Topical Seminar 7

Topical Seminar 7:
Does a life course perspective matter in preventing arthritis related work disability?

Session chair(s): Arif Jetha

Schedule Details

Wednesday October 1
14:00 - 15:30 Afternoon Concurrent Sessions (W O1 - W O4 and Seminars 7 and 8)
Topic: WDP and Musculoskeletal disorders
King Ballroom

Seminar Objectives

In Canada, arthritis affects over 4.4 million people, 60% of which are under 65 years of age. Arthritis is also the second most frequent cause of work disability in the country. In 2000, the burden of the disease was $6.4 billion per year. Two thirds of these costs were estimated to be indirect and included giving up employment and long-term disability. To-date, research examining arthritis related work disability has focused mostly on adults in their middle years. Few studies have taken a life course approach to problems like sustaining employment and return to work, despite research suggesting that the value, meaning, and tasks associated with roles like employment may vary at different phases of life. For instance, young adults (ages 18-30 years) living with arthritis may face challenges to gaining skills, finding full-time work and learning to independently manage their health while employed. Middle-aged adults (e.g., 40-55 years) with arthritis may face challenges balancing multiple roles (e.g., work and family) while managing changes in their condition and trying to sustain their careers. Older workers ( > aged 55 years) need to plan financially for retirement while experiencing challenges with arthritis disability, sustaining employment and possibly returning to work if arthritis or its treatment necessitates time away from the job. This session takes a life course perspective toward understanding arthritis work disability by examining potential similarities and differences in the needs of workers with arthritis, their use of accommodations and work modifications, retirement plans, and measurement of work disability and productivity.

The learning objectives of this seminar include:

  1. Greater understanding of the diverse ways that arthritis can impact employment at different times of life including young, middle and older adulthood.
  2. Awareness of life course similarities and differences in the ways individuals manage arthritis related work disability and other difficulties working.
  3. Recommendations for the application of a life course perspective to research and programs, policies and practices to address working with a chronic disease across the life course.

Presentation 1: Arthritis in the early career phase: A transitional perspective to understanding work disability

Presented by: Arif Jetha

Authors

Jetha A1

  1. Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA

Abstract

Background

Employment is an important milestone of the transition to adulthood. Arthritis may limit a young person’s ability to find paid work as well as be productive in the workplace. The objective of this study is to describe work disability experienced by young adults (ages 18-30 years) with systemic lupus erythematosus (SLE) and juvenile arthritis (JA). In particular, the impact of disease, psychosocial and work factors on employment status, disease-related absenteeism and job disruptions will be examined.

Methods

One hundred and forty three participants (Mean age = 23.3, SD = 3.5) with SLE (54.5%) and JA (44.5%) were recruited from clinics in four Canadian provinces. All completed an online questionnaire asking about health (e.g., pain, fatigue, disease activity), psychosocial (e.g., independence and overprotection) and work context factors (e.g., need for job accommodations, job strain, work-health conflict). Information on employment status, absenteeism (# of days) and number of job disruptions (e.g., work interruptions, arriving late/leaving early, missed meetings) was collected. Multivariable log-Poisson analyses examined factors associated with each work outcome.

Results

61% of the sample was employed, 26% were students and 13% were not working. Respondents indicated having a well-managed health condition and moderate perceived independence and overprotection. Involvement in employment was associated with greater independence (PR = 1.30, 95%CI 1.00-1.60) and less need for job accommodations (PR = 0.91, 95%CI 0.88-0.95). 56.5% of participants reported disease-related absenteeism in the previous 6 months. Greater job control (PR = 1.20, 95%CI 1.00-1.50) and less severe fatigue (PR = .90, 95%CI 0.82-0.99) were related to greater likelihood of reporting absenteeism. 53% reported at least one disease-related job disruption. Greater work-health conflict was related to a greater likelihood of reporting a job disruption (PR = 1.5, 95%CI 1.10-2.10).

Conclusions

For young adults with arthritis, work disability can be minimized by encouraging independence and providing accommodations that enable a person to balance their work and health. At the early phase of their careers, young people might also access missed workdays as an adaptive strategy to manage health.

Presentation 2: A comparison of middle- and older-aged workers with arthritis: Are we overlooking the impact on the middle-aged?

Presented by: Monique A.M. Gignac

Authors

Gignac MAM1,2

  1. Institute for Work & Health
  2. Toronto Western Research Institute, University Health Network, Toronto, ON, Canada

Abstract

Background

Arthritis is often depicted as a disease of older age. Yet, 60% of those with arthritis are under 65 years of age with most individuals in their prime earning years (40-65 years). Life span theories suggest that the occurrence of a chronic disease at a time of life that is not normative may be associated with greater distress and difficulties than the occurrence of a disease at a time considered normative. This research compared middle-aged workers (40-54 years), many of whom might perceive their arthritis as occurring early in life, to older workers (55< years) in work stress, transitions made to working and use of job accommodations and modifications.

Methods

Data were drawn from three separate community samples of people with inflammatory arthritis (e.g., rheumatoid arthritis) and osteoarthritis (total n = 1,021; 75.2% female). Respondents were recruited using community advertising and from rheumatology and rehabilitation clinics. Participants completed interview-administered, structured questionnaires assessing demographic, health, workplace and psychosocial variables. Two samples (n = 352, n = 492) are each comprised of 2 and 4 waves of data, respectively. Analyses included multiple linear regression and generalized estimation equations to model predictors of work transitions over time.

Results

Findings indicated that, despite age similarities in pain, fatigue, and workplace activity limitations, younger age was significantly associated with greater perceived role conflict in managing health and work demands and a trend for greater perceived arthritis-work stress. Overall, older age was significantly associated with fewer work transitions, although older workers were significantly more likely to report reducing their hours and leaving the labour force. For the most part, there were no significant differences in reports of job accommodations and use of benefits related to age.

Conclusions

The findings have implications for understanding work disability and the development of programs to sustain employment. They suggest that the impact of chronic diseases, especially in terms of the psychological meaning of illnesses like arthritis, may vary at different life phases and highlight diverse needs across the career life span.

Presentation 3: Workforce status of people with arthritis aged 55 plus: leaving early and staying later

Presented by: Elizabeth M. Badley

Authors

Badley E1,2, Chan, CH1, Gignac, MAM1,3

  1. Toronto Western Research Institute, University Health Network
  2. Dalla Lana School of Public Health, University of Toronto
  3. Institute for Work & Health, Toronto, ON, Canada

Abstract

Background

With the aging of the population along with retirement at later ages, attention is being focused on labour force (LF) participation and sustaining employment among the older worker, especially those with arthritis. The objective of this study is to document the prevalence and predictors of work status of people aged 55 to 74 years in the Canadian population with self-reported arthritis.

Methods

Data were analyzed from the 2008/09 Canadian Committee Health Survey-Healthy Aging (CCHS-HA). Prevalence ratios (PR) for being in the labour force versus not were calculated adjusting for sex, education, marital status, and other chronic conditions.

Results

Thirty two percent of the population aged 55 to 74 years reported arthritis as a chronic health condition, of which 39.5% were in the LF. Corresponding data by age were: ages 55-64 years, prevalence 27.7% and 56.6% in LF; ages 65-74 years, prevalence 39.5% and 18.5% in LF. While having arthritis slightly decreased the probability of being in the labour force for those aged 55-64 years (PR = 0.91 (95%CI 0.86-0.97)), having arthritis was not associated with working at ages 65-74 years (PR = 1.06 (95%CI 0.90-1.24)). In both age groups having two or more other chronic conditions was a major contributor to not being in the labour force: ages 55-64 years PR = 0.80 (95%CI 0.69-0.92); ages 65-74 years PR = 0.58 (95%CI 0.42-0.82). The majority of people with arthritis aged 55-64 years were still working. For those who were not, 66.1% said they were retired, 12.2% said they were permanently unable to work, and 11.6% that they had left the labour force because of illness or disability. It is unknown to what extent having arthritis may have contributed to a decision to retire.

Conclusions

The majority of Canadians aged 55 to 64 years and a significant minority of people with arthritis ages 65 to 74 years were still in the labour force. Supporting individuals with arthritis, many of whom also have other chronic conditions, to remain in the workplace is important for their health, financial stability, and quality of life, as well as for the economy.

Presentation 4: Measuring arthritis work disability outcomes across the life course: An integral research direction

Presented by: Dorcas Beaton

Authors

Beaton D1,2

  1. Mobility Program, Clinical Research Unit, St. Michaels Hospital
  2. Institute for Work and Health, Toronto, ON, Canada

Abstract

Background

It is said that if you don’t measure it you don’t see it. As discussed previously, employment and work productivity of young-, middle- and older-aged adults with arthritis is the main societal role for people with arthritis. Understanding the best work outcome measures is an integral direction for arthritis research and clinical practice. This presentation reviews a body of research being conducted to understand approaches to measuring arthritis work outcomes.

Methods

Systematic reviews of the literature were conducted to uncover available instruments for capturing at work productivity loss and work absence. The instruments discovered (n > 20) were reviewed for face value and suitability for arthritis. Based on an initial evaluation, a shorter list of set of seven instruments was developed. Evidence of measurement properties was sought, and where absent, new projects begun to create this knowledge base. Finally, contextual factors were considered to get an accurate estimate of productivity.

Results

Over 25 measures of at-work productivity loss were identified as well as several indicators of work absence. Some measures focused on ability/difficulties experienced at work, while as others focused on the amount of lost time. A subset appeared to have stronger measurement properties including the multi-item scales of the Workplace Activity Limitations Scale and Work Limitations Questionnaire. Single item indices were also attractive options but had less precision for inclusion in large burdensome trials. Though single items were only moderately correlated with the multi-item scales, the reliability was acceptable and they exhibited construct validity. Contextual factors like job demands, work pace or scheduling flexibility were found to be important moderators of work productivity. Few measures were compared at different life phases and instead were administered to general adult samples with arthritis ( > 18 years of age).

Conclusions

Several work productivity measures had merit. A limitation of existing measures is an understanding of whether their properties differ based on a person’s life and career phase. In order to expand research of arthritis work disability, work outcomes should be examined through a life course perspective and compared between young-, middle- and older-aged workers.