Background
Methods
Search strategy
Inclusion and exclusion criteria
Study selection
Data extraction and synthesis
Quality assessment
Results
Author (year) | Country | Population (N) | Intervention (N) | Control (N) | Follow-Up | Outcome | Main results | Study design and quality |
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DOMAIN 2-Increasing job retention | ||||||||
Wallen & Mulloy (2006) [29] | USA | 50 Factory workers at a medium sized electronics manufacturing plant | Computer-based respiratory safety trainings to young (<44 yrs) and older (44+ yrs; mean age 51 yrs) workers | Comparison of 3 different programs: TXT, TAP and NAP | – | Learning evaluation | Older participants who received instructions with NAP reached significantly higher level of learning than TXT/TAP participants; older learners may benefit from this approach | Cross Sectional Weak |
McDonald et al. (2010) [30] | Australia | 27 Hospital Nurses | Aged nurses acting as mentors (12 nurses aged between 40 and 70) and young mentees (15) | – | 6 months | Ideas and perceptions of mentors collected by interviews | Mentoring programmes, in particular including retirees, can stimulate professional development, personal growth and benefits both in mentors both in mentees. | Collective case study NA |
DOMAIN 3-Improving productivity and workability | ||||||||
Karazman et al. (2000) [31] | Germany | 122 Tram, bus and subway drivers of the Munich Transportation Authority 45 and older | 20 health days training (physical exercise, professional skills training and self-experience) | – | 1 year | WAI (stratified according another specific tool-effect typology questionnaire) | Non-significant increase of WAI (except in a subgroup of older participants) | Pre-post Weak |
Mackey et al. (2011) [36] | Australia | Academic and administrative employees between 45 and 70 (mean age = 54 yrs) without a physically active lifestyle | 12 weeks long flexible, individually targeted walking intervention facilitated by an occupational physiotherapist (32) | Usual activity (32) | 12 weeks | Measures for work ability | This worksite based intervention using behaviour change principles produced significant improvements in work ability | RCT (in press) NA |
Rutanen et al. (2014) [40] | Finland | 123 occupationally active symptomatic menopausal women aged 44–62 (mean age 54) | 6 months aerobic exercise intervention 4 times a week, 50 minutes per session, with a progressive increase in intensity (60) | Without intervention (63) | 24 weeks | WAI and Questionnaires on the daily physical and mental work strain | Women in the intervention group have lower work strain, but a tendency towards higher WAI. | RCT; Moderate |
Koolhaas et al. (2015) [32] | Netherlands | Nurse and administrative personnel (workers and supervisors) from a University and a University Medical Center (mean age 52) | “Staying healthy at work” problem-solving based intervention to achieve improvement, life-long learning or to tackle problems for a sustainable working life. (64) | Usual activity (61) | 1 year | WAI and Productivity (the Quality and Quantity method) | None or negative effects were found on main outcomes (respectively on productivity and WAI). However, effectiveness was shown on three of the secondary outcome measures (work attitude, self-efficacy and skill discretion) | NCT; Moderate |
De Boer et al. (2004) [33] | Netherlands | 116 employees older than 50 years (mean age 53 yrs) at risk for early retirement of a large international company, which develops and manufactures electronic equipment. | Construction of a detailed action plan, consultation of the employee’s supervisors and personnel managers, and, if appropriate, referral to the general practitioner, a medical specialist, or psychologist. (61) | Received care as usual (they were not invited for a consultation but they could always consult their occupational physician on request) (55) | 2 years | Work Ability Index, the Utrecht Burn Out Scale, and the Nottingham Health Profile measuring quality of life | After 2 years no significant differences (except for burnout) in work ability, quality of life and early retirement in the intervention group. A significant improvement was found in the mid term analysis. | RCT; Strong |
Palumbo et al. (2012) [37] | USA | 14 Nurses older than 49 years (mean age 54 yrs) at one academic medical center | On-site Tai Chi classes once a week and practice on their own for 10 minutes each day for 15 weeks. (7, but 6 included in the analysis) | No intervention (7, but 5 included in the analysis) | 15 weeks | Productivity | Tai chi group showed a significant improvement in work productivity (+3 %) and seems cost savings (preliminary cost analysis) | RCT; Moderate |
Strijk et al. (2013) [39] | Netherlands | Older workers (45 years or older-mean age 52 yrs) from two academic hospitals | The Vital@Work group (367 workers) received a 6-month Vitality Exercise Program, Personal Vitality Coach visits, and free fruit. | No intervention written except information about a healthy lifestyle in general (363 workers) | 1 year | Work engagement, productivity and sick leave | No significant differences regarding work engagement, productivity and sick leave were observed | RCT; Moderate |
van Dongen et al. (2013) [38] | Netherlands | See-Strijk et al. (2013) [39]-Domain 3 | 1 year | Costs related to the Vital@Work intervention, Health care utilization, sport, absenteeism and presenteeism | The program was neither cost-effective (COI) nor cost-saving (ROI). | A COI and ROI analysis of Strijk et al. (2013) [39] RCT: NA | ||
Siukola et al. (2011) [14] | Finland | Blue-collar workers aged 55 years or older (mean age 57 yrs) from Finnish food company | A senior programme looking at the specific needs of older worker with work-related arrangements and dispensations (opportunities to alter the content of work, need for rehabilitation or education) (129) | No intervention (229) | 6 years | Total sickness absence days and spells of 1–3, 4–7, 8–21 and >21 days | Sickness absence days increased significantly from baseline in both groups. Intervention group had higher risk for short-time sickness absence, with a reduced risk of long-lasting one | NCT; Weak |
Goine et al. (2004) [34] | Sweden | Two paper and pulp manufacturing plants. No specific intervention for older worker, but analysis were stratified for 50–59 and 60–64 age classes | PLANT A (1200) implemented an extensive programme of managerial training and vocational rehabilitation activities. It received about four times more financial support than plant B | PLANT B (1600) Without implementing programmes and with less financial support | 10 years (1989–98) | Sick leave and disability pensions. | For employees in the upper age groups, relative risk for long-term and very long-term sick leave was and remained elevated after the intervention. The RR of short-term sick leave (1–14 days), was (not significantly) lower in these groups than among the younger employees. | Cohort; Moderate |
Härmä et al. (2006) [35] | Finland | Line maintenance unit of a large airline company | Implementation of a very rapidly forward rotating workplace shift system among young (24–44 years) and elderly (45–61 years) maintenance workers | Without intervention | 2 years (1.5 years before and 6 months after a new shift system | Sleep wakefulness, well-being and social life of young and older shift workers | The intervention had positive effects on the sleep, alertness and well-being (including social and family life and hobbies), especially for the older shift workers | NCT; weak |
DOMAIN 4-Workplace interventions for health promotion and well-being | ||||||||
Strijk et al. (2012) [43] | Netherlands | Older workers (45 years or older-mean age 52 yrs) from two academic hospitals | The Vital@Work group (367 workers) received a 6-month Vitality Exercise Program, Personal Vitality Coach visits, and free fruit. | No intervention written except information about a healthy lifestyle in general (363 workers) | 6 months | Lifestyle behaviours (sports, vigorous physical activities and fruit intake) and vitality-related outcomes (aerobic capacity, mental health and the need for recovery after a work day) | The intervention favourably affected the weekly sports activities, the fruit intake and the need for recovery No effects were observed for other outcomes. | RCT; Moderate |
Strijk et al. (2013) [39] | Netherlands | See-Strijk et al. (2013) [39]-Domain 3 | 1 year | The primary outcome was Vitality (the RAND-36 vitality scale for general vitality, and UWES for work-related vitality) | No intervention effects were observed for vitality, even if high yoga compliers significantly increased their work-related and general vitality. | RCT; Moderate | ||
Palumbo et al. (2012) [37] | USA | See-Palumbo et al. (2012) [37]-Domain 3 | 15 weeks | Several measures for physical and mental health, work-related stress | Tai chi group showed a significant improvement in physical functions and seems (preliminary cost analysis) cost savings | RCT; Moderate | ||
van Dongen et al. (2013) [38] | Netherlands | See-Strijk et al. (2013) [39]-Domain 3 | See-van Dongen et al. (2013) [38]-Domain 3 | |||||
Chen et al. (2014) [44] | Taiwan | 108 Workers aged 50+ years (mean age 55 yrs) from small-and medium scale enterprises | Phase I (4 weeks): organizing action groups, individualized planning of behavioral changes, and updating workers’ health knowledge; Phase II (follow-up 20 weeks) emphasized carrying out the planned lifestyle improvements to reduce the risk of metabolic disorders (58) | Without intervention (50) | 24 weeks | Major outcomes were changes in lifestyle, anthropometric and blood biochemical variables | The intervention had a significant positive effect on waist circumference, body weight, BMI, physical activity, triglycerides ad HDL-C. However, the intervention did not improve blood pressure, or serum lipid or HbA1c levels, vegetable consumption, time use, or sleep duration, nor the proportions of subjects having metabolic disorders. The control group had a significant time-related decrease in total cholesterol and HDL-C | NCT; Strong |
Merrill et al. (2011) [42] | USA | 440 young (18–49 yrs) and old (50+ yrs) workers in a small company. Stratification according to age class allow specific analysis for 64 older worker | All employees receive a four-level wellness programs and quarterly screenings, with prizes and incentives for participants. | No Control | 3 years (2007–2009) | Selected Health Indicators: blood pressure, flexibility, body fat, body weight | Overall positive effects. Older employees, who had the highest blood pressure and weight at baseline, showed the greatest decreases in blood pressure and weight. | Cohort; Moderate |
Mackey et al. (2011) [36] | Australia | See Mackey et al. (2011) [36]-Domain 3 | Measures for step count, % body fat, waist circumference, blood pressure, physical activity & psychological wellbeing | This worksite based intervention using behaviour change principles produced significant improvements in physical activity and health status | RCT (in press) NA | |||
Hughes et al. (2011) [41] | USA | 423 participants (older support and academic staff at the University of Illinois at Chicago) aged 40 years and older (mean age 51, range 40 to 68) were categorized into 3 study arms | The COACH (150 workers received a Web-based risk assessments with personal coaching support); the RealAge (135 workers received only Web-based risk assessment and behaviour-specific modules) | The control group received printed health-promotion materials (138 workers) | 1 year | Dietary behaviours; Physical activity; Stress. Smoking cessation; Body mass index, waist circumference, and weight. | In the COACH group significant amelioration in fruits and vegetables consumption, percentage of energy derived from fat and physical activity. RealAge participants experienced a significant decrease in waist circumference COACH group participants were almost twice as likely to use their intervention as RealAge participants used theirs. | RCT; Moderate |
Cook et al. (2015) [45] | USA | 50 years of age and older (range 50–68 yrs) employees located in multiple US offices of a global information technology company (278) | HealthyPast50 workers received a Web-based multimedia program containing information and guidance on the major health promotion topics (138) | wait-list control condition (140) | 3 months | Measures of healthy aging, diet, physical activity, stress management, and tobacco use | The HealthyPast50 group performed significantly better than the control group on diet behavioural change self-efficacy, planning healthy eating, and mild exercise. There were not significant improvements on eating practices, moderate exercise, and overall exercise. | RCT; Weak |
Koolhaas et al. (2015) [32] | Netherlands | See Koolhaas et al. (2015) [32]-Domain 3 | Vitality (the single-item vitality scale of the 12-Item Short Form Health Survey) | Negative effects were found on Vitality. Workers in the intervention group had a 0.10 times higher odds of being in a higher vitality category than the persons in the business as usual group. | NCT; Moderate |
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Domain 1-Policy for older workers
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Initially the review focused on identifying interventions that addressed the development of policies for OWs, aimed at improving interpersonal communication between the latter and other workplace employees, or combatted the exclusion or discrimination of OWs. Only a few [46‐54] narrative studies were found to refer to the risk of ageism or express the need for a policy for OWs in the workplace, but since none of these described any intervention, they were not included in the review.
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Domain 2-Increasing job retention
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In the USA, Wallen and Mulloy [29] evaluated the response of a small sample of electronic company workers to a computer-based respiratory safety-training program. Three versions of the program (text, text with pictures, text with pictures and audio narration) were shown to employees who then took a high- and a low-level learning test. Younger workers (under 44 years of age) did better overall. No significant effects of age or treatment were observed on low level learning, while workers over the age of 45 years improved in the high-level learning test only after computer-based training with pictures and audio narration. McDonald et al. [30] proposed a mentoring service for nurses provided by a small group of older and retired nurses. Implementation of this program brought benefits for both mentors and mentees since it produced positive effects in three main areas by facilitating work and life decisions, by visibly helping other nurses and midwives, and by adapting to the role and the mentee. The mentors were a valuable source of knowledge; they also helped their mentees to manage and enjoy a long-term nursing career and cope with the high demands of the work environment. Moreover, they promoted the professional development and personal growth of mentees.
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Domain 3-Improving productivity and workability
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11 studies [14, 31‐40] reported interventions aimed at improving work ability, work organization and productivity in OWs, and at postponing the prospect of early retirement. However, a real change in work organization was the main experimental intervention in only 5 of these studies [14, 32‐35]; most of the studies explored the effect of various physical training programs on the aforementioned outcomes [31, 36‐40].
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3.1 Workplace interventions for maintaining work ability and postponing early retirement
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Most studies [31‐33, 36, 40] used the work ability index (WAI) as a way of self-assessing individual ability to deal with work demands. Karazman et al. [31] reported intervention in a subgroup of older participants selected through the “effect typology” questionnaire that identifies specific psychobiological patterns of response to intervention. Results from this study yielded a non-significant increase in the WAI after a 1-year health promotion program based on physical, psychological and stress management training accompanied by diet counselling. However, the authors highlighted a salutogenic effect of OH promotion intervention, due to an increase in the WAI and a decline in the desire for early retirement.
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Mackey et al. [36] investigated the possible effects on workability of a 12-week individually targeted walking program. Preliminary results indicated that this kind of worksite based intervention, individually tailored for OWs, can produce significant improvements in physical activity and, it is hoped, in work ability.
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Similarly, Rutanen et al. [40] investigated the effects on work ability and strain among menopausal female workers of a 24-week physical exercise program. At the end of this intervention, physical strain was lower in the treated group than in controls; however, differences in the WAI were not significant.
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The study by Koolhaas et al. [32] assessed intervention aimed at creating a motivating and healthy work environment through the use of problem-solving techniques. The program failed to produce effects on productivity, but had a significant, negative effect on the WAI. Nevertheless, the program was shown to be effective with regard to some secondary outcomes such as work attitude, self-efficacy, and skill discretion.
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In a very small self-selected group of OWs from an electronic company, intervention that included consultation with supervisors, the development of an action plan and referral to medical care when appropriate proved to be effective in reducing the frequency of early retirement after a short period (6 months). On the other hand, the overall rate of retirement (including disability retirement) in the intervention group was similar to controls at the end of the follow-up [33].
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3.2 Workplace interventions for improving work organization and productivity
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A limited number of studies reported interventions that focused on productivity, absenteeism, sickness absence and presenteeism in OWs.
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A pilot study was conducted by Palumbo et al. [37] on a very small group of workers (6 nurses) to evaluate the feasibility of a Tai Chi workplace wellness program. Most of the results failed to show statistically significant group differences in changes over time.
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In the Vital@Work study, a 6-month lifestyle intervention in the workplace that aimed to increase older workers’ productivity and decrease sick leave by improving mental (e.g. via yoga sessions) and physical (e.g. via aerobic exercising) vitality factors, failed to show any significant differences between cases and controls [39]. Subsequent cost-benefit analysis [38] failed to reveal any significant positive findings related to absenteeism and presenteeism, thus indicating that this program was neither cost-effective (from a societal point of view) nor cost-saving (for employers).
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In a Finnish food company, Siukola et al. [14] introduced a program for OWs designed to increase workability and the willingness to work until age-based retirement. A significant increase in the median number of sickness absence days per person/year was reported for the intervention and control groups during the follow-up period. Compared to the control group, the intervention group had a higher odds for short-term sickness absence, with a reduced odds of long-lasting sickness absence.
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Only one study was designed to evaluate the effect on the personal and relational life of workers of an organizational intervention involving the implementation of a very rapid forward rotating workplace shift system [35]. The authors concluded that the ergonomic change had positive effects on sleep, alertness and well-being (including social and family life and hobbies), especially in the older shift workers.
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Domain 4-Workplace interventions for health promotion and well-being
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The main outcome assessment made in the aforementioned Vital@Work study [43] concerned vitality. After the initial 6-months of follow up, the authors observed positive, statistically significant effects on sports activities and fruit intake, as well as on the need for recovery after a work day. However, no improvements were observed in vigorous physical activity, aerobic capacity or mental health. Furthermore, at 12-month follow up, no effects of intervention were observed for the main outcome, although there was a significant increase in the work-related and general vitality of the subgroup of high yoga compliers.
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Similar, though non statistically significant results, were reported for the Tai Chi workplace wellness program in the aforementioned study of Palumbo et al. [37].
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WHP programs were also implemented in small and medium-sized companies. A 24-week intervention trial designed to improve lifestyle, team spirit and goal keeping in workers aged 50+ years from small and medium scale enterprises in Taiwan significantly reduced workers’ waist circumference, body weight and BMI [44]. However, this intervention did not improve blood pressure, serum lipid, or HbA1c (glycated haemoglobin) levels, vegetable consumption, time use, or sleep duration. Merrill et al. reported an experiment in medium-sized companies [42] that involved promoting physical activity, better nutrition, smoking cessation, and health education seminars. All workers were involved in quarterly monitoring. Retrospective analysis of 3 years of activity showed overall positive effects. Employees aged 50 or older, who had the highest blood pressure and weight at baseline, showed the greatest decrease in these parameters after the follow-up period.
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Some interventions were based on specifically designed websites. A web-based multimedia program containing information and guidance on the major health promotion topics of healthy aging, diet, physical activity, stress management, and tobacco use, proved to be effective in obtaining behavioral modifications in mature aged workers [45]. The availability of personal coaching support in addition to web-based health risk assessment significantly increased the effectiveness of a WHP program [41].