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Occupational Health & Safety>Australian & New Zealand Journal of Health, Safety and Environment>2012 Volume 28(2)>FEATURE ARTICLE>[¶28-222] Ageing workers in the
health care environment — A review of available information to assist employers
© CCH 1
[¶28-222] Ageing workers in the health care environment — A
review of available information to assist employers
Click to open document in a browser
Last reviewed: 17 October 2012
C Marsh and P Rothmore
Colin Marsh, BHSc, BSSc, MOHS is a Graduate of the University of Adelaide.
Paul Rothmore, BAppSc (Hons) (Physio), MErg, FACP is a Lecturer and Program Director of the
Postgraduate Occupational Health and Safety Management Program in the Discipline of Public Health,
School of Population Health, at the University of Adelaide.
Address for correspondence Colin Marsh, c/- GPO Box 465, Adelaide SA 5001.
Email: Marsh.Colin@dpc.sa.gov.au
Abstract
The Australian population, and its workforce, is ageing. The increased risk of injury faced by the
older worker due to physiological changes, while generally well-known, is not well considered
in the design of the working environment. This is particularly apparent in the health care sector
where an ageing workforce provides care for an increasingly aged and infirmed patient population
in environments that do not specifically cater for the needs of either. We have sought to examine
the availability of information to assist workplace designers, health and safety professionals and
employers design health care environments for the older worker by undertaking a systematic search
of electronic media. The results have shown a lack of specific guidance or regulatory material. If
Australia seeks to promote work into, and beyond, potential retirement age then specific standards
are required to address the needs of the ageing workforce.
Keywords: ageing, workforce, health care.
Introduction
Australia’s population is ageing. This is the apparent result of sustained low fertility and increasing life
expectancy. The median age of the Australian population has increased by over five years between 1988
and 2008. During this same period, the proportion of Australians aged 65 years and over increased from
10.8% to 13.3%, while those aged over 85 years more than doubled from 0.8% to 1.7%.1
An ageing workforce reflects the impact of Australia’s ageing population, as many Australians choose an
older retirement age. The World Health Organization describes older workers as those aged 45 years and
over.2 A 2007 Australian Bureau of Statistics (ABS) report identified that of the 3.9m Australian workers over
the age of 45, 40% plan to retire aged 65–69 years, 24% plan to retire aged 70 years or over, while 15% do
not intend to retire from the workforce at all.3 This creates a health and safety issue particularly for workers
in the health care sector, where an ageing workforce is caring for an increasingly aged and dependent
patient population. This is further complicated by chronic staff shortages.4
To resolve this health and safety issue, since population demographics are not easily influenced, one must
look to changes in the health care environment. Unfortunately the building or refurbishment of health care
environments occurs relatively infrequently and usually at high cost. Traditionally, designers and planners
have been more motivated by cost-containment and compliance with mandatory regulations than by full
Occupational Health & Safety>Australian & New Zealand Journal of Health, Safety and Environment>2012 Volume 28(2)>FEATURE ARTICLE>[¶28-222] Ageing workers in the
health care environment — A review of available information to assist employers
© CCH 2
consideration of the long-term health factors of those working in the environment. This is especially the case
where clear guidance material is unavailable.
Against this background a review of the availability and relevance of both mandatory and guidance material
on the design of health care environments for the ageing workforce was undertaken.
Age-related changes
The risk of work-related musculoskeletal injuries increases with age, with those over 45 years of age most at
risk.5 It is suggested that this trend is related to the 20% decrease in physical work capacity, which is seen
between the ages of 40 and 60.6
The manual handling of patients is one of the major risk factors for the development of musculoskeletal
disorders in the lower back and shoulders of older workers.7 Lifting, handling and assisting patients requires
continuous postural and balance control — functions known to decrease markedly beyond the age of 50
years.8 In addition, reduced physical activity associated with ageing can result in decreased muscle mass,
tone and strength, further contributing to an overall decline in mobility.9
Dynamic balance is an important factor in ensuring the safe performance of physically demanding jobs
and the prevention of musculoskeletal disorders.8 Decreased muscle strength, along with declining vision
and balance, both of which predictably decline with age, are associated with a loss of dynamic balance
and increased likelihood of falls. 9 ,10 Other age-related phenomena, such as changes in spinal curvature,
can bring about changes to the centre of gravity. Gait patterns also undergo change with age, with males
adopting a wider gait pattern and females a narrower pattern. Consequently, older women may be more
prone to falls than their male counterparts.9
Age-related muscle atrophy is not confined to the skeletal locomotor system. The respiratory diaphragm, a
skeletal muscle, is also susceptible to age-related atrophy, resulting in decreased lung function. This, along
with similar effects on the heart muscles, results in older people being less able to undertake and recover
from rigorous exercise. Furthermore, the ageing process brings about a greater risk of disorders such as
osteoporosis — a condition found especially in women and one that can accelerate during menopause.10
The risk of injury in the health care setting is known to be higher in women than in men11 with strong
evidence that females are at greater risk of neck, shoulder, lower back, wrist, hand and ankle injuries. This
may be partly explained due to high concentrations of female employees in this sector.12 There are also
increased risks of back strain for direct caregivers, and those fatigued from working longer hours, as well as
those who are overweight or obese.5
Methods
A multi-step approach was applied to systematically determine the information available to designers of
workplaces and employers of older workers in the health care industry. Australian Standards, the Building
Code of Australia, Australian government department websites, industry associations and Australian media
outlet sites were each scanned using a list of 13 keywords, each previously identified in the literature as
those used most frequently to describe the physiological effects of ageing (see Table 1).
Table 1: List of keywords used for research
– Aerobic – Fitness – “Old age”
– Ageing – Frail – Older
– Aging – Geriatric – Posture
– Balance – Mature – Strength
– Elderly
Occupational Health & Safety>Australian & New Zealand Journal of Health, Safety and Environment>2012 Volume 28(2)>FEATURE ARTICLE>[¶28-222] Ageing workers in the
health care environment — A review of available information to assist employers
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A series of legislative and popular press databases were searched using the source’s online search tools to
locate the identified keywords. Documents containing keyword hits were closely scrutinised for relevance.
Relevant legislative documents were subjected to checks on the AustLII to determine if they were legally
binding in any Australian jurisdiction. The following databases were used:
• TV News
• Media Scan
• Australian Standards
• Building Code of Australia (BCA).
A series of government and non-government websites were searched using a targeted Google search string,
and the top 50 results from each search were individually scrutinised for relevance. This strategy relied on
the 13 identified keywords being divided into one of three subgroups:
1. words that identify a human attribute that declines with age
2. words used to describe older persons, and
3. words related to industry.
The search string ensured that webpage hits were only generated when at least one keyword from each
subgroup was found, and appears as follows:
site: www.safework.sa.gov.au (aerobic OR balance OR fitness OR posture OR strength) AND
(ageing OR aging OR elderly OR frail OR geriatric OR mature OR “old age” OR older) AND
(work* OR employ* OR nurs* OR “aged care” OR “health care” OR hospital)
The Australian government department websites searched using this strategy were those responsible for
the Development, Planning, Infrastructure, Occupational Health and Safety, Families, Health, Ageing and
Disability portfolios. The Australian industry association websites searched using this strategy are linked with
nursing, occupational health and safety, and aged care.
Results
Australian Standards
The keyword search of the Australian Standards database resulted in over 50 documents requiring full
review. However, none of the Standards or their related documents, including those still in the draft stage,
provided relevant information. While some drew upon the common point that consideration needs to be
given to all people when considering workplace design, none gave specific consideration of, or provided
recommendations to address ageing workforce issues.
Building Code of Australia
The search of the Building Code of Australia (BCA) — Volumes One and Two did not return any relevant
keyword hits. The keyword search of the BCA Guide did however, indicate that the needs of the elderly were
considered when setting out the provisions of the BCA.
Australian government departments
The results showed that very few Australian government departments publish information relevant to ageing
workforce factors; rather, they tend to reference the work of published authors.
One of the few sites to provide relevant guidance material — WorkSafe Victoria — published two guides of
interest: A guide to designing workplace for safer handling of people — for health, aged care, rehabilitation
and disability facilities (2007) and Transferring people safely (2009). While these guides are detailed and
Occupational Health & Safety>Australian & New Zealand Journal of Health, Safety and Environment>2012 Volume 28(2)>FEATURE ARTICLE>[¶28-222] Ageing workers in the
health care environment — A review of available information to assist employers
© CCH 4
highly valuable they do not consider factors relevant to the ageing workforce issue currently facing the health
care industry.
The search of the WorkCover New South Wales website located two documents of interest: the Ageing
Workforce Report (2007) and the Manual Handling Risk Guide (2009). While both of these documents
showed due consideration of ageing workforce factors, neither provided particular recommendations or
solutions for overcoming these issues.
Workplace Standards Tasmania previously published two documents on body strain — Body Strain
Prevention Kit — Your Guide to avoiding manual handling injuries in the workplace (2007), and Body Strain
Prevention for Workers — Your Guide to avoiding manual handling injuries in the workplace (2007). These
documents identified that workloads need to be adjusted throughout the ageing process to prevent injury;
however they did not cite the specific effects of ageing nor recommend ways in which workload should be
adjusted. These two documents have since been replaced by the Guide to Preventing Body Strain — How
to Avoid Manual Handling Injuries in Your Workplace (2009), which does not discuss factors related to the
ageing workforce.
The Comcare website provided the most relevant hit with a report entitled Productive and Safe Workplaces
for an Ageing Workforce (2003), however the document itself could not be located. This report was ultimately
located on the website of the Australian Public Service Commission (www.apsc.gov.au). While it provides
very strong guidance on how to reduce the risk of injury to ageing workers, providing recommendations
consistent with the current literature, the difficulty in its location is likely to mean that it is rarely accessed.
Industry associations
The search of the industry association websites did not generate any relevant results. Like the government
departments search, a large number of results focused on work-life balance issues, but there was no
evidence of consideration of ageing workforce factors.
Popular press (Media Scan and TVNews Databases)
The search of the TVNews and Media Scan databases from 1999 onwards did not yield any relevant
results. While a generous number of articles on related topics, such as work-life balance, general health
and wellbeing, superannuation and retirement, age discrimination, consumer issues and aged care crises
were found, none of these addressed the topics of ageing workforce factors from an occupational health and
safety or design perspective.
Discussion
The absence of relevant information within existing Australian Standards, beyond a general statement of
the importance of universal design, indicates that a specific Australian Standard to address the needs of
the older worker is required. While several standards do address age-related issues, this is done from the
consumer rather than a workforce perspective. As a result there is the potential for increased risk to the older
workforce if guidance is one-dimensional and focused only on the needs of the health care recipient.
Ergonomics seeks to match the worker with their environment and although the Australian Standards and
legislation do encourage employers and designers to adopt ergonomic principles, they focus on universal
designs only. Consequently older health care workers may inadvertently be placed at increased risk.
Furthermore, where no standards apply, the implementation of ergonomic principles may create uncertainty
for employers. An Australian Standard needs to be developed specifically for the ageing workforce, in order
to provide clear and concise direction and minimise the “grey” areas of ergonomics.
Like the Australian Standards, universal design is encouraged within the Building Code of Australia (BCA).
The BCA Guide states that the needs of the elderly were duly considered in its preparation. While at face
value this appears reasonable, rarely will one set of design guidelines adequately address a wide population
demographic.
Occupational Health & Safety>Australian & New Zealand Journal of Health, Safety and Environment>2012 Volume 28(2)>FEATURE ARTICLE>[¶28-222] Ageing workers in the
health care environment — A review of available information to assist employers
© CCH 5
Common to the Australian government department websites is that there are no stances taken, very few
recommendations made, and very little information available in relation to ageing workforce factors. Clear
guidelines for designers, employers and workers are absent. The literature has identified health care
workers as a high-risk group for manual handling injuries and exposure to ergonomic hazards, yet there is
no information to assist industry in general, let alone one of such high risk as the health care sector. While
governments are aware of ageing population patterns, there appears to be a relative absence of awareness
surrounding the issues relating to the older worker.
Overwhelmingly, Australian industry association websites lacked information relating to ageing workforce
factors. This may be a reflection of the fact that some industry association websites require memberships to
acquire access to certain parts of the site. Although the search strategy used did not appear affected by such
limitations (a test showed that Google still generates results for pages that are ultimately inaccessible without
membership and a password), it is unclear whether such information exists but is available to members only.
However, this only demonstrates that information is not readily available.
It is not known if the lack of positive results for the popular press search conducted is due to the lack
of published information relating to ageing workforce factors in the health care industry, or if the media
databases searched and the methods used were inadequate. However, given the lack of promotion of ageing
workforce factors among government departments and industry associations, it is highly likely that the media
is largely unaware of the dilemma facing the health care industry.
With the overwhelming availability of scientific research in the areas of ageing, both in the workforce and the
general population, it is questionable why more research has not been conducted on the combined effects
of the two. The relative absence of such research may partly explain why the two key drivers for potential
change, government departments and industry associations, have not addressed this issue. However, the
case for legislative reform is compelling.
Conclusions
While the physiological effects of ageing and the ageing workforce demographic are known, there is a
consistent lack of information linking these two issues — ie how do we cater for and maintain the health and
safety of the ageing worker? Where information does exist it is provided in the form of guidance material
rather than regulatory requirements with which employers and designers of workplaces must comply.
If Australia seeks to promote work into, and beyond, potential retirement age then specific standards are
required to address the needs of the ageing workforce. This requirement is particularly stark in the health
care sector where the expertise of an ageing workforce is needed to provide care for the aged, ill and infirm
members of the population.
Specific standards and design requirements are needed to ensure the minimum requirements of the ageing
worker are met. These should be legislated to ensure they are not consigned to the fate of other general
guidance material with which employers and designers may or may not choose to comply. While stronger
scientific evidence addressing the impact of an ageing population on an ageing health care workforce is
needed, regulatory action is required in the short-term if Australia is to maintain the health of this existing,
and ageing, workforce.
References
Footnotes
1 Australian Bureau of Statistics. 3201.0 — Population by Age and Sex, Australian States and Territories,
June 2008. Canberra, Australia: Australian Bureau of Statistics, 2008.
2
Occupational Health & Safety>Australian & New Zealand Journal of Health, Safety and Environment>2012 Volume 28(2)>FEATURE ARTICLE>[¶28-222] Ageing workers in the
health care environment — A review of available information to assist employers
© CCH 6
Government of Alberta, Human Resources and Employment . Safe and Healthy — a Guide to
Managing an Aging Workforce. Alberta, Canada: Government of Alberta, Human Resources and
Employment, 2006.
3 Australian Bureau of Statistics. 6361.0 — Employment Arrangements, Retirement and Superannuation,
Australia, April to July 2007. Canberra, Australia: Australian Bureau of Statistics 2007.
4 Gabrielle S, Jackson D, Mannix J. Older women nurses: health, ageing concerns and self-care
strategies. J Adv Nurs. 2008; 61(3):316-25.
5 Thomas NI, Brown ND, Hodges LC, Gandy J, Lawson L, Lord JE et al. Risk profiles for four
types of work-related injury among hospital employees — A case-control study. AAOHN Journal
2006;54(2):62-68.
6 Kenny GP, Yardley JE, Martineau L, Jay O. Physical work capacity in older adults: implications for the
aging worker. Am J Ind Med. 2008;51(8):610-25.
7 Kim S, Barker LM, Jia B, Agnew MJ, Nussbaum MA. Effects of two hospital bed design features on
physical demands and usability during brake engagement and patient transportation: A repeated
measures experimental study. Int J Nurs Stud. 2009;46(3):317-325.
8 Punakallio A. Balance abilities of different-aged workers in physically demanding jobs. J Occup Rehabil.
2003; 13(1):33-43.
9 Farley A, McLafferty E, Hendry C. The physiological effects of ageing on the activities of living. Nursing
Standard 2006; 20(45):46-52.
10 Watson R. Research into ageing and older people. Journal of Nursing Management. 2008;
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11 Thomas NI, Brown ND, Hodges LC, Gandy J, Lawson L, Lord JE et al. Factors associated with work-
related injury among hospital employees — a case-control study. AAOHN Journal 2006; 54(1):24-31.
12 Malone RE. Ergonomics, policy, and the ED nurse. J Emerg Nurs. 2000; 26(5):514-515.
