retention and ill-health early retirement.

How is the workforce ageing?

The number of people under the age of 50 will fall by 2% by 2016, while the 50-69 age group will rise by 17%². Although the rate of employment for men aged between 50 and 65 is currently higher than at any time since the mid-1980s, large numbers of both men and women leave the labour market before their normal retirement age.

Ill health is the most common reason given for leaving the workforce before retirement age, and for remaining outside it after a period of absence. Almost 15% of people aged between 50 and state pension age are on long-term incapacity benefits, but evidence indicates that employment up to and beyond pension age is associated with positive physical and psychological effects. The relationship between work, age and health is complex and, while it is often the case that ongoing ill health increases with age, this does not mean that the overall health of workers falls. Some facts³ about health, employment and age include:

• The proportion of people reporting long-term illness or disability increases with age, from 20% at age 50-54 to nearly 40% at age 60-64.
• High blood pressure, arthritis, asthma, heart disease and diabetes are the most common conditions for older workers - 36% of women aged 60-64 report arthritis and 8% in this age bracket have cancer.
• Verbal reasoning skills peak at 60, general reasoning skills in the late 40s, while numeracy is in decline from age 35.
• Health barriers to returning to work aft er sick leave increase with age - when an employee reaches the age of 50 the likelihood of their returning to work after long-term sickness absence is slim, and declines rapidly thereafter.
• Mental ill health is a particular issue for older women - rates of women on incapacity benefit with a mental health condition rise steadily with age, up to age 60, and the level of work-related mental ill health reported by women rises with age.
• Health inequalities rise with age, reinforcing the role of the workplace as a setting for tackling some of these issues - one-third of all men in their 50s report a long-standing, limiting illness. However, for professional men, that proportion is not reached until they reach 75, representing a 20-year health gap.

Work-related ill health rises with age: rates are higher in those over the age of 45, but the difference between younger and older workers narrows if economically inactive people are excluded from the statistics. The higher rate for older workers is explained by the fact that prevalence rates (new and existing cases of illness at any one snapshot date) rise with age owing to cumulative exposure to workplace hazards. In particular, rates of stress, depression and anxiety, MSDs and work-related deafness are higher in older workers⁴.

However, sickness absence is highest in the 16-24 age group (3.2%) and stays constant between age 35 and state pension age (2.8%). It is lowest among workers over state pension age⁵.

Many organisations will have more people in the 55-64 age bracket than in the 16-24 bracket. In addition, growing numbers of people will wish to, or need to, remain in employment beyond their normal retirement age. Experts have different predictions for the impact of the Department for Work and Pensions' (DWP) Opportunity Age policy on the actual numbers, and types, of people who will work beyond retirement age. Some believe that those choosing to stay in work beyond retirement age will be the fittest, and that the less fit will continue to leave the workforce earlier. Research for the Employers' Forum on Age finds that almost half of the workforce would be happy to work until 70, but only one in five thinks they will be fit enough to do so.

Dudley Lusted, head of healthcare development at AXA, believes that this picture will change in future, especially given the erosion of final-salary pensions and enhanced early ill-health retirement benefits. He says: "Nobody really knows the implications of a policy geared towards extending working life." He adds that the health status of future generations will play a crucial part in determining decisions on retirement.

Current employees in their late 40s and 50s - many of whom will have access to good final-salary pensions and who have taken on board the health messages of recent years - will most likely want to retire at their normal pension age to enjoy a long and healthy retirement, Lusted suggests. However, future generations, including those in their 20s and 30s who do not keep fit and healthy, are unlikely to have the financial security to stop work at 60 or 65, but may be in poor health, presenting employers with major health issues to manage, Lusted believes. He explains: "Many employees remain naive in both financial and health terms - we need to convey the message 'get fitter, save better'."

Working older can be good for health

The complex relationship between age, work and health raises important questions for the government's policy of increasing economic participation amongst older people. The Opportunity Age strategy aims to increase the post-50 employment rate by 1 million workers, and stresses that this will include the need for employers to manage any health conditions that these older workers might have. Working beyond retirement age has a beneficial effect on older workers' self-rated health and survival, but these beneficial effects depend on the jobs that they do being health-supporting ones. For example, older workers performing low-stress jobs, on hours they choose, experience better health, according to The Age and Employment Network.

An evidence review published in 2006 by the DWP⁶ sought to answer the question: "Is work good for you?" It concluded that it is difficult to disentangle evidence on the impact of work on older workers because one of the main indicators, early retirement rates, is determined not only by health problems, but by involuntary job loss or voluntary exit from the workforce, each of which may have different financial, social and health effects. However, the DWP publication concludes that there is "no evidence that continuing working is generally harmful to the health of older workers and it may be beneficial".

Dr Kerry Platman, senior research fellow at the Warwick Institute for Employment Research, is leading a network of employers looking at how to "make the workplace a healthy place to age". She believes that "not all older people will be willing or able to take part in the labour market, and there needs to be a way for them to bow out". Policymakers must be realistic about the potential for employers to recruit from among the long-term sick. Platman adds: "Wagging a finger at business, saying 'you must employ these people' will not work - there must be a business case."

Tackling the myths

Almost 70% of employers in a recent survey⁷ believe they will need to invest more in the health and welfare of employees to take account of an ageing workforce. Aspects of healthcare that are being reviewed by organisations, in the light of employee ageing, include support to manage stress and physiotherapy for MSDs (both were cited by 54% of survey respondents). Just over 40% of the employees questioned for the research intend to stay in work beyond retirement age. Proactive employers are already thinking in terms of adapting employer healthcare benefits to employees' needs as they change with age, and are considering using packages in which the content shifts over the working life of the employee, rather than simply offering an off-the-shelf service that is rarely used.

The myths and misconceptions that surround the health of older workers need to be dispelled so that these workers can remain a productive part of the workforce. For example, sickness absence does not rise with age in a linear way, but the pattern of absence changes, so that younger workers have more spells of short-term absence, while older workers take fewer spells of longer duration. Organisations typically have relatively few cases of long-term sickness absence, but these often represent around one-third of the total time lost each year. It is important to recognise that, although age often brings illness and disease, individuals' health is influenced by many factors, particularly lifestyle ones such as exercise and diet. Older workers do not have more accidents at work, and the types of accidents associated with older workers (for example, slips and trips) can often be prevented by interventions benefiting overall health and safety performance.

Workability and wellness

Workability - enabling people to stay economically active for longer - requires employers to engage in a range of interventions and to operate a range of policies. Workplace health and wellbeing, in its broadest sense, should be a vital part of the workability agenda. An important Finnish study, which led to the development of a workability index model, concluded that good workability is associated with, among other things, the promotion of workers' health and functional capacity. The model⁸ focuses on removing workplace factors that are likely to lead to people leaving employment before retirement age for health reasons - for example, reducing the physical demands of jobs, the need for better ergonomics throughout working life to prevent MSDs in later life, enabling workers to change working patterns and job content with age, and promoting healthy living throughout working life.

Progressive employers will respond to barriers to workability as they arise, regardless of the employee's age, with the aim of keeping them in, or returning them to, work. This is the case at Westbury Homes (house builders, and now part of Persimmon), where employees have the opportunity to change working hours to enable job retention, subject to operational constraints. The company believes that adjustments that make things easier for older workers tend to benefit all employees, with good returns on investment for the whole organisation⁹. Platman supports this view: "Don't single out workers by age, but take steps to eliminate health and environmental barriers to all people making a productive contribution at work, regardless of age."

Fitness for work

Good performance management is key to managing the health and capacity of all workers, including older ones, according to Rachel Krys of the Employers Forum on Age. She says: "It is important that employers do not look on the ageing workforce as a negative thing." For example, individual performance appraisal is an effective way of keeping in touch with an employee's ongoing health issues. Krys warns that there is a potential issue with so-called "age-onset impairment", particularly in terms of the requirements of disability legislation. For example, how much reasonable adjustment can an employer be expected to make to a physically demanding job performed by an employee who is no longer able to perform it?

In many cases, however, such a decline in capacity is a gradual process, and should not come as a shock to an employer or manager operating good performance management, Krys argues: "Employers are not going to suddenly be hit by lots of older, incapable workers." She adds: "There may be more employment tribunal cases involving older workers' capability in future, but these are most likely to be in organisations with no history of sophisticated performance management." Krys believes that problems surrounding older workers and capacity usually arise only when managers make too many assumptions about the capacity of older workers as a group, or about the skills or strengths needed to do a particular job.

Risk-based assessment

Health screening or assessments, ideally forming part of performance management, are central to assessing continuing fitness for work. However, screening must apply to all employees, regardless of age, and must have capability, not age, as its focus. For example, Aberdeen City Council⁹ operates an age-neutral policy stating that age is not to be regarded as a reliable indicator of an employee's ability to perform a job adequately, and regular risk assessments are used for employees of all ages to determine capability to perform duties. The council also provides for "dignified" exits in capability cases, using performance appraisal that covers the health and safety implications of job demands.

The British Occupational Health Research Foundation is developing a risk-based approach to making decisions on the employability of older workers and it hopes to develop a toolkit for employers over the next 18 months. The TUC argues that risk assessments are too oft en used only at induction or job change. It says that they should be used to regularly assess workers to prevent them having to leave employment early owing to exposure to work-related health risks. However, the TUC also stresses that assessments must be carried out in relation to all staff, otherwise the assessment could constitute an age-related criterion and be in breach of the age equality legislation.

Segment health promotion

Ongoing workplace health promotion should be an important part of an employer's efforts to enable older workers to stay healthy and at work. Programmes designed to raise awareness of particular health issues, or to change behaviour (for example, diet and smoking), can benefit older workers in particular, but need to be evaluated and sustained to be effective, The Work Foundation argues.

The business case for investing in health promotion programmes is beginning to emerge, but it is vital that such interventions start early and continue throughout working life, according to Lusted. Wellbeing is "about all the things that make the workplace a good place to be, including leadership, culture and engagement. Investing in workplace health can support the development of a good place to work in all these other respects." He suggests that employers tend to focus on health promotion programmes with most appeal to younger, more active workers. But health risks tend to rise as activity levels fall, and more needs to be done to encourage workers over the age of 40 to take more exercise and raise physical activity levels - "there is value in segmenting health promotion to meet the needs of workers at different ages," he believes. For example, older women are less likely to be attracted by the prospect of subsidised gym membership or a running club at work, but may find a lunchtime self-help or walking group attractive.

The demise of enhanced ill-health pensions

Occupational pension scheme rules providing enhanced pensions in cases of ill-health early retirement are still lawful, following the implementation of the age equality Regulations in relation to pension schemes in December 2006. Guidance on the Employment Equality (Age) Regulations 2006¹⁰ states that ill-health early retirement rules, enabling occupational pension schemes to enhance a member's pensionable service up to their normal pension age in the event of them leaving work early owing to ill health, are exempt from the Regulations' provisions on "rules, practices, action or decisions" that might result in a case for indirect discrimination. For example, two workers take ill-health retirement, but the younger one receives a higher enhancement to their pension because they have more years to go until they would normally receive their pension. In theory, the older worker could complain that they have suffered discrimination, but the exemption in the Regulations stops them bringing such a claim.

However, many employers are unclear about how the new Regulations will affect policies on phased and flexible retirement, according to respondents in a recent survey¹¹, and other trends suggest that early retirement might not be a viable way of managing older workers with ongoing health conditions. Many final-salary schemes have tightened ill-health retirement rules in recent years, making it harder for employers to use a pension scheme to manage ill health in older workers. For example, many large public sector schemes have been amended so that benefits are enhanced only in cases where the member is assessed as incapable of any work at all. Previously, employees would receive an enhanced pension if they were incapable of performing their own job.

The closure of many final-salary pension schemes in recent years, and the trend towards defined-contribution-based arrangements in many private sector organisations, also undermines the potential for early ill-health retirement to be used to manage older workers with ill health. Members in defined-contribution schemes build up individual "pots" of pension over their working life, rather than having benefits paid out of a fund, and it is unlikely that these pots will be sufficient to pay an enhanced early pension in the event of ill health. A survey by Mercer Human Resource Consulting found that only 13% of defined-contribution schemes include an ill-health provision, prompting the consultant to suggest that older employees are becoming more vulnerable to the effects of ill health in later working life.

Employers are reviewing health and benefit plans in the light of the age equality legislation to ensure that any age-related rules, for example, in private medical insurance cover, income protection and life insurance benefits, can be justified. Flexible benefit schemes, including health insurance, under which employees can "pick and mix" elements of an overall benefits package up to a certain value, are particularly vulnerable to challenges under the new legal framework as they tend to operate age-related charges for employees.

The tightening of final-salary scheme rules to make enhanced early retirement harder, and the rise of defined-contribution arrangements more generally, could mean that some older workers with poor health are keen to stay in the workforce, presenting employers with an increasing number of issues around capability. Martin Warren, head of human resources practice group at Eversheds, believes that this could result in more employment tribunal cases involving disputed ill-health retirements or capability.

Flexible working

Flexible working, including phased retirement and "step-down" arrangements under which employees agree to reduce job seniority in later working life, can be effective in ensuring that older workers stay healthy and at work. However, according to The Work Foundation, organisations need to ensure that such policies operate in a way that does not make older workers feel they are second-class citizens, or have lost status.

Government policy stresses the need for employers to enable flexible transitions from work into retirement, but Platman argues that "we need to look at what sort of jobs these will be, and how older workers can keep learning and training in them". Fast-paced working environments, particularly in customer-facing hi-tech job roles, are imbued with cultural pressures and customer expectations that may not always be inclusive. Step-down arrangements for older workers have wellbeing issues, and employers need to look at adapting working environments in ways that accommodate change without compromising older workers' wellbeing. Platman adds: "This could be something as practical as changing office layouts to make them more conducive to intergenerational learning."

Occupational health role

Occupational health (OH) professionals, either as part of an employer's in-house or contracted service, or in primary care, will have a crucial role to play in managing the health and wellbeing of older workers. Their role includes conducting fitness-for-work assessments (see box 1), perhaps as part of a risk-based assessment of an individual's capacity to continue in work beyond retirement age. In addition, OH professionals will be involved in designing rehabilitation programmes for older workers returning after long periods of sick leave with ongoing ill-health conditions such as cardiovascular disease. OH practitioners will be increasingly asked by employers to provide comprehensive work retention services for older workers, ranging from securing access to appropriate treatment services to liaising with line managers on phased returns to work, appropriate adaptations or permanent changes to working patterns.

OH professionals may also increasingly adopt an advocacy role, demonstrating to perhaps sceptical line managers that older workers are able to undertake particular tasks and duties. However, many employees do not have access to occupational health services. For example, the Age and Employment Network points out that there is currently one OH specialist for every 43,000 workers, and there are serious doubts about the capacity of the OH service to expand to meet the challenges an ageing workforce presents.

1. The ageing workforce by N Turner and L Williams, The Work Foundation, 2005, available at: www.theworkfoundation.com.

2. Opportunity and security throughout life, first report of Opportunity Age, available at: www.dwp.gov.uk/opportunity_age/volume2/section_one.asp.

3. Key facts on health, employment and age, The Age and Employment Network, June 2006, available at: www.taen.org.uk.

4. Occupational ill health age statistics: information sheet, HSE information sheet 2/02/EMSU, available at: www.hse.gov.uk.

5. "Sickness absence from work in the UK", by C Barham and N Begum, Labour Market Trends (PDF format, 1.42MB) (on the National Statistics website), vol. 113, no.4, April 2005.

6. Is Work Good for Your Health and Wellbeing? by G Waddell and AK Burton, Stationery Office, 2006, available at: www.tsoshop.co.uk, price £25.

7. UK companies looking forward to a healthy future: HSA annual corporate market survey 2006/07, HSA, available at: www.HSA.co.uk.

8. "Promotion of workability, the quality of work and retirement" by K Tuomi et al, Occupational Medicine, vol. 51, no.5, pp.318-324, 2001.

9. Age Positive case studies, available at: www.agepositive.gov.uk.

10. The impact of the age Regulations on pension schemes (PDF format, 205K) (on the DTI website), DTI/DWP, December 2006.

11. Pension flexibility hampered by age Regs. confusion, Occupational Pensions no.238, March 2007.

This article was written by Sarah Silcox, a writer on workplace occupational health and safety, sarah.silcox@waitrose.com.

Box 1: Assessing fitness for work Regular medical assessments of individuals' fi tness for work, ideally as part of an organisation's performance management process, should be a part of managing the workplace health and wellbeing of all employees, including older workers and those requesting to work beyond their normal retirement age. Assessments are most frequently carried out by an employer's occupational health (OH) service or an employee's GP, with the primary purpose of ensuring that the worker is fit to perform job tasks effectively, and without risk to their own or others' health and safety. Fitness should be interpreted in functional terms and in the context of the job tasks or roles to be performed. Although the medical professionals will prepare a report, and perhaps make recommendations on fitness for work, it is ultimately the employer's responsibility to set objectives for an employee's attendance and performance, and to ensure compliance with health, safety and employment law. OH practitioners carrying out medical assessments will usually consider the actual effect of an employee's medical condition on performance at work, by asking them what their job entails or visiting them at work, and will also consider the interactions between occupational factors (for example, job demands or exposure to particular hazards) and the employee's medical condition. Getting people back to work when they are off sick is an important part of an assessment, and OH practitioners will explore treatment options, such as surgery, or counselling in the case of an employee with mental health problems, and options for rehabilitation, for example, a phased return to work. OH professionals will also recommend reasonable adjustments to enable the employee to return to work; for example, temporary or permanent redeployment to a different part of the organisation, or a new system of mentoring or supervision. The medical assessment can explore long-term risk prevention and control measures, which may have benefits for the wider workforce; for example, job redesign or the provision of guidance and training to groups of staff. Source: "ABC of work-related disorders: assessing fitness for work" by W Davies, British Medical Journal, vol. 313, pp.934-938, October 1996.

Further information The British Occupational Health Research Foundation, at: www.bohrf.org.uk. Guidance and information on age discrimination and health is available from The Age and Employment Network, at: www.taen.org.uk. Age Positive is part of the Department for Work and Pensions, and is responsible for the Age Positive Campaign. It has information and guidance on issues around age, including case studies. Available at: www.agepositive.gov.uk. The Employers Forum on Age is an independent network of employers, and provides advice on age awareness and the law on age. Available at: www.efa.org.uk.