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NOTICE This presentation which you are about to hear and the information contained in these slides (collectively the materials) are the confidential and proprietary property of Midwest Employers Casualty Company (MECC) and its third party presenters. These materials are protected by U.S. Copyright Law and may also be protected under other applicable laws or treaties. These materials may NOT be printed, copied, reproduced, distributed, displayed or otherwise published, in whole or in part, without the express written permission of MECC and/or the applicable third party presenter. You may not alter or remove any trademark, copyright or notice. Copyright 2012 MECC All rights reserved Confidential and Proprietary - Copyright 2012 MECC. All rights reserved

Aging Workforce Challenges and Opportunities Fernando Branco M.D. Medical Director Midwest Employers Casualty a Berkley Company Confidential and Proprietary - Copyright 2012 MECC. All rights reserved Objectives 1. 2. 3.

4. 5. Learn why our workforce is aging. Know what drives the aging workforce to keep working. Effects of aging. Prevention and Solutions for keeping the aging worker safe. Claims management Objectives 1. Learn why our workforce is aging.

2. Know what drives the aging workforce to keep working. 3. Effects of aging. 4. Prevention and Solutions for keeping the aging worker safe. 5. Claims management. 6. Question and answer. Changing Demographics 2000 States with at least 18% of the population age 65 or over.

Changing Demographics The Tidal Wave is Coming Starting in 2012, nearly 10,000 Americans will turn 65 every day Within the next decade, 40% of the U.S. labor force will be eligible for retirement The total number of Americans over age 65 and eligible for Medicare will double to over 70 million within this generation The population over age 85 will increase nearly fivefold, to almost 19 million, by mid-century The Tidal Wave is Coming

Fewer younger workers coming into the labor force Retirement age changing to 70 (Source: Bureau of Labor Statistics, 2010) As many as 75% of older adults expect to work after age 70 Objectives 1. 2. 3. 4.

5. 6. Learn why our workforce is aging. Know what drives the aging workforce to keep working. Effects of aging. Prevention and Solutions for keeping the aging worker safe. Claims management. Question and answer. Myths and Realities #1

Myth Older workers dont need to work. Reality Many older adults do not have adequate savings to support full retirement and cant live at the standard of living for which they have become accustomed; therefore, many must work to support their lifestyle choices. Myths and Realities #2 Myth Generally, the aging workforce is eagerly anticipating retirement, and will not work at all after reaching the typical

retirement age. Reality Generally, aging workforce employees want to continue to work after reaching the typical retirement age. Social Security Depending on your birthday, electing to take Social Security early at age 62 will have a reduction in benefits from anywhere from 20% to 30% Social Security benefits are increased by a certain percentage if you delay your retirement beyond the full retirement age up to age 70. No additional benefits

accrue past age 70 Myths and Realities #3 Myth Older workers are viewed negatively. Reality While there might be some who want to avoid an older worker, there are many instances where the preference is to seek out the knowledgeable, experienced worker as opposed to their younger colleagues. Primary Reasons For

Working Reality Workers > 55 are more productive (Source: Bureau of Labor Statistics; Meyers, 2007) More likely to work through pain Less likely to report an injury Job satisfaction is slightly higher (Source: Galinsky, 2007) A Black Hole? Boomers make up over one third of the nations

work force. They fill many of its most skilled and senior jobs. Thanks to their near-workaholic habits, they are among the most aggressive, creative, and demanding workers in the market today. Economists predict their exit will cause a great, sucking hole in the workplace universe. Source: Daniel Holden, Disaster Resource Guide Objective 1. 2. 3. 4.

5. 6. Learn why our workforce is aging. Know what drives the aging workforce to keep working. Effects of aging. Prevention and Solutions for keeping the aging worker safe. Claims management. Question and answer. Deconditioning with aging

Bone osteoporosis Joints cartilage degeneration synovial atrophy ankylosis

Musculoskeletal atrophy, decreased strength 1%/day with strict bed rest, 10-20%/week, plateau at 25, recovery takes 2x as long(Mueller 1970) contractures Deconditioning with age

Cardiovascular increased rest HR decreased SV, Q decreased a-v O2 decreased plasma volume

Body Composition decreased LBM increased body fat Genitourinary increased PVR increased calculus formation decreased urine concentration difficulty voiding

Deconditioning with age Respiratory decreased VC, no change in total lung capacity Ventilation/perfusion mismatch Neurological compression neuropathies

decreased balance, coordination sleep disturbance decrease visual acuity increased auditory threshold depression/anxiety Deconditioning with age Gastrointestinal decreased appetite decreased bowel motility

decreased gastric secretion Endocrine decreased glucose tolerance decreased thermoregulation

decreased androgens decreased growth hormone decreased PTH Performance with age Running decrease by 1% per year from 25 to 60 y

Swimming decrease by 1% per year from 25 to 75 y. Depends also on skill, peformance can last longer. Cycling 0.7 % per year from 20 to 60 y Most athletics perfomances declines steady during middle age and older age due to decreased endurance and strength Aging

VO2max decrease by 10% per decade, starting late teens on females and early 20s on males Older endurance athletes with high-intensity training VO2

declines very little Difficult to differentiate between biological aging and physical inactivity Strength decrease due to physical inactivity and decrease in muscle mass from reduction of protein synthesis and loss of fast-twich fibers Aging

Temperature less regulatory due decrease in sweating Altitude affects less with aging Aging starts early teens and twentys Bodyfat increase due to Increased intake Decreased physical activity Reduced ability to mobilize fat

Risks of Aging Increased risk of falls 33% of all injuries over workers over 65 14% if all fatalities result from falls Increased muscle weakness Increased prescription side effects Increased risk of MVAs

Aging Worker Injuries Top 5 Types of Injuries that impact aging workers Rotator Cuff Sprains Lumbar Disc Disease Brain Injuries Carpal Tunnel Syndrome Knee Cartilage injuries

Objectives 1. 2. 3. 4. 5. 6. Learn why our workforce is aging. Know what drives the aging workforce to keep working. Effects of aging.

Prevention and Solutions for keeping the aging worker safe. Claims management. Question and answer. Solutions Reduce and minimize heavy lifting. Reduce static standing time. Improve walking and working surfaces. Improve illumination. Review office ergonomics. Eliminate work on ladders. Keep floors clear, dry and cushioned.

Solutions Remove clutter. Use large video displays. Use hands-free telephone equipment. Avoid above shoulder work. Ergonomic interventions to reduce discomfort. Prevention Corporate wellness programs

Reduce sick leave Increase productivity Decrease rates of illness and injury Helps speed recovery Source: Mercer Human Resources Consulting, 2007 Most Costly Higher cost due to higher severity and not frequency Higher indemnity costs due to higher wages

Older IWs received 26% more in temporary benefits per day than workers ages 20-34 Frequent Injuries What is causing the injuries? Intolerance Disease Consider fitness for duty evaluation

Voluntary participation in strenous physical Fitness for Duty activity on a regular basis is an unusual pattern of behavior that is not observed in most aging animals Jack H. Wilmore Physiology of Sport and Exercise Exercise Prescription

Endurance Training similar gains in healthy individuals regardless of age Take in consideration comorbidities as Diabetes Mellitus, degenerative bone and joint disease, cardiovascular disease Walking, chair and floor

exercises, aquatic therapy Rotator Cuff Injuries More prevalent with age (by age 67 30% have bilateral tears) (Source: Svendsen, 2004) Strong evidence for age and BMI Some evidence for force/repetition and force/posture NEJM, 2008

Knee Pain Osteoarthritis Very strong evidence for age and BMI (also prior injury) Internal derangements Strong evidence for BMI Not for age Spinal Canal Stenosis Common in age 60+ Ligaments, bone and

discs narrow the canal DDD Degenerative disc disease Is NOT a disease or medical condition 46-93% asymptomatic patients It is a radiographic finding unrelated to symptoms Normal Aging Consider the significance (or lack thereof) of many commonly ordered diagnostic tests,

especially spinal and joint imaging Rotator cuff Internal knee derangements Spinal canal stenosis DDD Second opinions for surgical recommendations

MRI: Asymptomatic pts Disc degeneration age 30 = 30% age 60 = 80% Disc bulging Disc prolapse 50-80% 40-70% MRI: Appropriate Use Strong neurologic signs Objective findings

Red flags Persistent symptoms > 4-8 weeks Patients should understand that imaging is to rule out serious conditions and to expect degenerative findings. MRI: Inappropriate Use Over-use of imaging studies risks: Reinforcing the suspicion of serious disease

Magnifying the importance of nonspecific findings and Labeling patients with spurious diagnoses Objectives 1. 2. 3. 4. 5. 6.

Learn why our workforce is aging. Know what drives the aging workforce to keep working. Effects of aging. Prevention and Solutions for keeping the aging worker safe. Claims management. Question and answer. Management of Claims Investigation: Causation Caused by work? Symptoms at work?

Shoulder Knee Low back Management of Claims Investigation Gather as much medical and activity information as possible Only use relevant information for compensability decision Use the same process regardless of age Beware of appearance of age discrimination Presumption claims

Management of Claims When do you think you will return to work? Conversations with employees Early intervention Transitional duty program is key No different from other ages Individualized Close follow up Communication

A A process process by by which which information information is is exchanged exchanged between between individuals individuals through through aa common common system

system of of symbols, symbols, signs, signs, or or behavior: behavior: exchange exchange of of information information Stay in touch Talk about health in general This is important to the older patient

They want to remain active Emphasize function, not pain Thank You!!!

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