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  1. ERGONOMICS and THE AGING WORKFORCE or ERGONIGHTMARE Michael A. Alday, MD, MPH Medical Director Regional Occupational Health

  2. As America Ages, So Does the U.S. Workforce • 78 million Baby Boomers (born 1946-1964) • Boomers comprise 46% of the U.S. workforce Source: U.S. Census Bureau, Bureau of Labor Statistics

  3. SOBERING FACTS ON AGING • Between 2000 and 2020, the number of people in the 55 to 64 brackets will increase by 40% • Of the 58 million workers in this country, the median age is now 40.5 years • The number of workers 45 and older has doubled since 1950

  4. MORE SOBERING FACTS • By 2008, it is predicted that there will be 25.2 million workers aged 55 and over • This is in part due to decreasing retirement benefits/pensions and delays in social security entitlements • Many workers are forced to work longer because they are part of the “sandwich generation” --taking care of kids & parents


  6. OLDEST WORKFORCE BY INDUSTRY(average ages) • Miners – 36 years old • Construction – 39 years old • Electric Power Industry – 44 years old • Ford Motor Company – 45 years old • Nurses – 48 years old • Doctors – ANCIENT

  7. PROBLEMS WITH AGING • Eyesight and hearing • Manual dexterity and coordination • Muscular strength(peaks at age 30) • Reduced cognitive function and memory • Chronic medical conditions, i.e. arthritis • More prone to injuries and CTD/RMI’s (cumulative trauma disorder/repetitive motion injury) • 37% of all work-related disabilities among older workers are due to CTD’s/RMI’s

  8. RISK OF FALLING • Workers over age 64 have a 3X greater risk of falling(U.S. Dpt of labor) • Average lost work days for a fall-related injury: • >55 – 11 days • <55 – 6 days • Older workers are one and a half times more likely to suffer a fatal fall

  9. A CRUCIAL DISTINCTION • Total injury rates are actually lower among older workers • However, older workers are more likely to die or take much longer to recuperate from an injury which adds to the costs

  10. ERGONOMICS: The science of matching the worker to the work

  11. OSHA and State Worker’s Comp We’re from the government and we’re here to help

  12. WHAT IS A CTD/RMI(Cumulative Trauma Disorder)(Repetitive Motion Injury) • A CTD/RMI is a disorder of the muscles, nerves, tendons, ligaments, joints, cartilage, blood vessels, or spinal discs from repeated stressful or awkward motions and/or forces • Can involve the neck, shoulder, elbow, forearm, wrist, hand, back, knee, ankle, foot, and abdomen(hernia related)

  13. SC Worker’s Comp and CTD’s • As recent as 7 years ago, CTD/RMI’s were considered diseases as opposed to injuries and were not covered by W/C • Today, they are readily accepted as work-related if there is a clear association with work and aggravation of symptoms

  14. ERGONOMIC STANDARD • Proposed standard was set for January 2001 • Goal was to reduce an estimated 1.8 million workers suffering from work-related MSD’s(musculoskeletal disorders) • Was shot down by U.S. Congress due to meddling into state W/C program(federal program telling states how to run their W/C programs and spend their money)

  15. ERGONOMIC STANDARD • Even with these legal challenges, we will see this standard reappear in the future • Designed to match the worker to the workplace • Strongly supported by the labor unions • Even without the standard, it makes good business sense to implement a program

  16. ONCE A CTD IS REPORTED • You must investigate and promptly determine if an CTD is an “incident” • Employers should request assistance of a health care professional to make this determination and to assess the “work relatedness” of the disorder

  17. BENEFITS OF AN ERGONOMICS PROGRAM • Predicted to prevent 4.6 million CTD’s in first ten years • $9.1 billion could be saved annually at a cost of $4.5 billion for employers • $27,700 savings for each CTD prevented • Work station fixes can be as little as $250-500 per station


  19. ERGONOMIC FORMULA Repetition + Position + Force + Time + No Rest = RMI or CTD

  20. UPPER EXTREMITY PROBLEMS Tendonitis Tenosynovitis Tennis Elbow Rotator Cuff Strain Neuropathies Carpal Tunnel Syndrome(CTS) Raynaud’s Ganglion Cysts??

  21. UPPER EXTREMITY PROBLEMS • Gradual onset • No history of injury • Dull pain, numbness, tingling • Swelling, bruising may be absent • Gets better with rest

  22. UPPER EXTREMITY PROBLEMS • Upper extremity CTD’s are much more common than back CTD’s and are generally more costly as a group • Average case going to surgery costs $15-25K • Indirect costs are up to $50-75K per case

  23. COMMON FACTORS • Sedentary lifestyle • Repetitive trauma near site • Vibrating or pneumatic tools • Resumption of tasks after inactivity • New tasks

  24. COMMON FACTORS • Increased production (high repetition) • Awkward & prolonged postures • More common in females(esp. CTS) • Prolonged(>8 hours) shifts and/or overtime

  25. DIAGNOSIS • Detailed job description is a must! • Strain index • X-rays/MRI’s • Nerve conduction studies

  26. STRAIN INDEX • Moore-Garg Strain Index • Based on various risk factors of time, intensity, and posture • Scoring: <3 Considered safe Between 3-5 Uncertain risk Between 5-7 Some risk >7 Considered hazardous

  27. REMEMBER • Better defined problems (“it hurts here” v. “my whole arm hurts”) are better associated with true pathologies and CTD/RMI’s • Rest and realignment (change the work toward a less awkward posture)

  28. REMEMBER • Ratio of muscle (e.g.,tendinitis) to nerve problems(e.g., carpal tunnel) is usually 5-10 to 1


  30. Look for easy fixes! • Emphasize adjustment of workstation (minimize awkward postures) • Emphasize rotation of tasks (don’t type or keyboard for 4 hours straight, alternate with filing, other jobs) • Use of lifting devices or strict procedures for lifting heavy objects

  31. Look for easy fixes! • Consider light and temporary job limitations or restrictions • Encourage strength and flexibility building with emphasis on early rehab/PT • Expect that they will continue to improve and reassure them that they will get better • Braces and ergonomic tools to help with the workload

  32. What about other ergonomic solutions? Worksite visit by the ergonomics team -- What is the value? • Very high • Why? reinforces employee’s significance, importance,and the idea that the healthcare system is taking action

  33. What do you look for? • Method of task accomplishment • Are there physical differences between workers? • Are there workstation or work area differences? • Can force, awkward positions, or prolonged duration of tasks be reduced?

  34. Pearls…….. • Light or modified duty whenever possible • Frequent follow-ups are OK • Be mindful of OSHA 300 recordability rules: • No prescription meds unless absolutely necessary • Use elastic splints and supports vs. rigid splints • Sending home for rest of shift is not recordable • People who like their jobs do better with less accidents • If you show that you care about the workers, they will care about you (remember the golden rule!)

  35. Low Back Pain The “other” CTD

  36. Significance • 70% of people will have LBP • 50% will have a recurrent episode • #1 disability for men <45

  37. Work Related • 75% of U.S. back cases are W/C • Only 25% of cases in Scandinavia are W/C for the same occupations • Differences in legal climate?

  38. Cost • LBP workers’ comp awards up 27 fold over past 20 years despite improved safety/work conditions • 28% of all lost work days due to LBP • Med cost per case $25-35K • Total claim cost $150-250K • Majority have deg. disc disease present

  39. Outcomes • 50% recover within 2 weeks • 90% recover within 6 weeks • 10% are major disability problems

  40. Surgery Outcomes • Failure rate for industrial cases - 50% • Failure rate for non-industrial cases -10% • Poorer outcome • low income / education level • job dissatisfaction • history of previous disability or in the family (W/C is an inherited disease)

  41. Treatments for early CTD/RMI’s • Education • positive expectations • reassurance that condition will improve • Provide comfort • Discuss activity alterations • avoid irritation • avoid debilitation

  42. Treat CTD/RMI’s like Combat Stress • Simple explanations • Avoid diagnostic labeling • Brief rest and modified or transitional duty • Encourage activity • Keep worker at work

  43. Treat CTD’s like combat stress • Avoid delaying care • Goal is return to the front lines (work) • Reinforce the expectation of returning to work