The Aging The Aging Worker: Worker: ExposuresExposures to to

Chemicals, Physical and Chemicals, Physical and Infectious AgentsInfectious Agents

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Presented by:Presented by:

Ron Pearson, M.S., CIHRon Pearson, M.S., CIH

Environmental Health & Safety, Inc.Environmental Health & Safety, Inc.

Today’s presentation Today’s presentation

�� Will focus on Occupational Health Will focus on Occupational Health related to aging and:related to aging and:

�� Chemical exposuresChemical exposures

�� Noise exposuresNoise exposures�� Noise exposuresNoise exposures

�� Heat stressHeat stress

�� It will It will notnot address:address:

�� Ergonomic issuesErgonomic issues

�� Cognitive issues and mental healthCognitive issues and mental health

�� Visual changesVisual changes

Today’s Presentation:Today’s Presentation:

�� Part 1 Part 1 -- Definitions and TrendsDefinitions and Trends

�� Part 2 Part 2 -- Chemical ExposuresChemical Exposures

�� Part 3 Part 3 -- Physical and Infectious AgentsPhysical and Infectious Agents

Part 4 Part 4 -- Management IssuesManagement Issues�� Part 4 Part 4 -- Management IssuesManagement Issues

Part 1 Part 1 -- Definitions and Definitions and TrendsTrends

What is an “Aging Worker”?What is an “Aging Worker”?

�� It depends on whom you ask…It depends on whom you ask…

�� Some sources say > 40 years oldSome sources say > 40 years old

�� Most say > 45 years oldMost say > 45 years old

�� Some prefer groupings such as:Some prefer groupings such as:

�� ‘Younger’ aging worker: 45‘Younger’ aging worker: 45--5454

�� ‘Middle’ aging worker: 55‘Middle’ aging worker: 55--6565

�� ‘Older’ aging worker: >65‘Older’ aging worker: >65

Some facts...Some facts...

�� Older workers have:Older workers have:

�� low workplace injury rates (highest low workplace injury rates (highest rates are among workers 25rates are among workers 25--44) 44)

fewer work absencesfewer work absences

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�� fewer work absencesfewer work absences

�� low turnover rateslow turnover rates

�� Why? increased experience, safer Why? increased experience, safer behaviors, less physically demanding behaviors, less physically demanding jobsjobs

But ...But ...

�� Older workers have higher fatality rates, Older workers have higher fatality rates, from: from:

�� homicideshomicides

car accidentscar accidents

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�� car accidentscar accidents

�� fallsfalls

�� struck by objectsstruck by objects

Some Trends in the U.S....Some Trends in the U.S....

�� Declining birthratesDeclining birthrates

�� The percentage of the workforce above The percentage of the workforce above age 55 is increasingage 55 is increasing

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% of workers > 65 in the labor force% of workers > 65 in the labor force

%

30

20

?

By 2020, 30% of the U.S. population will be over 55

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1950 1960 1970 1980 1990 2000 2010

As we age, some things As we age, some things decrease..decrease..

�� Pulmonary function (oxygen absorption, Pulmonary function (oxygen absorption, carbon dioxide elimination)carbon dioxide elimination)

�� Cardiac function Cardiac function

�� Immune system functionality Immune system functionality

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�� Immune system functionality Immune system functionality

�� Activity of some liver enzymes and Activity of some liver enzymes and blood flowblood flow

�� Kidney filtration rates and blood flowKidney filtration rates and blood flow

�� Hearing abilityHearing ability

�� Ability to regulate body heatAbility to regulate body heat

And some things And some things (unfortunately) increase….(unfortunately) increase….

�� Cardiovascular diseases Cardiovascular diseases

�� hypertension (high blood pressure)hypertension (high blood pressure)

�� atherosclerosis (hardening of the atherosclerosis (hardening of the arteries)arteries)arteries)arteries)

�� arrhythmia (abnormal heart rhythms)arrhythmia (abnormal heart rhythms)

�� Cancer ratesCancer rates

�� Chronic Obstructive Pulmonary DiseaseChronic Obstructive Pulmonary Disease

�� DiabetesDiabetes

�� Neurological diseasesNeurological diseases

Causes of death Causes of death -- Ages 65Ages 65--7474

Cardiovascular diseases

Cancers

© Env. Health & Safety, Inc., 200912

diseases

Other

Respiratory diseases

Part 2 Part 2 -- Chemical Chemical ExposuresExposures

Chemical exposures and Chemical exposures and the aging workerthe aging worker

�� Very few environmental chemicals have Very few environmental chemicals have been tested for toxicity in the elderlybeen tested for toxicity in the elderly

�� In most cases, deficits relate more to lifeIn most cases, deficits relate more to life--style and diseases than to the aging style and diseases than to the aging

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style and diseases than to the aging style and diseases than to the aging process process per seper se (lack of exercise, eating (lack of exercise, eating and drinking habits, alcohol consumption, and drinking habits, alcohol consumption, smoking)smoking)

�� However, increased susceptibility must be However, increased susceptibility must be considering when managing exposures to considering when managing exposures to chemical, physical and infectious agentschemical, physical and infectious agents

Application of the TLVsApplication of the TLVs

�� “There are numerous possible reasons “There are numerous possible reasons for increased susceptibility to a for increased susceptibility to a chemical substance, including chemical substance, including ageage, , gender, ethnicity, genetic factors gender, ethnicity, genetic factors

R

© Env. Health & Safety, Inc., 2009

gender, ethnicity, genetic factors gender, ethnicity, genetic factors (predisposition), (predisposition), lifestyle choiceslifestyle choices(e.g., diet, smoking, abuse of alcohol (e.g., diet, smoking, abuse of alcohol and other drugs), and other drugs), medicationsmedications, and , and prepre--existing medical conditionsexisting medical conditions(e.g., aggravation of asthma or (e.g., aggravation of asthma or cardiovascular disease).”cardiovascular disease).”

Loss of sense of smellLoss of sense of smell

�� Has profound safety implications for Has profound safety implications for certain situations where chemical certain situations where chemical warning properties are criticalwarning properties are critical

�� High prevalence of atrophy of olfactory High prevalence of atrophy of olfactory senses reduces ability of many older senses reduces ability of many older

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senses reduces ability of many older senses reduces ability of many older people to detect low concentrations of people to detect low concentrations of chemicalschemicals

�� Example:Example: Street maintenance workers Street maintenance workers entering confined spaces with hydrogen entering confined spaces with hydrogen sulfidesulfide

Chemicals that are poorly Chemicals that are poorly metabolized metabolized -- Group 1Group 1

�� Absorbed and distributed into tissues Absorbed and distributed into tissues according to “partitioning behavior”according to “partitioning behavior”

�� Example:Example: Agricultural workers Agricultural workers exposed to organochlorine compounds exposed to organochlorine compounds

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exposed to organochlorine compounds exposed to organochlorine compounds (e.g some pesticides), which (e.g some pesticides), which concentrate in adipose (fat) tissue concentrate in adipose (fat) tissue

�� During weight loss, adipose tissue is During weight loss, adipose tissue is mobilized and accumulated chemicals mobilized and accumulated chemicals are liberated into body fluids. are liberated into body fluids.

Chemicals that are poorly Chemicals that are poorly metabolized metabolized -- Group 2Group 2

�� Poorly excreted, and accumulate in the bodyPoorly excreted, and accumulate in the body

�� Some are detoxified by binding to specific Some are detoxified by binding to specific proteins, resulting in longproteins, resulting in long--term storageterm storage

�� Example: Example: Welders exposed to heavy Welders exposed to heavy

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�� Example: Example: Welders exposed to heavy Welders exposed to heavy metals such as cadmium metals such as cadmium -- toxicity among toxicity among workers over 50 may be related to the workers over 50 may be related to the decreased capacity of decreased capacity of metallothioneinmetallothioneinsynthesis with advancing agesynthesis with advancing age (which (which

normally help in detoxification of heavy normally help in detoxification of heavy metals)metals)

Lung ToxicantsLung Toxicants�� Air contaminants can be metabolized to Air contaminants can be metabolized to

“reactive intermediates” and damage cells“reactive intermediates” and damage cells

�� Can cause severe adverse effects on older Can cause severe adverse effects on older workers with weak defense mechanisms workers with weak defense mechanisms --chronic effects such as COPD (Chronic chronic effects such as COPD (Chronic

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chronic effects such as COPD (Chronic chronic effects such as COPD (Chronic Obstructive Pulmonary Disease) Obstructive Pulmonary Disease)

�� Example:Example: Auto or fleet maintenance Auto or fleet maintenance mechanics mechanics -- exhaust gasesexhaust gases

�� Example:Example: Maintenance workers exposed Maintenance workers exposed to irritant gases from torch cutting or to irritant gases from torch cutting or weldingwelding

WorkWork--related Asthmarelated Asthma�� Best estimates suggest ~ 15% of Best estimates suggest ~ 15% of

asthma cases are related to work asthma cases are related to work exposureexposure

�� Wide variety of causal agents Wide variety of causal agents -- epoxies, epoxies, acrylates, wood dusts, formaldehydeacrylates, wood dusts, formaldehydeacrylates, wood dusts, formaldehydeacrylates, wood dusts, formaldehyde

�� As workforce ages, so will number of As workforce ages, so will number of asthma casesasthma cases

�� Differentiation between COPD and Differentiation between COPD and asthma is complicatedasthma is complicated

NeurotoxinsNeurotoxins

�� Manganese can cause rigidity and Manganese can cause rigidity and tremorstremors resembling Parkinson's diseaseresembling Parkinson's disease

�� Example:Example: Metal workers using inertMetal workers using inert--gas welding (e.g. MIG, TIG) may be gas welding (e.g. MIG, TIG) may be

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gas welding (e.g. MIG, TIG) may be gas welding (e.g. MIG, TIG) may be exposed to high levels of airborne exposed to high levels of airborne manganese fumemanganese fume

General Toxicants General Toxicants --Carbon MonoxideCarbon Monoxide

�� Older workers are more susceptible to Older workers are more susceptible to the effects of carbon monoxide due to the effects of carbon monoxide due to cardiac insufficiencycardiac insufficiency

�� Blood Blood COHbCOHb ((carboxyhemoglobincarboxyhemoglobin) is a ) is a �� Blood Blood COHbCOHb ((carboxyhemoglobincarboxyhemoglobin) is a ) is a biomarker of exposure biomarker of exposure -- values of about values of about 5% for an average adult performing light 5% for an average adult performing light work for 6 to 8 hours at 35 work for 6 to 8 hours at 35 ppmppm

�� Studies have shown a reduction in the Studies have shown a reduction in the length of time to the onset of angina in length of time to the onset of angina in men with stable angina pectorismen with stable angina pectoris

Carbon monoxide Carbon monoxide -- continuedcontinued--

�� TLVTLV(R)(R) is set at 25 is set at 25 ppmppm to prevent to prevent COHbCOHbfrom exceeding 3.5%from exceeding 3.5%

�� Example:Example: Older forklift operators Older forklift operators chronically exposed to levels of carbon chronically exposed to levels of carbon chronically exposed to levels of carbon chronically exposed to levels of carbon monoxide below occupational exposure monoxide below occupational exposure limits may still cause adverse health limits may still cause adverse health effectseffects

�� ASHRAE recommends a limit of 9 ASHRAE recommends a limit of 9 ppmppm in in its Indoor Air Quality standard (62)its Indoor Air Quality standard (62)

Regulatory Issues:Regulatory Issues:Methylene ChlorideMethylene Chloride

�� Federal OSHA Standard puts a specific age Federal OSHA Standard puts a specific age requirement on medical surveillancerequirement on medical surveillance

�� For employees < 45 years, every three For employees < 45 years, every three �� For employees < 45 years, every three For employees < 45 years, every three yearsyears

�� For employees > 45 years, For employees > 45 years, everyevery yearyear

Regulatory Issues:Regulatory Issues:Methylene ChlorideMethylene Chloride

�� Preamble to the Federal OSHA Standard: “... it Preamble to the Federal OSHA Standard: “... it is ... more likely that employees 45 years and is ... more likely that employees 45 years and older would experience the adverse cardiac older would experience the adverse cardiac effects of MC exposure. Threeeffects of MC exposure. Three--year intervals year intervals between physical examinations for workers between physical examinations for workers between physical examinations for workers between physical examinations for workers younger than 45 seemed the proper interval to younger than 45 seemed the proper interval to balance the conservation of valuable medical balance the conservation of valuable medical resources and the provision of a medical resources and the provision of a medical surveillance program that is useful for detecting surveillance program that is useful for detecting adverse MC health effects.”adverse MC health effects.”

Medical Diagnoses IssuesMedical Diagnoses Issues

�� A 1991 Study (Landrigan and Baker) A 1991 Study (Landrigan and Baker) estimated that there are 50,000 to estimated that there are 50,000 to 70,000 deaths yearly from workplace 70,000 deaths yearly from workplace diseases, and;diseases, and;

�� These are typically These are typically notnot correctly correctly diagnosed because they mimic nondiagnosed because they mimic non--occupational illnesses or disorders, and;occupational illnesses or disorders, and;

�� Most physicians are not adequately Most physicians are not adequately trained to recognize them.trained to recognize them.

Part 3Part 3Physical and Infectious Physical and Infectious

AgentsAgents

Noise and Hearing LossNoise and Hearing Loss

�� Older workers lose ability to distinguish Older workers lose ability to distinguish high frequencies (presbycusis) high frequencies (presbycusis)

�� Decreased speech intelligibility (can’t Decreased speech intelligibility (can’t

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�� Decreased speech intelligibility (can’t Decreased speech intelligibility (can’t distinguish consonants)distinguish consonants)

�� Management responses Management responses -- will be will be discussed later in Management sectiondiscussed later in Management section

Heat StressHeat Stress�� WBGT (web bulb globe temperature) WBGT (web bulb globe temperature)

nomographsnomographs are typically how work regimens are typically how work regimens are established in hot, humid weatherare established in hot, humid weather

�� Older workers are less able to maintain Older workers are less able to maintain normal temperature because they:normal temperature because they:normal temperature because they:normal temperature because they:

�� have decreased peripheral blood flow, and; have decreased peripheral blood flow, and;

�� start sweating laterstart sweating later

�� They are at an increased risk for heat stroke They are at an increased risk for heat stroke (which is a life(which is a life--threatening emergency)threatening emergency)

Infectious AgentsInfectious Agents

�� Immunodeficiency among elderly is Immunodeficiency among elderly is wellwell--documented documented -- presents greater presents greater susceptibility to some infectious agentssusceptibility to some infectious agents

�� ExampleExample: HVAC maintenance : HVAC maintenance technicians and exposure to technicians and exposure to legionellalegionella

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technicians and exposure to technicians and exposure to legionellalegionellain water supplies (e.g. cooling towers) in water supplies (e.g. cooling towers) --potential to develop Legionnaire’s potential to develop Legionnaire’s diseasedisease

Part 4 Part 4 -- Management Management IssuesIssues

Why should we want to keep Why should we want to keep older workers in the labor force?older workers in the labor force?

�� Very good productivity Very good productivity

�� Work ethic, loyalty, dedicationWork ethic, loyalty, dedication

�� Job experienceJob experience�� Job experienceJob experience

�� Knowledge, including Knowledge, including basic skills in reading, writing, and math

�� AvailabilityAvailability

How should industry respond?How should industry respond?

�� Management needs to be careful to Management needs to be careful to respond not to just the ‘squeaky wheels”respond not to just the ‘squeaky wheels”

�� Older workers are most likely to raise Older workers are most likely to raise complaints about sensory issues complaints about sensory issues -- ‘too ‘too complaints about sensory issues complaints about sensory issues -- ‘too ‘too cold’, ‘too dim’, etc.cold’, ‘too dim’, etc.

�� They are unlikely to be aware of more They are unlikely to be aware of more serious health threats from ‘silent’ serious health threats from ‘silent’ chemical exposures until it is too latechemical exposures until it is too late

How should industry respond?How should industry respond?

�� Company managers need to Company managers need to anticipateanticipate and and prepare for ways to prevent occupational prepare for ways to prevent occupational health issues among older workershealth issues among older workers

�� Recognition of ageRecognition of age--related diseases (e.g. related diseases (e.g. diabetes) is needed to prevent confusion diabetes) is needed to prevent confusion

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diabetes) is needed to prevent confusion diabetes) is needed to prevent confusion with other workwith other work--related causes (e.g. related causes (e.g. peripheral neuropathy)peripheral neuropathy)

�� Most older workers are unlikely to ‘selfMost older workers are unlikely to ‘self--regulate’ their activities to accommodate regulate’ their activities to accommodate their own their own needneed

How should industry respond?How should industry respond?AdministrativeAdministrative ChangesChanges

�� Rotating staff to minimize chemical and/or Rotating staff to minimize chemical and/or noise exposuresnoise exposures

�� Assessment of hearing loss Assessment of hearing loss -- may need to may need to modify evaluation protocols modify evaluation protocols

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modify evaluation protocols modify evaluation protocols

�� Assigning younger workers to work Assigning younger workers to work outdoors in very hot/humid weatheroutdoors in very hot/humid weather

�� Training Training -- training older worker to be training older worker to be aware of their own physical aware of their own physical limitationslimitations

How should industry respond?How should industry respond?Engineering ChangesEngineering Changes

�� Upgrading exhaust ventilation (to eliminate Upgrading exhaust ventilation (to eliminate need for respirators)need for respirators)

�� Improving noise controlsImproving noise controls

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Improving noise controlsImproving noise controls

�� Modifying warning systems (e.g. existing Modifying warning systems (e.g. existing audible alarms)audible alarms)

�� compensate for existing hearing loss by compensate for existing hearing loss by using other senses using other senses -- e.g. add vibratory or e.g. add vibratory or visual alarms visual alarms -- or lowering ‘pitch’ or lowering ‘pitch’ (frequency(frequency))

How should industry respond?How should industry respond?Medical SurveillanceMedical Surveillance and and

PPE ProgramsPPE Programs�� Assessment of respirator use abilities Assessment of respirator use abilities -- may may

need to modify medical screening protocolsneed to modify medical screening protocols

Be aware of differentiating medical screening Be aware of differentiating medical screening

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�� Be aware of differentiating medical screening Be aware of differentiating medical screening requirements for older workers (e.g. requirements for older workers (e.g. methylenemethylene chloride)chloride)

�� Prescription safety glasses Prescription safety glasses -- consider consider providing this option to all workers > providing this option to all workers > 5050

Future TrendsFuture Trends

�� Occupational Exposure Limits may be Occupational Exposure Limits may be set with a new subset with a new sub--category for older category for older workersworkers

�� More research is definitely needed to More research is definitely needed to quantify risks and further define control quantify risks and further define control optionsoptions

ResourcesResources

�� International Program on Chemical International Program on Chemical Safety: Environmental Health Criteria Safety: Environmental Health Criteria 144 144 -- ““Principles of evaluating chemical Principles of evaluating chemical effect on the aged Population”effect on the aged Population”effect on the aged Population”effect on the aged Population”

�� “Health and Safety Needs of Older “Health and Safety Needs of Older Workers”, National Academies Press Workers”, National Academies Press (available on NIOSH website)(available on NIOSH website)