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Age, aging and physiological dysregulation in safety–critical work: a retrospective longitudinal study of helicopter emergency medical services pilots

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Abstract

Purpose

Concurrent progressive physiological dysregulation in different organ systems may be a driver of phenotypical frailty and is associated with morbidity and performance declines. In aging societies, health and performance of older workers are given increased scrutiny. However, there are few studies researching the effect of age on physiological dysregulation specifically in the working population and none for high-risk occupations with close medical supervision. Here, we aim to investigate this association cross-sectionally and longitudinally in a healthy sample of European helicopter emergency medical services pilots.

Methods

Using a retrospective cohort design, we constructed indices of (a) physiological dysregulation state (N = 52 participants) and (b) pace of change (N = 41 participants, average follow-up 7.9 years) based on measurements of 18 health risk-associated biomarkers, as documented in the participating pilots’ aeromedical examination records. The relationship of these two indices with average age (range 27.9–60.6 years) and average baseline age (29.3–57.2 years), respectively, was modeled by weighted least squares regression, adjusting for region of origin, smoking, and medication.

Results

Longitudinally, dysregulation significantly increased over the follow-up period, but the pace of change did not increase with baseline age. Cross-sectionally, we observed a significant negative quadratic effect of age on physiological dysregulation state, with maximum estimated physiological dysregulation at ages 45–50.

Conclusions

As hypothesized, progression of dysregulation over approximately 8 years is observable in a healthy occupational sample but it does not accelerate (i.e., does not increase with baseline age). Increases in dysregulation are counteracted by what appears to be a strong healthy worker survivor effect. The study shows that the development of physiological dysregulation in high-risk occupations differs from that in the general population and that physiological dysregulation indices may be helpful in reconciling safety concerns and fair treatment of aging workers in safety–critical jobs.

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References

  • Aerospace Medical Association (2004) The age 60 rule. Aviat Space Environ Med 75:708–715

    Google Scholar 

  • AGIS Investigators (2000) The advanced glaucoma intervention study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration. Am J Ophthalmol 130:429–440

    Google Scholar 

  • Aherne BB, Zhang C, Newman DG (2016) Pilot domain task experience in night fatal helicopter emergency medical service accidents. Aerosp Med Hum Perform 87:550–556

    Google Scholar 

  • Aiyar S, Ebeke C, Shao X (2016) The impact of workforce aging on European productivity. IMF Working Papers, 16/238. https://www.imf.org/external/pubs/ft/wp/2016/wp16238.pdf. Accessed 21 July 2019

  • Allen JO (2016) Ageism as a risk factor for chronic disease. Gerontologist 56:610–614

    Google Scholar 

  • American Speech-Language-Hearing Association (2018) Degree of hearing loss. http://www.asha.org/public/hearing/Degree-of-Hearing-Loss/. Accessed 13 May 2018

  • Arrighi HM, Hertz-Picciotto I (1994) The evolving concept of the healthy worker survivor effect. Epidemiology 5:189–196

    CAS  Google Scholar 

  • Astuti Y, Wardhana A, Watkins J, Wulaningsih W (2017) Cigarette smoking and telomere length: a systematic review of 84 studies and meta-analysis. Environ Res 158:480–489

    CAS  Google Scholar 

  • Avolio BJ, Waldman DA, McDaniel MA (1990) Age and work performance in nonmanagerial jobs. The effects of experience and occupational type. Acad Manag J 33:407–422

    Google Scholar 

  • Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380:37–43

    Google Scholar 

  • Bauer H, Herbig B (2019) Occupational stress in helicopter emergency service pilots from 4 European countries. Air Med J 38:82–94

    Google Scholar 

  • Beers H, Butler C (2012) Age related changes and safety critical work—identification of tools and a review of the literature. Research Report No 946. Health and Safety Executive, Liverpool

  • Belsky DW, Caspi A, Houts R, Cohen HJ, Corcoran DL, Danese A, Harrington H, Israel S, Levine ME, Schaefer JD, Sugden K, Williams B, Yashin AI, Poulton R, Moffitt TE (2015) Quantification of biological aging in young adults. Proc Natl Acad Sci USA 112:E4104–E4110

    CAS  Google Scholar 

  • Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, Moore SC, Tobias GS, Anton-Culver H, Freeman LB, Beeson WL, Clipp SL, English DR, Folsom AR, Freedman DM, Giles G, Hakansson N, Henderson KD, Hoffman-Bolton J, Hoppin JA, Koenig KL, Lee I-M, Linet MS, Park Y, Pocobelli G, Schatzkin A, Sesso HD, Weiderpass E, Willcox BJ, Wolk A, Zeleniuch-Jacquotte A, Willett WC, Thun MJ (2010) Body-mass index and mortality among 1.46 million white adults. N Engl J Med 363:2211–2219

    CAS  Google Scholar 

  • Bloom DE, Canning D, Fink G (2011) Implications of population ageing for economic growth. Oxford Rev Econ Policy 26:583–612

    Google Scholar 

  • Burkle A, Moreno-Villanueva M, Bernhard J, Blasco M, Zondag G, Hoeijmakers JHJ, Toussaint O, Grubeck-Loebenstein B, Mocchegiani E, Collino S, Gonos ES, Sikora E, Gradinaru D, Dolle M, Salmon M, Kristensen P, Griffiths HR, Libert C, Grune T, Breusing N, Simm A, Franceschi C, Capri M, Talbot D, Caiafa P, Friguet B, Slagboom PE, Hervonen A, Hurme M, Aspinall R (2015) MARK-AGE biomarkers of ageing. Mech Ageing Dev 151:2–12

    Google Scholar 

  • Cohen AA, Milot E, Yong J, Seplaki CL, Fulop T, Bandeen-Roche K, Fried LP (2013) A novel statistical approach shows evidence for multi-system physiological dysregulation during aging. Mech Ageing Dev 134:110–117

    Google Scholar 

  • Cohen AA, Li Q, Milot E, Leroux M, Faucher S, Morissette-Thomas V, Legault V, Fried LP, Ferrucci L (2015) Statistical distance as a measure of physiological dysregulation is largely robust to variation in its biomarker composition. PLoS One 10:e0122541

    Google Scholar 

  • Cornman JC, Glei DA, Goldman N, Weinstein M (2017) Physiological dysregulation, frailty, and risk of mortality among older adults. Res Aging 39:911–933

    Google Scholar 

  • Crimmins EM, Johnston M, Hayward M, Seeman T (2003) Age differences in allostatic load: an index of physiological dysregulation. Exp Gerontol 38:731–734

    Google Scholar 

  • Dellinger EP, Pellegrini CA, Gallagher TH (2017) The aging physician and the medical profession: a review. JAMA Surg 152:967–971

    Google Scholar 

  • Evans A, Evans S, Harper G (2016) International regulation of medical standards. In: Rainford D, Gradwell DP (eds) Ernsting’s aviation and space medicine, 5th edn. CRC Press, Boca Raton, pp 357–372

    Google Scholar 

  • Farrow A, Reynolds F (2012) Health and safety of the older worker. Occup Med 62:4–11

    CAS  Google Scholar 

  • Finkel D, Reynolds CA, McArdle JJ, Pedersen NL (2007) Cohort differences in trajectories of cognitive aging. J Gerontol B Psychol Sci Soc Sci 62:P286–P294

    Google Scholar 

  • Fraccaroli F, Deller J (2015) Work, aging, and retirement in Europe: introduction to the special issue. Work Aging Retire 1:237–242

    Google Scholar 

  • Freude G, Jakob O, Martus P, Rose U, Seibt R (2010) Predictors of the discrepancy between calendar and biological age. Occup Med 60:21–28

    Google Scholar 

  • Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    CAS  Google Scholar 

  • Hack MR (2016) Taking age equality seriously: the example of mandatory retirement. A comparative legal analysis between Norway and Germany in light of Council Directive 2000/78/EC. Nomos, Baden-Baden

  • Hammer GP, Auvinen A, de Stavola BL, Grajewski B, Gundestrup M, Haldorsen T, Hammar N, Lagorio S, Linnersjö A, Pinkerton L, Pukkala E, Rafnsson V, dos-Santos-Silva I, Storm HH, Strand T-E, Tzonou A, Zeeb H, Blettner M (2014) Mortality from cancer and other causes in commercial airline crews: a joint analysis of cohorts from 10 countries. Occup Environ Med 71:313–322

    Google Scholar 

  • Heikkinen E, Kauppinen M, Rantanen T, Leinonen R, Lyyra T-M, Suutama T, Heikkinen R-L (2011) Cohort differences in health, functioning and physical activity in the young-old Finnish population. Aging Clin Exp Res 23:126–134

    Google Scholar 

  • International Monetary Fund (2017) World Economic Outlook Database April 2017. https://www.imf.org/external/pubs/ft/weo/2017/01/weodata/index.aspx. Accessed 13 May 2018

  • Khan H, Kunutsor S, Kalogeropoulos AP, Georgiopoulou VV, Newman AB, Harris TB, Bibbins-Domingo K, Kauhanen J, Gheorghiade M, Fonarow GC, Kritchevsky SB, Laukkanen JA, Butler J (2015) Resting heart rate and risk of incident heart failure: three prospective cohort studies and a systematic meta-analysis. J Am Heart Assoc 4:e001364

    Google Scholar 

  • Ko DT, Alter DA, Guo H, Koh M, Lau G, Austin PC, Booth GL, Hogg W, Jackevicius CA, Lee DS, Wijeysundera HC, Wilkins JT, Tu JV (2016) High-density lipoprotein cholesterol and cause-specific mortality in individuals without previous cardiovascular conditions: the CANHEART study. J Am Coll Cardiol 68:2073–2083

    CAS  Google Scholar 

  • Kors JA, de Bruyne MC, Hoes AW, van Herpen G, Hofman A, van Bemmel JH, Grobbee DE (1998) T axis as an indicator of risk of cardiac events in elderly people. Lancet 352:601–605

    CAS  Google Scholar 

  • Lara J, Cooper R, Nissan J, Ginty AT, Khaw K-T, Deary IJ, Lord JM, Kuh D, Mathers JC (2015) A proposed panel of biomarkers of healthy ageing. BMC Med 13:222

    Google Scholar 

  • Leahy R, Crews DE (2012) Physiological dysregulation and somatic decline among elders: modeling, applying and re-interpreting allostatic load. Coll Antropol 36:11–22

    Google Scholar 

  • Levine ME (2013) Modeling the rate of senescence: can estimated biological age predict mortality more accurately than chronological age? J Gerontol A Biol Sci Med Sci 68:667–674

    Google Scholar 

  • Lewington S, Clarke R, Qizilbash N, Peto R, Collins R (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360:1903–1913

    Google Scholar 

  • Li W, Zhang J-Q, Sun J, Ke J-H, Dong Z-Y, Wang S (2007) Job stress related to glyco-lipid allostatic load, adiponectin and visfatin. Stress Health 23:257–266

    CAS  Google Scholar 

  • Li Q, Wang S, Milot E, Bergeron P, Ferrucci L, Fried LP, Cohen AA (2015) Homeostatic dysregulation proceeds in parallel in multiple physiological systems. Aging Cell 14:1103–1112

    CAS  Google Scholar 

  • Linnersjö A, Brodin L-A, Andersson C, Alfredsson L, Hammar N (2011) Low mortality and myocardial infarction incidence among flying personnel during working career and beyond. Scand J Work Environ Health 37:219–226

    Google Scholar 

  • Mackenbach JP, Stirbu I, Roskam A-JR, Schaap MM, Menvielle G, Leinsalu M, Kunst AE (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358:2468–2481

    CAS  Google Scholar 

  • Mäkinen IH (2000) Eastern European transition and suicide mortality. Soc Sci Med 51:1405–1420

    Google Scholar 

  • Mauss D, Li J, Schmidt B, Angerer P, Jarczok MN (2015) Measuring allostatic load in the workforce: a systematic review. Ind Health 53:5–20

    Google Scholar 

  • McEwen BS (1998) Stress, adaptation, and disease. Allostasis and allostatic load. Ann N Y Acad Sci 840:33–44

    CAS  Google Scholar 

  • Milot E, Morissette-Thomas V, Li Q, Fried LP, Ferrucci L, Cohen AA (2014) Trajectories of physiological dysregulation predicts mortality and health outcomes in a consistent manner across three populations. Mech Ageing Dev 141–142:56–63

    Google Scholar 

  • Mitchell SJ, Evans AD (2004) Flight safety and medical incapacitation risk of airline pilots. Aviat Space Environ Med 75:260–268

    Google Scholar 

  • Müller A, Prohn MJ, Huster KM, Nowak D, Angerer P, Herbig B (2014) Pilots’ age and incidents in helicopter emergency medical services: a 5-year observational study. Aviat Space Environ Med 85:522–528

    Google Scholar 

  • Müller-Nordhorn J, Binting S, Roll S, Willich SN (2008) An update on regional variation in cardiovascular mortality within Europe. Eur Heart J 29:1316–1326

    Google Scholar 

  • Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R, Zinman B (2007) Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 30:753–759

    CAS  Google Scholar 

  • National Cholesterol Education Program (2002) Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). Circulation 106:3143–3421

    Google Scholar 

  • Organisation for Economic Cooperation and Development (2006) Live longer, work longer. Ageing and employment policies. OECD, Paris

    Google Scholar 

  • Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM (2009) Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med 169:515–523

    Google Scholar 

  • Petrovic D, Pivin E, Ponte B, Dhayat N, Pruijm M, Ehret G, Ackermann D, Guessous I, Younes SE, Pechere-Bertschi A, Vogt B, Mohaupt M, Martin P-Y, Paccaud F, Burnier M, Bochud M, Stringhini S (2016) Sociodemographic, behavioral and genetic determinants of allostatic load in a Swiss population-based study. Psychoneuroendocrinology 67:76–85

    Google Scholar 

  • Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney M-T, Corra U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Lochen M-L, Lollgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM (2016) 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 37:2315–2381

    Google Scholar 

  • Rabl T (2010) Age, discrimination, and achievement motives. Pers Rev 39:448–467

    Google Scholar 

  • Rautaharju PM, Surawicz B, Gettes LS, Bailey JJ, Childers R, Deal BJ, Gorgels A, Hancock EW, Josephson M, Kligfield P, Kors JA, Macfarlane P, Mason JW, Mirvis DM, Okin P, Pahlm O, van Herpen G, Wagner GS, Wellens H (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part IV: the ST segment, T and U waves, and the QT interval. J Am Coll Cardiol 53:982–991

    Google Scholar 

  • Reiner Z, Catapano AL, de Backer G, Graham I, Taskinen M-R, Wiklund O, Agewall S, Alegria E, Chapman MJ, Durrington P, Erdine S, Halcox J, Hobbs R, Kjekshus J, Filardi PP, Riccardi G, Storey RF, Wood D (2011) ESC/EAS Guidelines for the management of dyslipidaemias. Atherosclerosis 217:3–46

    Google Scholar 

  • Rockwood K, Mitnitski A (2007) Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci 62:722–727

    Google Scholar 

  • Salthouse T (2012) Consequences of age-related cognitive declines. Annu Rev Psychol 63:201–226

    Google Scholar 

  • Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G (2015) Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci 52:86–105

    Google Scholar 

  • Schnorpfeil P, Noll A, Schulze R, Ehlert U, Frey K, Fischer JE (2003) Allostatic load and work conditions. Soc Sci Med 57:647–656

    Google Scholar 

  • Seeman TE, McEwen BS, Rowe JW, Singer BH (2001) Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proc Natl Acad Sci USA 98:4770–4775

    CAS  Google Scholar 

  • Seplaki CL, Goldman N, Glei D, Weinstein M (2005) A comparative analysis of measurement approaches for physiological dysregulation in an older population. Exp Gerontol 40:438–449

    Google Scholar 

  • Shah AJ, Vaccarino V, Janssens AC, Flanders WD, Kundu S, Veledar E, Wilson PWF, Soliman EZ (2016) An electrocardiogram-based risk equation for incident cardiovascular disease from the National Health and Nutrition Examination Survey. JAMA Cardiol 1:779–786

    Google Scholar 

  • Silverman MN, Deuster PA (2014) Biological mechanisms underlying the role of physical fitness in health and resilience. Interface Focus 4:20140040

    Google Scholar 

  • Skirbekk V, Loichinger E, Barakat BF (2012) The aging of the workforce in European countries: demographic trends, retirement projections, and retirement policies. In: Hedge JW, Borman WC (eds) The Oxford handbook of work and aging. Oxford University Press, Oxford, pp 60–79

    Google Scholar 

  • Sluiter JK (2006) High-demand jobs: age-related diversity in work ability? Appl Ergon 37:429–440

    Google Scholar 

  • Straus SM, Kors JA, de Bruin ML, van der Hooft CS, Hofman A, Heeringa J, Deckers JW, Kingma JH, Sturkenboom MC, Stricker BHC, Witteman JCM (2006) Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol 47:362–367

    Google Scholar 

  • Stuck AE, van Gorp WG, Josephson KR, Morgenstern H, Beck JC (1992) Multidimensional risk assessment versus age as criterion for retirement of airline pilots. J Am Geriatr Soc 40:526–532

    CAS  Google Scholar 

  • Sun J, Wang S, Zhang J-Q, Li W (2007) Assessing the cumulative effects of stress. The association between job stress and allostatic load in a large sample of Chinese employees. Work Stress 21:333–347

    Google Scholar 

  • Sverke M, Hellgren J, Näswall K (2002) No security: a meta-analysis and review of job insecurity and its consequences. J Occup Health Psychol 7:242–264

    Google Scholar 

  • van Rijn RM, Robroek SJW, Brouwer S, Burdorf A (2014) Influence of poor health on exit from paid employment: a systematic review. Occup Environ Med 71:295–301

    Google Scholar 

  • Woodward M, Webster R, Murakami Y, Barzi F, Lam T-H, Fang X, Suh I, Batty GD, Huxley R, Rodgers A (2014) The association between resting heart rate, cardiovascular disease and mortality: evidence from 112,680 men and women in 12 cohorts. Eur J Prev Cardiol 21:719–726

    Google Scholar 

  • World Health Organization (2006) Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation. World Health Organization, Geneva

    Google Scholar 

  • World Health Organization (2018) Grades of hearing impairment. http://www.who.int/pbd/deafness/hearing_impairment_grades/en/. Accessed 13 May 2018

  • Yang Y, Kozloski M (2011) Sex differences in age trajectories of physiological dysregulation: inflammation, metabolic syndrome, and allostatic load. J Gerontol A Biol Sci Med Sci 66:493–500

    Google Scholar 

  • Yano Y, Stamler J, Garside DB, Daviglus ML, Franklin SS, Carnethon MR, Liu K, Greenland P, Lloyd-Jones DM (2015) Isolated systolic hypertension in young and middle-aged adults and 31-year risk for cardiovascular mortality: the Chicago Heart Association Detection Project in Industry study. J Am Coll Cardiol 65:327–335

    Google Scholar 

  • Zaslavsky O, Cochrane BB, Thompson HJ, Woods NF, Herting JR, LaCroix A (2013) Frailty: a review of the first decade of research. Biol Res Nurs 15:422–432

    Google Scholar 

  • Zatonski W (2007) The East–West Health Gap in Europe—what are the causes? Eur J Public Health 17(2):121

    Google Scholar 

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Funding

This paper reports findings of a study on age and flight safety in helicopter emergency medical services (HEMS) pilots funded via an unrestricted educational grant from the European HEMS & Air Ambulance Committee e.V. (EHAC).

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  1. Institute and Clinic for Occupational, Social, and Environmental Medicine, University Hospital of LMU Munich, Ziemssenstraße 1, 80336, Munich, Germany

    Hans Bauer, Dennis Nowak & Britta Herbig

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  1. Hans Bauer
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  2. Dennis Nowak
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Contributions

HB assisted with the study design and had primary responsibility for data collection, data management & quality control, data analysis, and drafting of the manuscript. DN obtained research funding and conceived/designed the study. BH obtained research funding, conceived/designed the study, and assisted with data collection and data analysis. All authors contributed substantially to the paper’s finalization.

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Correspondence to Hans Bauer.

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Conflict of interest

EHAC represents European air rescue organizations who favor a liberalization of certain current European regulations on maximum professional pilot age. Freedom from interference in any stage of the research process was laid down contractually between EHAC and the research project team, represented by the manuscript authors. EHAC had no role in the formulation of the study design, the collection, analysis and interpretation of the data, the writing of the report, and the decision to submit the paper for publication.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Bauer, H., Nowak, D. & Herbig, B. Age, aging and physiological dysregulation in safety–critical work: a retrospective longitudinal study of helicopter emergency medical services pilots. Int Arch Occup Environ Health 93, 301–314 (2020). https://doi.org/10.1007/s00420-019-01482-9

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