Older Workers, Health and Employment

22 November 2011

This event is kindly supported by Sanofi Pasteur MSD

Welcome

Baroness Sally GreengrossILC-UK

This event is kindly supported by Sanofi Pasteur MSD

Trends in the health of older workers

Dame Carol BlackDepartment of Work and

Pensions

This event is kindly supported by Sanofi Pasteur MSD

Dame Carol Black UK National Director for Health and Work

Older workers, health and employment

ILC-UK / Actuarial Profession joint debate

London, 22 November 2011

Work, Health and Active Ageing

• The fullest possible working life benefits individuals and society. It is necessary to maintaining prosperity, health and wellbeing.

• People who are not working depend on the support of those who are in work.

• Being sufficiently healthy is a condition for work, and maximising healthy life as a proportion of total life is therefore a desirable goal for individuals and society.

Work, health and active ageing

Society needs the maximum number of productive years from as many of the population as possible.

We need the ratio of earners and wealth-generators to dependants (children, pensioners, unemployed) to be as high as possible.

Childhood Working life Retirement

In April 2011 it became illegal in the UK, without special justification, for an employer to require workers to retire at a fixed age.

On current predictions, the future population will be composed of longer survivors, with more long-term health conditions.

This is a challenge in many countries of the world.

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In 1900 a 65 year old would have about 11 years of life remaining, barely changed from 1850, by 2000 this had risen to about 20 and is forecast to reach about 26 by 2050

State pension introduced

Welfare state introduced

Lloyd George pension

1 in 4 children born today can expect to live to 100

Cohort life expectancy at 65 (England and Wales) – Years

Source: ONS

We are living considerably longer lives after 65…

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Average age of exit

Life Expectancy at 65

Gap between average age of exit from work and life expectancy at 65

Whilst people are working longer, its not enough…

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Average age of exit

Life Expectancy at 65

Males

Females

Men’s and women’s state pension age will be equalised at 65 and then both will start to increase to 68, this will help close the gap

Gap in 1984 – 16.3 yearsGap in 2010 – 21.6 years

Gap in 1984 – 23.0 yearsGap in 2010 – 26.4 years

Source: ONS and LFS

Seasonally adjusted employment rates by age

…the employment rate for older people is considerably lower than for 35-49 year olds

(but the gap is closing).

Source: Seasonally adjusted LFS

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16-17 18-24 25-34 35-49 50-64 65+

Whilst the employment rate amongst 50-SPA is lower than 35-49 year olds the gap has closed by 6.9 percentage points since 1992

Employment and Health Statistics

- all working age

730,000 off sick

26% with a health condition

or disability

30% with a health condition or disability

8.9 million inactive

50% with a health condition

or disability

2.4 million unemployed

(Labour Force self reported; Qtr 3 2009)

Source: Labour Force Survey 4 qtr average to June 2011 for men and women aged 16-64 in GB

27.5 million employed/ self employed

Employment and Health Statistics 50 – 64 year olds

7.2 million in work

3 million or 42% with a health condition

or disability

0.2 million or52% with a health

condition or disability

3.5 million inactive

2.4 million or70% with a

health condition or disability

0.4 million unemployed

(Labour Force self reported; Qtr 3 2009)

Source: Labour Force Survey 4 qtr average to June 2011 for men and women aged 50-64 in GB

Over half those with a health condition are in work

Employment increasing

• Employment between the ages of 55 and 69 has been increasing in recent years. – The increases have generally been largest for those

with mid and high levels of education; and – a greater proportion of the increase seems to have

come from increases in part-time working than from increases in fulltime working.

Banks et al (2010), Financial circumstances, health and wellbeing of the older population in England – The 2008 English Longitudinal Study of Ageing Wave 4.London: The Institute for Fiscal Studies.

Key statistics on older workers

• Every day the lifespan of the average British citizen increases by between five and six hours.

• In 2010, total employment in Britain went up by 218,000 - of which 104,000 went to the over 65s– nearly half of all new jobs went to just

3% of the labour force.

• The European working-age population is about to shrink, while the population over 60 will continue to increase by at least 2 million a year.

• By 2020 almost a third of the workforce will be over the age of 50.

Links with flexible working can be health related

• Many of those approaching retirement age do want to continue with some form of part-time or flexible working.

– Around 60 per cent of over 50s would like to continue working after state pension age, but on a part-time basis. Two-fifths would like to stay in their current jobs, but with greater flexibility in hours or days worked.

Equality and Human Rights Commission (2010), Working Better –

The Over 50s, the new work generation.

Older workers and Sickness Absence

A representative survey of 2,000 employees carried out by DWP indicated that over a 12 month period:· Fewer older workers took any time off due to sickness absence

(41% of those aged 55+ had any sickness absence compared with an average 48% for all employees)

· However, of those that took time off, average working days lost were higher (18.2 days compared with 10.3 days for all employees).

· Overall, the average number of working days lost per older worker (including those with no absence) was 7.6 days compared with an average of 4.9 days for all employees.

• Note calculations are based on respondents who had worked for their employer for at least 12 months.

What prevents us from working?

As well reported in many countries:• common mental health problems• musculo-skeletal problems• chronic diseases – mental and physical• organisation of work, quality of line management,

lack of leadership, inflexibility of the workplace, changing nature of work

• lack of education and/or skills • deprivation, poverty, unavailability of employment.

Solutions depend on collaboration, understanding and action involving employees, employers, healthcare professionals, trade unions, and local and national governments.

Increasing working life expectancy

• Increase in working life expectancy is difficult to achieve without accompanying improvements in healthy life expectancy (together with skills matched to labour demand).

• The Health Survey for England and the General Household Survey for 1998 and 2004 show that the additional years of life are usually spent with co-morbidities rather than a single disease – these may be non-limiting diseases.

• The first challenge is to minimise ill-health and to mitigate its effects on function, enabling increased participation in work and

extended working life.

February 11, 2010

Retire at 68? Three-quarters of us will be too ill to even work that long...

Lifestyle trends in UK

It is likely that by 2025 40% of adults will be obese, and the number of people living and working with chronic conditions will rise steadily, affecting morale, competitiveness, profitability.

In an increasingly competitive global economy, only the healthiest businesses will prosper. Companies that invest to support employees’ health will be fitter to survive.

Obesity and chronic disease

Predicted rates per 100,000 2006 2030 2050

Arthritis 603 649 695

Breast cancer 792 827 823

Colorectal cancer 275 349 375

Diabetes 2869 4908 7072

Coronary heart disease 1944 2471 3139

Hypertension 5510 6851 7877

Stroke 792 887 1050

The latest Health Survey for England (HSE) data shows us that nearly 1 in 4 adults, and over 1 in 10 children aged 2-10, are obese.

In 2007, the Government-commissioned Foresight report predicted that, if no action was taken, 60% of men, 50% of women and 25% of children would be obese by 2050.

Chronic conditions and extending working life

Common chronic conditions e.g. cardiovascular and respiratory conditions, diabetes, rheumatic diseases, treated cancers do not deny the possibility of fulfilling work or an extended working life.

Previously fatal diseases are also becoming chronic, after improved medical treatment. Obesity may promote earlier onset of chronic conditions.

Chronic conditions require:

• good clinical care, Vocational Rehabilitation, well- informed work-conscious healthcare professionals

• flexibility & adaptation in a health-promoting workplace.

If managed effectively and proactively, disability can be minimised and disease progress delayed - extending working life and reducing healthcare costs.

Extending working lives – the social factors

• In the UK, labour participation rates drop significantly after age 50.

• Those with longest working life expectancy at 50 are more educated, are home owners, are married or co-habiting, and are in reasonable health.

• Besides poor health, the reasons for ceasing economic activity at age 50+ include limited skills and increased caring responsibilities.

• Reversing these factors will depend on more than healthcare interventions alone. Marmot Review 2010

Retiring at 68 comes with a health warning for us all

Sir Michael Marmot, Professor in the Department of Epidemiology and Public Health at University College London, stressed that it is not only the poor but everyone except the very wealthiest whose healthy life expectancy is affected by the “social determinants of health” such as employment, education levels and housing conditions.

He is clear about what is at stake if the government presses ahead with plans to raise the pension age , now 65, to 68 by 2046:

“We will not have disability-free life expectancy as long as 68 years. If we want people to work longer, we must reduce the social gradient in disability-free life expectancy. If action is not taken, it won’t just be the poor, it will be the bottom two-thirds who suffer.”

Financial Times. 5 November 2011

The workplace – its potential

• There is increasing emphasis on the role of the workplace in influencing and providing the conditions necessary for healthy and fulfilling working lives …

• … with persuasive evidence that the health and well-being of employees are significant determinants of the success of business enterprises and services.

Older Workers at Lafarge Construction - background

• The largest diversified supplier of construction materials in the U.S. and Canada, employing approximately 13,000 people at over 900 locations.

• Workforce mainly male, older and of long tenure (often 20 to 25 years)

Challenge: • Medical, dental and pharmacy costs increased 13% annually 2001 to

2006.• Many high-cost claimants with chronic conditions. • Before 2005, long-term disability claims were more than twice expected,

causing significant premium increase.

Research: • Showed that costs could be reduced by $30 million within 3 years by

early diagnosis and treatment and improving medication adherence for asthma, diabetes and heart disease.

Older Workers at Lafarge Construction – the initiatives

Initiatives included:• rigorous use of data to monitor and manage results against a 2005

baseline • communication/education effort for employees, family members, senior

management and operations managers (all education material sent directly to employees’ homes).

• health and productivity culture premised on the existing safety culture • evidence-based identification of the need for, and encouragement of,

medication compliance• financial incentives to reward program participation, clinical screening• on-site health screenings• integrating all clinical resources and benefits through a dedicated cross-

functional team.

Locally, several plants were encouraged to partner with local hospitals to - provide sleep apnea tests, - create counselling sessions to train on prevention of low back injuries - bring nutritionists to the workplace to promote healthier eating.

Older Workers at Lafarge Construction - results

• 97% of the 5500 benefit-eligible employees in the U.S. workforce now participate in the Lafarge Health risk assessment

• In 2010, 2800 employees participated in onsite health education programs.

• Medical/pharmacy cost trend is now 4.7% compared to 13.0% in 2001 – 06

• Claims in excess of $50,000 are at the lowest level in the past five years.

• Medical costs for diabetics and asthmatics are down 25% and 38%, largely due to reduction in hospital and emergency room visits

• 7,102 employees now participate in the disease management programme (159% increase)

• Lafarge received the 2010 IBI/NBCH Healthy Workforce Productivity Award for leadership in health and productivity.

Integrated Benefits Institute, Dec 2010

Employees’ needs change over time

• In recognition of how personal priorities change, an increasing number of employers are offering flexible benefits packages

• In some ‘salary sacrifice schemes’ – in which employees can buy or sell annual leave – it is common to find that younger staff sell some of their leave entitlement to generate more cash, while older workers sacrifice cash to buy more annual leave.

• Time, it seems, becomes a more value commodity as people get older.

‘Good Work and Our Times’, Report of The Good Work Commission 2011

Flexible working

• The traditional stereotype of ‘a white able-bodied male under 45 years old in full time work’ is now only 20 per cent of the UK workforce.

• This means the UK has an unprecedented degree of diversity in the labour market with a corresponding growth in demand for flexible working and non-standard hours.

• ‘Flexible working probably gives people a sense that the company is looking after them, and hence hopefully a sense of better well-being, a sense that they do have a certain degree of empowerment about and when they work, within business restrictions, of course’.

Kelliher C and Anderson D, ‘For better or for worse? An analysis of how flexible working practices influence employees’ perceptions of job quality’,

International Journal of Human Resources Management, 19(3) pp 419-431, 2008

ASDA (a supermarket chain) and Older Workers

Currently employs over 20,000 older workers (19% of workforce)

Business benefits include• Mirrors the business's customer base more closely, thus

providing better customer service • Professional and life experience shared with colleagues• Continuity of staff and experience • Extra flexibility • Improved customer satisfaction survey results and staff

satisfaction.

ASDA supports older workers• One week unpaid leave for grandparent or carer duties • ‘Benidorm Leave’ – up to three months unpaid leave • ‘Seasonal squad’ – choose to work only during 10 busiest

weeks of the year (Christmas, Easter)

Absenteeism has reduced to levels that are a third lower than the national average for this industry.

WANTED ASDA is

looking for workers in the 50-plus age group.

Supporting the employment of older workers

Provides guidance for employers on employing older workers, including recruitment, flexible working, training and development, and retirement www.businesslink.gov.uk

Provides good practice case studies, FAQs, guidance on fixed retirement age and research into extended working lives www.dwp.gov.uk/age-positive

Co-financed by the European Regional Development Fund, the Silver Academy encourages the over 50s in engaging with new enterprises and SMEs, and runs practical workshops www.peopleproject.eu

Extending working lives: steps to be taken

• Build upon current policies to strengthen concerted action, across clinical medicine, occupational health and employment practice, to minimise the impact of ill-health and ageing on capability for work.

• Develop and promote fuller understanding of :

- the role of healthcare in maintaining/restoring function at working age, - employers’ role in enabling people not wholly well, or ageing, to undertake fulfilling work, - the natural history of common disorders in relation to function, emphasising prevention and delaying onset, - the interplay of psychosocial, economic and medical factors in relation to functioning and work.

• Strengthen the evidence base on the clinical and cost effectiveness of interventions in relation to disability and extended working life

• Ensure the workforce has the skills required to maintain and extend working life• Put in place the practical arrangements and interdisciplinary practices

necessary to realise these aims.

Final thought

“ In the end, it’s not the years in your life that count.

It’s the life in your years.”

Abraham Lincoln

Case Study: Shingles and the Older Worker

Dr Robert JohnsonUniversity of Bristol

This event is kindly supported by Sanofi Pasteur MSD

Shingles & Postherpetic Neuralgia in older adults

Effects on the individual and the economy

Robert Johnson, MD.,FRCA.,FFPMRCA.

University of Bristol, UK.

Topics What is shingles (herpes zoster)? Who gets it? How common is it? Complications? What is PHN? Can PHN be treated? Effects of PHN on QoL and ADL. Can shingles and PHN be prevented?

Varicella Zoster Virus (VZV): One virus two diseases

Primary infection• Varicella (chicken pox)

Persistence with clinical latency

Reactivation• Herpes zoster

(shingles)

Herpes zoster (shingles)

• Only occurs in people who have had chicken pox

• Affects mainly older adults• Immunocompromised persons• 25-30% lifetime risk• Long lasting immunity – 2nd attacks <5%

• Not epidemic as not transmitted• Low infectivity (causing chicken pox)• Rash on one side of body only

Bilateral HZ

Age 39. Acute Zoster.

Thanks to Judy Breuer

Noel Coward – ‘That is the end of the news’

Verse 11 – last verse

Aunt Isabel's shingles have met in the middle, She's buried in Devon So God's in His heaven And that is the end of the news

Thanks to Mike McKendrick

Sero-epidemiology of VZV in Europe

(individuals who have had chicken pox)

Sengupta N et al. Varicella vaccination in Europe are we ready for a universal childhood programme. E ur J Pediatr 2007

Switzerland

Italy

Turkey

Spain

Germany

Belgium

UK

USA (prevaccine)

Perceived Likelihood of Developing HZ†

2%

24%

39%

32%

Very likely

Somewhat likely

Unlikely

Very unlikely

All respondents (n=4479)

Paek E, Johnson R. Public awareness and knowledge of Herpes Zoster: Results of a global survey. Gerontology 2008

† Question asked (all respondents, n=4479): How likely do you think you are to have shingles (herpes zoster) at some point in the future?

Incidence of HZ by age group & gender

Epidemiology and management costs of Herpes Zoster (HZ) andPost-Herpetic Neuralgia (PHN) in the UK. Remy et al

Complications of HZ

Neurological• Postherpetic neuralgia, Hearing loss, vertigo, VZV

encephalitis, facial paresis, other cranial nerve palsies, myelitis, granulomatous arteritis with secondary stroke

Ophthalmic• Ptosis, scleritis, iridoyclitis, secondary glaucoma, keratitis,

blindness, chorioretinitis Dermatological

• Disseminated HZ, persisting pruritus, secondary bacterial skin infections (→ scarring, cellulitis, sepsis)

Visceral• Pneumonia, peri-myocarditis, hepatitis, myositis

Duration of zoster pain according to age.

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Meister W, Neiss A, Gross G, et al. A prognostic score for postherpetic neuralgia in ambulatory patients. Infection 1998;26 (6): 359-63

PHN – symptoms and signs Pain

• Continuous (burning)• Paroxysms (intermittent shooting)

Allodynia (severe pain from minor stimulus)

Itch

Sensory loss (numbness)

Factors associated with development of PHN

• Greater acute pain severity • Greater severity of rash• Older age• Immune compromised

• Restriction of ADL prior to HZ• Prodromal pain• Female sex• Diabetes• Ophthalmic zoster

Effect of Zoster on Activities of Daily Living1

1. Lydick E, Epstein RS, Himmelberger D, White CJ. Neurology. 1995;45(suppl 8):S52–S53.

Pain interference with activities of daily living: Percent of cases reporting interference 5.

(63 PHN patients)

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MASTER study group – Drolet M et al. Accepted for publication by CMAJ

Medical costs of HZ & PHN

Average HZ cost per patient - U.K.(Pop. ~60 million)

HZ Mean Overall Outpatient Cost (excluding hospitalisation)

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Adapted from Gauthier A, et al. Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom. Epidemiol Infect. 2008 May 9:1-10.

UK13486 010/09

CHKS HZ hospitalization study – U.K.(Pop. ~60 million)

5,297 HZ patients admitted to hospital in one year

Mean age 76.5 (sd 11.2)

3,119 (58.9%) female

42.3% (2,239) had HZ as the primary diagnosis

HZ related hospital admissions cost £13.36M

The burden of HZ hospitalisations is highest in the over

70s

51Sanofi Pasteur MSD Data on File 2009 UK13472

Work & productivity loss due to HZ

Singhal PK et al. J Med Econ 2011;14(5):639-645

Management of HZ

Johnson R, Wasner G, Saddier P, Baron R. Expert Rev. Neurotherapeutics 7(11),2007

Antiviral drugs & PHN

Evidence for prevention of PHN by antiviral drugs is confusing (n.b. Cochrane review).

but it is clear that…

Despite a large proportion of HZ patients receiving antiviral drugs, the burden of PHN remains considerable both in terms of numbers and severity.

Management of PHN

Johnson R, Wasner G, Saddier P, Baron R. Expert Rev. Neurotherapeutics 7(11),2007

‘If a great many remedies are prescribed for some disease, that means the disease is incurable.’

Dr. Anton Pavlovich Chekhov

1860 -1904

The Cherry Orchard (1902)Act 1, Gayev to Varya

PHN Pharmacotherapysummary

Drugs for postherpetic neuralgia :

• have a modest effect• reduce pain by 50% in 50% of patients at best• have side effects

Bartolomeo from Salerno. 12th C

Practical medicine is divided into two parts: a science which preserves health, and one which cures disease.

To preserve health is a thing that can be done better and with more certainty than restoring health once it has been lost.

With thanks to Paolo Bonnani – Univ. of Florence

Study Subjects

Oxman M et al. N Engl J Med. 2005;352:2271-2284.

Terminated before end of study 793 (4.1%) Died 57 (0.3%) Withdrew 61 (0.3%) Lost to follow-up

Zoster vaccine19,270

Terminated before end of study 792 (4.1%) Died 75 (0.4%) Withdrew 52 (0.2%) Lost to follow-up

Completed study18,357 (95.2%)

Placebo19,276

Enrolled 38,546

Completed study18,359 (95.3%)

A Vaccine to Prevent Herpes Zoster and PostherpeticNeuralgia in Older Adults

Herpes zoster vaccine

Reduces incidence of HZ by 51%

Reduces incidence of PHN by 66%

Reduces ‘Burden of illness’ by 61%

Oxman M et al. N Engl J Med. 2005;352:2271-2284.

Efficacy on interference with Activities of Daily Living

ZOSTER VACCINE EFFICACY FOR HZ BOI AND INTERFERENCE ENDPOINTS

All Subjects (N=38,501) - MITT Analysis

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Relative Vaccine Efficacy (1-Vaccine/Placebo)

HZ Burden of Illness (BOI) Score

ZBPI - ADL Interference AUC

ZIQ - ADL Inteference AUC

Gnann JW J of Pain 2008

Schmader K Abstract 859 & poster. 44th IDSA congress 2006 (publication ongoing)

Interference with activities of daily living (ADL) were measured by 7 functional items of the Zoster Brief Pain Inventory (ZBPI) and 12 ADL items in the Zoster Impact Questionnaire (ZIQ)

Zoster vaccine efficacy for HZ BOI and interference endpoints (All subjects (N=38501) – MITT analysis)

61.1%

66%

68%

Safety summary

Well tolerated and safe in older immunocompetent adults

Modest increase in the rate of acute innoculation-site events

No increased risk for HZ No pattern suggesting any serious

adverse events causally related to vaccination

Older Workers, Health and Employment - What can we do?

What should we do?

Chris BallThe Age and Employment Network

(TAEN)

This event is kindly supported by Sanofi Pasteur MSD

Chris Ball, Chief Executive

Older workers, health and employment22nd November 2011

What can we do? What should we do?

Can we work ‘til we drop?

45-59 year olds – 21%60-74 year olds – 40%With long term limiting disabilties

One third will reach 68 in good health. (2001 census)

Poorer people, living longer, but no corresponding increase in disability free years. (Marmot)

The value of physical exercise

Dimensions of age management

Example of Older Workers

• All over 60 years• Still working• Control over working

time• Will not comment on

lifestyle• Excellent access to

health care• Not many vacancies

for this type of work

OH Services at or near work

• Small businesses and OH• Primary health care in UK• Need to increase provision in sectors

close to work place • More OH practitioners• More use of OH nurses and technicians• Partnerships of health trusts and others

Boots

Aims• To embed activity promoting a healthy workplace into the Boots

culture

• To create a workplace health programme that is integrated into all operations and empowers all employees to improve their health and well-being

• To help improve employee engagement across all areas of the business.

What they did

• Boots Healthy Workplace - drove the agenda, engaged leaders reported progress to the Board.

• ‘People Packs’ for every employee - health information pedometer, fruit snacks Vitamin C, waist tape measure…

• ‘People Programme’ - support to quit smoking/be more active

• Healthy Living events include fruit giveaways, BMI checks, walking/cycling promotion

• ‘Wednesday Walks’ promotion - power walk around the Boots HQ

• Healthier food choices • Vending machines selling healthier choices

What was the result?

• Within 18 months - embedded health workplace activity into core business

• “My Health” now part of Boots employment brand programme - received financial support from the business

• ‘People Packs’ to over 65,000 employees - very popular • 1,050 employees signed Commit to Quit/Commit to Get

Fit, in first year (2006) • 500 + employees participated in over 50 ‘Wednesday

Walk’ sessions. • Healthy choices in canteen - 60% of sales

Eight hours watch c 1860

“We require8 hours labour,8 hours for ourown instructionand 8 hours forrepose.”

chris.ball@taen.org

Web: www.taen.org.uk

© TAEN 2011

Dr Ross Wilkie

Keele University

This event is kindly supported by Sanofi Pasteur MSD

Russell Turner

Marks and Spencer

This event is kindly supported by Sanofi Pasteur MSD

Older Workers, Health and Employment* Do older workers take more or less sick leave than their younger counterparts?

* What kind of health problems commonly lead to older workers taking sick leave or exiting the workforce early?

* What government policies exist to help support older workers who experience health problems?

* What interventions or innovations can minimise or prevent ill health amongst older workers?

This event is kindly supported by Sanofi Pasteur MSD

Older Workers, Health and Employment

22 November 2011

This event is kindly supported by Sanofi Pasteur MSD