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X NOVEM- OCTO- MONTH library at www . ausdoc . com . au / therapy-update
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2022
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workforce for longer ( see figure 7 ); even in the absence of any specific medical conditions , the effects of ageing may impact a person at work . 15 In Queensland , nearly 4 % of workers are aged over 65 years . 16
Considerations may include any relevant diagnoses , but also the reduced tolerance for shift or night work , the reduced capacity for physical activity , and changes in cognitive function . 15 These will not affect all older workers but require consideration in relevant workers .
In addition , simple changes associated with ageing , such as changes in vision or hearing , may have an impact in roles with close eye work , low light or noisy environments . 17 There may also be reductions in aerobic capacity , strength and balance with age , although these will not affect all older workers equally . 17
Although not exclusive to older workers , people exposed to hazardous substances at work for longer are at increased risk of many occupational diseases , including dust-induced diseases and occupational cancers . 18
When considering whether a patient will be returning to the workforce , assess for the following : if work is a causative factor in their condition ; the risk of progressive disease with ongoing exposure ; and the impacts of the condition on a worker ’ s ability to safely perform their role . Referral to an occupational physician is recommended to assess ongoing capacity in the same industry where there is a disease caused by exposure at work .
Assessment for older workers follows the same process as for all other workers , with information collected on physical capability , special senses ( including vision and hearing ), chronic disease ( if present ) and cognitive capacity .
ALCOHOL AND OTHER DRUGS
THE use and misuse of alcohol , prescription
and illicit drugs can all impact fitness for work . A review of the potential adverse effects of alcohol and illicit drugs is beyond the scope of this article ; however , in general , the chronic misuse of alcohol and / or illicit drugs is likely to be incompatible with the safe and effective performance of many work duties . Use of these products may have an impact on safety critical work and tasks requiring attention to detail or high degrees of concentration .
In assessing fitness for work in individuals taking prescription medications , it is important to consider not just the potential effects of the medication or medications , but also the potential impact of the condition for which the medication is prescribed . While not exhaustive , the classes of drugs listed in box 5 require close consideration .
The use of medicinal cannabis is increasing in Australia ( see figure 8 ). This has resulted in an increase in interest and concern from both employers and employees about how this may impact fitness for work . Broadly speaking , most medicinal cannabis preparations contain some combination of delta-9-tetrahydrocannabinol ( THC ) and cannabidiol ( CBD ). As with illicit or recreational use , medicinal THC can result in impairment of cognitive and motor skills via its intoxicating effects . 19 While CBDonly preparations do not have intoxicating effects and generally have fewer
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Figure 5 . Antarctic expedition work .
safety concerns , CBD still has potential side effects ( including fatigue , sedation , vertigo , nausea and vomiting ) that may impact fitness for work . 2 Note that it is currently against the law to drive with any amount of THC present in bodily fluid in Australia ; 3 if driving is required of part of their work , this is incompatible . Each state has different legislation regarding driving and cannabis , and it is recommended that GPs keep up to date with the relevant legislation in their jurisdiction , which due to the recent introduction of medicinal cannabis may be subject to change .
In general , the assessment of fitness for work for individuals taking medicinal cannabis should proceed in the same manner as for individuals taking any other medications .
PREGNANCY / BREAST FEEDING / MENOPAUSE
PREGNANCY is not an illness or
injury , but the physiological changes associated with pregnancy may impact on a worker ’ s fitness to perform their usual job role . These may include nausea , urinary frequency , balance , standing tolerance and
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Table 2 . Symptoms commonly impacting function at work
Symptom or problem
Autonomic dysfunction — orthostatic intolerance
Fatigue ( cognitive and physical )
Neurocognitive Exertional symptoms ( chest pain , dyspnoea , desaturation , tachycardia )
Pain
Voice dysfunction
Sense of distress / traumatic experiences
lifting capacity . In many roles , pregnancy will have little or no effect on the person ’ s physical capability to perform the job ( see figure 9 ). 20 However , the impacts of normal physiological change or pregnancy complications may affect work capacity in the short term , or for the duration of the pregnancy .
Pregnant workers may be exposed to potentially dangerous physical ,
Effect on function
Prolonged standing , sitting Endurance / concentration
Task endurance
Safety , procedures , Physical endurance ‘ Health on work ’ and ‘ work on health ’ considerations
Comfort , endurance , concentration
Voice endurance , telephone and meetings
Aggravates physical symptoms
Reproduced with permission The Society of Occupational Medicine 2022 23
Figure 6 . Diabetes in the workplace .
chemical or biological hazards ; the controls used for adult workers are insufficient in these circumstances to protect the fetus . Examples include noise , radiation , lead or other chemicals , or infections such as cytomegalovirus . It is essential that the worker is kept safe while in the workplace , and this includes any potential exposure to the fetus . Options may include increased controls , a reduction in
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Box 5 . Drug classes to consider closely
• Opiate or opioid pain relievers .
• Benzodiazepines and other sedatives or hypnotics .
• Antipsychotic drugs .
• Some antidepressants .
• Antihistamines .
• Anti-epileptic drugs .
• Motion sickness medications .
• Stimulants .
tasks with the highest exposures or a temporary change of work location . Similar considerations may be needed for workers who are breastfeeding . They may require access to somewhere to pump and store breast milk during the working day and should have limited exposure to any relevant hazards .
The effects of menopausal symptoms in the workplace have been a more recent area of research . 21 Consider the impact of physical and psychological symptoms on work for affected individuals .
COMPLEX SYMPTOMATOLOGY
MANY patients experience a constellation
of symptoms that may be varied in type and degree of severity over time . Some will be diagnosed with a known condition such as long COVID , myalgic encephalomyelitis / chronic fatigue syndrome ( ME / CFS ), functional neurologic disorder or similar , while others may never be given a formal diagnosis . It is essential that individuals with these conditions , including those without a diagnosis , are assessed individually for the effect of their condition on work .
Recent research into the effects of long COVID has shown that nearly half of affected participants required a reduced schedule on return to work , and an additional 22 % were not working at the time of the survey . 22
These conditions frequently feature a combination of physical and psychological symptoms that can impact on the patient ’ s day to day functioning . Fatigue is often prominent , and in the case of long COVID , ‘ brain fog ’ or other experience of cognitive dysfunction is common . 22
Post-exertional malaise is commonly seen in long COVID and ME / CFS . This can be challenging to manage in the workplace , particularly in manual jobs . 22
Table 2 lists the common symptoms of long COVID ( that overlap in other similar conditions ) and the potential effects on function in the workplace . 23 This may assist the GP when considering the impacts on the patient ’ s individual situation .
There is controversy regarding the best type of return to physical activity in conditions involving chronic fatigue . Pacing ( limiting physical and mental activities to stay within energy reserves , with the aim of avoiding symptom exacerbation ) is frequently recommended but may not be suitable for all work environments . 24
Placing long-term stringent restrictions on an individual who has a non-specific chronic pain or fatigue syndrome is likely to significantly decrease the likelihood that the individual will be able to maintain engagement with employment . This , in turn , may result in worse or more negative outcomes for their health in the longer term . At the other end of the
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