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Specialist GP Ngaire Kerse explains that older people are an important part of the workforce, and primary care can help keep them there
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Welcome to a new year, a new prime minister and ever-present pressure on general practice to deliver more for less. The ageing demographic is now hurting with not enough workers to do usual jobs and not enough young people to train for those jobs. In my day, there were lots of younger people waiting for jobs, and we encouraged older workers to “step aside” and make room.
Those days are gone, and there is a need to rethink older workers, understand their needs and motivations to work, and facilitate them continuing if possible. I know this is happening to older GPs right now.
Older workers do face challenges, not the least of which is ongoing ageism that constrains some employers from considering them as viable candidates for jobs. There will be a great need for innovation in all areas. Please be aware that your older patients may continue to work, and that older people may be one of the answers to your workforce shortages.
Te Ara Ahunga Ora Retirement Commission reports that over one-third of New Zealand’s workforce is aged 55 and over, and of those aged 65–79, 44 per cent have paid jobs.1 In the LiLACS NZ study, up to 10 per cent of octogenarians were in paid work in 2010 (and this is increasing yearly).2 I think we all have stories of people in their 90s contributing to the workforce. In my GP’s practice, the gardener was a retired patient for many years.
Last year, minister for seniors Ayesha Verrall, before she became minister of health, launched the Older Workers Employment Action Plan, focusing on workers aged 50 and over, and calling for training and upskilling, supporting employers to be inclusive and planning for opportunities for the ageing workforce.3
Cognitive stimulation and “use it or lose it” are common topics of conversation; however…some of this talk can be thought of as ageist stereotyping
The importance of health for the older worker is more salient when there are conditions that interfere with the job. Reviews about older workers show age-related changes such as reduced aerobic capacity, reduced physical strength and endurance, and the need for greater times in recovery. How this impacts work performance depends on the job of course. Intolerance to severe weather events (heat and cold) is worth a mention, and awareness of this can be increased.4
On the other hand, older workers are at reduced risk of accidents and take less unscheduled time off. Older workers are recognised for work-related experience and life experience, which often makes them attractive to employers.
Psychologically, wisdom and judgement increase with age, while reaction times and rapid calculation times reduce. Cognitive stimulation and “use it or lose it” are common topics of conversation; however, the vast majority of older workers are cognitively normal on testing, and some of this talk can be thought of as ageist stereotyping.
Interventions to improve health and work performance are not well studied, but general health promotion and physical exercise do seem to make a difference. As the GP, I think our job is to manage proactively according to the needs of the person and the job. That means asking about those needs, asking about any developing difficulties, and really focusing on prevention and increasing physical activity to improve endurance and musculoskeletal function.
Musculoskeletal difficulties are manageable with good physiotherapy. I just wish physiotherapy was free to the patient, as older manual labourers have the most problems and the least disposable income. Shall we all write to ACC to ask for proactive maintenance physiotherapy to keep older people working comfortably?
As society and individuals (and us) go through demographic ageing, it is not just the complexity of the very old with multimorbidity that can be a focus for primary care, but also the needs of those reaching older age. We really need public health physiotherapy and exercise specialists to keep everyone moving.
Anything that primary care can do to promote ongoing engagement in physical activity, self-management of chronic conditions and early identification of reversible and treatable conditions will be good for the workforce, the practice, and older people and their loved ones.
Ngaire Kerse is president of the New Zealand Association of Gerontology and the Joyce Cook Chair in Ageing Well, University of Auckland
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