Economic pressures and the ageing population have increased the importance of maintaining fitness to work in older adults. Dyspnoea and airflow limitation are associated with disability particularly in individuals with diagnosed disease. A cross-sectional general population survey of 51–60 year olds demonstrated significant associations between breathlessness, airflow obstruction and work performance; a follow-up survey was completed 18 months later to examine changes in work.
Participants from the first study were sent a postal questionnaire asking about job and employment changes. Questionnaire and spirometry results from the initial study were used to define breathlessness (modified MRC scale) and airflow obstruction (GOLD stage) respectively. Information from the follow up questionnaire was also used to identify cases, defined as those who had experienced a change in employment, and frequency matched controls of the same gender, who reported no change in work circumstances (with a ratio of two controls per case).
Results from respondents to the follow up questionnaire (1663/1773 (94%)), all of whom had been in full time work at the time of the first study) showed that the majority (78.5%) continued in full time employment; however 10.6% were working part time and 10.9% were no longer in paid employment at follow up. Of the participants still in employment who reported changing their hours or activity at work, 9.3% stated that this change had been to their health. Prevalence of economic inactivity rose with increasing breathlessness and with increasing airflow obstruction in workers of both sexes; these relationships were statistically significant in all cases except for airflow obstruction in women (Figure). The odds of GOLD stage 1 or greater airflow obstruction was significantly higher in cases than in controls (unadjusted OR 1.71, 95% CI 1.10–2.77, p = 0.02).
These findings suggest that breathlessness and airflow obstruction are associated with subsequent job instability and premature loss from the workforce in older workers. A focused surveillance programme could identify those at higher risk of employment problems with the intention of ameliorating them – providing that there are suitable interventions available to support continuing workforce activity in adults in their sixth decade of life and beyond.
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