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Working Towards Wellbeing
1
PHYSIO UK 2014
Measuring Functional Capacity in the
Ageing Workforce
Nicola Hunter
Session objectives
Delegates will be able to describe
– the demographic problem the UK faces with the
ageing workforce and increase in long term conditions
– the physical changes that occur in the body due to
increasing age
– what is a FCE is and what it can and cant measure
– Delegates will be aware of the ACPOHE guidelines
for safe administration of FCE/ functional
measurement
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Today's talk
• The effects of ageing
• Impact on work
• Physio’s role and ACPOHE guidelines for physiotherapists
• What is FCE
• Key contacts and key points
The effects of ageing
• Skin
• Hair
• Teeth
• Body shape
• Activity
Aerobic fitness
• Reaches its peak by age 20
• Declines with age – 3% in 20’s
– 6% in 30’s
– 8% in 40’s
– 20% + in 70’s
• Maintained by moderate activity 70% maximum heart rate
• Increased by moderate to intense aerobic activity 80-85% maximum heart rate
Fleg et al 2005
Muscle gets weaker with age
• Loss of skeletal muscle mass which can reduce by
35-40% between 20 and 80 without regular exercise.
– ½% per year until 50
– 1% per year after 50
BUT
• 80 - year olds can gain 10% in strength in 6 week
training programme
Cadore et al 2014
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4037310/pdf/ad-5-3-183.pdf
Muscle strength declines with age
7 Changes in the muscle/body weight ratio with aging in healthy men and women (Proctor et al 1998)
Effects of weak muscles …
• Decline of explosive power (can’t set off so quickly)
• Decline in the ability to perform rapid repetitive
movements (cant do stuff so quickly)
• Reduction in strength of knee extensors (harder to rise
from a chair, get up from the floor, lift, carry etc)
• Reduction in calf strength to body weight
– Slower walking times
– Reduced step up ability
– Falls
Posture and flexibility
• Posture become stooped with age
Skelton 2001
Flexibility should not change with age
• Only small losses in joint range of movement
before age 75
- Up to 20 % loss of hip extension
• So up to age 75 substantial loss of joint mobility
is abnormal and should not be attributed to
ageing
Balance and agility changes
• Nerve conduction – velocity and amplitude slows
• Slower movement
• Reduced balance
Jagga et al 2011
The impact on work
• Ageing population
• No retirement age
• People are working later
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Work is good for you!
40% of 50 year olds have at least one long
term conditions
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Effects of age at work
• Biological and chronological age difference
– Physiological decline (strength aerobics etc)
– Mental decline (memory reaction times)
In the past people left at 65
• Extended working due to economic, business or
personal preference
• No known link between age and performance
– Older workers can perform just as well as younger
counterparts
– Longer exposure to occupational risks
– Impact on safety and performance is currently
unknown
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Physio’s role?
• Treat people of working age – Assess the workers capabilities
– Consider the physical demands of the job
– Maintain or raise the workers capability to meet job demands
– Adjust or modify the job
• Work is good for the economy and the health service
• Being unemployed is unhealthy (Black, 2008)
Advising employers about
fitness for work
The RTW Panel
AHP Advisory Fitness for
Work Report
allows you to provide
information on the
functional impact of a
patient’s reported
problem
allows you to suggest
options that may support
the patient to remain in
or return to work.
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The workplace and RTW
Organisational
perspective
• Sickness absence costs
employers £11bn pa
• Long term absence =5%
lost time and 75% cost
Employee perspective
• Work is good for health
• Brings normality ,self
esteem mental wellbeing
social inclusion financial
stability
• Failure to RTW linked to
poor health outcomes Despite significant advance in rehabilitation
policies and RTW interventions, employees still
have difficulty with RTW after long term
absence.
People with LTC are more likely to cease work
ACPOHE FCE guidelines
Functional Capacity Evaluations and Psychosocial Screening Tools
By Dr Julie Denning
What is FCE
• Now used internationally
• Work disability (chronic pain)
• Objective basis for rehab and return to work
• Key researchers: Netherlands, Canada,
• Bi Annual FCE research meeting
FCE is an evaluation of capacity of activities that is used to make recommendations for participation in work, while considering the person’s body functions and structures, environmental factors, personal factors and health status. Soer 2008
Objective functional test
SOCIAL
BIO
PSYCHO
OCC
Typical evaluation
• Routine MSD assessment
• Psychological factors beliefs and behaviours
• Occupational demands and beliefs
• Functional tests to simulate key job requirements
What sort of functional tests can
physio’s use?
• Aerobic
• Walking distance/time
• Mobility
• Lifting and handling
capability
• Hand dexterity
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Short FCE Protocols Gross and Battie 2007
Trunk
• 15-min stand
• Lift floor-to-
waist
• 1-min crouch
• 2-min kneel
• 5-min rotation
Lower extremity
• 15-min stand
• Lift floor-to-waist
• 1-min crouch
• 2-min kneel
• Stepladder/stairs
Upper extremity
• Waist-to-overhead lift
• Elevated work
• Crawling
• Handgrip
• Hand coordination
How do we measure fitness
for work?. Consider…
• What physical capabilities does the job require?
• What does the person’s pre illness or injury lifestyle require?
• What's the best functional test to use to simulate this?
• Is the test safe bearing in mind the persons condition?
• How do you ensure that your test accurately?
• What can you deduce from the result?
• How do you report it?
• What should physio’s do if the person does not meet the mark?
Plan to tackle factors
identified
0
17.5
35
52.5
70
bio psycho occupational functional
Functional rehabilitation
ACPOHE Functional
measurement working party
• Glyn Smith Chairperson
• ACPOHE training courses
• www.acpohe.org.uk
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The Association of Chartered Physiotherapists in Occupational Health and Ergonomics
Key points
• The UK workforce is getting older and many
workers will have long term conditions
• Physio’s are well placed to advise on fitness for
work
• Physio’s must use objective measures to make
decisions and provide advice
• Physio’s must provide effective return to work
functional rehabilitation
• Physio’s should promote activity for health
• Exercise is Medicine
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Thank you
www.acpohe.org.uk
www.workingtowardswellbeing.com
