AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 51:269–280 (2008)
Meeting the Challenges of an Aging Workforce
Michael Silverstein, MD, MPH?
increases in the number and percentage of U.S. workers 55 and older. In some ways these
workers will be our most skilled and productive employees but in others the most
Methods The literature on aging and work was reviewed, including demographic trends,
physical and cognitive changes, safety and performance, work ability, and retirement
ResultsandConclusions Olderworkershavemoreserious,butlessfrequent, workplace
be prevented and their consequences reduced by anticipating the physical and cognitive
changes of age. Many employers are aware that such efforts are necessary, but most have
not yet addressed them. There is a need for implementation and evaluative research of
programs and policies with four dimensions: the work environment, work arrangements
and work-life balance, health promotion and disease prevention, and social support.
Employers who establish age-friendly workplaces that promote and support the work
ability of employees as they age may gain in safety, productivity, competitiveness, and
sustainablebusinesspractices. Am.J.Ind.Med.51:269–280,2008. ?2008Wiley-Liss,Inc.
KEY WORDS: aging workforce; work ability; prevention; human factors; older
Two simultaneous demographic changes have begun to
produce a marked growth in the number and percent of older
workers (those 55 and older) in American workplaces. First,
the enormous birth cohort born between 1946 and 1964 has
started to crest past the age of sixty. Second, the twentieth
century trend toward earlier retirement has reversed and
growing numbers of employees are planning longer working
in 1984,rose to 40.3in 2004and isexpectedtoreach 41.6 by
2014. The number of those in the workforce who are 55 and
older will increase by 49% from 2004 to 2014. Their
proportion is also growing, from 11.9% in 1994 to 15.6% in
2004 to 21.2% expected in 2014 [Toossi, 2005].
OUR AGING WORKFORCE
Prior to the passage of the Social Security Act in 1935
work did not typically end with a planned retirement.
from an initial age cohort remain in the workplace) was age
70 or more for men. After World War II there was a need
to open the workplace to growing numbers of unemployed
younger workers, particularly veterans. Also retirement
leisure was becoming a symbol of success. Social security
and private pension policies were designed to encourage
lowered the age men were eligible for unreduced Social
Security benefits from 65 to 62. Average retirement dropped
from age 70 in 1950 to age 65 in 1970 with age 62 becoming
the norm by 1985 [Quinn, 2002; Cahill et al., 2005].
Despite this long trend toward earlier retirement since
the 1940s, the 78 million baby boomers born between 1946
and 1964 comprise such a large group that there are more
As they leave the workforce, whether at age 55, 62, 65 or
later, there will also be more retirees than ever before. To
complete the picture, as these baby boomers age at work and
smaller younger generation, the baby bust of 1965–1976
of this demographic transformation are becoming clear. In
the State of Washington, for example, 29% of employed
workers were 45 or older in 1995. This had grown to 39% by
2005 [Kaglic, 2005]. This growth is not being matched by
younger workers. By 2015 therewill be 115,000 more 60- to
64-year olds and 30,000 fewer 40- to 44-year olds in the
or seeking employment) than there were in 2005 [Bailey,
2006]. Nationally, from 2004 to 2014, ‘‘the labor force will
continue to age, with the annual growth rate of the 55-and-
older group projected to be 4.1%, four times the rate of
growth of the overall labor force. By contrast, the annual
growth rate of the 25- to54-yearagegroup will be 0.3%, and
that of the young age group consisting of 16- to 24-year olds
will be essentially flat’’ [Toossi, 2005].
As these older workers move into retirement the direct
skills. According to the International Brotherhood of
Electrical Workers by 2010 as many as 60% of today’s
experienced utility workers will retire [IBEW, 2005].
Similarly, the average age of hospital caregivers today is
over the next 20–25 years [Briley and Hutson, 2002].
The indirect, but equally profound, impact of the
demographic changes will be economic. The integrity of
our federal social security system has depended upon the
labor and income of large numbers of young workers
supporting the retirement needs of smaller numbers of
disabled and retired workers and their dependents. In 2005
64 (i.e., an old age dependency ratio of 20%). The Social
more than double, to more than 40%, with only 2.5 younger
people for every older one (Fig. 2). Not only will the number
of retirees grow, but their life expectancy and associated
duration of retirement is increasing as well. While private
pensionsystemsare theoreticallyfullyfundedatthe timethe
is often not fully realized. Underfunded pension programs in
both the private and public sectors are now common, the
federal assurance program for these pensions is not robust,
and these pensions may also be jeopardized by these
dependent older population will be somewhat mitigated by
lower fertility rates which reduce the numbers of the very
[Burtless, 2005], this will not offset the profound economic
consequences of the demographic trends.
STAYING ON THE JOB LONGER
As these trends progress—more older workers moving
toward retirement with fewer younger replacements—
substantial pressure on our social security and pension funds
will accompany the anticipated shortages of labor and skills.
evolve to encourage workers to stay on the job longer. Other
factors creating incentives to stay at work longer include the
the face of relentlessly rising health care costs and the
increasing uncertainty about pension benefits that comes
toward defined contribution programs.
Some of the expected policy changes are already
evident, including the 1978 and 1986 amendments to the
FIGURE 1. GrowthofU.S.Workforce2002^2012.
FIGURE 2. Oldagedependencyratio(age65þ/age20^64).
Age Discrimination in Employment Act of 1967 [ADEA,
1967] which have largely eliminated mandatory retirement
ages, the gradual increase in the age for full social security
benefits from 65 to 67, and a relaxation of the social security
retirement earnings test so that workers can stay on the job
longer without a loss of benefits. The Pension Protection Act
retirement plans by starting to draw pension income without
penalty while theycontinue toworkfullor part time past age
62 [PPA, 2006].
These changes are probably not enough. Business Week
retirement age will incrementally rise to 70 [Coy and Brady,
2005]. This, however, is not certain since along with
predictable political opposition many actuaries assume that
raising the retirement age would result in an increasing
number of older people applying for Social Security
disability benefits, thus offsetting the possible savings from
the raised retirement age.
The impact of these developments is already apparent.
While the labor force participation rate among 65-year-old
men dropped from 70% in 1940 to only 32% in 1985
[National Research Council, 2004] this trend shows signs of
reversingas the incentivesforearly retirement are beginning
of 25- to 54-year olds stayed essentially stable (fluctuating
between 82% and 84%) while the rate among 55- to 64-year
This trend is likely to continue, as signaled by a May, 2005
put off retirement until after age 62 had risen from 35% in
that the percent of older workers staying on the job will
continue to rise at least through 2014, even without major
changes in social policy such as further increases in full
social security retirement age.
PHYSICAL AND COGNITIVE
CHANGES OF AGING
In some ways older workers are the most skilled and
productive employees but in others they are the most
vulnerable. Employers who do not anticipate the physical
and cognitive capacities of older workers and who fail to
provide the programs and policies needed to support their
productive capacities and minimize their vulnerabilities will
experience adverse impacts on quality, productivity, work-
place safety, and workers’ compensation.
Older workers differ from their younger counterparts in
several important ways that might have an impact on their
safety and health at work. Whether these are normative
effects of aging (e.g., loss of visual acuity) or age dependent
increases in various ‘‘abnormal’’ conditions (e.g., coronary
artery disease), aging brings changes to all parts of the body,
from decline in brain cell connections to decrease in
muscle mass. Maximum physical strength is at age 20–30,
gradually declining until 40–50 and more quickly thereafter
[Millanvoye, 1998]. Bone density, pulmonary oxygen
uptake, exercise capacity, visual acuity, resistance to heat
predictably with age. The prevalence of work-limiting
disabilities increases with age, from 3.4% of workers aged
18–28 to 13.6% of those greater than 60, according to the
1994 National Health Survey [National Research Council,
The impacts of age on cognitive function are more
complicated. Some mental processes such as those requiring
stimuli are especially age sensitive. Cross sectional data sets
suggest declines in these domains beginning as early as 20–
30 years old, while the onset is a bit later for longitudinal
studies. Performing multiple simultaneous tasks or holding
functions which involve processing input at the time of
performance from other ‘‘crystallized’’ cognitive functions
better preserved with age. The ‘‘crystallized’’ knowledge of
word meaning or the ability to retrieve familiar information,
for example, is relatively age stable. In addition to these
crystallized semantic skills, memory for procedural skills
such as typing, which relies on early learning, is also
relatively well maintained with age [National Research
While age-related changes in mental and physical
function are inevitable, they do not invariably lead to
incapacity orreducedperformance andproductivity atwork.
Whilemanyolderworkers with illnesses orlimitations leave
the workforce a considerable number remain on the job.
Seitsamo and Klockars  followed a group of 4,534
Finnish municipal workers over an 11-year period. 37% had
a self-reported musculoskeletal disorder and 17% had a self-
50). Prevalence of self-reported musculoskeletal disorders
rose to 51% and cardiovascular diseases to 31% at 11 years
(with mean age of 61.6). Twenty percent of the cohort
and workers in this subgroup had a prevalence of 45% for
self-reported musculoskeletal disorders and 23% for self-
reported cardiovascular diseases after 11 years. Forty-five
percent of the cohort had retired due to old age and their
prevalence of musculoskeletal and cardiovascular diseases
was no different from their counterparts who remained at
work. Disease prevalencewas higher, however, among those
who had retired due todisability.The fact that manyworkers
health conditions are not severe, the need towork outweighs
Protecting the Aging Workforce271
other incentives, they have strong social support and coping
skills, or their job duties or work environment are modified.
There are other important reasons that workers, even
with diminished physical or cognitive function, may
continue to work effectively as they age. First, most jobs do
not require performance at full capacity even for older
physical limits than younger workers. Second, while various
physical and cognitive capabilities decline with age, there is
great inter-individual variation in these normative trends, it
being ‘‘axiomatic in gerontology that most general physio-
logical and biological functions in older persons tend to
have greater variation than in younger persons’’ [National
Research Council, 2004]. Third, older individuals can often
compensate for age-related losses with relatively age stable
strategies and skills related to their experience and expertise,
although the relationships are complex and the literature is
mixed [Morrow et al., 1994; Meinz and Salthouse, 1998;
Charness et al., 2001].
Salthouse  notes a ‘‘discrepancy between the
rather pessimistic results of the laboratory and the more
encouraging observations of daily life’’ and offers several
possible explanations. First, people sometimes are able to
select into work or other activities as they age that match
their competence. Second, the artificial nature of laboratory
tests of physical and cognitive capacity may result in low
motivation and high anxiety that result in diminished
performance. Third, laboratory tests of cognition may
measure age-sensitive fluid capacities while daily activities
are more likely to utilize age-preserved crystallized cogni-
tion. Fourth, experience is more of a factor in daily activities
than in most laboratory settings.
The ability to work successfully with increasing age is
typists have been shown to have slower tapping rates and
reaction times, but are able to compensate for declining
advance than younger, less experienced typists [Salthouse,
1984; Bosman, 1993, 1994]. Similarly, despite significant
age-related declines in the cognitive ability to recall short
and skills tend to maintain their advantage in musical
Salthouse, 1998; Meinz, 2000]. Based on a comprehensive
review Salthouse  has concluded that while many
types of cognitiveand physical performance are improved at
all ages with training and practice, this does not appear
to change the rate at which capability declines with age. In
other words training, practice and experience can enhance
performance at older ages and can often result in older
workers outperforming younger ones, despite the fact that
age-related declines continue at the same rate as they do in
workers with less experience and practice. Laflamme and
Menckel  have summarized these complex relation-
ships in a study of work injuries by noting that skills and
experience can compensate for age-related physical and
cognitive declines only when the job demands remain lower
than overall work capacity and that this compensation is
not feasible when work organization and working methods
AMONG OLDER WORKERS
and brain function, we might predict aging to be associated
with poor performance, particularly because many of the
functions that decline with age—like the ability to solve
abstract problems—are strong predictors of initial job
performance. But, with the exception of certain jobs with
exceptionally high cognitive demands like air traffic
controllers, most studies have not found an age trend in
measures of job performance [Waldman and Avolio, 1986;
McEvoy and Cascio, 1989; Avolio et al., 1990]. Duration
tends to be a better predictor of performance than age and
variations within age groups tend to exceed the average
differences between age groups. McEvoy and Cascio 
point out that those who continue to work after normal
retirement age are probably not average workers and that
selective retention may partially explain why performance
does not tend to decline with age. Not surprisingly, findings
vary depending on the nature of the work. Warr 
proposes four types of jobs, depending on whether their
physical and cognitive requirements exceed capacities as
with experience. Performance is expected to diminish with
experience provides little advantage (e.g., unskilled manual
labor or fast paced data processing). In many others where
capacities are maintained with age and experience enhances
performance, the relationship between performance and age
is expected to be positive. Warr  provides several
examples of such ‘‘age enhanced’’ jobs, including mail
sorters, shoe leather cutters and sales workers.
In addition to their generally satisfactory performance,
older workers experience lower overall rates of non-fatal
work-related injury and illness compared with younger
workers. In the 1988 National Health Interview Survey
Supplement on Occupational Health and Safety,men greater
than 50 averaged half the lost workday injury rate of men
aged 30–49 [Landen and Hendricks, 1992]. In a review of
13 studies Laflamme and Menckel  report ‘‘the most
common finding is that accident frequency tends to decrease
not fully understood. Whileexperience, skill and maturity of
older workers may play a role, Rix  notes another
plausible explanation to be systematic differences in the
exposures to hazards of different age groups. While overall
injury rates are low,thereisevidence thatsomesubgroups of
older workers with pre-existing problems may bevulnerable
to higher workplace injury rates and a variety of adverse
and hearing is associated with occupational injuries among
Although injury rates are generally low, the impact of
workplace injury among older workers has been found
disproportionately high in most studies [Mitchell, 1988;
Layne and Landen, 1997; Layne and Pollack, 2004].
Laflamme and Menckel  note the most common
finding in nine studies reviewed to be that ‘‘age-related
accident severity tends to increase with age.’’ According to
the Bureau of Labor Statistics, the median duration of
absence from work due to a work injury increases
consistently with age, from 5 days among those less than
25–12 days for those aged 55 and older [Rogers and
Wiatrowski, 2005] (Fig. 3). Laflamme et al.  found
Swedish iron-ore miners. The literature has not been
completely consistent, with exceptions including reduced
self-reported adverse outcomes among older workers in the
National Health Interview Survey Supplement cited above.
et al.  found that despite more severe injuries the
workers 55 and older did not have more lost work time or
other adverse outcomes than the younger workers. In this
population older workers reported greater satisfaction and
fewer residual symptoms than younger workers, possibly
as a healthy worker effect.
While the rates for non-fatal injuries are lower for older
workers, fatality rates have been higher [Goldberg et al.,
1989; Bell et al., 1990]. Kisner and Pratt  found that
workers over 65 had a workplace fatality rate nearly
three times that of those aged 16–64, despite the fact that
each week. The difference persisted after stratifying by type
of injury and industry. The rate of machinery-related
deaths among males in retail trade was nearly seven times
greater among older workers and for machinery-related
deaths among males in transportation was nearly nine times
greater. Agnew and Suruda  also found an increased
energy of impact, suggesting that ‘‘once a fall has occurred
older workers are more vulnerable to serious injury than
injury with age. First, the types ofinjuries sustained by older
workers tend to be more severe; fractures accounting for a
substantially greater percentage of non-fatal injuries among
older workers compared with younger ones, while the
percentage of strains and sprains decreases with age. For
example, 20% of injuries to older truck drivers are from
fractures, compared with only 9.3% of injuries to all truck
condition older workers experience more severe outcomes,
including longer recuperation and lost work time. Fractures
from falling to the floor result in a median 35 days for
recovery among older workers and 25 days among younger
workers [Bureau of Labor Statistics, 1996]. In a study of fall
injuries among union carpenters Lipscomb et al. 
found age was not associated with the risk of falls from
elevations but the mean cost per fall increased fourfold with
age. Whether this is a function of injury severity or medical
care delivery and personnel practices is not clear.
MAINTAINING WORK ABILITY,
SAFETYAND HIGH PERFORMANCE
IN AN AGING WORKFORCE
Since we can reasonably predict growing numbers and
percentages of older workers for the next 25 years, we
collectively have a strong interest in ensuring that our
workplaces are hospitable to their needs and capacities so
they may contribute their labor with maximum safety and
productivity. Under current conditions the rate of workplace
injury and illness among these older workers will be lower
than that of their younger counterparts, but the number of
cases will increase substantially and their average severity,
outcomes are likely to outweigh the advantages of relatively
low rates unless we adopt workplace strategies that build
upon the strengths and protect against the vulnerabilities of
workers as they age [Ilmarinen and Rantanen, 1999; Rix,
2001; National Research Council, 2004].
employers to develop programs which match the workplace
environment with the needs and capabilities of older
workers: ‘‘If employers are to reap the benefits of the work
FIGURE 3. Median days away from work for non-fatal workplace injuries and
Protecting the Aging Workforce273
ethic and experience of older workers, they must design the
workplace of the future to meet their needs.’’ The concept
of designing work to match the physical and cognitive
capacities of workers applies equally well at all ages and
there is some evidence, mostly from the Nordic countries
and the European Union, suggesting that carefully designed
employer programs can provide age friendly working
environments that preserve the capacity of employees to
function safely and effectively as they age.
Ilmarinen  and colleagues at the Finnish Institute
of Occupational Health have developed a conceptual model
of work ability in which an individual’s capacity to perform
job functions successfully is the integrated product of a
number of self-reported individual and workplace environ-
mental factors. The critical work ability factors include
health status and physical impairment, the physical and
cognitive demands of work, the psychosocial work environ-
ment, and the individual’s general well being and supportive
resources. Since 1981, a quantitative Work Ability Index
(WAI), derived from a standardized, self-administered
1998, 2001; Nielsen, 1999; Kiss et al., 2002; de Zwart et al.,
Finnish municipal employees ranging in age from 44 to 58
was first evaluated in 1981 [Ilmarinen et al., 1991a]. Five
4,534 in 1992, with four principal sets of findings [Nygard
Ilmarinen and Tuomi, 1992; Seitsamo and Ilmarinen, 1997;
Ilmarinen and Rantanen, 1999; Ilmarinen, 2001; Savinainen
et al., 2004].
with disability pensions and mortality at 4 and 11 years of
follow-up [Ilmarinen et al., 1991b; Tuomi et al., 1997a]. For
example, among a group of municipal workers with poor
work ability scores in 1981 62.2% had retired on disability
pensions and 11.6% had died in 1992, while the correspond-
ing outcomes for those with good work ability were 21%
disability pension and 3% deceased. Similarly, in a group of
construction workers the WAI predicted disability pensions
also predicted self-reported good health and physical
condition after 5 years of follow-up and were positively
associated in cross sectional analysis with self-reported
quality and productivity of work [Tuomi et al., 2001].
Ilmarinen  has also reported an association between
WAI scores and per person disability and sickness absence
Second, there is an overall decrease inWAI with age but
ers (818) remaining in the same occupation were followed
from 1981 to 1992[Ilmarinen et al., 1997]. WAI in 1981 was
not associated with age but declined significantly for each
age cohort for both men and women over the period of the
study. The prevalence of poor work ability increased with
age, from 1.7% atage 47, 3.3%at age 51, and 18% atage 58.
Third, several potentially modifiable variables are
shown to be associated with WAI. Among the group of
818 workers noted above, variables associated with
improved WAI over the 11-year study period included
decreased repetitive movements, increased satisfaction with
supervisor attitude and increased leisure physical exercise
[Tuomi et al., 1997b]. Variables associated with decline in
WAI were increasedstanding atwork,decreased satisfaction
with restless and noisy workrooms, decreased recognition
and esteem at work and decreased leisure time physical
Fourth, four sets of variables have been associated with
the preservation or enhancement of WAI over time and
work environment (physical workload, rest/work schedule,
repetitive motion, and regulation of one’s own work and
breaks); (b) adjustments in the psychosocial work environ-
ment (flexible work schedules, teamwork, age-management
skills for supervisors); (c) health and lifestyle promotion
(physical exercise, risk factor reduction, occupational health
services); and (d) worker skills and competency building
[Ilmarinen et al., 1997; Ilmarinen and Rantanen, 1999].
in the U.S. literature, Burkhauser, using data from the 1978
Survey of Disability and Work and the 1992 Health and
Retirement Study, found that provision of a workplace
accommodation for an employee with a health impairment
slowed withdrawal from the workforce and delayed the time
et al., 1995, 1999].
PROGRAMS AND POLICIES TO MEET THE
NEEDS OF AN AGING WORKFORCE
Several recommendations have been made for the
implementation of practical programs consistent with the
evidence summarized above. Four strategic dimensions
have been suggested, including interventions that focus on
the work environment, the way work and retirement are
arranged and organized, the health and fitness of the
2001; Moyers and Coleman, 2004; National Research
Council, 2004] (Fig. 4).
The Work Environment
Injuries and poor job performance are more likely to
occur when work requirements exceed individual capabil-
ities, a mismatch potentially more frequent among older
workers. The tools of workplace ergonomics and human
workforce, can be used to eliminate or modify exposure to
hazards so that young workers can reach older ages without
injury or that impaired or limited workers can continue to
work without further harm [Garg, 1991]. The principles of
can be used safely and effectively by people of widely
ranging differences in age, size and other characteristics, are
principles (including equitable use, flexible use, simple and
intuitive design, perceptible information, tolerance for error,
and use) are more fully described at http://www.design.
The opportunities for safe design are particularly
disorders, an Institute of Medicine panel having concluded
‘‘that primary and secondary prevention interventions to
reduce the incidence, severity and consequences of muscu-
loskeletal injuries in the workplace are effective when
properly implemented...’’ [National Research Council,
2001]. For example, in a randomized, population based
clinical trial Loisel et al.  found that workers with
subacute work-related back pain returned to work 2.5 times
faster when modified work was added to the usual regimen
of clinical care. Krause et al. [1998, 2001] concludes that
rates twofold and reduce disability days in half.
The principles of ergonomics, human factors and
universal design can be applied to challenges in the areas
of balance, vision, hearing, strength and endurance faced by
workers as they age.
Many workers above the age of 50 begin to have
problems with balance, risking injuries from trips and falls
[Whipple et al., 1993; Konrad etal., 1999; Rogers and Mille,
2003]. Measures to compensate for postural instability
clutter, slip resistant walking surfaces, repair of uneven or
wet floors, and the use of color contrast between stairway
risers and treads.
Vision deteriorates with age in several ways, including
normative changes such as the loss of ability to focus on
near objects (presbyopia) as well as age-related pathology
including macular degeneration, glaucoma, and cataracts
[Das, 1999; Quillen, 1999]. As a result older people
at varying distances, diminished color discrimination and
of older workers have been suggested, although without a
great deal of scientific validation [Figueiro, 2001]. These
include general lighting at intensities 50% greater than for
general levels to help with fine detailed low contrast objects,
placement of task lights to the side and in front of theworker
to reduce shadows, increased contrast for stair edges and
curbs, and high illuminance fluorescent fixtures to enhance
Even without noise induced hearing loss, workers after
age 50 typically begin to lose higher frequency hearing
[Irwin, 2000; Seidman et al., 2002; Rosenhall, 2003]. They
may have difficulty in understanding conversations or
localizing sounds in space. This is especially important
where audible signals are important for safety or perform-
ance. In addition to noise reduction, helpful steps include
redundant warning signals such as flashing warning lights
or cell phones with vibration, reduced speech rate and
elimination of speech compression on automated systems
such as voice mail, and provision of telephone amplifying
Strength and endurance
physical stresses on the body, particularly the musculoske-
letal system, are well understood [Hagberg et al., 1995;
Cohen et al., 1997; National Research Council, 2001].
Strategies for fitting theworkplace to theworker (rather than
the reverse) include substituting mechanical for manual
strength, reducing highly repetitive tasks, allowing adequate
recovery time, reducing static and stressful postures, and job
rotation. As a last choice it may be necessary to provide
alternate job assignments and appropriate retraining for
FIGURE 4. Fourstrategicdimensionsforprogramsthatmeettheneedsofanaging
Protecting the Aging Workforce275
workers whose physical capacities are so reduced that even
modest strength or endurance is impossible and adjustments
on the usual job are not feasible.
Work Arrangements and
The way relationships at work are designed can have a
major impact on the ability of employees to perform safely
and productively. Important factors include work schedules,
supervisory relationships, decision control, information
transfer, and avenues for conflict resolution. Factors
associated with lower injury rates include empowerment of
the workforce, autonomy, delegation of control, good
relations between management and workers, low stress,
low grievance rates and encouragement of long-term
commitment of the workforce [Shannon et al., 1997; Hale
and Hoyden, 1998]. A stressful work organization can
increase the risk of chronic diseases, such as cardiovascular
disease [Belkic et al., 2004]. A 1999 Swedish study found
increases in self-reported stress and systolic blood pressure
over a work shift on a traditional auto assembly line but not
opportunities to alter pace and content of work [Melin et al.,
[Schnall et al., 1992; Iwasaki et al., 1998].
In addition to concerns about the design of work itself,
many employers and employees are searching for alter-
to full time retirement. There is a growing need for career
path and retirement options that take into account issues
related to increased longevity, elder care, and the increased
prevalence of chronic illnesses. For example, the Health and
Retirement Study, conducted every 2 years by the National
Institute on Aging and the University of Michigan, ‘‘has
consistently shown that three out of everyfour older workers
have said they would prefer to reduce hours gradually rather
than retire abruptly’’ and that older adults are ‘‘increasingly
interested in part-time opportunities and other activities to
stay busy and productive with age’’ [National Institute on
Aging, 2007]. A variety of alternative job designs such as
flexible hours, job sharing, telecommuting or phased retire-
ment may provide more supportive working environments
that reduce job stressors and enable safe and productive
performance [Landsbergis, 2003].
Individual measures are also needed to protect workers,
promote their health and build their competencies. Five
chronic diseases (heart disease, cancer, stroke, chronic
obstructive lung disease, and diabetes) cause almost 70%
of the deaths in the USA every year [Centers For Disease
Control, 2003]. These diseases become more common as
people age and they cause significant disability and
dysfunction long before people die from them. In addition,
other chronic problems that increase in frequency with age
but do not typically lead to death, such as arthritis, hearing
loss and obesity, are responsible for enormous medical costs
and disability. Medical care costs are nearly two times more
those without disease and these costs for 65-year olds are
four times those of 40-year olds [Centers For Disease
Control, 2003]. Indirect costs can be even greater than the
costofhealth care—includingabsenteeism andproductivity,
employee turnover and replacement, workers’ compensa-
tion, and life insurance benefit costs. Expenditures for
employees just at risk for chronic disease—measured by
blood pressure, body weight, and cholesterol—averaged
over 50% more than for those at low risk [Lichiello et al.,
2005]. A number of key clinical services, such as influenza
immunization, colorectal cancer screening, mammography,
cholesterol and blood pressure screening and maintaining
threehealthy habits—notsmoking,eating ahealthydiet,and
moderate physical fitness—can prevent or delay disability
from chronic conditions by as much as 10 years [Centers for
Disease Control, 2003; Moyers and Coleman, 2004; U.S.
Preventive Services Task Force, 2006]. Yet most employers
The cognitive changes of aging also deserve individual
attention at the workplace. For example, older workers
process information more slowly than when they were
two times the training time provided for young adults; allow
for self-paced learning; minimize distractions such as
background noise; present ‘‘how to’’ information in a step-
by-step format; teach spatial tasks using a visual medium;
provide immediate feedback about how to correct mistakes;
make sure learners are actively involved, for example by
problem solving exercises or hands-on practice; and
minimize demands on working memory using visual cues
and aids such as drop down menus on computer screens.
A broad range of daily living tasks become more
complex and challenging with aging and these non-work
factors can interfere with successful performance on the job.
For example, older workers may not be able to drive to work
as easily as when they were younger and therefore have
greater needs for public transportation, car pools or tele-
commuting. As workers age, evolving family needs may
become a significant distraction at work. For example, an
employee may not be able to function adequately at work
without knowing that the home health care needs of an older
spouse are under control. While some of these steps may be
within the reach of individual employers (e.g., work based
car pools or elder care benefits), some must be addressed as
broader social services such as improved access to health
care, public transportation, and laws to protect against
We are beginning to experience profound workplace
changes related to the demographic changes of an aging
ees to stay on the job as they age may experience escalating
pension costs as well as a host of expenses associated with
tighter labor markets and shortages of various skills. Those
who do encourage older employees to remain at work but
fail to take steps to support their productive capacities
and minimize their vulnerabilities may experience adverse
impacts onquality, productivity,workers’ compensation and
other insurance costs. On the other hand employers who
promote and support the work ability of employees as they
age may gain in safety, productivity, competitiveness, and
sustainable business practices.
A 1998 survey of 400 employers by AARP found that
while 55–68% of employers recognized thevalue of various
programs to address the needs of older workers, only 18–
44% were actually implementing them [AARP, 2002b].
There are severalpossible reasons why employers have been
slow to anticipate and meet the needs of an aging workforce.
First, some of the actions that that have been suggested—
changes in pension law, benefits agreements and personnel
policies. Second, many employers still harbor false beliefs
that older workers are less reliable, less productive, less safe
and more expensive than younger ones [Wegman, 1999].
Third, some employers are insufficiently informed about
fearful that measures perceivedto favor older workers might
open them to charges of discrimination. Two recent U.S.
Supreme Court decisions should mitigate these fears, but
knowledge of them is not widespread [General Dynamics,
2004; Smith, 2005]. In combination these decisions make it
clear that while age sometimes does affect an individual’s
the special needs of older workers without providing
equivalent assistance to relatively younger workers. Thus,
it is permissible to treat older workers preferentially in
comparison to younger workers, but it is not permissible to
deny them advantages or privileges extended to younger
workers. It is important to note, however, that programs and
policies which most effectively meet the needs of an aging
workforce are not just programs for older workers but are
those starting when workers are young in order to prevent or
evidence to support the implementation of some of the
interventions discussed in this paper (e.g., ergonomic
measures to prevent musculoskeletal disorders and clinical
preventive services to reduce disability from cancer and
cardiovascular disease), the evidentiary base for compre-
to most employers. Evaluative research is needed to
determine the effectiveness of various program designs
together with a substantial effort to disseminate results and
recommendations to employer and employee organizations.
The author’s experience as a member of the Institute of
Medicine Committee on the Health and Safety Needs of
Older Workers provided the initial stimulation for the work
on this article. The author appreciates the opportunity for
interaction with the members of that committee, several of
whom provided helpful comments on a draft of this article:
David Wegman, Richard Burkhauser, Gary Burtless, Neil
Charness, Paul Landsbergis, Charles Levenstein, Michael
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