Aging populations: impact on

compensation schemes

Ian Cameron

Rehabilitation Studies Unit

University of Sydney, and Royal Rehabilitation Centre Sydney

Second Australasian Compensation Health Form

Auckland, 8 November 2012

ian.cameron@sydney.edu.au

A Health Perspective

Summary

Examples effects of injuries on older people

The Ageing Population

Conceptual approaches to ageing (and beware of age, period and cohort effects)

The ageing driver and the ageing worker (briefly)

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The Rehabilitation Studies Unit is supported by grants from the NSW Motor Accidents Authority, and the NSW Lifetime Care and Support Authority

Ian Camerons salary is supported by an Australian National Health and Medical Research Council Practitioner Fellowship

3

http://www.crash.lshtm

.ac.uk/Risk%20calcula

tor/index.html

The MRC CRASH

Trial Collaborators.

Predicting outcome

after traumatic brain

injury: practical

prognostic models

based on large cohort

of international

patients. BMJ 2008

doi:10.1136/bmj.3946

1.643438.252007

4

http://www.crash.lshtm.a

c.uk/Risk%20calculator/i

ndex.html

5

http://www.crash.lsht

m.ac.uk/Risk%20cal

culator/index.html

Traumatic brain injury outcomes by increasing age

Why this difference? o Physiological changes

o Comorbidities / multimorbidity

o ? Other factors psycho-social determinants

Between the ages of less than 40 years and 80 years o15 x increase in mortality

o 8 x increase in disability (dead, vegetative or severe

disability on Glasgow Outcome Scale)

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Whiplash outcomes age effects

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Kamper et al. Course and prognostic factors of whiplash: a systematic

review and meta-analysis. Pain 138 (2008) 617629.

Systematic review 38 cohort studies Some effect of older age, but it appears to be limited

Whiplash outcomes by increasing age

Why this difference? o Physiological changes

o Comorbidities / multimorbidity

o ? Other factors psycho-social determinants

Some studies (far from all) detect worse outcome for older people o The effect, if present, does not appear to be large

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Effect of Age general injury example

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New Zealand Prospective Outcomes of Injury Study (POIS)

N = 2856, Status 3 months after injury, adjusted for pre injury health status

Langley et al. Health and Quality of Life Outcomes 2011, 9:68

http://www.hqlo.com/content/9/1/68

Older age is associated with poorer health related quality

of life in the mobility, self care and pain / discomfort

domains

Conclusion 1

Older age does have a negative effect on health, disability and recovery

However, this varies with injury type (and severity)

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How is the population changing?

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http://www.abs.gov.au/websitedbs/d3310114.nsf/home/Population%20Pyramid%20

-%20Australia Australian Bureau of Statistics

Many more older people especially over the age of 80 who are women

Disability Prevalence by Age

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Prevalence of disability at age 70 approx 50%

Aust Bureau of Statistics. Disability, Ageing and Carers. 4430.0 2009

Health related quality of life changes with ageing

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Dal Grande et al. Health related quality of life by South Australian Regions ..

http://www.publications.health.sa.gov.au/cgi/viewcontent.cgi?article=1055&context=pop

Psychological health is maintained with ageing

Conclusion 2

In the next few decades, there will be a lot more older people, especially very old women

There is also an increase in younger old people

Disability is very common in older people

Health related quality of life shows varying changes according to domain

o Psychological health is stable (or improved)

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Conceptual approaches multimorbidity

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At age 65 two thirds of the population have

more than one chronic health condition

Barnett et al. Lancet 2012 DOI:10.1016/S0140-6736(12)60240-2

Conceptual approaches compression of morbidity

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Compression of morbibidity is not happening

Compression of disability might be happening

Conceptual approaches - frailty

Frailty is a state of reduced physiological reserves in the domains of physical ability, cognition and health.

It increases an individuals vulnerability to adverse outcomes, including functional dependence,

institutionalisation, and death.

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Rockwood 2000

Conceptual approaches - ageing in context

Age effect, changes with ageing of the population ie more older people

Cohort effect, ie an 80 year old today is different to an 80 year old 20 years ago

Period effect, ie a factor affecting all the population such as the cost of petrol and the

GFC

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Age, cohort and period effects

Modelling age, cohort and period effects

Aging effects, ie more older people

Cohort effects, ie an 80 year old today is different to an 80 year old 20 years ago

Period effects, ie a factor affecting all the population such as the cost of petrol and the GFC

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... age, period and cohort all have signicant independent effects. ... Simple extrapolation

produces higher estimates than modelling which

considers these three factors.

Langley, Samaranayaka and Begg. Age, period and cohort effects on the

incidence of motorcyclist casualties in trafc crashes. Inj Prev 2012: June 30, 2012 10.1136/injuryprev-2012-040345

Conclusion 3

Older people are more complex than younger people

Many older people have multiple health conditions

Older people are operating closer to their limits

Cohort and period effects mean assumptions based solely on an ageing population will be

wrong

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Ageing in the context of compensation schemes

Older driver age 70 and 75 years

- Older drivers overall fewer crashes than other age groups

- Drive shorter distances, restrict driving if uncertain

- In a crash have greater risk of serious injury or death

- Some medical conditions (esp nervous system) and medicines increase

crash risk.

Older passengers and pedestrians health problems relatively common

Current issues

- Assessments for re-licensing

- Driving and dementia

- Social importance of driving

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http://www.vicroads.vic.gov.au/Home/SafetyAndRules/SaferDrivers/FamilyandFriends/

TheAgeingDriver.htm Vic Roads

Ageing in the context of compensation schemes

Older worker age 45 or 55 years

- Tend to have fewer injuries

- But if injured, injuries often more severe and have longer

duration

- Different spectrum of injury, esp back injury

Current issues

- What is a reasonable and fair retirement age? 70 years or

less?

- Should older workers be looking for work, or on government

disability benefits?

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Canadian Centre for Occupational Health and Safety.

http://www.ccohs.ca/oshanswers/psychosocial/aging_workers.html

Conclusion 4

Older drivers / passengers / pedestrians are different to younger road users

Older workers are different to younger workers

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Executive Summary

There are real differences in older people

The New Zealand and Australian populations are ageing - this is already having effects on compensation schemes

o more older people with injuries

o older people have recovery complexities

Older people in the future are not the same as older people in the past beware of assumptions and stereotyping

Realignments in compensation schemes are needed

What realignments are needed?

Education and information all stakeholders

Accept that recovery may be slower and less complete

Consider pre-injury health and disability status (they are important predictors)

Dont blame all ongoing problems on pre-injury factors adopt the approach how would the person have been but for the injury

Accept that older people probably will have more severe impairments given similar injury severities

Build on the psychological strengths of older people experience, resilience and wisdom

Implications for compensation schemes with ageing populations

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