-
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
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)
2
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)
6
-
Whiplash outcomes age effects
7
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
8
-
Effect of Age general injury example
9
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)
10
-
How is the population changing?
11
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
12
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
13
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)
14
-
Conceptual approaches multimorbidity
15
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
16
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.
17
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
18
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
19
... 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
20
-
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
21
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?
22
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
23
-
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
26