Tuesday, December 5, 2023

Targeted Assessments May Help Identify Workers Experiencing Cognitive Impairment

“As the United States gears up for a likely presidential contest between an 81-year-old incumbent and a 78-year-old challenger, the dilemma of how to deal with the issue of older people in important positions who may be experiencing cognitive limitations is front and center in the public eye,” wrote psychiatrist and past APA President Paul Appelbaum, M.D., in a Law & Psychiatry column appearing today in Psychiatric Services.

According to 2022 data, nearly 58 million adults ages 65 and older live in the United States, accounting for about 17.3% of the nation’s population. This percentage is expected to keep growing.

“Encouraging workers to remain active beyond standard retirement ages will be important to satisfy demands for labor, especially in skilled positions,” noted Appelbaum, who is the Elizabeth K. Dollard Professor of Psychiatry, Medicine, and Law and the director of the Division of Law, Ethics, and Psychiatry at Columbia University. But some may experience challenges with cognitive impairment while still in the workforce. What can employers do to prepare for the future?

He described two federal laws that prohibit discrimination based on age—the Age Discrimination in Employment Act (ADEA) and the Americans With Disabilities Act (ADA)—before noting that under federal law, employers are permitted to conduct target assessments of employees who show signs of impairment. “Applying that rule in a fashion that is fair to employees, and protective of the interests of employers and the public, is the difficult, but vital, task ahead.”

Appelbaum described how new approaches might include routine assessments of worker performance throughout an organization that do not single out older employees for more intensive scrutiny and clear standards for determining when evidence of impairment warrants targeted assessments.

“The prevalence of the most widespread form of neurocognitive disorder, Alzheimer’s disease, increases with age from 3% between 65 and 74 years of age to 17% between ages 74 and 84, jumping to 32% for people 85 years or older—hence the urgency of understanding the current parameters for how workplaces can and cannot address concerns about the mental functioning of older workers,” Appelbaum wrote.

For related information, see the Psychiatric News article “Tools for Countering Burnout Mirror Those for Aging Well as a Physician.”

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