Falls, Fall Injuries and the Aging Workforce

Health is a resource that enables an individual to act more freely within the labor market. A person in good health can initiate and maintain gainful employment, even in a physically or cognitively demanding occupation. Poor health can limit an individual’s functional abilities and job prospects, or the ability to work altogether. As individuals age, the likelihood of poor health increases as various health conditions and health events become more common. By informing which health conditions are likely to have significant economic consequences as the US population ages, epidemiologic research can help guide prevention strategies to reduce the economic burden of poor health and to maintain older adults’ quality of life through retirement.

Falls and fall injuries become more common as people age. This is true for falls that occur in the workplace as well as falls that occur outside of work. Falls already have a significant effect on the economy – a trend that will likely increase as the workforce ages. The projected lifetime costs of fall injuries occurring during 2010 in the US was over $152.9 billion. Falls also are a useful window through which researchers can see how work and health interact to influence retirement decisions. Like some other public health issues, such as heart attacks and strokes, falls have a dual nature. Falls are, on the one hand, discrete events and, on the other, indicators of ongoing changes in health and social status. An individual’s labor force participation could, theoretically, be influenced by an injury subsequent to a fall, health changes that preceded and caused the fall or both.

The dissertation research presented below is comprised of three research studies that explore how work and health, specifically the experience of falls, might influence older workers’ retirement decisions. The introductory chapter will begin by describing the epidemiology of falls and fall injuries. We present the unadjusted US rates of falls analyzed by age and other factors. We highlight epidemiologic research that has described fall injuries in the workplace and we compare the patterns of fall injuries to other types of occupational injuries, again focusing on age-related patterns. After summarizing the descriptive epidemiology, we highlight analytic research studies that have identified individual-level and environmental risk factors for fall injuries. The consequences of fall injuries are then described, including the types of injuries commonly caused by falls, as well as their effects on disability and retirement. Finally, we present several conceptual models that tie together research on falls and research on work disability.

After the introductory chapter, each paper of the dissertation is presented as a chapter. The first paper examines the patterns of same-level fall injuries in US workplaces, exploring whether the relationship between age and fall injury incidence varies by industry. The second paper tests whether, among US workers 65 and older, falls - injurious and non-injurious – are associated with a shorter time to first report of a health-related limitation in the work they can perform. The third paper then examines whether falling is associated with a shorter time to labor force exit among US workers 65 and older. A concluding section compares the findings from each study in relation to the research and broader context covered in the introductory chapter.