Work ability in midlife as a predictor of mortality and disability in later life: A 28-year prospective follow-up study

Gerontology Research Centre, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
Canadian Medical Association Journal (Impact Factor: 5.96). 03/2011; 183(4):E235-42. DOI: 10.1503/cmaj.100713
Source: PubMed


Poor work ability correlates with increased morbidity and early retirement from the workforce, but the association in old age is not known. We investigated work ability in midlife among white-collar and blue-collar employees as a predictor of mortality and disability 28 years later.
A total of 5971 occupationally active people aged 44-58 years participated in the Finnish Longitudinal Study of Municipal Employees (FLAME) in 1981. Perceived work ability relative to lifetime best was categorized as excellent, moderate or poor. In 2009, the ability to perform activities of daily living was assessed among 2879 respondents (71.0% of the survivors). Mortality data were available up to July 2009.
At the 28-year follow-up, 1918 of the 5971 participants had died and 1403 had some form of disability. Rates of death per 1000 person-years among white-collar men were 7.7 for those with excellent work ability, 14.7 for those with moderate work ability and 23.5 for those with poor work ability. Among blue-collar men, the corresponding rates were 15.5, 20.2 and 25.3. In women, rates ranged between 6.3 and 10.6 per 1000 person-years. The age-adjusted hazard ratios (HRs) for mortality were two to three times higher among blue-collar male employees with lower work ability than among white-collar male employees with excellent work ability in midlife (i.e., the reference group). The odds of death or disability at follow-up compared with white-collar workers with excellent work ability were highest among blue-collar employees with poor work ability in midlife (odds ratio [OR] 4.56, 95% confidence interval [CI] 2.82-7.37 for men; OR 3.37, 95% CI 2.28-4.98 for women). Among the survivors, similar but slightly lower risks of disability 28 years later were found.
Perceived poor work ability in midlife was associated with accelerated deterioration in health and functioning and remains evident after 28 years of follow-up.

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    • "The work ability concept is an important consideration in the P–E framework as it is based on both an individual's perceptions of the demands of work and their self-rated ability to cope with these demands (Feldt et al. 2009). One measure of work ability – the Work Ability Index (WAI) – was developed in 1981 by Ilmarinen, Tuomi and Seitsamo (2005) and has been used extensively to identify and quantify employee workability and its relationships with health and retirement (Feldt et al. 2009; Sell et al. 2009; von Bonsdorff et al. 2011). Links have been established between workability and both psychosocial workplace factors and job satisfaction (Oakman and Wells 2013; van den Berg et al. 2008). "
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    ABSTRACT: This paper examines the role of person-environment fit in encouraging longer working lives in a sample of Australian public servants. Study results are of interest to those involved in the development of effective HRM policy aimed at retention of older workers. A sample of 332 workers aged 40 and over, completed a questionnaire. Multivariate regression analyses were used to identify the most important predictors of intention to retire. Focus group interviews (n = 42) were also undertaken. Age and duration of service were strong, negative predictors of time to intended retirement. Work ability and Job satisfaction, two key elements in a P-E fit model, were important in identifying people who intended to retire within the next five years. HRM policy needs to take into account the complexity of retirement decisions and recognise that decision points exist and a one-size fits all approach is unlike to be successful.
    Asia Pacific Journal of Human Resources 07/2015; DOI:10.1111/1744-7941.12075 · 0.86 Impact Factor
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    • "Work, on the other hand covers the work environment and community, as well as the actual contents, demands, and organization of work (management and supervision included) [1]. The factors that help to promote or reduce work ability have been studied in several countries and, due to an aging population, an increasing number of studies have focused primarily on promoting and maintaining this work ability [1] [2] [3] [4]. The assumption underlying most of these studies is that adequate work ability is associated with good quality of life at work and increased chances for a delayed and healthier retirement [5]. "
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    ABSTRACT: Work ability depends on a balance between individual resources and work demands. This study evaluated factors that are associated with inadequate work ability among workers in the clothing industry. We conducted a cross-sectional observational study of 306 workers in 40 small and medium-sized enterprises. We assessed work ability, individual resources, physical and psychosocial demands, and aspects of life outside work using a binary logistic regression model with hierarchical data entry. The mean work ability was 42.5 (SD=3.5); when adjusted for age, only 11% of the workers showed inadequate work ability. The final model revealed that smoking, high isometric physical load, and poor physical environmental conditions were the most significant predictors of inadequate work ability. Good working conditions and worker education must be implemented to eliminate factors that can be changed and that have a negative impact on work ability. These initiatives include anti-smoking measures, improved postures at work, and better physical environmental conditions.
    Work 11/2013; 50(2). DOI:10.3233/WOR-131801 · 0.52 Impact Factor
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    • "1) Could the assessment of work ability be based on the use of a single item of WAI, the first one, which consists in self-assessment by workers of their current work ability level by comparison with the highest work ability experienced during their career, this question being termed “Work Ability score” (WAS) by the designers of the method [9]? Assessing work ability from this single question appears seducing on the grounds that the assessor has not to check the categorisation of the job function reported by the worker and it is also more understandable by the persons surveyed; some other WAI items, the 3rd one - asking for the number of diagnosed diseases or the 7th one – assessing psychological resources – are for instance often not well understood and may be left unanswered [10-15]. In addition, the 1st item of WAI has high discriminating power (the highest) over the entire index [16]. "
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    ABSTRACT: Background Public authorities in European countries are paying increasing attention to the promotion of work ability throughout working life and the best method to monitor work ability in populations of workers is becoming a significant question. The present study aims to compare the assessment of work ability based on the use of the Work Ability Index (WAI), a 7-item questionnaire, with another one based on the use of WAI’s first item, which consists in the worker’s self-assessment of his/her current work ability level as opposed to his/her lifetime best, this single question being termed “Work Ability score” (WAS). Methods Using a database created by an occupational health service, the study intends to answer the following questions: could the assessment of work ability be based on a single-item measure and which are the variables significantly associated with self-reported work ability among those systematically recorded by the occupational physician during health examinations? A logistic regression model was used in order to estimate the probability of observing “poor” or “moderate” WAI levels depending on age, gender, body mass index, smoking status, position held, firm size and diseases reported by the worker in a population of workers aged 40 to 65 and examined between January 2006 and June 2010 (n=12389). Results The convergent validity between WAS and WAI was statistically significant (rs=0.63). In the multivariable model, age (p<0.001), reported diseases (OR=1.13, 95%CI [1.11-1.15]) and holding a position mostly characterized by physical activity (OR=1.67, 95%CI [1.49-1.87]) increased the probability of reporting moderate or poor work ability. A work position characterized by the predominance of mental activity (OR=0.71, 95%CI [0.61-0.84]) had a favourable impact on work ability. These relations were observed regardless of the work ability measurement tool used. Conclusion The convergent validity and the similarity in results between WAI and WAS observed in a large population of employed workers should thus foster the use of WAS for systematic screening of work ability. Ageing, overweight, decline in health status, holding a mostly physical job and working in a large-sized firm increase the risk of presenting moderate or poor work ability.
    BMC Public Health 04/2013; 13(1):305. DOI:10.1186/1471-2458-13-305 · 2.26 Impact Factor
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