Holistic Approach

in Employing

Older Staff

DR CHNG SHIH KIAT

MBBS MMed(FM) MCFP GDOM

Deputy Medical Director

Raffles Medical Group

Topics

Epidemiology

Effects of Aging on Health

Work and Health

Work Hazards

Fitness Examination

Workplace Health Promotion

Conclusions

Epidemiology

Aging population

> 65 yo 8.7% in 2008 to 19% in 2030

Aging workforce 2004 22% >50 yo, 2015 29%

Epidemiology

Chronic diseases

2010 2 in 5 people

2020 3 in 5 people

Top 4 causes of death (72% of all deaths)

Cancer

Ischaemic heart disease

Pneumonia

Stroke

A Dilemma

Experienced

Trained

Know the company’s culture and values

? More health problems

? Increase susceptibility to hazards

? Increase cost

? productivity

When It Comes to Work, How Old Is Too Old? My 92-year-old grandfather cuts hay atop a 5-ton

tractor each summer, baling winter feed for more than 800 head of cattle. The rest of the year he herds, corrals, immunizes, and cares for the cattle.

A senior scientist at the Centers for Disease Control and Prevention (CDC) reported to work each day well into his 80s, contributing greatly to our understanding of biomarkers, and helping advance laboratory safety measures. An annual laboratory safety award is now given each year in his honor.

By L. Casey Chosewood, MD Posted: 05/03/2011 at Medscape

How old is too old?

Fumi Chinen, 102 years old has been in the same business for more

than 50 years-a tiny Okinawan kimono shopkeeper at Naha Public

Market. She is often difficult to find since she recently enrolled in

English classes Adapted from http://okicent.org/media.html

Seikichi Uehara, 96

years old is a karate

master, who is also the

guardian of a rare

karate method,

"Mutubu-Udundi." The

method was originally

created in secret to

protect the Royal Family

of the Ryukyus. Now

that there is no official

royal family, anybody

can learn it, if they can

keep up with the master

Adapted from http://okicent.org/media.html

Benefits of work

To the doctor, work is medicine as stated by Dr Casey Chosewood

Enhances well-being

Promotes social interaction

Increases variety and quality of life

Sense of accomplishment and satisfaction

Maintain and extend their physical activity

Improve mental health and memory

12 Benefits of older workforce Sept 20, 2006 Entrepreneur Dedicated Punctual Honest Detail-oriented, focused and attentive

Good listeners Pride in job well done Organisation skills Efficiency and confidence Maturity

Setting an example Communication skills Lower labour cost

Changes as We Age Cell

More vulnerable to damages

Less efficient eg in energy release

Declining functions

Connective tissue

Stiffness

Vision deterioration eg catarract

Immunity

Susceptibility to infection

Less surveillance

Common conditions in the

older person

Physiological Decreasing vision

Decreasing hearing

Decreasing energy and concentration

Decreasing strength Decreasing flexibility

Decreasing stamina

Decrease thermoregulation

Decreasing cognitive functioning and ability to pick up new skills

Decrease response time

Common conditions in the

older person Pathological Chronic diseases

Diabetes Hypertension High cholesterol

Heart disease Neurological diseases eg Parkinsons, dementia, stroke

Infection

Skin problems

Cancer

Musculo-skeletal disorders eg osteoarthritis

Risk of falls

Common conditions in the

older person

Psycho-Social

Mental health

Social relationship, empty nest

Retirement planning

Caregiver

WHO Definition of Health

Health is a state of complete physical,

mental, and social well-being and not

merely the absence of disease or infirmity.

Work Health

Work Health

Decreased

Productivity &

Increased

Healthcare Cost

Health Promotion as the

Cornerstone for Prevention

Health promotion comprises efforts to

enhance positive health and prevent ill-

health, through the overlapping spheres

of health education, prevention, and

health protection.

Downie, R.S., Fyfe, C. & Tannahill, A. (1990), Health promotion. Models and values. Oxford (Oxford University Press), 1990, 59

Invest in Prevention “We dedicate resources to prevention

because, like any successful investment we’ve made, it yields steady returns….a healthier, more productive, more committed workforce and significantly lower overall healthcare cost. For every dollar we invest in our workers’ health, we see a return of more than $4…..”

- William Weldon, Chairman and CEO, Johnson and Johnson (Jan-Feb 2011, Harvard Business Review)

Invest in Prevention

In addition to the health benefits for

workers, every Euro invested in WHP leads

to a Return on Investment (ROI) of

between 2,5 – 4,8 Euros ($4 - $8)due to

reduced absenteeism costs. European Agency for Safety and Health at Work (EU-OSHA).

European Network for

Enterprise for Health

Justification for WHP

Reduces costs of ill-health and poor work quality

Drives innovation and productivity

Addresses the challenge of an ageing workforce

Satisfies employees, customers, shareholders and public stakeholders

Aligns with corporate social responsibility, a central pillar for future welfare and economic prosperity

(Breucker, 2004, draft executive summary)

Where does employee health and

well-being appear on senior

management’s list of priorities?

The number one priority 4%

Near the top of the list of priorities 35%

At the middle of the list of priorities 33%

Low on the list of priorities 16%

Not on the list of priorities 12%

Canadian Survey (Lowe, 2003 and Bachman, 2002)

Benefits of WHP

To the Staff

Better working conditions

Improved social climate

Improved organisational process

Greater health awareness

Improved state of health: Many chronic diseases can be prevented through adoption of healthy lifestyle

Happier

Benefits of WHP To the Company

Improve staff health

Increase staff morale

Increase staff productivity

Decrease staff turnover

Decrease staff training needs

Decrease absenteeism and injuries

Decrease presenteeism

Decrease healthcare cost

Enhanced Company image

Not just having a form…

The reason for workplace health promotion

is that it contributes to the main goals of the

company. It should be part of the

company’s culture, integrated and aligned

with companies’ goals and strategy.

Interventions that work

Empowering

Individuals

Empowering Individuals Chronic disease prevention/risk factor

reduction programs (Family physicians)

Smoking cessation

Healthy eating

Weight gain prevention/weight loss

Physical activity programs

Low impact aerobics: walking, steps counting

Balance/core training: Dancing, tai chi

Strength training

Stress management/depression

Empowering Individuals

Health portals

Health screenings

Lifestyle survey

Company health profiles

Supportive Environment Hazards control (Occupation Medicine

Physicians)

Workplace hygienic factors Temperature

Noise Lights

Ergonomic workstations

Non slipped flooring

Healthy vending machines

Water coolers

Financial support for health related initiatives

Organisation Policies (most

important) Health related policies (periodic screening, no-

smoking policy etc)

Staff communications (feedback and suggestions)

Specifically for re-employment Eliminate age-based discrimination, promote age

diversity and age-friendly culture through Events

Talks

Workshops

Mixed-age work team

Flexible job design, flexible working hours

Organisation Policies (most

important)

Training and re-training opportunities from

employment to retirement

Special business unit

Leave policies

Extended family care leave

Employee assistance programmes

Mental health assistance programmes

Financial/ retirement planning

Assistance Workplace Health Promotion Grant The Workplace Health Promotion (WHP) Grant is a

funding scheme offered by the Health Promotion Board (HPB). The Grant provides financial support to help organisations start and sustain their workplace health programmes.

The maximum grant quantum is $10,000. The organisation must co-fund the WHP project by contributing 50% or more of the project cost.

Adapted from http://www.hpb.gov.sg/hpb/default.asp?pg_id=2165

Assistance

Mental Health Top Up Grant

An additional funding option offered by HPB.

Provides financial support to sustain and augment

their workplace mental health promotion programmes.

The maximum top up quantum is $2000. No co-

funding by the organisation is required.

Adapted from

http://www.hpb.gov.sg/hpb/default.asp?pg_id=2165

Work and Health

Workplace Health and Safety

Identify work hazards

Identify worker’s health issues and match

it to the work

Identify Work Hazards

Workplace inspection by DWDs/ Hygienists

Mechanical factors including physical work

Ergonomics

Work stations

Work environment (Temperature, noise, light

etc)

Chemical/ biological hazards

Psychosocial factors

Staff interview

Control for work hazards

Personal protective gears

Ventilation eg LEV

Mechanical assist for lifting heavy loads

Engineering control eg substitution of

hazardous material in process

Workability

Developed by the Finnish Institute for

Occupational Health (FIOH)

Workability

Appropriate match and balance between:

individual resources, including health, functional

capacity, knowledge, skills and competencies,

values, attitudes, motivation, personal support

systems and other individual factors; and

the physical, mental and social demands

created by the nature of the individual’s work

and their physical and psychosocial work

environment.

Workability

Jo

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He

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Co

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Medical Fitness

Matching health and work

Need to know

Job scope and what exactly is involved

Match physical health, capability to the job task

Pre-existing illnesses/ Newly diagnosed

illnesses

Does it affect work performance

Will the work aggravate the medical condition

Medical Fitness

Medical illness ≠ Un-employability

Focus is on matching of work and health

Implication is possibility of higher medical

cost

Financing Healthcare Services

Agreed medical benefit plan

Capping

Co-payment

Insurance schemes

Financing Healthcare Services Managing and controlling of chronic diseases CDMP programme

Diabetes Hypertension Lipid disorders

Stroke Asthma Chronic Obstructive Pulmonary Disease (COPD) Schizophrenia Major depression

Bipolar depression Dementia

Financing Healthcare Services

Primary care partnership scheme

As of 2012 1st quarter

Extended to include patients > 40 yrs old

Cover chronic disease management

Government subsidy of $50 per visit for per

capita income of 901-1500 (Annual cap $300)

Government subsidy of $80 per visit for per

capita income of < 900 (Annual cap $480)

Financing Healthcare Services

Important to consider coverage for

hospitalisation and surgery

Maintenance of Health

Routine health screening

Occupational screening

GP coverage for chronic diseases

Important to adopt the concept of one

patient, one family doctor

What does it all mean? Medical checkups Redesigning of Work culture

Work-station, work environment

Job scope, job rotation

Work hours, shift pattern

Removal of hazards

Active staff feedback and actions

Monitoring of MC trends Expert assessment of workplace, work stations

Discussion with staff on new re-employment package

Etc etc etc

It’s a Paradigm Shift

Planning for re-employment

WHP

Promote and

encourage

healthy behaviours

Healthy workforce

Workplace

Assessment

Promote and

encourage

healthy workplace Ensure good job fit

Re-employment

PE

Successful engagement of

healthy experience staff

Management Support and HR policies

Thank You