The concept of healthy aging at work

Introduction

The trend of population aging observed all over the world and the increase in the number of older people dictate the need to maintain their health and performance. Today, older people make up a significant part of the workforce: more than 20% of workers in developed countries are over 60 years old, and by 2050, workers over the age of 60 will account for 33%¹. In the USA, by 2024, 25% of workers will be over 55 [1].

Unlike past years, when the main task was to provide the elderly and old people with high-quality healthcare, as well as decent social and living conditions, it is currently relevant to create not only physical and psycho-emotional wellbeing for the older generation but also the possibility of maintaining working capacity, including prolongation of occupational activity.

In recent years, issues of healthcare management of an employee in the workplace have been developed in order to increase physical, emotional, and psychological wellbeing².

Physical, physiological, and psychosocial abilities of workers change while they get older. Maintaining the health and productivity of older workers is one of the key objectives of European labor policy [2].

In the USA, "most people approaching retirement age don't really want to retire"³. Therefore, among new entrepreneurs in the USA in 2011–2012, 23% were persons aged 55–64 years [3].

The concept of the demographic policy of the Russian Federation until 2025⁴ provides for "the development of measures aimed at healthcare maintenance and prolongation of the occupational engagement of the elderly, the development of geriatric care." The trend toward the aging of the population determined the implementation of the pension reform in Russia which implied raising the retirement age for Russians by 5 years⁵.

Both social, economic and cultural trends in the world practice and the possibility of creating an adequate workplace adapted to the physiological and psychological resources of an elderly person are considered conditions for maintaining the occupational health of older workers [4]. In production and nonproduction areas, older workers are an effective foundation for sharing experience with younger workers⁶. Management of the occupational health of older workers is the basis not only for the prolongation of their lives but also for a real opportunity to make the life of older workers full-fledged and socially significant [2][5]. It should be noted that it is important to ensure an integrated approach to health maintenance at the workplace [6][7] and the use of the employer's organizational practice at all levels [8].

Policy documents are being developed in various countries on issues such as working for a healthy future, improving the health of workers and working conditions, health in employment, examination of the professional suitability of retirees, and training older citizens in skills and competencies that are in demand in the economy.

The advantage of work is both an increase in material wellbeing, the quality of life of an employee, and the possibility of participation in society. Good work has a therapeutic effect and promotes recovery and rehabilitation [9]. Work becomes an important defense mechanism against depression, disability, and asthenia, as well as maintains wellbeing, cognitive function and independence in daily activities. However, long hours of work and physically hard work have a negative impact on employee performance and may contribute to early functional aging [10].

An active social life of an elderly person today is becoming a strategically important component of the state's economic policy. In this regard, in recent years, issues of health maintenance and performance of aging workers aged 45 years [11] and 40 years [12][13] have been considered in order to prevent premature aging and ensure further productive longevity of this contingent.

In Russia, the priority areas of the strategy of addressing the interests of older citizens are to stimulate the employment of older citizens, to provide access to information and educational resources, and protect their rights⁷.

However, there are still many unresolved issues related to older workers, in particular, related to ways to improve the prevention of health disorders, extend the period of working capacity, create working conditions that correspond to the physiological characteristics of the body of an elderly person, and propose an adequate solution to the professional suitability examination.

In order to induce further actions in this area, the World Health Organization (WHO) published the first World Report on Aging and Health in 2015 based on comprehensive, prospective, and practically relevant research on the global aging process, including research on public health actions on healthy aging with due consideration of the functional capabilities of a person⁸.

Population aging – the global demographic situation in the world

The aging of the world's population is a global problem. The share of the population aged 65 and over will increase in high-income countries from 9% in 2020 to 16% by 2050, in China – from 12% to 26%, in India – from 7% to 14%, in South Africa – from 6% to 11%, and will reach more than half a billion people⁹. Life expectancy in Hong Kong in 2020 reached 82.7 years for men and 88.1 years for women¹⁰. According to a demographic comparison study between Hong Kong and 18 countries of the Economic Cooperation Organization, these indicators are associated with a decrease in the rate of cardiovascular diseases in the population, cancer in women, low rates of smoking and traffic accidents, as well as the economic prosperity of this special administrative region of China [15].

Demographic trends in Russia are similar to those around the world, which is confirmed by the increase in the proportion of people older than the working age: in 1959, the share of this contingent was 10.2%, in 1970 – 11.9%, in 2003 – 22%, and by the beginning of 2018 – 25.4%¹¹. The priorities of health maintenance of Russian citizens and their long-term active life are enshrined in law¹². In the current socio-demographic situation, the priority tasks are to increase healthy life expectancy to 67 years, as well as to increase life expectancy to 78 years by 2030¹³.

Increasing human life expectancy opens up many opportunities, and appropriate investments in health can create a demographic dividend for society [15].

The current demographic situation in the world served as the basis for the development of an active aging strategy that factored in the key areas of employment policy, pensions, retirement, health and citizenship and made economic sense [16].

Stages of development of the concept of healthy aging

The Vienna Plan of 1982¹⁴, which was the first international document on the rights of the elderly, affirmed the right of every elderly person to a pension and rest after work during 20 years until 2002.

In 2002, the UN General Assembly approved the Political Declaration and the Madrid International Plan of Action on Aging¹⁵. The recommendations in these documents identify three priority areas for action: "the participation of older people in development; ensuring health and wellbeing in older age, providing opportunities and favorable conditions for older people". Thus, the Madrid Plan recommended a transition from an old age free from labor obligations to the values of active aging and participation in the labor market.

WHO published "Active Aging: A Policy Framework" in 2002¹⁶ which defined active aging as "the process of optimizing opportunities for health, participation and security in order to enhance the quality of life as people age"; the goal is to ensure "the contribution of older people to family, community and economic activity".

The policy framework identified six key factors of active aging (economic, behavioral, personal, social, health, and social services) and the physical environment. Four components necessary for a health policy response are recommended¹⁷:

• prevention and reduction of the excessive burden of disability, chronic disease, and premature death;
• reducing risk factors associated with major diseases and strengthening factors that promote health throughout life;
• building a continuum of affordable, accessible, high quality and age-friendly health and social services to meet the needs and rights of people as they age;
• providing training and education for caregivers.

The issues of harmonious aging [17], active and productive aging [18], and successful aging [19] have been discussed in recent years; it is proposed to consider a wide range of factors, including social ones, as determining the formation of aging in the 21st century [20].

The development of the concept of healthy aging is closely related to modern ideas about health with a variety of health dimensions.

The International Council on Active Aging (ICAA) defines seven dimensions of wellness: emotional, professional/vocational, social, spiritual, intellectual/cognitive, environmental, and physical¹⁸.

According to the WHO Constitution (1948)¹⁹, "health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity". In Russia, the concept of health is enshrined in legislation²⁰ and is defined as "a state of physical, mental and social wellbeing of a person, in which there are no diseases, as well as disorders of the functions of organs and systems of the body." According to Convention No. 155 of the International Labor Organization (ILO), the term "health" means not only the absence of disease or infirmity but also includes physical and mental elements affecting health, which are directly related to occupational safety and health²¹.

According to the joint committee of the ILO and WHO (1950), the goal of occupational health and wellbeing is to maintain the highest degree of physical, mental and social wellbeing of workers in all occupations²².

The main indicator of occupational health (health in professional activities) is working capacity²³. However, working capacity tends to decrease with age: about 30% of working men and women over 45 years old show a noticeable decrease in the work ability index (WAI) among both office and production workers.

The conditions for maintaining the occupational health of older workers are as follows:²⁴

• creation of an adequate workplace adapted to the physiological and psychological resources of an elderly person;
• using the experience of older workers for younger employees;
• occupational health management of older workers in the workplace;
• pension reform that takes into account the individual differences of older workers with a flexible range of retirement dates and a financial bonus for working longer.

The aging of the Earth's population, accompanied by the aging of the labor force, leads to the need to stimulate the employment of older people in the labor market both in the form of financial benefits [21] and in the form of raising the official retirement age or reducing pensions in case of an early exit from the labor market [22]. However, retirement can be associated not only with the state of health of the employee but also with such factors as the employee's competence, motivation, and ability to work [23].

Today, older people often remain professionally active for quite a long time [24][25], which confirms the relevance of the concept of "active aging" that has developed since 2002 as an international benchmark. Considering the involvement of older people in the work process, WHO has identified further priorities for the elderly population and workers and proposed the concept of "healthy aging". This conceptual change is due to the responsibility of society and health authorities for the long-term participation of a person in labor and the role of environmental factors in maintaining the active occupational longevity of older people while taking into account their own value orientations [26].

The concept of "healthy aging" and the prospects for its development

The WHO World Report (2015) defines "healthy aging" as "the process of developing and maintaining the functional capacity that enables wellbeing in older age". However, functional capacity is characterized by "the internal ability of a person (i.e., the totality of all physical and mental, including psychosocial, abilities of a person), the environment in which he or she lives (understood in the broadest sense of the word and including the physical, social and political environment), and the interaction between them²⁵. The main goal of healthy aging is to maintain functional capacity, which is achieved by developing and maintaining individual vitality, as well as enabling people with reduced functional capacity to perform activities that are important to them²⁶. The assessment of functioning is presented in the report taking into account the International Classification of Functioning, Disability and Health²⁷, which considers the functional capacities (residual abilities) of a person. The report defines healthy aging as a lifelong process requiring the maintenance of functional abilities and capabilities throughout life and during older age. In addition to longevity, the ability to function and interact in a supportive environment (including the work environment) is an important determinant of healthy aging.

Elderly people consider role and identity, relationships, autonomy (independence and the ability to make independent decisions), security, and the potential for personal growth as the most significant factors [27] throughout their lives²⁸, which largely corresponds to the main components of the functional capacity to satisfy their basic needs, learn, develop and make decisions, stay mobile, build and maintain relationships [28].

The World Report states that the assessment of labor productivity and its changes with age is still difficult due to the limitation of its objective measurements and dependence on specific professions [29]. In general, labor productivity may decrease with age in professions implying physical overstrain, which is associated with the accumulation of physical damage inherent in such jobs [30][31]. However, when correcting work (for example, career promotion), older workers are able to find a way out of difficult situations and concentrate on performing urgent tasks [32]. Age heterogeneity among members of labor collectives can be an important factor determining the level of labor productivity. Teams (employees) involved in performing creative tasks have certain benefits from age diversity compared to teams engaged in routine work [33].

The World Report considers the need to reduce risk factors for noncommunicable diseases as the main burden of diseases in older age: promoting a healthy lifestyle and controlling metabolic risk factors, combating hypertension [34] and smoking [35], and improving nutrition [36]. It has been established that a decrease in the risk of developing cardiovascular diseases reduces the risk of developing certain types of dementia [37]. A significant reduction in the relative risk of developing functional limitations in people who regularly engage in physical activity has been determined [38]; physical activity is especially beneficial for people over the age of 60 [39][40].

While considering the individual resilience assessment, the World Report reveals plans to help older people with due regard for the goals of an older person, the ways of achieving them, and the function of various sectors of the healthcare and social security system, as well as plans for subsequent monitoring and re-assessment [41][42].

The WHO World Report (2015) expands the notion of "active aging" by promoting the most appropriate responses from public healthcare and social security systems to address the needs and rights of older people.

The main objectives of the healthcare system to ensure healthy aging are²⁹ as follows:

• implementation of strategies with due regard for the diversity of manifestations of aging;
• reducing injustice by smoothing social differences;
• ensuring the possibility and right of choice (preservation of autonomy, ensuring interests, control over the situation, etc.).

The implementation of the healthy aging concept as a new paradigm was further continued by means of the adoption of the Global Strategy and Action Plan on Aging and Health for 2016–2020³⁰. This document emphasizes that "globally, populations are aging rapidly regardless of income levels…the range of opportunities that older populations have, longer life expectancy and active aging will depend to a large extent on good health". The global strategy aims to improve "measurement, monitoring and research on healthy aging at all levels", to promote the "creation of supporting environment for older people", to support "research and innovation to promote healthy aging".

The Decade of Healthy Aging (2021–2030) launched by WHO and the United Nations³¹ aims to improve the quality of life for older people, their families and communities. The NEW WHO baseline report on the Decade of Healthy Aging 2021–2030³² lays the foundation for changing the monitoring of the health of older people while considering the main components of healthy aging (intrinsic capacity, functional capacity and environment) outlined in the WHO World Report (2015). The report presents the results of a systematic analysis of the main components of healthy aging in 151,718 adults aged 60 years and older from 42 countries, showing the heterogeneity of population aging both within and between countries, including by gender and education. The new baseline report also revealed that age-related decline in performance depends on both chronological age, changes in physical and mental condition, socioeconomic status, and their relationship.

The healthy aging concept is closely related to the quality of solving the issues of professional suitability of various age groups and providing older workers with working conditions that correspond to their functional abilities and individual life activity. Updating of methodological approaches to the examination of professional suitability while taking into account current trends in the world (increase in life expectancy and occupational longevity of workers, socio-economic aspects of maintaining labor potential) and the principles of occupational medicine can be considered promising.

In Russia, the ultimate goal of medical examinations is to preserve the health of workers, their ability to work, and occupational longevity through the timely detection of health disorders and their primary and secondary prevention [43].

In European countries, the need for a medical examination is considered with due regard for both the state of health of the employee and the ability to perform a particular job (the state of health of the employee may interfere with working efficiency, may worsen in the course of work, may make working conditions unsafe for the employee personally or for other people) [4]. When conducting an examination of professional suitability, the assessment of the functional capabilities (residual abilities) of an employee, as well as the requirements for work (physical, intellectual, organizational, ergonomic), is recognized to be of paramount importance [9].

When assessing the professional suitability of workers in the UK, the workplace and work process are adapted for people with disabilities or older workers who have retained their ability to work and have valuable skills and experience. It has been established that the costs for the workplace adjustment to retain an employee are much lower than the costs of recruiting and training new personnel; in addition, work benefits a person’s health and wellbeing, as well as ensures integration into society [4][44].

Today, the issues of extending working life and healthy aging of workers are being adjusted by the COVID-19 pandemic and its long-term consequences in the post-COVID period.

Before the COVID-19 pandemic, starting in 2002, the global defining international benchmark was the concept of active aging, formulated in the Madrid Plan of Action³³, according to which older people could participate in the labor market and stay social in retirement. The WHO World Report on Health and Aging has defined healthy aging³⁴ as the process of developing and maintaining functional abilities that enable wellbeing in older. The aging workforce was actively involved in social and industrial life, the elderly worked longer. In many countries and in Russia, the pension reform secured the active occupational longevity of the elderly.

The coronavirus pandemic raises the question of whether the corona crisis will generate a demand for a new concept of aging. The COVID-19 pandemic reminded of the physiological characteristics of an aging organism. Now people over 65 years of age are defined worldwide as a special risk group in need of isolation and protection; these individuals may not return to work after the pandemic [45]. Therefore, other forms of employment for workers, including the elderly ones, should be found. However, even with a gradual return to work, with the adaptation of working conditions or the transition to remote work, it is not always possible to achieve a positive result. Patients report difficulty performing work with the same efficiency, psychological problems, and prolonged symptoms in the post-COVID period after returning to work [46].

Conclusion

Conceptual approaches to healthy aging are still being developed, which is associated both with the accumulation of practical experience in this area and with the need to consider modern trends (increased life expectancy; maintaining the working capacity of people who have reached retirement age; personnel problems; the need to create adequate conditions at the workplace upon returning of an employee after an illness/injury, a new coronavirus infection, etc.).

In a number of foreign countries, the assessment of the professional suitability of employees, including those of retirement age, is performed with due consideration of the International Classification of Functioning, Disabilities and Health and international principles of occupational medicine, namely the principle of adaptation (adaptation of work and the working environment to the capabilities of the employee) and the principle of protection and prevention (protecting the health of workers from hazards at work). In domestic practice, these principles have not yet been clearly reflected [47]. However, in Russia, modern legislative and regulatory documents on medical examinations and examination of professional suitability of workers, aimed at protecting the health of the able-bodied population, contribute to the implementation of the concept of the country's demographic policy [48].

In the Decade of Healthy Aging (2021–2030), the main vectors of scientific research in medicine and healthcare are to improve assistance to older people in increasing their individual and age-related resiliency [49].

Authors' participation:

Gantman AA. — data collection, writing the text;

Gorblyansky Y.Y. — research design development, writing the text;

Kontorovich E.P. — editing, writing the text;

Ponamareva O.P. — bibliography design, writing the text.

Conflict of interest. Authors declares no conflict of interest.