FAST TRACK ARTICLE

FAST TRACK ARTICLE
Advancing Workplace Health Protection and Promotion for an
Aging Workforce
Ronald R. Loeppke, MD, MPH, Anita L. Schill, PhD, MPH, MA, L. Casey Chosewood, MD,
James W. Grosch, PhD, Pamela Allweiss, MD, MPH, Wayne N. Burton, MD, Janet L. Barnes-Farrell, PhD,
Ron Z. Goetzel, PhD, LuAnn Heinen, MPP, T. Warner Hudson, MD, Pamela Hymel, MD, MPH,
James Merchant, MD, Dee W. Edington, PhD, Doris L. Konicki, MHS, and Paul W. Larson, MA
Objective: To explore issues related to the aging workforce, including barriers to integrating health protection and promotion programs, and provide
recommendations for best practices to maximize contributions by aging workers. Methods: Workgroups reviewed literature and case studies to develop
consensus statements and recommendations for a national approach to issues
related to older workers. Results: Consensus statements and actions steps
were identified for each of the Summit goals and call-to-action statements
were developed. Conclusions: A national dialogue to build awareness of integrated health protection and promotion for the aging workforce is needed.
Workers will benefit from improved health and performance; employers will
realize a more engaged and productive workforce; and the nation will gain a
vital, competitive workforce.
The workforce of the twenty-first century is aging, with increasingly larger proportions of the workforce 55 years of age and
older. This development is the result of a convergence of demographic and societal trends. First, the global population is aging. By
2018, people aged 65 years and older are expected to outnumber
From US Preventive Medicine (Dr Loeppke), Brentwood, Tenn; National Institute for Occupational Safety and Health (Dr Schill), Washington, DC; Total
Worker HealthTM (Dr Chosewood), National Institute for Occupational Safety
and Health, Centers for Disease Control and Prevention, Atlanta, Ga; National Institute for Occupational Safety and Health (Dr Grosch), Centers for
Disease Control and Prevention, Cincinnati, Ohio; Division of Diabetes Translation (Dr Allweiss), Centers for Disease Control and Prevention, Atlanta, Ga;
American Express—Wellness Center (Dr Burton), New York, NY; Department of Psychology (Dr Barnes-Farrell), University of Connecticut, Storrs;
Institute for Health and Productivity Studies (Dr Goetzel), Rollins School of
Public Health, Emory University, Washington, DC; Consulting and Applied
Research (Dr Goetzel), Analytic Consulting and Research Services, Truven
Health Analytics, Bethesda, Md; Institute on Innovation in Workforce Wellbeing (Ms Heinen) and Institute on Health, Productivity and Human Capital
(Ms Heinen), National Business Group on Health, Washington, DC; Occupational Health Facility (Dr Hudson), University of California, Los Angeles,
Medical Center, Los Angeles; Walt Disney Parks and Resorts (Dr Hymel), Burbank, Calif; Department of Preventive Medicine and Environmental Health
(Dr Merchant), University of Iowa, Iowa City; Health Management Research
Center (Dr Edington), University of Michigan, Ann Arbor; KDK Solutions,
Ltd (Ms Konicki), Chicago, Ill; and Paul Larson Communications (Mr Larson), Evanston, Ill.
A call to action: highlights from the first Invitational Summit on Advancing Workplace Health Protection and Promotion in the Context of an Aging Workforce,
hosted by American College of Occupational and Environmental Medicine
and National Institute for Occupational Safety and Health.
The Invitational Summit was supported in part by a grant from National Institute
for Occupational Safety and Health.
The findings and conclusions in this report are those of the authors and do not
necessarily represent the views of the Centers for Disease Control and Prevention.
The authors declare no conflicts of interest.
Address correspondence to: Ronald R. Loeppke, MD, MPH, US Preventive
Medicine, 5166 Remington Dr, Brentwood, TN 37027 (Rloeppke.md@
uspm.com).
Copyright C 2013 by American College of Occupational and Environmental
Medicine
DOI: 10.1097/JOM.0b013e31829613a4
children younger than 5 years, and by 2040, they will account for
14% of the world population.1 In the United States, the population
aged 65 years and older is expected to increase more than double
between 2012 and 2060, representing about one in five residents as
compared with one in seven today.2
The second trend of note is the dramatic increase in life expectancy. In just over a century, life expectancy in the United States
has increased from 48.3 years for males and 51.1 years for females
in 1900 to 75.3 and 81.1 years, respectively, in 2008.1 The third trend
is the decline in fertility rates,1 which has resulted in fewer young
workers entering the workforce.
The fourth demographic trend driving the aging of the workforce is the impact of the baby boom generation. The baby boomers,
who were born between 1946 and 1964, began turning 65 years old
in 2011. As a group, they have impacted societal trends over the
past six decades. For years, demographic experts and economists
have predicted a “silver tsunami” of social ripple effects as the baby
boom generation ages—one of the most significant of which will
be its effects on our national workforce. Nevertheless, many older
workers are staying in the workforce longer than they had anticipated
because of personal preference or out of necessity. This has led to an
older workforce with many chronic medical conditions. The global
economic downturn and changing policies related to retirement and
retirement benefits partly explain this trend.
According to the US Bureau of Labor Statistics, there are
more workers aged 55 years and older in the workplace than ever
before. The number of workers aged 65 years and older increased by
101% between 1977 and 2007,3 and in the 25 years between 2005
and 2030, the number of Americans aged 65 years and older, overall,
will almost double—with a significant number of them continuing
to work.4 The Bureau of Labor Statistics projects that between 2006
and 2016, the number of workers aged 55 to 64 years will increase
by 36.5%, while workers aged between 65 and 74 years and older
than 75 years will increase by 83.4% and 84.3%, respectively.5 By
2015, one in every five workers will be a baby boomer.6
Although there is no consensus on the age at which workers
are considered “older workers,” the aging workforce phenomenon
is real. Given these trends, older workers are becoming increasingly
critical for national economic prosperity. Employers no longer have
access to a steady pipeline of younger workers and will need to rely
on older workers to remain competitive in the global marketplace.
Thus, the new workforce model will be multigenerational. Employers
will increasingly be challenged to maximize contributions from each
generation, while simultaneously addressing the health, safety, and
well-being needs of their workers.
Recognizing these trends, American College of Occupational
and Environmental Medicine (ACOEM) and National Institute for
Occupational Safety and Health (NIOSH) convened a 2-day, national
Invitational Summit on Advancing Workplace Health Protection and
Promotion in the Context of an Aging Workforce in Washington, DC,
from April 3 to 4, 2012. The goal of this Summit was to address the
following questions:
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
500 JOEM Volume 55, Number 5, May 2013
JOEM Volume 55, Number 5, May 2013 Advancing Workplace Health Protection and Promotion
1. Why should employers care about aging in the workplace and how
can we begin to establish best practices to maximize the health
and productivity of aging workers?
2. How can organizational structures—ranging from health benefit
plans and disease management programs to initiatives such as
Accountable Care Organizations (ACOs) and the Patient Centered Medical Home (PCMH)—be better aligned, utilized, and
measured to improve our approach to aging in the workplace and
address the special needs of older workers?
3. What are the barriers to integrating health protection and promotion programs to benefit the aging workforce, and what tools,
programs, and resources exist now that could help overcome these
barriers?
To answer these questions, Summit participants were organized into three workgroups, each of which focused on answering
one of the specific questions. After the workgroup discussions, the
full Summit group reconvened and developed consensus statements
and action steps on the basis of the workgroup reports. Participants
at the Summit focused their discussions on the potential impact of
applying the integrated workplace health protection and promotion
model, advocated by Hymel et al7 and the NIOSH Total Worker
HealthTM8 program, specifically to issues related to aging workers.
This model is based on the concept that integration of occupational
safety and health protection activities with those aimed at health promotion is a more effective approach to worker health and well-being.
Simultaneously, Summit participants considered how to extend their
deliberations beyond the aging workforce to encompass healthy aging across the entire multigenerational workforce.
The purpose of this article was to provide a broad overview of
issues related to the aging workforce as background for the consensus
statements and action steps developed by the Summit participants.
The article was intended to stimulate and encourage a national dialogue on the aging workforce and actions that both protect and
promote the health, safety, and well-being of workers as they age.
BACKGROUND: THE IMPACT OF AGING
ON OUR WORKFORCE
The health, safety, and well-being of workers are influenced
by the aging process, which creates both advantages and disadvantages for older workers and their employers. For example, employers
report that older workers often possess a stronger work ethic than
their younger colleagues. Advancing age may also be associated with
greater levels of experience, autonomy, and efficiency, which often
bring more control over the nature of work and the conditions under
which it is performed. Generally, older workers report lower levels
of work-related stress and less conflict with their coworkers. They
may also experience more flexibility in balancing work and nonwork demands than younger workers, because they are more likely
to be self-employed, work part-time, work in small enterprises, or
function as independent contractors.9 In addition, older workers may
have less interest in career advancement as they come closer to retirement; many are “empty nesters” with minimal responsibilities
of raising children. Interestingly, older workers tend to experience
lower rates of work-related injuries and illnesses than younger workers. This advantage is likely the result of greater adaptability with
age, the compensating benefits of experience and knowledge, and
employment in generally less hazardous settings.
Nevertheless, older workers may also face a number of jobassociated challenges, including diminished physical capacity, slowing cognition and decreased working memory, more difficulty with
hearing and vision, and higher rates of musculoskeletal conditions. It
is important to note that most occupations (with certain exceptions,
like public safety or heavy construction) do not require individuals
to perform at full physical capacity. Therefore, many demonstrable
limitations will not affect the necessary level of work performance or
function to any significant degree.10 Despite this, older workers tend
to fare more poorly with certain organizational demands of work,
such as long hours and shiftwork. In addition, they may find greater
difficulty with reemployment after an involuntary job loss.11
Although older workers may have a lower overall rate of
job-related injuries, their rate for fatal injuries on the job is much
higher. They also experience relatively greater levels of higher injury severity.10 Figure 1 illustrates these findings by age categories
for both fatal and nonfatal work-associated injuries and illnesses.
Note that workers aged 65 years and older have approximately four
times the rate of fatal events than workers aged 18 to 19 or 20 24
years.11
Older workers also have slower recovery after a nonfatal jobrelated injury or illness and, therefore, have greater delays in return
to work.12,13 The interaction of age, injury, and recovery after workassociated injury is complex and may be highly job-specific and
worker-dependent. Older workers (55 years of age and older) accounted for 12.1% of all workplace injuries or illnesses resulting in
time away from work in 2003.14 Although the mean length of time
away from work for occupational injury or illness was 8 days for all
workers, it was 11 days for workers aged 55 to 64 years and 18 days
for workers aged 65 years and older.15 Nearly 40% of those aged 65
years and older were away from work 31 days or more because of
occupational injury or illness, compared with 33% for workers aged
55 to 64 years and 26% for workers overall.14
The number of health-related risk factors for chronic diseases
increases with age and this has significant implications for work,
disability, and health care costs. Older workers have higher overall
rates of chronic-disease risks, greater medical care costs, and a higher
likelihood of disability than younger workers.11 But it is important
to note that it is the number of health risks and evidence of chronic
diseases—not advancing age itself—that is more highly associated
with increased health care costs.16 A 2001 article by Edington12
indicated that workers aged 19 to 34 years at high risk (5 or more
risk factors) had higher medical expenses than workers aged 65 to
FIGURE 1. Rate of fatal and nonfatal occupational injuries
and illnesses as a function of age. *Fatal injuries: rate per
100,000 full-time equivalent workers; Nonfatal injuries: rate
per 1000 full-time equivalent workers. Fatal data: National
Electronic Injury Surveillance System (NEISS-Work), United
States, 2004. Nonfatal data: Bureau of Labor Statistics Census
of Fatal Occupational Injuries, United States, 2005. Reprinted
with permission from Grosch and Pransky.11
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
C 2013 American College of Occupational and Environmental Medicine 501
Loeppke et al JOEM Volume 55, Number 5, May 2013
74 years at low risk (0 to 2 risk factors). Another study in 2001 found
that annual medical claims costs for people with five or more health
risks were double the costs of individuals with two or fewer health
risks.12
Nonetheless, older workers do have higher levels of overt
chronic diseases. Almost four in five adults older than 50 years in
the United States have at least one chronic health condition requiring
regular management.4,17 It is estimated that 20% of Medicare beneficiaries have five or more chronic health conditions.4 This trend
led Tinetti et al18 to report that the most common chronic medical
condition in adults today is “multimorbidity.” Seventy-five percent
of all health care spending in the United States is for the 133 million
Americans with at least one chronic condition.19 For every $3 spent
by Medicare, $1 is for the management of diabetes.20 Older age
groups facing chronic conditions often require more care, and their
chronic conditions are more likely to be disabling and more difficult
and costly to treat than those that are commonly seen in younger
age groups.21 Workers aged 55 years and older report their most
prevalent types of chronic health conditions to be arthritis (47%)
and hypertension (44%).22 Heart conditions, diabetes, psychiatric
or emotional problems, and cancer are reported by 10% or more
workers aged 55 years and older.22
Higher rates of chronic diseases and associated disability directly affect the ability of American workers to remain on the job and
may diminish economic security. Both workers and employers will
be impacted by these trends because they face the shared burden of
medical care costs and other losses associated with absenteeism and
short- and long-term disability.23 One study reports that five common chronic conditions—hypertension, mood disorders, diabetes,
heart disease, and asthma—account for $36 billion in lost wages to
workers each year.24
Job characteristics and personal health may substantially affect work opportunities for older workers, but these issues do not act
in isolation. A number of federal and state laws, policies, and protections influence work as we age. Age-related antidiscrimination laws,
occupational safety and health regulations, reasonable accommodations mandates, entitlement eligibility (such as Social Security and
Medicare), workers’ compensation, and other social support systems
all influence both the necessity and opportunity for work and may
strongly influence the decision of when older Americans exit the
workforce.10
It may be most important to acknowledge that older workers
are diverse and should not be viewed as a homogeneous population.
Desire to continue working, ability to work, health risks and conditions, and many other factors vary greatly. In addition, disparities
related to socioeconomic status, race or ethnicity, occupation, and
gender that are faced by workers alter opportunities for health on
and off the job.10
By better coordinating distinct environmental, health, and
safety policies and programs in the workplace into a continuum of activities, employers could substantially enhance the overall health and
well-being of the workforce, while better preventing work-related injuries and illnesses. Recent analysis by workplace health experts suggests that employers who place workplace health promotion (wellness programs) and workplace health protection (safety programs)
in separate organizational structures are missing opportunities to increase the overall positive impact of these programs. A 2011 article
by Hymel et al,7 for example, demonstrated the disadvantages of
poorly integrated health protection and promotion programs, while
proposing conceptual models for change that employers could adopt.
In summary, aging confers both benefits and risks to the health
and well-being of workers. Given the complexity of the aging process, an individualized approach to addressing the needs of workers
in the context of their own unique skills, abilities, limitations, and
risks is necessary. At the same time, the risks associated with aging (eg, higher rate of fatal injuries, slower recovery after illness
or injury) suggest that a primary prevention perspective is particularly important and that a more holistic approach to improving
worker health—focusing on both health protection and promotion—
is needed as the workforce continues to age.
THE ACOEM and NIOSH SUMMIT
In choosing Summit participants, ACOEM and NIOSH considered a diverse pool of leaders in business, safety, and health—
including corporations, labor, academia, medicine, government,
health insurers, business coalitions, industry, and health benefits
groups. The goal was to include individuals with combined expertise in aging, generally, and in the health and productivity of aging
workers. Organizers also sought participation from “aging-friendly”
employers and key stakeholders in health and productivity management. A total of 15 individuals were identified and participated in
the Summit and were included as authors of this article.
An opening general session provided Summit participants
current research findings and information on the aging workforce
and concerns regarding the safety and productivity of older workers.
To address the ACOEM and NIOSH Summit’s goals, participants
were then organized into small workgroups with each assigned to
consider a specific question. Workgroups were composed of four
to five members each, and discussions were held in an interactive
workshop format to explore in more depth particular aspects of the
health and safety of the aging workforce. Each workgroup met for
approximately 4 hours over 2 days to discuss and develop consensus statements and recommendations on targeted topics. After the
workgroup discussions, the entire Summit group gathered to review
and discuss each workgroup’s recommendations until consensus was
reached among all participants. The questions and discussion summaries are presented below.
Question 1: Why should employers care about aging in the
workplace, and how can we begin to establish best practices
to maximize the health and productivity of aging workers?
Why Employers Should Care About Aging Workers
Employers should care about aging in the workplace because
it is vital to the viability of their corporate interests. By maximizing
the health, safety, and well-being of workers as they age, employers
make a strategic decision to invest in future business success and
maintain productivity as the mean age of the workforce increases.
Employers can no longer rely on a steady influx of younger workers
or set retirement dates for older workers. A 2005 study estimated
that by 2010, workers in the 35- to 44-year age range would decrease
by 19%, while workers aged 55 to 64 years will increase by 52%.25
Older workers can provide significant cost savings, compared to the
cost of recruitment and training of younger workers, at a period of
time when global competition will be high.25
A new “continuum-based” approach to aging in the workplace
could have a major impact on health care costs in the long run—for
both employers and programs such as Medicare and Medicaid—
because costs per employee will generally rise in the absence of
prevention-based health protection and promotion programs.16 Multiple studies confirm that both direct (medical and pharmacy costs)
and indirect costs (absenteeism and presenteeism) for employers can
be lowered with effective implementation of such programs.26–29
Strategies aimed at bolstering health at a younger age will ensure
that workers reaching the eligibility age for Medicare will have less
cost impact on the system. One study showed that Medicare beneficiaries who participated in various workplace health programs in
addition to completing a Health Risk Assessment (HRA) had lower
health care cost trends than those who did not participate in any
health program or completed a HRA only.30 Another study demonstrated that by preventing 10% of the upward risk transitions that
would normally occur once an individual became Medicare eligible,
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
502 C 2013 American College of Occupational and Environmental Medicine
JOEM Volume 55, Number 5, May 2013 Advancing Workplace Health Protection and Promotion
costs would be reduced by $4361 (the average lifetime costs per
beneficiary in 2008 dollars).31 Investing in the workforce beginning
at a young age will save money in the long term through reduction
of chronic health conditions.
How to Establish Best Practices
We can begin to establish best practices to maximize the health
and productivity of aging workers by placing a greater emphasis on
incorporating health care strategies across homes, communities, and
the workplace to create a 24/7 “culture of health,” similar to the
culture of safety that many companies already embody and promote
to their workers. This is particularly important for aging workers,
who increasingly will be managing multiple chronic diseases. Maximizing worker health will improve overall quality of life on and off
the job.
Nevertheless, a one-size-fits-all approach to healthy aging
in the workplace will not work. Employers will be challenged to
customize and tailor programs on the basis of the needs of their
workforce, which will include workers of all ages. Thus, successful
workplaces of the future will focus on being “age-friendly,” helping
individuals adapt, learn, and grow together, across demographic divides. The focus will be on keeping employees healthy by beginning
interventional efforts early in their careers aimed at helping them
manage their health risks to stay productive over time. One of the
most important organizational principles for employers in this new
environment will be flexibility and adaptation. At the same time, by
better coordinating distinct environmental, health, and safety policies and programs in the workplace into a continuum of activities,
it is theorized that employers could substantially enhance the overall health and well-being of the workforce while better preventing
work-related injuries and illnesses. In short, a healthier workforce
could be a safer workforce; a safer workforce could be a healthier
workforce.7
Tools to assist employers in building “culture of health” and
“age-friendly” workplaces are available. For example, the Center for
Work, Health, and Well-being at the Harvard School of Public Health
published the SafeWell Practice Guidelines: An Integrated approach
to Worker Health.
32 These guidelines include practical tools as well
as links to other resources to aid employers in implementing and
evaluating worksite health protection and promotion programs. Another tool available now is the NIOSH document titled, “Essential
elements of effective workplace programs and policies for improving worker health and wellbeing.”33 This publication identifies 20
essential elements for integrating health protection and promotion
programs to benefit all workers. A more recently published tool to
assist employers with promoting employee well-being is the CDC
Worksite Health ScoreCard.34 The newly released Health ScoreCard
is a tool designed to help employers assess the extent to which they
have implemented evidence-based health promotion interventions
in their worksites at the organizational level. Another on-line tool
developed by ACOEM, the HPM Toolkit, provides an understanding
of the concepts of health and productivity management and access
to practical tools for implementing workplace wellness programs.35
Consensus Statements and Action Steps
Employers, occupational health professionals, health promotion professionals, and others have a shared interest in raising awareness and understanding of the opportunities and challenges specific
to the aging workforce. The following consensus statements and action steps will move us toward our shared goal of establishing best
practices and policies for aging workers.
• Integrate health protection with health promotion to create a “culture of health” throughout the workplace. A “culture of health”
maximizes the social, intellectual, and emotional dimensions of
good health, as well as the physical dimension. As a part of this effort, greater emphasis must be placed on preventive care throughout the health care system.
• Create and implement “age-friendly” programs and policies. Agefriendly programs and policies include those that:
Prioritize workplace flexibility, and give additional control over
work schedules, work conditions, and work location, which benefit workers of all ages
Use adaptive technology and design work tasks to meet older
workers’ physical needs
Manage noise hazards, slip and trip hazards, physical hazards,
and conditions that are more challenging to older workers
Provide ergo-friendly work environments, such as workstations, tools, floor surfaces, adjustable seating, better illumination where needed, screens and surfaces with less glare
Provide health promotion and lifestyle interventions
Accommodate medical self-care in the workplace and time away
for health visits
Invest in training and skills-building at all age levels
Proactively manage reasonable accommodations and the returnto-work process after illness or injury absence
Require aging workforce management skills training for supervisors that addresses the specific needs of older workers in
addition to the needs of all generations of workers
• Broaden the dialogue about workforce aging through stronger collaboration in the workplace. Developing and sharing best practices
for aging workers can be accelerated if it includes a spirit of collaboration between employers and workers. This requires honestly
discussing issues related to aging and engaging employees, employers, and key stakeholder groups, such as labor representatives,
occupational safety and health professionals, health promotion
professionals, community health care providers, academics, advocacy organizations (such as the American Association of Retired
Persons), and governmental agencies in discussions of policies
and strategies, and then broadly disseminating these policies and
strategies so others can benefit from them.
• Raise awareness of the workforce aging issues among employers
and policymakers. A greater understanding and awareness of aging and its impact on the workforce is needed, especially among
employers. Although more research is always needed, a wider dissemination of published studies demonstrating the importance of
integrating health protection and promotion programs would help
focus national efforts on addressing age-related challenges and
opportunities.
Question 2: How can organizational structures—ranging from
health benefit plans and disease management programs to
initiatives such as ACOs and the PCMH—be better aligned,
utilized, and measured to improve our approach to aging in
the workplace and address the special needs of older workers?
New approaches to the organizational structures of our workplaces can help maximize opportunities for older workers. Traditional concepts of career development, progression, and retirement
are outdated. Individuals are more likely to have multiple “careers”
throughout their work lives. Because companies have downsized and
“right-sized” to meet the challenges of the new economy, increasing
numbers of contingent workers are used in the workplace. These
individuals may have numerous employers, which in total, make up
their annual income, and as a consequence, in many cases, may not
have access to health benefits. Twenty percent of waged and salaried
employees now work a shift that comprises a time other than regular
daytime hours and many are working extended hours or in more
than one job.36 In this environment, existing organizational tools
such as benefit program design will provide opportunities to meet
the workers’ needs during each career stage as physical capacity
changes. Employers in industrial sectors where workers “age out”
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
C 2013 American College of Occupational and Environmental Medicine 503
Loeppke et al JOEM Volume 55, Number 5, May 2013
of their jobs—various construction jobs, for example—will be especially well-served by designing new programs and benefits to extend
aging workers’ health and productivity. Changes in workplace culture to reflect and embrace the advantages of older workers—such as
enhanced institutional memory—provide additional opportunities to
improve our approach to the aging workforce.
Regarding health and well-being, organizational structures
that shift the focus from treatment to prevention of disease will
provide opportunities and incentives for participation in health protection and promotion programs. Although important for all workers,
older workers will especially benefit because many are faced with
management of chronic diseases and changing levels of workability.
Incentivizing age- and gender-appropriate disease prevention behaviors and moving toward an integrated culture of health will be key
to success in extending healthy and productive careers for older
workers.
In keeping with the growing shift away from transactional
health care toward value-based and outcomes-based care, new and
more effective ways of measuring the impact of workplace programs
on population and individual health are needed. Examples of this
trend are ACOs and the PCMH. In aligning with the principles of
ACOs and the PCMH, workplace health and wellness programs will
become more value-based, developing measures for assessing health
risk, outcomes, and the cost performance of health plans. Employers
may also need to be more willing to collaborate with others within
the health system, integrate interventions in their programs that arise
outside the workplace, and rigorously evaluate effectiveness and
other outcomes.
Consensus Statements and Action Steps
Opportunities are available to better align and utilize private
and public sector organizational structures and incentives to create
workplace environments that address the needs of older workers.
The following consensus statements and action steps will move us
toward that goal.
• Increase the use of incentives to impact change in the workplace.
Benefit programs provided by employers will be more effective
when designed with various innovative incentives tailored to the
needs of workers in each of the stages of life. For example, flexible work that helps balance work and life demands is especially
important for older workers.
• Integrate workforce health as a standard business measure. The
development of an overall index that measures workforce health,
safety, and well-being as part of the Financial Accounting Standards Board would advance the integration of this metric into
common practice. Such an index would allow companies to better
assess the tangible value of health programs that impact aging
workers and assist in the identification of companies that promote
a healthy and safe workforce.
• Create new models that facilitate age-related job transitioning.
Special incentives are needed to encourage employers in physically demanding industrial sectors, in which workers “age out”
of their jobs, to extend opportunities for meaningful employment. Development of these incentives will benefit from input
by labor unions, the public and private sectors, and other interested stakeholders. Programs that provide early-career anticipatory guidance for later career transition are an example of such
incentives.
Question 3: What are the barriers to integrating health protection and promotion programs to benefit the aging workforce,
and what tools, programs, and resources exist now that could
help overcome these barriers?
Barriers to Integration
Several barriers to integrating health protection and promotion programs to benefit the aging workforce, including knowledge
gaps, limited metrics, and lack of coordinated effort, were identified
and discussed by Summit participants. Knowledge gaps are due to
limited research in the area and insufficient dissemination and adoption of existing information. A growing body of research findings
demonstrates a close relationship between effective health protection and promotion programs and worker health and productivity.4,7
Nevertheless, these findings are based primarily on research done at
large companies, which are not widely distributed in the employer
community. Although large employers are more likely to adopt integrated programs, reaching small- and mid-size employers is more
challenging. In addition, efforts to translate best practices of large
companies into models that can be adopted by smaller employers
have been generally lacking.
Although the body of research on health and productivity in
the United States is on the rise, return-on-investment studies of integrated programs and the aging workforce are needed to help establish
the positive impact of health protection and promotion programs beyond medical and pharmacy costs. Implementation of these programs
will be expedited once research is conducted by using better metrics. Improved analysis of factors such as disability and productivity
costs, caregiver productivity loss, and long-term benefit to Medicare gained by a healthier older population will stimulate program
adoption. Research needs to go beyond the return on investment
and look at the value of investment, which includes looking beyond
the financial indicators and assessing participation indicators, health
risk indicators, clinical indicators, and utilization and productivity
indicators.
Even with more complete knowledge and better metrics, development and implementation of integrated programs will require
a coordinated effort between stakeholders. Program success will require a shared responsibility between employers, employees, labor
representatives, occupational safety and health professionals, health
promotion professionals, community health care providers, and governmental agencies. A common understanding among these partners
on the health, safety, and well-being needs of older workers will facilitate a more unified effort.
Furthermore, a coordinated national campaign is needed to
better leverage and coalesce the work of disparate programs and
stakeholders. Existing programs that could advance this effort, such
as the NIOSH Total Worker HealthTM8 program, provide an opportunity for extended partnership with all stakeholders concerned about
the aging workforce.
Tools, Programs, and Resources to Overcome
Barriers
The HRA is a potential tool to overcome barriers related to integrated programs for an aging workforce. Although the HRA model
has been widely and successfully implemented for worker populations in general, modifications are needed to make HRA modules
specific for older workers. A recent guidance document developed
recommendations on what a standardized HRA should include for the
Medicare population.37 Standardized approaches for record-keeping
and better linkages between workplace-based HRAs, primary care
physicians, and community health care services are all needed to
better address the needs and challenges of older workers. Within
the workplace, integrated data warehouses—encompassing not only
medical and pharmacy data but also lost time, workers’ compensation, and business data as well as productivity metrics and human
resources or payroll information—are critical for the true assessment
of the impact of health on the workplace.
Existing innovative programs provide instructive guidance on
how to advance a culture of health protection and promotion in
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
504 C 2013 American College of Occupational and Environmental Medicine
JOEM Volume 55, Number 5, May 2013 Advancing Workplace Health Protection and Promotion
the workforce. Such programs include those at the Veterans Health
Administration and studies and research conducted by the National
Business Group on Health and ACOEM. In addition, a pilot program
has been launched by the Centers for Disease Control and Prevention
(National Healthy Worksite Program).38
Additional resources to overcome barriers include nontraditional partners from both the private and public sectors. These partners include business-oriented organizations such as the US Chamber of Commerce, America’s Health Insurance Plans, and the National Federation of Independent Businesses and labor coalitions.
Private sector thought leaders may also provide valuable resources.
Consensus Statements and Action Steps
To help break through the barriers to integrating health protection and promotion programs to benefit the aging workforce, the
following consensus statements and action steps take advantage of
existing tools.
• Develop new research design models for better collection of
worker health data. New standardized research design models
will assist with data collection and analysis for older workers, including age-adjusted HRAs. As a part of the data collection effort,
electronic health records will be critical to create a better linkage
between employers, health care providers, and the payers as the
worker population ages.
• Conduct new research studies on the investment value of health
protection and promotion. A stronger evidence base is needed
to support the positive long-term impacts of integrated health
protection and promotion programs for employers, demonstrating
the value of investing in such activities.
• Create a new culture of “shared accountability.” An effective national effort to change our approach to aging in the workplace will
require active input from all stakeholders. This culture of shared
accountability will rely on integrating and coordinating efforts
between primary care providers, occupational and environmental
health professionals, employers, labor organizations, health insurers, ACOs, and others, including workers.
CALL-TO-ACTION STATEMENTS ON THE
AGING WORKFORCE
Summit participants agreed that a change in our national approach to aging in the workplace can be accelerated with a shared
vision and common language. The summit participants adopted the
statements in Table 1 as calls to action for advancing workplace
health protection and promotion for an aging workforce.
CONCLUSION
The Invitational Summit on Advancing Workplace Health Protection and Promotion in the Context of an Aging Workforce represents the first in what ACOEM and NIOSH hope will be continued
collaborative efforts to build awareness of aging in the workforce. Assembling experts to begin to define the specific role for occupational
health professionals in addressing the challenges and opportunities
related to workplace aging is an important first step.
Who will ultimately benefit from this effort?
• Workers will benefit because the interests of workers and their
families are always best served when they are healthy, able, and
productive at work and at home. Good health is a gateway to
improved performance and greater satisfaction on the job, and
an especially important component for those who wish to extend
their working years beyond what has been the traditional norm.
• Employers and their stakeholders will benefit because the interests of employers are best served in the context of a maximally
engaged and productive workforce, which in significant measure
derives from physical and psychosocial health, feelings of contriTABLE 1. Summit Participant Call-to-Action Statements
on an Aging Workforce
We should not fear the term “aging workforce.” Aging workers are a
valuable resource that can be engaged for the nation’s benefit—if we
go about it in the right way. A new national consciousness and
approach by employers to aging workers could actually strengthen
our workforce and may, in fact, be essential for continued economic
growth.
Much needs to be done to make this vision a reality. Currently, our
workplaces—and our national perspectives on “work”—are not
geared to respond and adapt to the impact of an aging workforce.
We must stress prevention in all phases of workplace health. We must
intervene earlier to prevent illness and injury, rather than managing
illness and injury when it occurs, keep the healthy well and assist
those with acute and chronic conditions to manage and/or reduce
future health problems.
We must integrate workplace health with the other two key sites in
which individuals’ health are impacted: the community and the home.
Employers must link more closely with primary care and public
health efforts to ensure we create a true 24/7 “culture of health” that
extends from home to work to community. The workplace should be
closely linked with trends such as Accountable Care Organizations
and the Patient Centered Medical Home, as a part of this effort.
We need to understand our aging workforce much better than we do
now. There are many myths and misperceptions.
We need to shift our paradigm from an overemphasis on the words
“aging” and “illness.” This is really all about creating a new
multigenerational perspective on worker health, safety, well-being,
and productivity.
The key is creating a workplace in which worker health and satisfaction
is maximized as people age, period. It’s not about simply paying
attention when people turn 55.
We should be thinking of “worker health” from the first day a young
person enters the workforce—and anticipating how we can maximize
that person’s health over the rest of his or her career.
We should be thinking of new ways to talk about aging in the
workplace—ways in which no one is stigmatized, and in which we
can discuss age and the prevention and management of chronic
disease openly and productively.
bution, and overall quality of life. The health of any organization
is inseparably linked to the health of its employees.
• The nation will benefit because there is an inextricable link between workforce health, productivity, and our national prosperity.
America’s future economic growth is dependent on the creativity,
innovation, and productivity of the workforce. A vital workforce
is necessary for the United States to remain competitive in the
global economy.
Continued collaborative efforts to advance our understanding
of protecting and promoting the health of the aging workforce will
benefit from a collective focus and further discussion and research
in two key areas:
• The relationship between health promotion and wellness programs
and work-related illness and injury rates among older workers
• The benefits, impacts, and value of integrated health protection
and promotion programs
To achieve this collective focus, we must engage not only
employers but also employees and many other stakeholders—ranging
from primary care providers to health insurers—to create a shared
responsibility for results.
It is the intention of the authors and Summit participants that
this article serve as a call to action for a new national effort aimed
at maximizing the contributions of our aging workforce to national
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
C 2013 American College of Occupational and Environmental Medicine 505
Loeppke et al JOEM Volume 55, Number 5, May 2013
economic prosperity while simultaneously enhancing quality of life
for working adults. This effort will undoubtedly be challenging.
Fortunately, occupational health and safety professionals have years
of collective knowledge and wisdom to move the conversation
forward.
REFERENCES
1. Kinsella K, Wan H. An Aging World: 2008. International Population Reports,
P95/09–1. Washington, DC: US Government Printing Office; 2009.
2. US Census Bureau. U.S. Census Bureau projections show a slower growing, older, more diverse nation a half century from now. Available at:
https://www.census.gov/newsroom/releases/archives/population/cb12-243.
html. Published December 12, 2012. Accessed April 19, 2013.
3. US Bureau of Labor Statistics spotlight highlights trends toward more
older workers. Available at: http://www.agingworkforcenews.com/2008/
07/us-bureau-of-labor-statistics-spotlight.html. Published 2008. Accessed
February 11, 2011.
4. Committee on the Future Health Care Workforce for Older Americans, Board
on Health Care Services. Institute of Medicine. Retooling for an Aging America: Building the Health Care Workforce. Washington, DC: The National
Academies Press; 2008.
5. Bureau of Labor Statistics. Older workers. Available at: http://www.bls.gov/
spotlight/2008/older workers. Published 2008. Accessed November 15, 2012.
6. Selden B. The aging workforce – a disappearing asset? Management Issues.
March 21, 2008. Accessed February 11, 2011.
7. Hymel PA, Loeppke RR, Baase CM, et al. Workplace health protection and
promotion: a new pathway for a healthier- and safer-workforce. J Occup
Environ Med. 2011;53:695–702.
8. National Institute for Occupational Safety and Health. Total Worker HealthTM.
Available at: http://www.cdc.gov/niosh/twh/history.html. Accessed July 30,
2012.
9. Grosch JW. Older workers in the US: national data regarding working conditions and health. Paper presented at: 28th International Congress on Occupational Health Conference; 2006; Milan, Italy.
10. Wegman DH, McGee JP, eds. Health and Safety Needs of Older Workers.
Washington, DC: The National Academies Press; 2004.
11. Grosch JW, Pransky GS. Safety and Health Issues for an Aging Workforce in
Aging and Work: Issues and Implications in a Changing Landscape. Baltimore, MD: Johns Hopkins University Press; 2010.
12. Rix SE. Health and Safety Issues in an Aging Workforce. Washington, DC:
AARP Public Policy Institute; 2001.
13. Silverstein M. Meeting the challenges of an aging workforce. Am J Ind Med.
2008;51:269–280.
14. Wiatrowski WJ. Older workers and severity of occupational injuries and illnesses involving days away from work. Published July 26, 2005. Available
at: http://www.bls.gov/opub/cwc/sh20050713ch01.htm. Accessed April 19,
2013.
15. Rogers E, Wiatrowski WJ. Injuries, illnesses, and fatalities among older workers. Mon Labor Rev. 2005;128:24–30.
16. Edington DW. Emerging research: a view from one research center. Am J
Health Promot. 2001;15:341–349.
17. Anderson G. Chronic care. Public Health Policy. 2003;3:110–111.
18. Tinetti ME, Fried TR, Boyd CM. Designing health care for the
most common chronic condition—multimorbidity. JAMA. 2012;307:2493–
2494.
19. Thorpe KE, Howard DH, Galactionova DH. Differences in disease prevalence as a source of the U.S.-European health care spending gap. Health Aff.
2007;26:w678–w686.
20. Centers of Medicare & Medicaid Services. Medicare healthcare
support overview. Available at: http://www.cms.gov/Medicare/MedicareGeneral-Information/CCIP/Downloads/overview_ketchum_71006.pdf. Published 2011. Accessed December 10, 2012.
21. Summer L, O’Neill G, Shirey L. Chronic Conditions A Challenge for the
21st Century [Monograph]. Vol 1. Washington, DC: National Academy on an
Aging Society; 1999:1.
22. National Institute on Aging, National Institute on Aging, National Institutes
of Health, US Department of Health and Human Resources. Growing Older in
America: The Health and Retirement Study. Bethesda, MD: National Institute
on Aging, National Institutes of Health, US Department of Health and Human
Resources; 2007.
23. Thorpe KE. Factors accounting for the rise in health care spending in the
United States: the role of rising disease prevalence and treatment intensity.
Public Health. 2006;20:1002–1007.
24. Druss BG, Marcus SC, Olfson M, Tanielian T, Elinson L, Pincus HA. Comparing the national economic burden of five chronic conditions. Health Aff.
2001;20:233–241.
25. Reeves S. An Aging Workforces’ Effect on US Employers. Business Basics.-
Forbes.com. September 9, 2005. Accessed July 18, 2012.
26. Loeppke R. The value of health and the power of prevention. Int J Workplace
Health Manag. 2008;1:95–108.
27. Loeppke R, Taitel M, Haufle V, Parry T, Kessler RC, Jinnett K. Health and
productivity as a business strategy. J Occup Environ Med. 2009;51:411–428.
28. Berger ML, Howell RA, Nicholson S, Sharda C. Investing in healthy human
capital. J Occup Environ Med. 2003;45:1213–1225.
29. Stewart W, Ricci J, Chee E, Hahn S, Morganstein D. Cost of lost productive work time among US workers with depression. J Am Med Assoc.
2003;289:3135–3144.
30. Ozminkowski RJ, Goetzel RZ, Wang F, et al. The savings gained from participation in health promotion programs for Medicare beneficiaries. J Occup
Environ Med. 2006;48:1125–1112.
31. Rula EY, Pope JE, Hoffman JC. Potential Medicare savings through prevention & health risk reduction. Franklin, TN: Center for Health Research,
Healthways Inc; 2009.
32. McLellan D, Harden E, Markkanen P, Sorensen G. SafeWell Practice Guidelines: An Integrated Approach to Worker Health Version 1.0. Washington, DC:
Harvard School of Public Health, Center for Work, Health, and Well-being;
2012. Available at: http://www.cdc.gov/niosh/docs/2010-140/pdfs/2010-140
.pdf. Accessed April 19, 2013.
33. National Institute for Occupational Safety and Health. Essential elements
of effective workplace programs and policies for improving worker health
and wellbeing. Available at: http://www.cdc.gov/niosh/TWH/essentials.html.
Published 2010. Accessed November 15, 2012.
34. Centers for Disease Control and Prevention. Worksite Health ScoreCard. Available at: http://www.cdc.gov/dhdsp/pubs/worksite scorecard.htm?
goback.gmr 4473829.gde 4473829 member 160224074. Published 2012.
Accessed November 15, 2012.
35. American College of Occupational and Environmental Medicine. HPM
Toolkit. Available at: http://hpm.acoem.org/index.html. Published 2006. Accessed January 28, 2013.
36. Cummings KJ, Kreiss K. Contingent workers and contingent health. JAMA.
2008;299:448–450.
37. Goetzel RZ, Staley P, Ogden L, et al. A Framework for Patient-Centered
Health Risk Assessments—Providing Health Promotion and Disease Prevention Services to Medicare Beneficiaries. Atlanta, GA: US Department of
Health and Human Services, Centers for Disease Control and Prevention;
2011. Available at: http://www.cdc.gov/policy/opth/hra/. Accessed April 19,
2013.
38. Centers for Disease Control and Prevention. National Healthy Worksite Program. Available at: http://www.cdc.gov/nationalhealthyworksite/index.html.
Published 2012. Accessed December 14, 2012.
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
506 C 2013 American College of Occupational and Environmental Medicine

Place this order or similar order and get an amazing discount. USE Discount code “GET20” for 20% discount

Posted in Uncategorized