Work Ability Index

Kaija Tuomi
Juhani Ilmarinen
Antti Jahkola
Lea Katajarinne
Arto Tulkki

Finnish Institute of Occupational Health

Helsinki 1998

Working Group

Juhani Ilmarinen, departmental director, Finnish Institute of Occupational Health

Antti Jahkola, head occupational health physician, The Finnish Post Ltd
Lea Katajarinne, trainer (occupational health care), Finnish Institute of
Occupational Health
Arto Tulkki, secretary of the project, Pension Foundation of The Finnish Post Ltd
Kaija Tuomi, special researcher, Finnish Institute of Occupational Health

Computer programme
Jorma Seitsamo, researcher, Finnish Institute of Occupational Health

Editors: Sirkka Rautoja and Rauni Pietiläinen

Graphic designer: Tuula Solasaari-Pekki
Translator: Georgianna Oja

2nd revised edition

ISBN 951-802-202-X
ISSN 0357-5519
Maintaining work ability – a challenge
for occupational health care!

The ability to work is the basis of well-being for all of us. Nevertheless, our work
ability will deteriorate unless we take care of it. Many factors affect work ability,
and we can influence several of them through our own activity. We can
influence both our own life-style and our work environment.

Work ability cannot be measured objectively with a single instrument. It always

requires an assessment based on data obtained from several different sources.
A worker's own concept of his or her work ability is as important as the
evaluations of experts. Together the evaluations provide the best overall picture
of work ability.

The work ability index is a product of research meant for practical use in
occupational health care as an aid to help maintain work ability. It depicts the
worker's own assessment of his or her work ability. Its agreement with the
results of clinical examinations has proved to be good (Eskelinen et al. 1991). In
large follow-up studies of the Finnish Institute of Occupational Health the work
ability index has also reliably predicted changes in work ability in different
occupational groups.

The work ability index is meant to support the worker. It can be used at an early
stage to help ensure the correct measures are taken to maintain work ability.
The work ability index helps to determine which workers need the support of
occupational health care. In this manner optimal conditions can be established
to prevent a premature decrease in work ability.

The work ability index is an instrument to be used in occupational health care. It

is easy and quick to use, it is reproducible, the results are received quickly, and
it can be used for follow-up at both the individual and group level. Its data are
confidential, and at the individual level the data are used only for occupational
health care purposes.

The work ability index forms the basis for further measures. If needed,
occupational health personnel can, in cooperation with the worker, draw up an
individual program to help maintain work ability. The professional skill of safety
personnel and management may be needed to help decrease risk factors at
work, and the employer's support is needed to ensure any psychological and
economic conditions. Activities to maintain work ability result in benefits to both
the employee and the employer.

It pays to maintain and work toward improving work ability at all phases of
worklife. The factors that weaken work ability begin to accumulate in middle age
and are seen in workers from about 45 years of age. Investing in the
maintenance of work ability and functional capacity produces results already in a
few years. Improved functional capacity remains with workers as they retire and
enter the third phase of their life, the "third age". The "third age" can represent a
meaningful, independent and active 10–20 years of life after retirement. The
quality of retirement life remains good, and society benefits through lower health
care expenses.
1
What is
the work ability index?

The work ability index is an instrument to be used in occupational health care. It

reveals how well a worker is able to perform his or her work. The work ability
index can be used as one of the methods for assessing work ability in health
examinations and workplace surveys.

The work ability index is determined on the basis of the answers to a series of
questions (form on pages 25–28) which take into consideration the physical and
mental demands of work and the worker's health status and resources. The
worker fills out the questionnaire before his or her interview with an occupational
health professional, who collects any missing information in consultation with the
worker when needed. The occupational health professional rates the responses
according to the instructions, the result being a score of 7–49. The designated
value depicts the worker's own concept of his or her work ability, and, according
to it, the work ability level and the objectives of any measures needed to be
taken are classified as follows:

points work ability objective of measures

_______________________________________________________________
_
7–27 poor restore work ability
28–36 moderate improve work ability
37–43 good support work ability
44–49 excellent maintain work ability

With the aid of the questionnaire the occupational health professional is able, at
an early stage, to identify workers and work environments which need measures
of support. Measures directed toward restoring work ability or additional
evaluations of work ability are needed by those whose work ability is poor
(maximum score 27). For those whose work ability is moderate (score 28–36),
measures to help improve work ability are recommended. Workers with a good
work ability index (score 37–43) should receive instructions on how to maintain
their work ability. Those whose work ability is excellent (44–49) should also be
informed about which work and life-style factors maintain work ability and which
factors weaken it. The effects of the measures taken can be followed by having
workers fill out the questionnaire in conjunction with periodic health
examinations or other types of screening procedures.

The index can also be used to predict the threat of disability in the near future. It
was developed by the Finnish Institute of Occupational Health in its follow-up
study of ageing municipal workers, and it was found to predict the incidence of
work disability for a group of 50-year-olds. Almost two-thirds of the persons in
the group with poor work ability according to the index were granted a work
disability pension during the 11-year follow-up (table 1). However, more than
one-third of those who were able to continue to work in the same occupation
throughout the follow-up and who had a poor work ability rating initially were
able to improve their work ability (table 2).

The work ability index was constructed in conjunction with a follow-up study of
ageing municipal workers in 1981 so that the 15% of the workers with the worst
work ability score formed the poor category and the 15% with the best work
ability formed the excellent category. The moderate and good classifications
were divided by the median, in other words, the number of points dividing the
distribution of the work ability index in half.
TABLE 1.
Work disability pensioning of municipal workers between the ages of 50 and 62
years according to their work ability index at approximately 50 years of age
(Tuomi 1995)

Work ability index Number of Retired on disability pension

at approx. 50 years workersa
of age Number %
________________________________________________________________
Men
poor 287 187 65.2
moderate 710 287 40.4
good 728 203 27.9
excellent 359 64 17.8

all 2084 714 35.6

________________________________________________________________
Women
poor 359 215 59.9
moderate 934 311 33.3
good 1098 204 18.6
excellent 470 60 12.8

all 2861 790 27.6

________________________________________________________________
aThe figures exclude those who died or received an old-age pension during the follow-up.

TABLE 2.
The work ability index at approximately 50 years of age and improvement in the
work ability of municipal workers who continued to work in the same occupation
during the 4-year follow-up in 1981–85 and the 11-year follow-up in 1981–92:
percentance of those whose work ability score had increased from a lower
category to some of the higher categories

Work ability index Approx. 55 years of age Approx. 58 years of age

at approx. 50 years
of age in 1981 Number of Work Number of Work
subjects ability subjects ability
improved, % improved, %
______________________________________________________________________
Men
poor 118 37.3 8 20.0
moderate 430 15.4 54 11.1
good 542 6.8 142 7.8
excellent 288 a 104 a
______________________________________________________________________
Women
poor 147 34.0 8 62.5
moderate 625 16.0 105 15.2
good 803 5.0 241 3.7
excellent 359 a 159 a
_____________________________________________________________________
a None of the workers had moved to a higher category because this category is the highest
possible.
2
Calculating the work ability index

The work ability index covers seven items, each of which is evaluated with the use of
one or more questions (table 3). It is calculated by summing the points received for
each item according to table 3. In the calculation it is especially important that the
score for item 2 (work ability in relation to the demands of the job) be weighted
according to the following instructions and that the final scores for items 3 (number of
current diseases diagnosed by a physician) and 7 (mental resources) be determined
according to the instructions in table 3. The best possible rating on the index is 49
points and the worst is 7 points. All the questions in the questionnaire must be
answered before the index can be calculated. Half points in the final scores are
rounded off to the next whole number (e.g., 28.5 is rounded to 29 points).

TABLE 3.
Items covered by the work ability index, the number of questions used to evaluate
each item, and the scoring of the responses

Item Number of Scoring of the responses

questions
_____________________________________________________________________________

1 current work ability compared 1 0–10 points

with the lifetime best (value circled in the questionnaire)

2 work ability in relation 2 score weighted according to the nature

to the demands of the job of the work (formula for the calculation
appears on the next page)

3 number of current diseases 1 at least 5 diseases = 1 point

diagnosed by a physician
(list of 51 3 diseases = 3 points
diseases) 4 diseases = 2 points
2 diseases = 4 points
1 disease = 5 points
no disease = 7 points
(only diseases diagnosed
by a physician are counted)

4 estimated work impairment 1 1–6 points

due to diseases (value circled in the questionnaire;
the worst value should be chosen)

5 sick leave during the past year 1 1–5 points

(12 months) (value circled in the questionnaire)

6 own prognosis of work ability 1 1, 4 or 7 points

two years from now (value circled in the questionnaire)

7 mental resources 3 the points of the question series

(note: item 7 refers to the are added together and the sum
worker's life in general, both is modified as follows:
at work and during leisure time) sum 0–3 = 1 point
sum 4–6 = 2 points
sum 7–9 = 3 points
sum 10–12 = 4 points
_____________________________________________________________________________
Item 2 (ability in respect to demands): weighting of the response

In item 2 work ability is assessed in relation to both the physical and mental demands of the
job. The response to the question is weighted according to whether the work is primarily
physical or mental. The term "work ability score" refers to the number of the response
circled in the questionnaire.

For physically demanding work, for example, auxiliary, installation and home care work
the work ability score for the physical demands of the job is multiplied by 1.5
the work ability score for the mental demands of the job is multiplied by 0.5.

For mentally demanding work, for example, office, teaching and administrative work
the work ability score for the physical demands of the job is multiplied by 0.5
the work ability score for the mental demands of the job is multiplied by 1.5.

For work that is both physically and mentally demanding, for example, nursing,
transport, dental and kitchen supervision work, the work ability score remains unchanged.

Example of the weighting of the response

Suppose that the respondent circled alternative 3 for the physical demands of his or her job
and alternative 5 for the mental demands of the job.

If he or she has a physically demanding job, item 2 is calculated as follows:

(3 x 1.5) + (5 x 0.5), that is 4.5 + 2.5 = 7.

If his or her job is mentally demanding, item 2 is calculated as follows:

(3 x 0.5) + (5 x 1.5), that is 1.5 + 7.5 = 9.

If he or she has a job that is both physically and mentally demanding, item 2 is calculated
as follows:
3 + 5 = 8.
3
Example of how to determine
the work ability index
A construction supervisor whose job is basically mentally demanding will serve as the
example. When the supervisor filled out the work ability questionnaire the first time, he was
50 years old and had separated from his wife the preceding autumn. A physician had
diagnosed hypertension, and he had hurt his back on a construction site the preceding
winter. He considered himself somewhat overweight, and he sometimes had stomach
trouble. In spite of his problems, his work ability index was good, score of 38.

The supervisor's work ability index was determined from his responses to the questionnaire
as follows:

Item Response Score

___________________________________________________________________________

1 current work ability compared score 7 7

with the lifetime best

2 work ability in relation work ability in relation to 7 because the job was
to the demands of the job physical demands: 2 primarily mental work:
work ability in relation to (2 x 0.5) + (4 x 1.5)
mental demands: 4 =1+6=7

3 number of current diseases diagnosed injury to the back 4

diagnosed by a physician
and hypertension
(2 diseases =score of 4)
(own opinion: digestive
problems and overweight,
but these did not receive
points because they were not
diagnosed by a physician)

4 estimated work impairment score 5 (able to work 5

due to disease but it causes symptoms)

5 sick leave during the past year score 4 (less than 9 days) 4
(12 months)

6 own prognosis of work ability score 7 (rather certain) 7

two years from now

7 mental resources enjoys daily tasks: 3 4

active and alert: 4
full of hope for the future: 3
____
total points: 10,
so the score is 4
____________________________________________________________________
Total score 38

Work ability index 38, good

4
Reference values

How can the reference values be used?

The reference values used for the work ability index have been taken from several
investigations, and more data are continually being gathered. The reference values
given on pages 13–15 present the averages and percentages of different categories of
work ability index according to gender, age and occupation (tables 4–7).

The reference values can be used, for example, for the following comparisons:
What is the work ability of the employees in your own workplace at the age of 50, 55
and 58 years in comparison with the average work ability of municipal workers and
other occupational groups at the same age?
What is the percentage of workers with a poor work ability in your own workplace in
comparison with the results of municipal workers, construction workers, and
industrial workers?

On the basis of the comparison, you can determine if the work ability of the workers in
your own workplace deviates from the reference values. Of primary importance is to
determine how many workers have a poor work ability in different occupations
according to age group. Measures should especially be directed towards the workers
with poor work ability because a large proportion of these workers may become
disabled to work within the next few years if proper supportive measures are not taken.
When the work ability indices are checked and supportive measures are considered,
different occupational and job groups should be taken into account.

As a result of the work ability follow-up, occupational health personnel can establish
their own reference values for clients on the basis of their follow-ups (group follow-up
form). The work ability distribution of the clients by age and occupation will form the
most important reference values for occupational health personnel. The most
important task of occupational health personnel is to follow the changes in work ability
on the individual and group level (for example, departmental, age or occupational
group) and evaluate the effectiveness of the measures that have been taken.
TABLE 4.
Means of the work ability indices of 50- , 55- and 58-year-old men and women currently in municipal
occupations according to work content (physically demanding, mentally demanding or a combination of both)
and profile group

Gender/work content/ Age (years) Gender/work content/ Age (years)

profile group 50 55 58 profile group 50 55 58
_____________________________________________ _________________________________________
Men 35 34 34 Women 36 35 34
_____________________________________________ _________________________________________
Physically demanding work 34 33 31 Physically demanding work 34 32 32
auxiliary work 33 33 31 auxiliary work 34 33 31
unskilled assistants cleaners
painters hospital aides
construction workers and kitchen helpers
streetsweepers construction workers
park workers and streetsweepers
laborers park workers
installation work 35 33 31 home care work 34 31 33
fire fighters bathers
janitors domestic helpers and
mechanics and pipe fitters housekeepers
car mechanics
carpenters
electricians
_________________________________________ _________________________________________
Combination of physically Combination of physically
and mentally demanding work 34 34 33 and mentally demanding work 37 35 34
transport work 34 34 32 kitchen supervision 36 34 30
machine operators dental work 39 37 38
bus drivers nursing work 37 35 34
other transport workers child care workers
dump work 33 33 .. practical nurses
dental work 37 38 .. psychiatric nurses
nursing work 35 36 .. specialized nurses
psychiatric nurses other nurses
_________________________________________ _________________________________________
Mentally demanding work 39 36 36 Mentally demanding work 39 35 35
administrative work 40 38 37 office work 38 36 35
social workers drafting personnel
office supervisors typists
technical supervision 38 35 36 clerks
fire chiefs administrative work 40 37 36
supervisors at social workers
construction sites head ward nurses
physician's work 44 41 40 head nurses
teaching work 38 35 34 office supervisors
vocational school teachers physician's work 40 39 38
secondary school teachers teaching work 38 35 35
vocational school teachers
secondary school teachers
day care center teachers
_________________________________________ _________________________________________
TABLE 5.
Percentage of 50-, 55- and 58-year-old municipal workers in the work ability categories
according to the workers' gender and whether the work is physically demanding, mentally
demanding or a combination of both (Ilmarinen 1988, Ilmarinen et al. 1995)

Age gender/ Physically Physically and Mentally

work ability demanding mentally demanding
index* work demanding work work
______________________________________________________________________________
50 years Men
of age poor 18 20 9
moderate 40 38 21
good 32 32 39
excellent 10 10 31

Women
poor 21 10 6
moderate 40 34 24
good 30 40 46
excellent 9 16 24
______________________________________________________________________________
55 years Men
of age poor 19 18 8
moderate 47 42 37
good 28 31 43
excellent 6 9 12

Women
poor 22 14 10
moderate 52 42 39
good 22 31 41
excellent 4 9 10
______________________________________________________________________________
58 years Men
of age poor 26 21 13
moderate 50 44 37
good 20 25 31
excellent 4 10 19

Women
poor 28 15 15
moderate 44 47 39
good 21 27 34
excellent 7 11 12
______________________________________________________________________________

TABLE 6.
Percentage of construction workersa in the work ability categories according to their
age (based on data from Matikainen et al. 1993)
Work ability Age, years
index* 40–44 45–49 50–54 55–59 60–65
______________________________________________________________________________
poor 2.4 2.8 7.0 13.5 15.7
moderate 13.1 13.8 29.3 34.6 41.2
good 60.3 64.9 52.1 44.2 35.3
excellent 24.2 18.5 11.6 7.7 7.8
______________________________________________________________________________
total, % 100.0 100.0 100.0 100.0 100.0
total, n 252 254 242 156 51
a
Occupational groups: carpenters, building men, measuring carpenters, cement and concrete
workers, renovators, pipe fitters, bricklayers, tilers, truck drivers.
TABLE 7.
Percentage of workers in a middle-sized industrial enterprise in the work ability
categories according to their age (based on data from Ilmarinen et al. 1996)
Work ability Age years
index* 20–29 30–39 40–49 50–59 60–64 total
______________________________________________________________________________
poor – – 1.2 8.3 25.0 2.8
moderate 1.6 6.3 11.3 21.7 37.5 12.2
good 26.5 41.3 40.9 43.9 25.0 40.1
excellent 71.9 52.4 46.6 26.1 12.5 44.9
______________________________________________________________________________
total, % 100.0 100.0 100.0 100.0 100.0 100.0
total, n 64 126 338 158 8 683

*categories of the work ability index:

poor = 7–27 points
moderate = 28–36 points
good = 37–43 points
excellent = 44–49 points
5
Practical follow-up measures

Occupational health care personnel can use the work ability index in their overall assessment
of a worker's work ability and functional capacity. They consider whether, in addition to the
work ability index, other evaluations, such as tests measuring physical or mental function or
laboratory tests, are needed.

Once a reliable assessment of a worker's work ability has been made, the occupational health
personnel can determine the measures and recommendations needed to support this work
ability and develop the worker's job, work conditions and work community (employee's feed-
back form and follow-up form for actions taken). The need for supportive measures depends
on the worker's work ability and functional capacity and on his or her work conditions.

If the worker's work ability is excellent, the occupational health personnel should explain
which work and life-style factors help maintain and which help weaken his or her work ability.
The worker is urged to continue to avoid or decrease the factors which weaken work ability.

Attempts to strengthen a good work ability are supported, and it is determined whether the
worker's work and life-style have features to help strengthen work ability or whether they have
characteristics that threaten it.

If work ability is moderate, an effort should be made to increase the worker's own initiatives to
promote his or her work ability (diet, exercise, sleep and rest, social activities, and other
hobbies and study). In addition a worker may need medical rehabilitation. Often a worker also
needs measures to develop his or her professional knowledge and to increase and diversify
his or her occupational skill. In addition any risks in the work or work environment and work
organization and problems with supervisors should be corrected.

If work ability is poor, the prerequisites and possibilities for rehabilitation should be
determined and also whether the worker's work ability can be restored by correcting the
hazards found in his or her work or work environment and by remodelling the work
organization to make it more efficient. Possibilities such as job rotation, change in tasks, free
work shifts and other individual solutions should be considered.

The work ability index is a concrete aid to the creation of an overall picture of a worker's work
ability and functional capacity and the factors affecting them. An individual worker's work
ability index or the mean index of a group can be checked at suitable intervals (worker's
follow-up form). In this manner the prerequisites for supporting an employee's work ability and
functional capacity are improved, and through this effort the productivity of the enterprise,
among other things, is increased. At the same time occupational health personnel have the
possibility to develop work methods and cooperation with management, personnel
administrators, foremen, and occupational safety and health groups.

Activities to maintain work ability require cooperation between all the concerned parties.
For the follow-up of work ability and the assessment of associated supporting measures, the
following system supporting work ability has been constructed:

determination of the work ability

index and examination made by
a health care professional

other examinations

overall assessment of work ability

and functional capacity

occupational health measures

follow-up of measures

work ability index

interview by health care professional,
examination of general health status, etc

laboratory and other examinations

other examinations, for example,
focusingon physical and
psychological functional capacity

on the individual level

on the work group level (for example,
departmental, age or occupational group)

feedback on work ability and functional capacity

instructions for maintaining and
strengthening work ability
activities to maintain and strengthen work ability
improving the work load and work environment
(ergonomic, occupational hygiene, safety)
- muscular work
- difficult work postures
- monotonous work movements
- tools and work spaces
- climatic conditions
- machine use
- hazardous substances
improving the work community and work organization
- possibilities for development
- responsibility
- management and supervisory work
- feedback and support
- use of knowledge
- work schedules
- lack of freedom
- inspirational work
improving functional capacity (physical exercise,
healthy and invigorating life-style) and promoting
professional skill
- exercise
- sleep and rest
- diet and eating habits
- smoking and alcohol consumption
 - hobbies and other invigorating activities
- maintenance and promotion of professional skill
- professional and medical rehabilitation
other supportive services

follow-up of work ability

follow-up of work and work conditions
follow-up of the occupational health personnel's activities
follow-up of feedback and realization activities
Confidentiality of the data

Data obtained with the questionnaire of the work ability index is strictly confidential, and
they are covered by the same regulations for secrecy as the activities of health care
professionals in general. The data cannot be given to anyone not employed by the
occupational health unit, for example, the worker's employer, in a form that will reveal the
identity of the employee or employees in question. To ensure confidentiality, it is
recommended that data be presented in statistical cells comprised of 10 persons, for
instance, in age or occupational groups, when sensitive topics such as health are under
consideration.

Filling out the questionnaire of the work ability index is always voluntary. Refusing to fill
out the form must not in any way negatively influence the treatment of a worker by
occupational health personnel or the employer.

Occupational health professionals can use the work ability index to help promote and
maintain work ability and to follow workers who must cope with a disability or illness at
work. It can also be used in counseling for rehabilitation and in reference to treatment or
rehabilitation and the person's participation in workplace activities that maintain work
ability. When the questionnaire is given to a worker to be filled out, the worker must be
informed of the purpose for which the questionnaire data will be used and also how to
proceed if a need for treatment or other health care is revealed. According to ethical
rules, the information must be given in written form, but should also be presented
verbally.

The work ability index is calculated from the data on the questionnaire, and a summary
is written for the worker's personal health data file. Workers are asked to give their
informed consent for the summary and the index score to be included in their health file,
and generally the data will not be added without this consent. A request for the worker's
consent is included for this purpose at the bottom of the form. If, however, the
questionnaire data are collected for the purpose of following a worker's illness or
disability or for counseling for treatment or rehabilitation, the worker's consent is not
necessarily needed. The data can be recorded in the summary to the degree necessary
for the activity in question. The original questionnaire form is retained with the records of
the occupational health unit (in a form file or in a computer database), and it is kept
separate from worker's personal health data file. Occupational health professionals are
permitted access to the original detailed data when needed.

The same regulations that cover occupational health care records also cover the delivery
of the work ability summary and work ability index. When personal health care data are
delivered, the forms and corresponding computer database must remain with the
occupational health unit which collected the data.

The instructions for processing, compiling, saving, and delivering occupational health
care records are being updated. At the same time instructions concerning the
permissible limits for retaining such documents are being drawn up, for example, for
databases and for forms.
6
Feedback and follow-up

To aid the provision of feedback to the worker, a form has been devised that both
explains and gives instructions for activities to maintain and promote work ability. In
conjunction with the feedback, activities to promote work ability are recommended in the
sample list . The back of the follow-up form for the worker contains a follow-up form
meant for the use of occupational health personnel; it has been designed to aid the
follow-up of recommended measures.

Sample list of measures to improve work ability

1 Improving the work load and the environment (ergonomics, occupational hygiene,
safety)

11 decrease in muscular work

111 manual carrying, lifting and moving
112 standing
113 work rotation
114 other muscular work

12 decrease in difficult work postures and movements

121 stooped and twisted or other difficult work postures
122 similar repetitive movements
123 other difficult postures and movements

13 improvements in tools and work spaces

131 which tools?
132 which work spaces?

14 decrease in climatic hazards

141 heat, cold or changes in temperature
142 dryness, dampness, wetness
143 other climatic hazards

15 decrease in machine hazards

151 noise
152 vibration
153 risk of accident
154 other hazards related to the use of machines

16 protection from hazardous substances

161 mold or dusts
162 hazardous substances, dirty conditions
163 other hazardous substances

17 decrease in other hazardous work loads or work conditions

2 Improving the work community and work organization (personal relations,
collaboration, management)

21 increase in possibilities to develop

211 participation in planning of one's work
212 training related to work tasks
213 other possibilities to develop

22 increase or decrease in work-related responsibility

221 possibilities to control one's work
222 responsibility for other persons
223 possibility to fail or take incorrect action
224 other work responsibility

23 development of management and supervisory skills

231 attitude of superior toward ageing
232 communication
233 clarification of role description
234 development of other management and supervisory skills

24 development of feedback and support systems

241 recognition and acknowledgement of value
242 support of superior
243 other development of management and supervisory tasks

25 increase or decrease in use of knowledge

251 precision in the receival of information
252 hurried decisions
253 other use of knowledge

26 improvement of work schedules

261 workbreaks
262 part-time work
263 other work schedules

27 decrease in lack of freedom

271 rush and tight schedules
272 paced work
273 other work restrictions

28 increase in inspiration in work

281 addition of diversity and enrichment of the work
282 decrease in isolation and solitarity
283 increase in contact and social relations
284 increase in other forms of inspiration

29 other development of the work community and work organization

3 Improving functional capacity (physical exercise, healthy and invigorating life-style)

and promoting professional skill

31 increase in physical activity

311 increase in the person's general condition
312 increase in musculoskeletal strength and endurance
313 increase in motor and body control
314 increase in flexibility
315 relaxation exercises
316 other physical activity
32 improvement in quality of sleep and rest

33 improvement in diet and eating habits

331 meals at the workplace (recommendations)
332 dietary recommendations (fat, salt, sugar)
333 weight loss (goal)
334 other dietary and eating habits (groups, etc)

34 decrease in smoking and alcohol consumption

341 cessation of smoking
342 limiting of alcohol consumption
343 other recommendations for tobacco and alcohol use (groups, etc)

35 promotion of hobbies
351 cultural activities (for example, music, movies, art exhibitions)
352 club and association activities
353 handicrafts, woodwork, and other such hobbies
354 other possibilities to promote hobbies

36 maintenance and promotion of professional skills

361 training and maintenance of professional skills
362 complementary courses
363 support for additional education
364 other means to promote professional skills

37 professional and medical rehabilitation

371 job retraining
372 vocationally oriented medical rehabilitation
373 training designed to maintain work ability
374 training designed to improve work ability
375 other rehabilitative activities

38 other development of the worker's work ability and functional capacity

Bibliography

Aging and work capacity. Report of a WHO Study Group. WHO Technical Report Series 835.
World Health Organization, Geneva 1993.

Elo A-L et al.: Occupational stress questionnaire: user's instructions. Institute of Occupational
Health, Helsinki 1993.

Eskelinen L, Kohvakka A, Merisalo T et al.: Relationship between the self-assessment and clinical
assessment of the health status and work ability. Scand J Work Environ Health 17 (1991):suppl 1,
40–47.

Huuhtanen P, Nygård C-H, Tuomi K et al.: Changes in stress symptoms and their relationship to
changes at work in 1981–1992 among elderly workers in municipal occupations. Scand J Work
Environ Health 23 (1997):suppl 1, 36–48.

Ilmarinen J (ed.): Työ, terveys ja eläkeikä kunta-alalla [Work, health and retirement age in
municipal occupations]. Työterveyslaitoksen tutkimuksia 3 (1985):2.

Ilmarinen J (ed.): Työ, terveys ja eläkeikä: seurantatutkimus ikääntyvillä kunta-alan työntekijöillä

[Work, health and retirement age: follow-up study of ageing municipal workers]. Työ ja ihminen
2 (1988):4.

Ilmarinen J (ed.): The aging worker. Scand J Work Environ Health 17 (1991):suppl 1.

Ilmarinen J, Leppänen A, Louhevaara V et al.: Työkyky tukee mahdollisuuksien toteutumista.

MAHIS-projektin alkumittausten tuloksia. [Work ability makes posibilities come true].
Työterveyslaitos, Helsinki 1996.

Ilmarinen J, Tuomi K: Work ability of aging workers. Scand J Work Environ Health 18
(1992):suppl 2, 8–10.

Ilmarinen J, Tuomi K: Work ability index for aging workers. In: Aging and work. Ed. by J Ilmarinen.
Proceedings 4. Institute of Occupatonal Health, Helsinki 1993.

Ilmarinen J, Tuomi K, Klockars M: Aging and work ability index: A 10-year follow-up of municipal
employees. In: The paths of productive aging. Proceedings of the XIVth UOEH IIES International
Symposium and the IEA Technical Group for Safety and Health Conference, 19–21 October 1995.
Taulor & Francis, Kitakyushu 1995, 300–306.

Ilmarinen J, Tuomi K, Klockars M: Changes in the work ability of active employees over an 11-
year period. Scand J Work Environ Health 23 (1997):suppl 1, 49–57.

Matikainen E, Malmivaara A, Muller K et al.: Rakentajien työkyky. Kyselytutkimus

rakennustyöntekijöiden terveydentilasta, työkyvystä ja eläkeasenteista. [Work ability of
construction workers]. Ikääntyvä arvoonsa 10. Työterveyslaitos, Työsuojelurahasto, Helsinki 1993.

Nygård C-H, Eskelinen L, Suvanto S et al.: Associations between functional capacity and work
ability among elderly municipal employees. Scand J Work Environ Health 17 (1991):suppl 1, 122–
127.

Nygård C-H, Huuhtanen P, Tuomi K et al.: Perceived work changes between 1981 and 1992
among aging workers in Finland. Scand J Work Environ Health 23 (1997):suppl 1, 12–19.

Seitsamo J, Ilmarinen J: Life-style, aging and work ability among active Finnish workers in 1981–
1992. Scand J Work Environ Health 23 (1997):suppl 1, 20–26.
Seitsamo J, Klockars M: Aging and changes in health. Scand J Work Environ Health 23
(1997):suppl 1, 27–35.

Tuomi K (ed.): Ikääntyvä työntekijä v. 1981–92. [Aging worker in 1981–92]. Työ ja ihminen,
tutkimusraportti 2. Finnish Institute of Occupational Health, Helsinki 1995.

Tuomi K (ed.): Eleven-year follow-up of aging workers. Scand J Work Environ Health 23
(1997):suppl 1, 1–71.

Tuomi K, Eskelinen L, Toikkanen J et al.: Work load and individual factors affecting work ability
among aging municipal employees. Scand J Work Environ Health 17 (1991):suppl 1, 128–134.

Tuomi K, Ilmarinen J, Eskelinen L et al.: Prevalence and incidence rates of diseases and work
ability in different work categories of municipal occupations. Scand J Work Environ Health 17
(1991):suppl 1, 67–74.

Tuomi K, Ilmarinen J, Martikainen R et al.: Aging, work, life-style and work ability among Finnish
municipal workers in 1981–1992. Scand J Work Environ Health 23 (1997):suppl 1, 58–65.

Tuomi K, Toikkanen J, Eskelinen L et al.: Mortality, disability and changes in occupation among
aging municipal employees. Scand J Work Environ Health 17 (1991):suppl 1, 58–66.
WORK ABILITY INDEX Worker feedback To be filled out by occupational health personnel

____________________________________________________________ ________ / ______________

Surname and first names Date

work ability index score score category objective

_____________________________________
7–27 poor restore work ability
28–36 moderate improve work ability
37–43 good support work ability
44–49 excellent maintain work ability

Recommendations:

WORK AND WORK CONDITIONS WORK COMMUNITY

Improvements in work load and the Improvements in the work community and
work environment work organization
(ergonomics, occupational hygiene, safety) (personal relations, collaboration, management)

_______________________________ WORK ABILITY ____________________________

_______________________________ PROMOTION ____________________________
_______________________________ ____________________________
_______________________________ ____________________________

WORKER
Improving functional capacity (physical exercise,
healthy and invigorating life-style) and
promoting professional skill

______________________________
______________________________
______________________________
______________________________

GOOD WORK ABILITY AND HEALTH

HIGH QUALITY OF HIGH QUALITY OF

WORK AND LIFE AND WELL-BEING
PRODUCTION

GOOD ABILITY AT RETIREMENT,

ACTIVE AND MEANINGFUL
"THIRD AGE"

Planned date for the next follow-up: _________/__________

WORK ABILITY INDEX Follow-up of recommendations To be filled out by occupational health
personnel

Surname and first names ___________________________________________________________________

Work place/work site ________________________________________________________________________

immediacy: 1 within 1 month realization: 1 entirely realized

2 within ½ year 2 partially realized
3 within 1 year 3 not realized

recommen- contents or number of imme- when to realiza- means (or cause why not succeeded)
dation recommendation diacy be car- tion
made (time) (no.) ried out (no.)
___________________________________________________________________________________________

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