Notice, I am not talking about the old worker or even the aging worker. We are examining the plight of the “aged worker.” “Aged” has nuance beyond the chronologic¹; there is the ripening of skills, the familiarity of space, the comfort with station. Americans who came of age in the mid-20th century held “aged” up as a goal.

For any of us, but for such an individual in particular, change is difficult. Compound that difficulty with alternatives that seem demeaning, even a little demeaning, and change becomes painful. Few can manage it, and even fewer can manage it gracefully. Compound change further by prejudice against the older worker, and change can become untenable. The consequences are highly relevant to our considerations.

Do you like your job? Are you valued at work? These questions deserve a prominent place in clinical history gathering. They should anchor a major public health initiative. They demand a prominent place in the body politic. Untoward answers associate with much clinical morbidity and harbor crucial secrets to longevity even for those who could change jobs. For growing numbers of workers whose answers are untoward, job mobility is not an option or leads to less acceptable alternatives. For growing numbers of the aging workforce, this reality comes as a surprise.

Regional musculoskeletal disorders are the bane of the workforce, particularly the aging workforce,² accounting for the preponderance of disabling illness. As discussed at length in the preceding chapters, regional musculoskeletal disorders are remittent and intermittent predicaments of life with which we all much cope and with which we all do cope with varying effectiveness. That effectiveness is far more dependent on the psychosocial context in which the morbidity plays out than on the quality of the disorder, or even the physical demands in life that one is forced to circumvent. In the workplace, it is an adverse psychosocial context of working that confounds coping and renders the morbidity more memorable, less tolerable, and often disabling.

The frontier for epidemiology is to further define “psychosocial context.” That is an exercise that is nearly as daunting as defining the psychosocial correlates of poverty.³ Some of the common threads emerging from studies in the workplace include aspects of job “stress,”⁴ “strain,”⁵ “allostatic load,” and motivational “flow.”⁶ These measures are sampling such complex psychologic functions as job satisfaction, perception of psychologic demand, job autonomy, motivation, and the like. No wonder that associations with “psychosocial” variables are weak, even inconsistent. There may be much that is idiosyncratic. However, that does not
diminish the implications; working in a psychosocial context that is adverse compromises coping with the next episode of a regional musculoskeletal disorder and places longevity at risk. There are four cohort studies that dramatically make this point.

In the early 1990s, the Finnish economy experienced a considerable setback lasting several years. Many workers were dismissed. The effect of impending downsizing on the local government employees in one small city was monitored.⁷ The rate of absenteeism escalated, most markedly for sick leave ascribed to regional musculoskeletal disorders, particularly among employees aged more than 50 years. Furthermore, those who remained in employment after the downsizing also exhibited an increased frequency of sickness absence attributed to musculoskeletal pain.⁸

The “Whitehall” studies are cohort studies of British civil servants that long ago documented an inverse relationship between civil service grade and mortality rate, particularly mortality from cardiovascular disease. In recent years it has become clear that the association with grade paled next to the association with psychosocial job “stress,” particularly job “control,” regardless of grade.⁹ Similar relationships pertain to sickness absence from back pain.¹⁰ One nested Whitehall cohort, faced with impending outsourcing,¹¹ experienced a fate similar to that observed in the Finnish cohort just discussed. Impending downsizing wreaks havoc on the psychosocial context of work, inflicting “stress” and “strain” on all, particularly the aging worker.¹² Downsizing accelerates that noxious, insalubrious, and lethal process that I am denoting as an adverse “psychosocial” work context. It does so without regard for prior station in life.