In late 1993, the Social Security Administration (SSA) began an initiative potentially to develop a new procedure to evaluate whether an individual claiming benefits on the basis of disability was “disabled,” as defined in section 223(d) of the Social Security Act. In September 1994, the Commissioner of Social Security issued the disability process redesign in the “Plan for a New Disability Claim Process,” in which the agency discussed the need for a structured approach to disability decision making that takes into consideration the large number of claims being processed annually and still provides a basis for consistent, equitable decision-making by adjudicators at each level. The approach, the report states, “must be simple to administer, provide for consistent application of the rules at each level, and result in accurate decisions.” Moreover, the public must perceive the process as straightforward, understandable, and fair. The Commissioner noted that certain aspects of the proposed new methodology would ‘require much study and deliberation with experts and consumers,’ and the subsequent November 1994 report, “Disability Process Redesign: Next Steps in Implementation,” described the need for long-term research, consultation, development, and refinement that would be needed. As part of that research effort, the Federal Research Division (FRD) of the Library of Congress was engaged to survey and analyze the relationship between what SSA collectively calls “vocational factors,” i.e., age, education, and work experience, and an individual’s ability to work. The guidelines or “grids,” published in the 1978 Code of Federal Regulations, provide a framework for decision making. However, SSA staff and administration determined that the grids seemed to fit fewer and fewer cases at that stage of the decision process and required updated research. One reason for the disconnect may have resulted from the fact that the grid regulations, like the medical listings, were intended to be the subject of constant evaluation and change in a changing world. However, the grids have been relatively static over the years, and the current research is the first, systematic effort to update the information necessary to re- evaluate the vocational factors since 1978. The Commissioner of SSA has determined

ii that no further decisions will be made concerning the disability process until further research has been conducted. The context of the FRD research project is the need to identify possible changes in the application of the vocational factors in making decisions on disability claims. Although the overall process involves many other factors, such as medical evaluation and administrative procedures, the scope of the FRD project has been limited strictly to the statutorily mandated consideration of the three vocational factors in claims where medical evidence does not provide a conclusive decision. The task was to review literature on those subjects written since the late-1970s (when SSA published the “Medical-Vocational Guidelines” in the Code of Federal Regulations) to determine whether any of the conditions underlying the factors had changed in the intervening two decades. Special emphasis was placed on current literature, with a view toward collecting information that would help construct a system relevant to both present and future claims. In addition to information on the three vocational factors, the report also contains background information on the legislative history of the current SSA disability system with special emphasis on the vocational factors and, for purposes of comparison, summaries of disability determination systems used in the armed forces, the Department of Veterans' Affairs, and private disability insurance companies. Research on the vocational factors was done in coordination with a panel of experts: Dr. Laurence Branch, Professor, Duke University; Dr. Richard Burkhauser, Professor, Cornell University; Dr. Mary Daly, economist at the Federal Reserve Bank San Francisco; Dr. Alan Hartley, Professor, Scripps College; Dr. Kevin Hollenbeck, The Upjohn Institute; and Dr. Samuel Osipow, Professor, The Ohio State University. These experts were chosen after initial study of the subject brought their names to the forefront of those who have spent many years investigating these topics (various aspects of the aging process, disability and the workplace, vocational behavior, and worker training and education). These individuals served as consultants to the research team, making suggestions and guiding the research, and participating in a public workshop held at the Library of Congress in February 1998. Workshop

ii participants reviewed the initial research findings and defined and discussed the issues critical to the final compilation of information. In addition, FRD analysts consulted the experts throughout the process as particular problems or issues emerged. Other experts have been consulted as well. The FRD analysts learned immediately that the SSA disability program has characteristics that make it distinct from what most disability specialists understand to be the issues confronting individuals with impairments. First, the program is a medically based one that does not grant partial or short-term disability status--the impairment must be expected to last at least 12 months or result in death. Second, with the exception of eyeglasses, hearing aids, and canes, disability examiners cannot consider assistive devices--the decision on disability status must be based on medical impairment and the ability to perform other work. Third, generally speaking, applicants who come to SSA are looking for financial assistance; they are less inclined to be interested in help with their disability. The FRD research team, after extensive orientation by SSA vocational specialist Elbert Spivey, understood that their task was delimited by the statutory requirements of the SSA program. In the preliminary stages of the project, the FRD research team met with the SSA project working group and attended a two-day meeting of the National Academy of Science Institute of Medicine’s Committee to Review the Social Security Administration’s Disability Decision Process Research. Throughout the process, other briefings, training sessions, and less formal meetings familiarized the analysts with the existing system and the directions in which the search for information could most productively focus. The analysts have been in regular contact with SSA working group project officers Howard Bradley and Dr. Paul Burgan, who have identified new areas of exploration as they appeared. The research process itself has relied heavily on the Library of Congress collections for journal and monographic treatment of topics such as the physical and psychological aspects of aging, changes in the American workplace and workforce, the nature of disability and human responses to physical impairment, and the role that education plays in determining an individual's work career and opportunities. In addition, researchers tapped online sources via the Internet, as well

ii as the resources of the National Rehabilitation Information Center and the National Library of Medicine. The FRD research team is grateful for the assistance of Mr. Larry DeWitt, Historian for the Social Security Administration’s Office of the Librarian, Records, and Management, and Mr. Robert Krebs, Office of Records and Reprographics, who helped the team locate archival documents relating to the legislative history of the disability program. Thus, this report summarizes several months of intensive activity on several levels. Its aim is to present a broad picture of current and likely future conditions that may have significant impact on the characteristics of the population of claimants to be encountered in disability evaluation procedures. The research effort undertaken by FRD is part of a much larger research effort sponsored by SSA. The information from this report will be added to other research (including an “integration” effort that will combine all the various projects into a larger, more comprehensive product) that will help SSA analysts and policy makers determine the future operation of the disability program. The report is organized into sections: Introduction, Legislative History and Chronology, Age and the Ability to Work, Education and the Ability to Work, Work Experience and the Ability to Work, Results and Conclusions, and Appendices (including private disability insurance policies and procedures, disability procedures and policies for the United States Department of Veterans Affairs and Department of Defense, and medical case studies).

ii EXECUTIVE SUMMARY1

In late 1993, the Social Security Administration began an initiative potentially to develop a new procedure to evaluate whether an individual claiming benefits on the basis of disability was “disabled,” as defined in section 223(d) of the Social Security Act. As part of that effort, in 1997, the Federal Research Division of the Library of Congress was engaged to survey and evaluate the relationship between what SSA collectively calls “vocational factors,” that is, age, education, and work experience, and an individual’s ability to work. The context of this research project is the need to identify possible changes in the application of the vocational factors in making decisions on disability claims. Although the overall process involves many other factors, such as medical evaluation and administrative procedures, the scope the FRD project has been limited strictly to the statutorily mandated consideration of the three vocational factors in claims where medical evidence does not provide a conclusive decision. The FRD task was to review literature on those subjects written since the late- 1970s (when SSSA published the “Medical-Vocational Guidelines” in the Code of Federal Regulations) to determine whether any of the conditions underlying the factors had changed in the intervening two decades. Special emphasis was placed on current literature, with a view toward collecting information that would help SSA construct a system relevant to claims in the future as well as in the present. In addition to the three vocational factors, the report also contains background information on the legislative history of the current SSA disability system, with particular emphasis on the vocational factors. The research team at FRD reviewed the legislative history of the Social Security Act and its various amendments, including advice and counsel supplied to the Agency by the Social Security Advisory Council (in writings as early as 1938) and the Medical Advisory Committee. This summary reportsbriefly on

1This Executive Summary was delivered as an oral briefing before the Committee to Review the Social Security Administration’s Disability Decision Process Research at the National Academy of Sciences Institute of Medicine on October 8, 1998.

ii the background for the task, the key elements of legislative history relating to the vocational factors, what the team did, and the researchers’ findings. Previous research into the vocational factors was done by the Agency’s own research staff in preparation for the 1978 Guidelines. However, senior staff told the FRD team that the research effort was not extensive and that the staff had relied on its extensive history of practical casework and adjudication to support its guidelines. No significant research was conducted in the intervening 20 years. The task confronting the FRD research team was to delve into the literature of the last 20 years in the vocational factors and to determine, if possible, how these three factors affect the ability of a person to work. In order to do that effectively and efficiently, the FRD team members had to become as well versed as possible in the SSA Disability Evaluation Process. They participated in sessions conducted to train case evaluators in the role of vocational factors in the determination procedure. This two-day, 8-hour course was taught by Elbert Spivey, the vocational expert at SSA. It was Mr. Spivey explained that the research done 20 years ago was not on the scale of this current effort. FRD team members came to the project without disability expertise per se--they are not experts in the field. They believed that they could engage experts, perhaps, as was stated in the introductory report, advanced graduate students who could work with FRD researchers and review their efforts almost daily. For a variety of reasons, FRD changed its tack, and, contrary to some predictions concerning their likely unavailability, was able to avail themselves of the services of nationally known experts. Those experts included: Dr. Laurence Branch, Professor at Duke University, PhD in Psychology and an expert in cognition and aging; Dr. Richard Burkhauser, Sarah Gibson Blanding Professor and Chair, Cornell University, Policy Analysis and Management, PhD in Economics and an expert on disability in the workplace; Dr. Mary C. Daly, PhD in Economics and senior economist at the San Francisco Federal Reserve Bank, author of numerous publications in the field of disability in the workplace; Dr. Alan Hartley, PhD in Psychology, Professor at Scripps College, and an expert in the field of cognitive processes and intellectual functioning and aging; Dr.

ii Kevin Hollenbeck, PhD in Economics, senior economist at the Upjohn Institute and an expert in issues of education to work, vocational training, and workplace education; and Dr. Samuel Osipow, PhD in Psychology and Professor of Psychology at The Ohio State University, an expert in occupational stress and vocational behavior. These experts were consulted at each step of the research process. FRD researchers worked with them by telephone, e-mail, fax, and letter. They answered questions, suggested avenues of research, recommended sources, and met with the team in February 1998 at a workshop at the Library of Congress. That workshop included, in addition to those mentioned, members of the SSA work group, other invited experts in education and economics, members of the research team from the American Institutes for Research who will use our report in their much larger disability evaluation study, and experts in public policy, including a gentleman who had worked in the Congressional Research Service and the Senate and House Committees that debated and wrote the legislative amendments to the Social Security Act. Mr. Fred Arner was present at the birth of much of the legislation from the late 1950s into the 1980s. SSA project officers also were very helpful in answering questions about the evaluation system’s “real-life” operations. The issues raised at the workshop helped the FRD team further to refine its research efforts and to produce an interim report. That interim report, read by the experts and the SSA work group, led to a draft final report, which was presented to SSA on September 25, 1998. The panel of experts participated in that briefing via teleconference. The 21 years of congressional debate on whether to establish a disability income program raised many issues, among them arguments of excessive government interference in the medical profession, “socialized medicine,” and fears that doctors would enroll claimants because of sympathy, with the resultant uncontrollable growth of the program. The 1956 Amendments to the Act made clear Congressional intent to make the program a medically based disability program, not an unemployment program. A claimant is declared disabled only if a medical impairment prevents him/her from working. Hiring practices in a given geographical area or the absence of jobs in the

ii claimant’s region play no role in the decision: the claimant must be able to perform substantial gainful activity in ranges of work. The vocational factors (age, education, and work experience) were intended to help control costs and facilitate management of the program. Because medical evidence is not always clear-cut (as early as 1938, Arthur Altmeyer, member of the SS Advisory Council, admitted his concerns about what he called the “subjectivity of medical evidence”), other factors enter into the decision process to determine whether an applicant is able to contribute to substantial gainful activity in the national economy. In 1942, 14 years prior to enactment of the program, Altmeyer introduced work experience to the list of factors to be considered. In 1955, the Medical Advisory Committee advised that age, education, training, experience, and other individual factors be used whenever medical and work records were insufficient to determine disability. Thus, although there was no statutory requirement to do so at this stage, beginning in 1955, the individual’s vocational capacity was considered when pertinent to the disability decision. The 1957 implementation regulations contained specific language on vocational factors: “...applicant’s impairment results in such a lack of ability to perform significant functions...that he cannot, with his training, education, and work experience, engage in any kind of substantial gainful activity.” Given the political climate and the phrasing of the new legislation, the vocational factors clearly were intended as a condition whose consideration would tend toward denial. The factor of age was added in the 1960 Amendments, which stated that “physical or mental impairments must be the primary reason for an individual’s inability to engage in substantial gainful activity.” In the course of the past year, the FRD team has reviewed most of the available literature concerning age, education, and work experience that falls within the parameters of the Social Security disability program. In the current disability evaluation process, the vocational factors enter at step 4 with a consideration of past relevant work. If the applicant can perform past relevant work, then he/she is not disabled. If he/she cannot perform past relevant work, then SSA must demonstrate what the claimant can do. Three factors enter the evaluation at this stage: a--the work must have been SGA; b--the claimant must have learned how to perform the work; c--the

ii work must have been performed within the past 15 years. At step 5, the examiner considers whether--given the claimant’s age, education, and work experience--the impairment prevents performance of any other work that exists in the national economy. The vocational rules are based on several assumptions:  An individual’s age affects his/her ability to adapt to new work situations;  Educational background contributes to the ability to meet vocational requirements such as reasoning ability, communication skills, and arithmetical ability. In addition to formal schooling, past work experience, level of responsibility while working, daily activities, hobbies, and results of testing may show an individual’s intellectual abilities;  Work experience (skills and abilities that have been acquired through work done in the past) shows the kind of work an individual may be expected to do. Consequently, in the current process, age, education, and work experience operate independently as well as in combination with one another to establish a favorable or adverse vocational profile. The research team at FRD investigated the relevant literature in these three areas published in the past two decades with the understanding that the research must focus on the effects of age, education, and work experience and the ability to work. The researchers quickly determined that much new information has come to light with respect to aging (physiological, psychological, and sociological aspects) and that future workers will be expected to extend their working lives over those of preceding generations. The team anticipates that new research about aging will make it possible to evaluate better a claimant’s functional ability to return to vocationally relevant previous work? In the 1950s when the disability amendments were passed, the frequency of re- tooling, changing careers, and re-education was much lower than today. In the 1950s and 60s, the manufacturing process was fairly consistent: the assembly line model dominated industry and each worker had his specific task to perform as the item passed through the production process. In the 1990s, however, many manufacturing

ii facilities are oriented toward the team concept where groups work together to produce the product. Some of the most highly valued qualities in the workplace are communications skills, working well with others, and being able to make judgments independent of direct supervision. The knowledge and skills acquired in the workplace accumulate over time, enabling workers to learn and to expand their repertoires beyond a job description printed in the company literature or the U.S. Department of Labor’s Dictionary of Occupational Titles. The research into the literature concerning the workplace and requirements of employers reflects the cumulative effect of multiple jobs or occupations--as well as the type, duration, and recentness of training--on the work experience history of disability claimants. How does the workplace environment of the 1990s and of the next century affect a disability examiner’s ability to determine whether a claimant’s work history reveals substantive information about the ability to work? Evidence strongly suggests that better paying jobs are tied more closely to educational attainment than ever before. Many welfare recipients exhibit characteristics similar to those who are unskilled and disabled. Recent reports from the states that have begun to reform their welfare programs describe new techniques that are used to upgrade skills and enable former welfare recipients to get better, longer-term jobs. This research merits attention from SSA. The following account briefly describes the research team’s findings. AGE:  Aging is not disease: one must distinguish between agemarkers and disease markers. Agemarkers provide information about vocational age at a given point in time and, cumulatively, they can be considered risk factors for potential declines. Agemarkers, as indicators, are reliable only if they actually measure an age-related factor and only if their measurement is repeatable and accurate.  Variance of the population increases with age. It is difficult to associate chronological age with particular characteristics of groups of individuals. No one theory of aging can predict an individual’s ability to function from chronological age alone.

ii  If an impairment does not affect the individual’s knowledge, skill, or abilities, then age by itself may be irrelevant. If the impairment affects these attributes, then some age-related factors may act to delay or prevent recovery. The result will be a person who is less likely to be employable.  Likelihood of new employment declines with age. Chronological age is not sufficient to predict the individual’s knowledge, skills, or abilities. Employers often prefer younger workers with the same or better knowledge, skills, and abilities to older employees. Thus, the likelihood of employment tends to decrease with increasing age.  Functional age assessment is a more useful criterion than chronological age. Functional age may be preferable to chronological age as a way of evaluating age-related vocational limitations because it measures performance directly. Knowing whether a particular person is a younger individual, closely approaching advanced age, or of advanced age has little predictive value for his or her performance. Functional age is not a predictor either; it is a direct measure of current ability to perform set tasks. Chronological age does not predict performance, and it is too weak an agemarker to be used as the sole measure of vocational age limitations. Determining an individual’s functional age is potentially more useful as a vocational factor. Functional age, commonly associated with the level of self-sufficiency, is an attribute that is relatively independent of chronological age. Functional age is determined by direct evaluation. Functional age testing is not fully developed and reliable, however, and is more costly than using chronological age as a marker.  Adaptive capacity declines with age. Adaptive capacity is the ability to maintain performance in the face of altered circumstances and is a biomarker. This capacity tends to be linked with the ability to adapt to changing environmental or exertional conditions. Adaptive capacity diminishes with age and may be insufficient for certain levels of demand. Thus, to accommodate diminished capacity, one must reduce task demands. Physical and cognitive slowing occur with age, and older individuals should not be expected to make great vocational

ii adjustments. Older workers may be capable of performing tasks demanded by a job for which they have no prior work experience. But the expectation of success in that job must be tempered by expecting only minimal adjustment or adaptation. Individuals who must make significant adjustments should be allowed sufficient time to reach satisfactory levels of performance. EDUCATION:  Education impacts the ability to acquire new skills;  Special groups in the population (some foreign-born) will be poorly educated in the future;  Earning power is related to educational level;  About one-quarter of US adults are at level one (lowest)literacy;  Mental impairments have the greatest impact on educational attainment;  One-half of adults at level one literacy are unemployed. The National Literacy Act of 1991 defined literacy as “an individual’s ability to read, write, and speak in English and compute and solve problems at levels of proficiency necessary to function on the job and in society, to achieve one’s goals, and to develop one’s knowledge and potential.” The Survey demonstrated that, among all variables tested, the level of education attained had the strongest relationship with literacy proficiency. The survey also revealed that racial/ethnic minorities were more likely than white adults to perform in the two lowest literacy levels. One reason for this finding may be that many of these individuals were born outside the United States and learned English as a second language. Individuals in this group tended to have fewer years of schooling in this country than whites. Lower literacy skills mean a lower quality of life and more limited employment opportunities. A recent report from the American Society for Training and Development reached a similar conclusion that the “association between skills and opportunity for individual Americans is powerful and growing....Individuals with poor skills do not have much to bargain with; they are condemned to low earnings and limited choices.” Research in education theory and practice shows much on-going fermentation.

ii For example, the concept of skill standards has become prominent. Skill standards define what someone should know and be able to do to work successfully. The focus is on using academic and work-based skills and knowledge to meet the demands of occupations or industries. The National Skill Standards Board is to spearhead the establishment of a national system of voluntary skill standards that can support and inform education and training efforts. The standards that focus only on entry-level jobs will confine students to future job inflexibility and will fail to help them meet general life requirements in a highly technological age. The Secretary’s Commission on Achieving Necessary Skills (SCANS) stresses skills such as being on time, communicating with adults, working in teams, and wearing appropriate dress--and should be taught from an early age. These basic work skills can be reinforced through work-based learning experiences. These deficiencies are often found in claimants in SSA’s disability program. SSA should continue to follow developments in SCANS and the National Skill Standards Board. WORK EXPERIENCE:  Job stability has declined for those at the lowest skill levels. Between 1983 and 1991, the chances of a worker with no college education holding the same job for more than four years decreased from 64 percent to 58.5 percent.  Worker traits are a function of education more than experience. In a given work environment, they combine with and influence the contribution of the worker’s specific skills.  Basic skills are a priority with employers. The literature indicates that employers place a growing emphasis on the possession of “basic skills” in identifying new employees. Because SSA regulations note specificity and isolation as factors working against skill transferability (20CFR 404.1568c), the trend toward valuing more general characteristics may be significant as a factor beyond the specific match up of work activities.  Upgrading in skill levels for semi-skilled and skilled workers will have little effect on employability for the majority of disability applicants if unskilled workers continue to dominate the claimant population.

ii Research into education and work experience indicates that the workplace today changes frequently and presents unfamiliar situations to workers of all ages. The expansion and diversification of the service economy have complicated traditional formulations of workplace evolution by leading to the development of nontraditional workplaces, working relationships, and schedules. These nontraditional workplaces may complicate the ability of SSA examiners to evaluate the work experience of claimants. The disappearance or blending of specific job descriptions may affect the SSR 82-41 prescription that requires comparing the job duties with regular definitions of skill levels. If work activities become more autonomous and more dependent on individual initiative and interpretation, the description of job duties cannot accurately capture the activities for the purpose of comparison with SSA’s established skill levels. Regulatory definitions cannot capture what is happening in the real world. The research clearly shows that education impacts the ability to learn new skills and that earning power is related to educational level. Evidence also points to the fact that a GED certificate does not place an individual in the same category as a bona fide high school graduate. Employers regard the holder of a GED as having lower skills and group him with the class of high school dropouts. This circumstance does not bode well for those who do not complete the traditional K-12 curriculum. Another key finding stems from a national study of literacy, which shows that the level of education is linked to literacy proficiency. Level one and level two individuals face lifetimes of lower earnings (one-half are unemployed) and the increased likelihood of physically demanding unskilled and semi-skilled employment. Statistics show that these individuals are most likely to become disabled and apply for benefits. The literature indicates that employers place substantially more emphasis on the possession of “basic skills” when identifying potential employees. Two of three service jobs created in the economy in the decade of the 1990s have been low level jobs. Some researchers see basic skill demands increasing at many entry-level jobs, with the market for those possessing less than high school education shrinking from 1 in 11 jobs to 1 in 25. Many of the job characteristics found in the fast-growing service sector include

ii oral and written communications and inter-personal skills--those skills that stress the team approach to job accomplishment and how the individual “fits” with and adjusts to a variety of co-workers. Given that employers are placing more emphasis on these worker traits, will those individuals with mental impairments find it even more difficult to find employment in even unskilled and semi-skilled positions? If one considers the key judgments noted above, one may evaluate how these factors may interact to affect a claimant’s case. For example, demographically, the baby-boom generation is the largest worker cohort. Its oldest members are now over age 50. Therefore, any linkages that occur in connection with the age factor will apply to an increasingly larger group in the next two decades. If the principal age group of claimants is in the “approaching advanced age” or “nearing retirement age” groups, then the upward “spike” in the number of claimants is likely to grow. Likewise, for the present and for the foreseeable future the average (impaired) worker will have undergone more training iterations than in previous years. Older claimants will increasingly have the most training history. To the extent that adaptability to other work is reduced by aging (considering that physical and cognitive slowing occur with age and older individuals should not be expected to make great vocational adjustments), will the work experience and training factor offset the negative aspects of age? Or, because training and re-tooling occurs more frequently on the job today than in previous years, will the ad hoc nature of the training (learning just enough to perform a given job) combine with the frequency of training to render the learning less important to the process? Should the current (grids) limitation of work performed in the previous 15 years be reduced to five years since the frequency of job change and complexity of some training will have been forgotten after five years’ neglect or non-use? On the other hand, if younger workers are found increasingly lacking in basic skills (unprepared for the workforce by today’s education system), will employers give higher consideration to the education factor for older workers who have (potentially) more work experience and better basic skills from previous years, thereby balancing a probably negative aspect of aging? It is likely that the principal pool of claimants will continue to be those with the lowest level of literacy and least work experience.

ii Therefore, the absence of good basic skills will be a given for many jobs in the national economy at levels other than unskilled. Workers with lower education achievement tend to change jobs more often. At the unskilled level, the lack of education is likely to prevent the gathering of meaningful work experience or advancement at any one job. The additional training iterations gained in multiple jobs are less likely to provide skills of use later in the form of work experience. Research shows that foreign-born ethnic and racial minorities constitute a high percentage of those whose literacy levels are on the lowest level. These groups are at a disadvantage in the workforce because they have been at a disadvantage in the education system. The Census Bureau reports that in 1995, the foreign-born population of the United States reached 22.6 million people, about 9 percent of the total population. Unemployment in this group was higher and median income in the group was lower. This large pool of foreign-born workers could increase the number of claimants. The skills now identified most often by employers as critical but lacking are not job-specific ones but general ones, such as being able to use English properly and well, doing simple arithmetic, and being able to read instructions. These basic skills would come from the education process. Individuals who lacked basic skills when hired likely received job-specific training that would not improve the basic skills available as disability claimants. In other words, work experience is not likely to be a substitute for education in improving transferability. Given steady or increased demand for basic skills, the lack of education may increase in importance. Will SSA revise its assumptions about what a given education level means for transferability? One significant interaction is the “learning to learn” ability that employers prize highly. This concept correlates with the educational attainment and level of literacy. Based on current literature, there is an increased likelihood that a given claimant will bring with him/her one or more of the following “bundle of attributes”: a history of multiple training and multiple jobs held; experience in an interactive service or manufacturing occupation (either traditional or revamped) where some type of “people skill,” undefinable in conventional skill terms, was required; a flawed package of “basic

ii skills” that has been patched pragmatically along the way; job experience where information was shared between management and the worker, who then made some cognitive contribution to adjusting the job process; experience in a job some aspect of which (order of work, time of work, place of work) was determined at some points by the employee rather than the employer; or time spent in an unskilled job in which existing skills eroded because they were not applied. Although the amount of quantifying evidence varies, each of those characteristics has the potential to alter the current understanding of the content and the role of past work experience in disability claims. Therefore, SSA might consider moving toward the concept of “functional literacy” rather than grade level as a determinant. A further avenue of research would be a definition of functional literacy. Research into the current literature concerning age, education, and work experience has raised these and other questions. How the Social Security Agency will attempt to apply this new information in its evaluation process remains to be determined. Perhaps only some of the criteria that currently constitute the “grids” will be changed to reflect the new research data.

ii I. INTRODUCTION

Every eight seconds somebody in America turns 50. The oldest of America’s 76 million baby boomers (the generation born between 1946 and 1964) will reach 55 in 2001. By 2025 the whole of America will be as gray as Florida, the country’s retirement home, is today. By 2005, the American workforce will include 27 million people aged between 50 and 59, compared with 20 million in 1997.2

In 1956, after almost 20 years of debate and discussion, the U.S. Congress passed the Amendments to the Social Security Act that established the disability income program. In 1978, another significant year in the establishment of the present- day disability program, the Social Security Administration published its program rules and regulations enumerating the guidelines for disability determination. The guidelines relating to vocational factors (age, education, and work experience) reflect some of the characteristic traits of American society. A picture of the United States in 1956 and 1978 as revealed through a few vital statistics is useful in understanding the background of how the vocational factors were understood as the disability program evolved. In 1956 the population of the United States was 184 million. The decade between 1940 and 1950 witnessed an increase in the nation’s population that was greater in absolute numbers than the increase in any earlier decade in United States census history (in terms of percentages, the figure represented a 14.5 percent increase). The generation of “baby boomers” was under way, and this generation has affected almost every social and political event since its beginning. In 1956, the population was 49 percent male and 51 percent female; racially it was 89 percent white, 9 percent African-American, and about 2 percent “other” (mostly Asian-American and Native American). In June 1956, the United States reported 321,625 immigrants during the preceding year, the highest number of any preceding year since 1927 and an increase of 35 percent over the 1955 total. The increase was caused by the Refugee

2"Can America’s Workforce Grow Old Gainfully?” The Economist, July 25, 1998, p. 59.

ii Relief Act of 1953 and an increase in the admission of natives of western hemisphere countries. Approximately 77.3 percent of all males and 28.6 percent of all females aged 14 and above were employed, most were in the age groups 20-24 and 35-44. In 1955, the United States produced almost one-half of all the world’s crude steel and two-thirds of the world’s automobiles. American corporations manufactured 9 million autos, and Americans imported only 650,000 (7 percent). The greatest number of imports came from West Germany, France, and the United Kingdom. Virtually no Japanese cars were imported into the United States in 1955. The principal sectors of the national economy consisted of manufacturing (25 percent), service industries (21.6 percent), wholesale and retail trade (18.6 percent), agriculture (12 percent), transportation and communications (7.6 percent), construction (6.2 percent), and mining (1.7 percent). The nation’s population was evenly distributed, roughly 50-50 urban-rural. In 1978 the population of the United States (based on the 1970 census) was 203,212,000. This figure represented an increase of 13.3 percent over 1960. Approximately 11 percent of the total was African-American, and 5 percent was of Hispanic origin. Only 9,400,000 lived in rural areas, representing 4.6 percent of the population. Small, family-style farms were disappearing in the wake of the growth of large-scale, capital-intensive farming. Agriculture represented 3 percent of net national income, down from 4.1 percent in 1960. During the period between 1950 and 1970, the number of farms decreased by 25 percent and the farm size increased by 33 percent. In 1978 the United States produced only 18 percent of the world’s crude steel, and Americans imported 18.5 percent of their personal automobiles. The divorce rate was up and the marriage rate was down during the period 1951-1976. In 1940, 24.5 percent of all Americans over age 24 had completed high school; in 1960, that figure was 41.1 percent; and in 1970, the number of high school graduates was 55.2 percent of the total population above the age of 24 (13.4 percent had completed eight years of schooling and 5.3 percent had completed only five years). Based on the 1990 census, the population of the United States was 249,600,000 and projected to be 282,300,000 in the year 2005. These figures are not

ii completely reliable: in 1991 the Bureau of the Census announced a census undercount of six million persons. In 1990 white Americans represented 71.8 percent of the total, with African-Americans representing 11.7 percent, Hispanic-Americans--9.0 percent, and Asian-Americans--2.9 percent. By the year 2005, those numbers are projected to be 66.4 percent, 12.9 percent, 12.3 percent, and 3.8 percent, respectively. By the year 2005, experts estimate that 56 percent of the workforce will be employed in service industries, 19 percent will work in manufacturing, and 1.7 percent will be employed in agricultural-related activity. The following sections of this report, consisting of discussions of age, education, and work experience as vocational factors in the Social Security Administration’s disability decision process, will present more of the picture of the United States today and forecasts for the future. Although the citation that introduces this report would seem more appropriate to discussing the issues confronting the Social Security retirement system than the disability issue, it is directly relevant to the question of disability. The next decade will see an increasing percentage of older workers. Older workers are more susceptible to serious accidents and disabling injuries. Therefore, the pool of potential disability claimants will increase. For the Social Security Administration disability program, age 50 opens the category “approaching advanced age” in the disability evaluation process. By age 59, the upper end of the age category cited in The Economist, the journal from which the introductory citation was taken, a claimant is in “advanced age.” If, as projected, the working population of the United States is headed toward significantly greater numbers of “advanced age” members, the potential for significantly greater numbers of disability claimants is obviously much greater as well. Age plays an important role in the five- step evaluation process used to screen each application. During this process, the examiner must determine:  whether the individual is performing substantial gainful activity;  whether the individual has a severe impairment;  whether the individual has an impairment that meets or equals the criteria in the Listing of Impairments;

ii  whether the individual is able to perform past relevant work, given his/her residual functional capacity;  and whether the individual is able to perform other work existing in significant numbers in the national economy, given his/her residual functional capacity and considering age, education, and past relevant work.

The 21 years of debate on whether to establish a disability income program raised many issues, among them arguments of excessive government interference in the medical profession, “socialized medicine,” and fears that doctors would enroll claimants because of sympathy, with the resultant uncontrollable growth of the program. The 1956 Amendments to the Act made clear Congressional intent to make the program a medically based disability program, not an unemployment program. A claimant is declared disabled only if a medical impairment prevents him/her from working. Hiring practices in a given geographical area or the absence of jobs in the claimant’s region play no role in the decision. The vocational factors (age, education, and work experience) were intended to help control costs and facilitate management of the program. The 1967 Amendments, published in 1968, provided the first statutory guidance on the use of vocational factors: “an individual shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any kind of substantial gainful work....” The 1978 Federal Register report further states: “If, considering the severity of his impairment together with his age, education, and experience, he has the ability to engage in some other type of substantial gainful work...” he will not be granted disability status under the conditions and requirements of the program. The 1978 Rules and Regulations, the Medical-Vocational Guidelines (so-called “grids”), were intended to provide uniformity to the vocational portion of the decision process. The rules reflect the analysis of an individual’s vocational factors in combination with his/her residual functional capacity (RFC) in evaluating the individual’s ability to engage in “substantial gainful activity” (SGA) in other than his or her vocationally relevant past work.

ii Social Security Regulation 96-8p states that ordinarily, RFC is an assessment of an individual’s ability to do sustained work-related physical and mental activities in a work setting on a regular and continuing basis. A ‘regular and continuous basis’ means eight hours per day, five days per week, or an equivalent work schedule. The RFC assessment considers only functional limitations and restrictions that result from an individual’s medically determinable impairment or combination of impairments, including the impact of any related symptoms. Age and body habitus are not factors in assessing RFC. Residual functional capacity is not the least and individual can do despite his or her limitations or restrictions, but the most. A fundamental question confronting the examiner is whether the impairment prevents the individual from working or engaging in SGA in the national economy (an earnings-based determination set at a monetary figure of a minimum income of $500/month for non-blind applicants; $1,050/month for blind applicants). The decision process is not completely standardized: each applicant is evaluated on an individual, case-by-case basis. The determination requires “substantial evidence” from the examiner, with substantial evidence being relevant evidence that a reasonable person needs to make a judgment.

The steps in the process include: 1) Determining whether the claimant has been working and engaged in SGA ($500/month non-blind applicants and $1050/month blind applicants) in the past five months. (According to a Social Security Regulation from July 1996, the work must be considered full-time employment [i.e., 8-hours per day, five days per week] and not part time.) If the claimant has been engaged in SGA, then denial of the claim can follow a determination: an SGA finding and a medically determined impairment must be the basis of unemployment. The claim of an applicant earning less than $500/month, for example, $300-$499, still would be reviewed by SSA to determine whether that individual were actually keeping his or her earnings artificially low, through an employer subsidy, by accepting a much lower salary than the fair value

ii of his/her work, etc.3 2) Determining whether the impairment is severe. The impairment must significantly limit basic work activity (walking, standing, lifting, carrying- -exertional; seeing, hearing, understanding--non-exertional). Is the impairment expected to last at least 12 months or result in death? 3) Consideration of the medical listings, which have the force of law. The listings are a screening in device, not one to screen out claimants: if the individual meets these criteria in the medical listings, he/she would receive disability; if the individual fails to meet the criteria, the process continues. Evaluation of residual functional capacity (RFC) is the bridge between the medical listings and the vocational factors that is required for all vocational evaluation. The evaluation must have a sound medical basis and assess all limitations (for example, the effects of medication and environment). Some of these may preclude past relevant work. 4) According to SSR96-8p, “ when an individual is not engaging in substantial gainful activity and a determination or decision cannot be made on the basis of medical factors alone, the sequential evaluation process generally must continue with an identification of the individual’s functional limitations and restrictions and an assessment of his or her remaining capacities for work-related activities. This assessmentof RFC is used at step 4 of the sequential evaluation process to determine whether an individual is able to do past relevant work, and at step 5 to determine whether an individual is able to do other work, considering his or her age, education, and work experience.” Vocational evaluation procedures begin with a consideration of past relevant work. If the applicant can perform past relevant work, then he/she is not disabled. The claimant bears the burden of proof. If he/she cannot perform past relevant work, then the burden shifts to SSA to determine what the claimant can do. Three factors enter the evaluation at this stage: a--the work performed must have been SGA; b--the claimant must have learned how to perform the work (for unskilled labor SSA defines average successful job performance achieved within 30 days); and c--the work must have been performed within the past 15 years. 5) Given the claimant’s age, education, and work

3Clarification made by Administrative Law Judge Robert Young at Teleconference held at Social Security Administration Headquarters, September 25, 1998.

ii experience, does the impairment prevent performance of any other work that exists in the national economy? According to Office of Disability literature, the vocational rules are based on several assumptions:  An individual’s age affects his/her ability to adapt to new work situations;  Educational background contributes to the ability to meet vocational requirements such as reasoning ability, communication skills, and arithmetical ability. In addition to formal schooling, past work experience, level of responsibility while working, daily activities, hobbies, and results of testing may show an individual’s intellectual abilities;  Work experience (skills and abilities that have been acquired through work done in the past) shows the kind of work an individual may be expected to do.

Consequently, in the current process, age, education, and work experience operate independently as well as in combination with one another to establish a favorable or adverse vocational profile. As noted above, the statute requires that examiners consider the vocational factors in the disability decision process. The agency decided, over years of experience and practice, how to establish the use of the factors in the process. The research team at FRD investigated the relevant literature published in the past two decades in these three areas, with the understanding that the research focus on the effects of age, education, and work experience and the ability to work.4 The

4The FRD research effort did not include analysis of the Americans With Disabilities Act (ADA) and its potential effects on the disability decision process because the government disability law reflects a different conception of the disability problem. As Matthew Diller points out in “Social Security Forum” in his review of an article in the Texas Law Review (V. 20, No. 5, May 1998, p. 12), the ADA seeks to reform social institutions and public attitudes in order to integrate people with disabilities into the work force. Diller writes, “The disability benefit programs view the inability to work as a natural consequence of medical impairments and provide income support outside the framework of the market economy....The courts view the ADA as intended to protect individuals who ‘can’ work, while they see the benefit programs as aid for individuals who ‘can’t’ work. The disability benefit programs rely on the classification of individuals as ‘able’ or ‘unable’ to work, and the ADA rejects such blanket categorization.” The Social Security Administration (SSA) Office of Disability Research currently has no plan to seek statutory relief or reconsideration of the present rules and regulations governing the program. In the SSA program, an applicant determined to be disabled must not be able to work because of relevant medical evidence,

ii researchers quickly determined that much new information has come to light with respect to aging (physiological, psychological, and sociological aspects) and that future workers will be expected to extend their working lives over those of preceding generations. The question presented to the team was, what new research about aging will make it possible to evaluate better a claimant’s functional ability to return to vocationally relevant previous work? FRD analyst Robert Garian, who performed age research, had to consider all related aspects of the aging process to ascertain how the ability to work is affected by age. As early as 1942, the Social Security Advisory Council discussed vocational factors, and, in 1955, the Medical Advisory Committee advised that age, education, training, work experience, and other individual factors be used whenever medical records were insufficient to determine disability. When the disability amendments were passed in 1956, the average American could expect to spend his/her entire working life in the same company. The frequency of re-tooling, changing careers, and re-education was much lower than today. According to the National Commission for Employment Policy, in the 1970s, 12 percent of male workers changed employers four times or more; but in the 1980s the figure had nearly doubled, to 23 percent (although no figures were available for women in the 1970s, in the following decade 20 percent of them switched four times or more). In addition, the manufacturing process was fairly consistent in the 1950s and 1960s: the assembly line model dominated industry, and each worker had his specific task to perform as the item passed through the production process. In the 1990s, however, many manufacturing facilities are oriented toward the team concept where groups work together to produce the product. Some of the most highly valued qualities in the workplace are communications skills, working well with others, and being able to make judgments independent of direct supervision. In today’s factories, robots perform many

which is supplemented, when necessary, by analysis of residual functional capacity, severity of the impairment, and the effects of the vocational factors as applied to each individual case. With time, the ADA may effect subtle changes in the decision-making process, for example influencing the environment in which decisions are made. However, the effects of the ADA were not considered in the research for this report into the literature concerning age, education, and work experience and an individual’s ability to work.

ii of the repetitive tasks. Workers must be able to program and re-program machines to perform the work that humans did in the 1950s and 1960s. Questions confronting researcher Ihor Gawdiak with respect to education as a factor in the disability determination process included whether the type of education is significant, the degree to which the duration and quality of formal education are relevant, and whether the time elapsed since the educational experience occurred is meaningful with respect to the ability to adapt to new work. If disability strikes an individual, what is his/her potential for adapting to other work? Recent reports from states that have begun to reform their welfare programs (many welfare recipients exhibit characteristics similar to those who are unskilled and disabled) describe new techniques that are used to upgrade skills and enable former welfare recipients to get better, longer-term jobs. Are there features in these programs that might be applicable to SSA? Evidence strongly suggests that better paying jobs are tied more closely to educational attainment than ever before. What kinds of worker training and education work best? What kinds of education and training programs teach skills that a disability claimant can bring to new work that may be outside the parameters of his/her vocational history? The knowledge and skills acquired in the workplace accumulate over time, enabling workers to learn and to expand their repertoires beyond a job description printed in the company literature or the U.S. Department of Labor’s Dictionary of Occupational Titles. The research into the literature concerning the workplace and requirements of employers reflects the cumulative effect of multiple jobs or occupations--as well as the type, duration, and recency of training--on the work experience history of disability claimants. A question considered by FRD analyst Glenn Curtis was, how does the workplace environment of the 1990s and of the next century affect a disability examiner’s ability to determine whether a claimant’s work history reveals substantive information about the ability to perform other work? FRD analysts have researched these questions in the literature and attempted to answer them. The research indicates that, with respect to age as a vocational factor, variance in the population increases with age, the likelihood of new employment declines with

ii age, and that functional age assessment is a more useful criterion than chronological age. With respect to education, the research suggests that special groups in the population will be poorly educated in the future, education impacts on the ability to acquire new skills, about one-quarter of US adults are at level one (the lowest) literacy level and that one-half of these individuals are unemployed. With respect to work experience, job stability has declined for those at the lowest skill levels, basic skills are a priority with employers, and jobs for unskilled workers in the under-45 category will remain constant. The disability examiner will be required to examine a varied set of job experiences in a claimant’s case and determine whether any of those skills are still viable in the work place. With the launching of the disability redesign plan, SSA began to review and to reassess the decision process. Contrary to the expectations at the time of their creation, SSA never updated the research into age, education, and work experience-- the vocational factors--that had been used to formulate the Medical-Vocational Guidelines in 1977/78. SSA experts deemed it appropriate to re-visit the literature in these areas to determine whether the Guidelines required reformulation, alteration, or possibly elimination. The research conducted for this report is intended to assist SSA in making those decisions about the process. Options for SSA may include changing the sequence of the decision process, dropping some steps in the current sequence, eliminating the Guidelines, or maintaining the current process using the updated research information to validate the process. As noted above, the Commissioner of Social Security will not make any further decisions about the disability process until all the research has been completed. This report will be added to a larger research effort that will encompass foreign disability systems, an evaluation of SSA’s current disability decision process, the operations of the state DDS offices, and recommendations for possible changes in the program. Currently, SSA does not intend to seek statutory remedy to any issues raised by the current research effort because of the history of adjudication that has established the current system in the law.

ii II. SOCIAL SECURITY DISABILITY: LEGISLATIVE HISTORY

This section of the report traces the legislative history of the Social Security disability program and the role of vocational factors in the disability determination process. The research grew out of the effort in the 1990's to re-examine the disability decision process. The Commissioner of Social Security determined that the decision process was not optimally efficient, could be more streamlined, and that SSA staff required updated research to assist them in making any recommendations for changes. The grids, developed in the 1970's and published in the Code of Federal Regulations in 1978, apply to fewer and fewer cases. In preparing this section of the report, FRD staff members consulted with those individuals who had a long association with the legislative history of the Social Security Act, examined successive years of the Code of Federal Regulations, and combed the archives of the Social Security Administration for references to age, education, and work experience as factors in the disability determination process. The disability program has always been a medically based program: each applicant must provide medical evidence of the inability to work. However, because medical evidence is not always clear-cut (in discussions about a potential disability program held by members of the advisory board in 1938, Social Security Advisory Council member Arthur Altmeyer admitted his concerns about the “subjectivity of medical evidence”), other factors enter into the decision process to determine whether an applicant is able to contribute to substantial gainful activity (SGA) in the national economy. As early as 1942, fourteen years prior to the enactment of the disability benefits amendment, Altmeyer, later Chairman of the Social Security Board, introduced prior work experience to the list of factors to be considered. In 1955, the Medical Advisory Committee advised that age, education, training, experience, and other individual factors be used whenever medical and work records were insufficient to determine disability. Therefore, the concept of vocational factors has a long history in the disability program--informally within the discussions of the Social Security Advisory Council as early as 1942, and formally when the language was introduced into the

ii implementation regulations accompanying the 1956 amendments. Disability insurance began in the United States as a state-supported program. Individual states became involved in social insurance early in the 20th century. The first state enacted a workmen’s compensation law in 1910, and other states gradually followed suit until 1948, when the roster of states providing insurance for occupational injuries was completed. Probably because of a history of state activity in this arena, the original 1935 Social Security Act provided benefits to needy aged and blind people through a program administered by state and local governments and funded partially by the federal government. Although the Act provided for no payments until 1942, and then a maximum of $30 per month, substantial opposition was voiced by business groups and some members of Congress, who evoked the specter of socialism as well as government interference and regulation of business. The idea of benefits payments for disabled workers was floated very early in the discussions about a national program of old-age insurance. In addition to the standard argument about socialism, opponents argued early that courts would tend to favor claimants, using standards not foreseen in the original regulations. In 1938 Congress agreed with the Social Security Advisory Council proposal to delay further discussion of disability, tabling the issue indefinitely.5 Between 1938 and 1942, the Social Security Board and the Bureau of Old-Age and Survivors Insurance (BOASI) continued research on the possibilities of establishing a disability insurance program under the SSA. As they had been between 1935 and 1938, objections in the Social Security Advisory Council to such a program were based on the difficulty foreseen in making objective disability determinations, the high cost and complexity of administering and policing the program, and distrust of the medical profession. According to the Social Security account of deliberations, the same objections reverberated until the first disability program was passed in 1956: "costs were incalculable, borderline older people would be 'put on the rolls' because of

5The Advisory Council is an independent group that includes members from academe, industry, and labor, and meets under a legislative mandate to deliberate quadrennially. The panel’s recommendations are not binding on any official body.

ii sympathy, doctors could be bought, courts would be headstrong." In 1942 Arthur Altmeyer of the Advisory Council (and later Chairman of the Social Security Board), a proponent of disability benefits, introduced prior work experience into the mix of factors to be considered in disability cases. He advocated the use of employment experts together with medical experts, and the concept of residual functional capacity as a protection against labeling as disabled workers who still could work: "If his health is such that he can engage in work which is reasonably suited to his abilities--whether or not the work is in a field in which he worked prior to his disability--his claim should be denied."6 In both the 1940s and the 1950s, a major concern was rehabilitation to eliminate malingerers and keep from extinguishing the incentive to work. The first disability bills were introduced, and defeated, between 1943 and 1945 (the Wagner-Murray-Dingell bills); under them, the Social Security Board would have set standards for disability determinations, with advice from the Surgeon General. In 1948 the Advisory Council on Social Security recommended to the Senate Finance Committee a program of cash payments to workers with "medically demonstrable disability which prevented [them from]...performing any substantial gainful activity and which was likely to be of long-continued and indefinite duration." (A six- month waiting period was considered a satisfactory test of permanency.) This proposal was the first attempt to outline a full disability program, and it was the basis of legislation introduced in the early 1950s. A bill including those recommendations passed the House in 1950, but the Senate tabled the bill for further study. Objections by opponents included assertions that objective determinations would be impossible and that such an entitlement would invite "living off the Government." The unspoken acknowledgment in these arguments was that medical evidence was not always conclusive. At that point, the SSA defined "permanently and totally disabled" as meaning that the individual had some physical or

6A. J. Altmeyer, “Formulating a Disability Insurance Program,” Inter-American Committee to Promote Social Security, Montreal, 1942, p. 1.

ii mental impairment, disease, or loss that substantially precluded him from engaging in useful occupations within his competency, such as holding a job or homemaking. In 1952 the House passed a bill (HR 7800) preserving the Social Security insurance rights of persons who had become permanently and totally disabled, and thus unable to continue payments into the system. Hearings never were held on the disability part of the bill, and it died. According to Fred W. Arner, who participated in much of the legislative activity at this time, SSA used the failed plan to justify its authority and ability to study and perfect future disability legislation. A 1954 amendment passed with the support of President Eisenhower and after public pressure on the issue had increased. The amendment protected disabled workers from losing retirement or survivor benefits that would have accrued had they been able to work rather than being disabled, with a minimum disability duration of six months. The amendment, commonly called the disability freeze, defined disability thus: "The inability to engage in any substantial gainful activity because of any medically determinable physical or mental impairment that can be expected to result in death or to be of long- continued and indefinite duration." There was no language about vocational factors at this time. Although factors limiting subsequent ability to obtain work weren't considered in this period, in 1955 the newly formulated Medical Advisory Committee (consisting of 12 physicians active in different fields and specialties of medicine, and three others, experienced in psychology, social work, and care of the blind) advised that age, education, training, experience, and other individual factors be used whenever medical and work records were insufficient, despite the lack of specific language in the law. Thus, although there was no statutory requirement to do so at this stage, beginning in 1955, the individual's vocational capacity was considered when pertinent to the disability decision. The Medical Advisory Committee was appointed by the Commissioner of Social Security in February 1955 to advise on standards designed to ensure equal consideration to all individuals in following the 1954 law. These standards included a specific description of procedures for obtaining medical evidence, both upon initial consideration of the claim and as needed to confirm or review earlier findings at later

ii stages. The board, which provided a link between the government social security program and the medical profession, also recommended a wide-ranging role for medical personnel in the determination process, including the provision of medical evidence, promoting communications between state Social Security offices and other medical sources, setting medical eligibility standards, and working with examiners to resolve claims. To ensure that disability status not discourage incentives to work, the committee recommended that disability benefits continue for a time after an individual resumed work under a rehabilitation program. Determination of disability was to be performed by state vocational rehabilitation agencies or other appropriate state agencies, with power of review by the Secretary of the Department of Health, Education, and Welfare. All the amendments proposed between 1943 and 1956 were opposed by the American Medical Association as "socialized medicine," by employers as a drag on the economy, and by private insurance companies as excessive government interference. Eisenhower Administration backers of the freeze provision strongly opposed cash payments to the disabled, calling them a disincentive to work and rehabilitation. They shared the general opinion that large numbers of people could not resist the temptation such a program would offer. The 1956 amendments, which barely passed the Senate after long debate, provided for disability insurance payments (for the first time) to permanently and totally disabled workers aged 50 to 65, and also included specific language on other factors. The 1957 implementation regulations contained specific language on vocational factors: "Consideration is also given [after medical factors are considered] to such other factors as the individual's education, training, and work experience....It must be established that...applicant's impairment results in such a lack of ability to perform significant functions...that he cannot, with his training, education, and work experience, engage in any kind of substantial gainful activity." Arguments in opposition to the 1956 bill included the difficulty of determining the medical severity of impairment, upon which eligibility depended, and the likelihood that benefits payments would reduce incentives for rehabilitation. It is not always easy to

ii determine “legislative intent.” However, given the political climate and the phrasing of the new legislation, the vocational factors likely were intended as a condition whose consideration would tend toward denial. The “law of unintended consequences” may have been at work: despite the fact that the vocational factors may have been seen as a method for limiting enrollment in the program, with the participation of vocational experts and legal challenges to decisions, more claimants have been enrolled in the program based on the vocational allowances than would have been foreseen by the framers of the legislation. In 1956, the blind were not automatically considered disabled; that determination depended on a claimant's individual ability to engage in substantial gainful activity. A six-month waiting period was established to test the duration of impairments before beginning payment. Concerning rehabilitation, the amendments stated that “monthly benefits will be suspended if a beneficiary refuses to accept rehabilitation services without good cause [such as religious belief].” One year of work was allowed under a rehabilitation program before benefits ceased. Under the 1956 provisions, the 1954 protective (freeze) legislation continued to preserve overall Social Security eligibility for individuals under age 50; then at 50, if the person still qualified as disabled, payments could begin under the disability program. The 1958 amendments broadened the scope of the 1956 legislation to provide benefits to dependents of all eligible workers. The claims procedure was judged to be very cumbersome and unfair; and in 1959 the Harrison Subcommittee (U.S. House of Representatives) discussed the fact that only 62 percent of projected payment amounts had been disbursed and that, according to anecdotes, benefits were denied as a result of overly harsh evaluations of residual functional capacity. But the subcommittee's work resulted in no major changes, only in revised procedures for vocational evaluation. Beneficiaries were estimated at 750,000, with 30,000 determinations made per month. The subcommittee reported that in 1959 some 10 percent of disability allowances were based solely on nonmedical factors. The most dramatic change in the 1960 amendments was elimination of the age fifty requirement for receiving disability benefits. This step was based on the lower-

ii than-expected costs of the program to that point. The 1960 amendments again included nonmedical factors (listed as "including age, education, training, and work experience"--age added for the first time, although it already was included in the unpublished regulations), but noting that "physical or mental impairments must be the primary reason for the individual's inability to engage in substantial gainful activity." There must be "evidence that medically ascertainable anatomical, physiological, biochemical, or psychological aberrations exist....An alleged impairment is medically determinable only if it can be verified by the use of clinical and laboratory techniques." The new language was published in the Code of Federal Regulations in 1961. Section §404.1502 of the US Code, Evaluating Disability, states that “primary consideration is given to the severity of the individual’s impairment. Consideration is also given to such other factors as the individual’s age, education, training and work experience.” The 1961 edition of the Code of Federal Regulations marked the first publication of regulations on disability determination, which previously had been available only as an internal manual because of the belief that dissemination of the standards would give claimants an unfair advantage in preparing their claims. The next set of amendments, passed in 1965, eliminated the requirement that an impairment be expected to be of long-continued and indefinite duration, substituting the requirement that the impairment had lasted or be expected to last for more than 12 months (the alternative, the expectation that the condition would result in death, remained). For blind persons aged 55-64, disability was defined as inability to work at a job requiring skills comparable to those required in past occupation(s). No changes were made in the vocational factors language at this time. Among the amendments of 1967 was new language requiring the comparison of claimants' positions with work in the national economy rather than with actual jobs or hiring practices in the claimant's local area. The aim here was to improve uniformity in court decisions and to provide a statutory basis for what hitherto had been regulations and policies. Court interpretations of the law in previous years had tended to require that the government identify specific job vacancies, often in the region of the claimant, in order to deny a disability claim. The starting point of such decisions was the 1960

ii case of Kerner v. Flemming. In responding to that judicial trend, the 1967 amendment stated: "An individual shall be determined to be under a disability only if his physical or mental impairment or impairments are of such severity that he is not only unable to do his previous work but cannot, considering his age, education, and work experience, engage in any kind of substantial gainful work which exists in the national economy." The last phrase was further defined as existing in significant numbers either in the individual's region or in several other regions of the country. Thus the 1967 amendments introduced a new specific restriction that regional hiring practices and technological advances were not grounds for disability. In other words, the disability program was not to be considered an unemployment program. Workers displaced by regional economic slumps or new technology would have to find other employment and not attempt to claim disability. Other 1967 amendments extended retirement and survivor benefit guarantees to disabled workers under age 31 and extended the deadline for applications by claimants under this program. The definition of disability was refined to read: "Inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." Also in the 1967 amendments is the first statutory guidance on the use of vocational factors and the first statement that they must be used in certain circumstances. The 1978 Federal Register report characterizes them as "factors which must be applied to individuals whose medical impairments are not of a sufficient level of severity so that the presumption of disability would apply (in other words, not obviously disabled with no need of further substantiation). The U.S. House of Representatives report characterizes the obvious medical-based disability decision as the type that will occur "IN MOST CASES." "Severe medically determinable physical or mental impairment" is clearly identified as the primary factor: "If, considering the severity of his impairment together with his age, education, and experience, he has the ability to engage in some other type of substantial gainful work...he also is not under a disability....” The Federal Register report further states: "The legislative history of this

ii amendment indicates that the Congress clearly intended that medical factors be given predominant importance...." Amendments passed in 1972 established the SSI (Supplementary Security Income) program, which provided supplemental security income to adults already on standardized assistance programs for the needy. The provisions had a definition of adult disability identical to that of the SSDI (Social Security Disability Insurance), federalizing the "adult categories" under the Social Security Administration. The SSI program began in 1974 with 3.2 million beneficiaries receiving an average of $114 per month. Major staff expansion was undertaken, and a new computer network was added at this time. The 1972 amendments also altered the SSDI waiting period for eligibility, reducing the time to five months of continuous disability from six. Between 1972 and 1975, Social Security Administration review of state disability decisions dropped from 70 percent to 5 percent, and the number of benefit awards went up and "recoveries" went down; in the same period, eligibility criteria generally were relaxed, and more subjective factors were used in determinations.7 In 1976, 552,000 claimants were awarded benefits (doubling the 1967 total), and the percentage returning to work was halved compared with 1967. A 1975 memorandum established a special SSI case: individuals over age 55 with no work experience. The disability test for this category was the same, but collateral requirements were established by need, not by previous participation in a work-related payment system (Social Security). This provision remains active but still is not in the regulations. In 1976 another set of amendments followed hearings by the House Subcommittee on Social Security, which identified inefficiency and lack of uniformity as major problems in the system. The amendments gave the Secretary of Health, Education, and Welfare, hence the Social Security Administration, greater control over

7Monroe Berkowitz and M. Anne Hill, eds., Disability and the Labor Market: Economic Problems, Policies, and Programs, 2d ed. (Ithaca: ILR Press, 1989), p. 33.

ii the state agencies that made disability determinations, with the goal of improving nationwide uniformity. Among measures to reduce subjectivity in the adjudication process at the state level, the secretary received authority to establish both medical and vocational standards. In 1978 Medical-Vocational Guidelines (grids and "rules and regulations") were announced in the Federal Register as 20 CFR parts 404 and 416, becoming binding at all levels of adjudication and appeal when passed as amendments to the regulations in February 1979. The aim of the guidelines was to improve the uniformity and efficiency of the vocational portion of the decision process, which previously had depended on the input of vocational experts. Appendix 2 to the guidelines prescribes application of the vocational factors after degrees of residual functional capacity are determined (limiting the claimant to sedentary, light, or medium work). "Adjudicative judgment is to be based on consideration of the interaction of all the individual factors" (in other words, impairment severity plus vocational factors). It is worth noting that the grids do not cover strictly sedentary impairments or the combined effects of more than one impairment; in those situations, the medical- vocational rules are to be used as a "general framework" for the decision. Since their introduction, the grids have remained basically unmodified, although the original intent was for regular reevaluation and updating. In February 1979, the Social Security Administration updated the medical listings, making them more specific and reflecting medical advances. In addition, an SSA handbook was issued on procedures for physicians conducting SSDI and SSI eligibility exams. In 1980 the Advisory Council recommended liberalizing criteria for workers aged 55 to 60 by making criteria the same as for workers over age 60. The council also identified administrative inequities in the use of medical and vocational standards. It urged that all stages of the process provide greater incentives for return to work for those who were able, while not withholding just benefits from those who were not. In 1980, 4.7 million workers and dependents were receiving SSDI benefits, at a cost of $16 million, and the backlog of cases was growing. Driven by congressional

ii concern over high cost and increasing reversals of DDS denials by administrative law judges (ALJs) (see graphs), the 1980 amendments made numerous changes in work incentives in SSI and SSDI benefits. The so-called Bellmon Amendment required review of all disability decisions made by ALJs upon appeal. The stricter review requirements added a large, controversial workload to SSA; and, in the first three years, the combination of updated medical listings and stricter eligibility followups reversed the eligibility of 480,000 people (700,000, counting dependents) on the rolls through administrative determinations that their conditions had improved. A strong political backlash resulted. Appeals clogged federal courts; ALJs and federal judges then reversed about 200,000 ineligibility decisions. The 1980s amendments also established a demonstration project that allowed for developmentally disabled persons to maintain Social Security disability benefits while working. In 1981 the president's nine-member National Commission on Social Security made recommendations covering the entire Social Security system; no new recommendations were made for administration of the disability program. In the early 1980s, the disability review process changed to include personal interviews and to require retention of medical records by examiners and district offices for twelve months. In the case of Fogg v. Schweiker (1981), a U.S. Circuit Court decision disallowed the concept that disability decisions must consider physiological age as well as chronological age (the former would have incorporated physical condition as a mitigating circumstance in application of the "age" factor); the court said that impairment always can be considered, but it cannot alter the age factor, which must remain separate. In 1982 Social Security Ruling 82-41 further clarified the use of work experience and skill transferability as factors to be used in the last step of the sequential process of claim evaluation. In 1983, the review process, begun under the 1980 amendments, was halted in response to political pressure over the drastic cutbacks in eligibility that those

ii amendments had caused; at that point, many states already had ceased reviewing. In the 1983 case of Heckler v. Campbell, the U.S. Supreme Court reversed a U.S. District Court, finding that the 1978 vocational guidelines' failure to provide the "specific evidence" of jobs existing in the national economy, which had been provided in the previous system, wrongfully deprived the claimant of "individualized determination based on evidence adduced at a hearing." In the system that preceded the use of vocational guidelines, the Secretary of the Department of Health and Human Services was required to list "specific alternative occupations" available in the national economy as evidence backing a denial. The SSA claimed that the ruling rendered the guidelines useless, that specific listings of available jobs posed an untenable burden on the agency, and that the act's legislative history provides the Secretary the power to "proceed by regulation" to determine the existence of substantial gainful work (without specifying where). The U.S. Supreme Court recognized the Secretary's broad authority in such matters, finding the use of the vocational guidelines to be consistent with authority granted in the Social Security Act. This court test marked full approval of the guidelines' application. The Social Security Disability Benefits Reform Act of 1984 aimed to provide an explicit review standard, using improvement in condition, new evidence of an unchanged residual functional capacity (RFC), new technology or treatment, prior error, or fraud as the chief standards; the report claimed a balance between language that would imply a right to remain on the rolls barring significant improvement and language that would imply the possibility of arbitrary termination and result in removal of still- qualified individuals. The 1984 amendments also required that regulations setting forth uniform standards for disability determinations be published and subject to public comment before enactment by means of Federal Register notices of proposed rulemaking. The purposes were to improve the accuracy and uniformity of decisions and to return policy making to the federal level by requiring compliance of state standards with federal standards. These regulations included multiple impairments (the combined effect of such impairments is to be considered in cases where each individual impairment falls

ii short of justifying disability; such consideration is to be carried through all steps of the evaluation). Disability caused by pain requires a medically accepted evaluation showing the pain-causing impairment. Subjective evidence of pain is not to be accepted. For purposes of review, the previous 12 months of medical records are needed for new determinations. Medical evidence must come first from the claimant's doctor, after which a consultant is to be called if needed; in psychiatric cases, a specialist must make the medical and vocational decisions. In 1988 the Disability Advisory Council, appointed by the Secretary of Health and Human Services, reported that the SSA had no oversight capability for its vocational rehabilitation program, and that current policies failed to encourage people to return to work. The council called for a review of the referral criteria (to include "many workers" capable of working but currently not enrolled in Vocational Rehabilitation) and for tracking of persons who are referred to ensure that they follow through--all based on the original legislative stipulation that "the maximum number of such individuals be rehabilitated into productive activity."8 In 1991 new regulations set standards for the use of consultative examinations, stressing use of a claimant's physician's medical data whenever possible. In 1994 the SSA Disability Process Reengineering Team released its set of proposals for reconsidering the disability decision process, including the use of vocational factors. The present work grew out of that disability process review effort. According to the publication “A Plan For A New Disability Claim Process,” the Commissioner of the Social Security Administration will not consider any further decisions on the process until further research is completed.

8"Report of the Disability Advisory Council: Executive Summary.”

ii III. AGE AND THE ABILITY TO WORK

INTRODUCTION TO AGING ...... 47 DIFFERENTIATING AGING FROM DISEASE ...... 48 BASIC CONCEPTS IN AGING RESEARCH ...... 51 FUNCTIONAL AGING AND WORK ...... 56 THEORIES OF AGING--SENESCENCE ...... 60 Molecular Theories ...... 61 Cellular Theories ...... 62 System-Level Theories ...... 62 AGEMARKERS ...... 63 COMPONENTS OF AGING AND THEIR RELATIONSHIP TO DISABILITY ...... 69 Physiological Component ...... 70 Nervous System ...... 70 Sensory Systems ...... 71 Vision ...... 71 Hearing ...... 71 Other Senses ...... 72 Strength and Mobility ...... 72 Chronic and Acute Diseases ...... 73 Psychological Component ...... 75 Adaptation ...... 76 Attention ...... 79 Perception of Control ...... 79 Intelligence ...... 81 Competence ...... 82 Other Psychlogical Factors ...... 82 Sociological Component ...... 84 CONCLUSION ...... 86 Bibliography ...... 87 Appendix ...... 93 Figures ...... 94 Tables ...... 98

ii Executive Summary: Age and the Ability to Work

 Aging is a complex process, with personal, interpersonal, and social ramifications.

 Aging is a universal, intrinsic, progressive, “deleterious,”9 and irreversible process.

 Visible changes caused by aging are sufficient to change people’s expectations and cause many misconceptions.

 Aging is not a disease and being old does not mean being infirm. Aging increases one’s susceptibility to disease.

 It is difficult to associate chronological age with particular characteristics of groups of individuals. The variance in characteristics increases with age.

 Specialists hold many theories of aging, including molecular, cellular, and systems-level theories. No one theory can predict an individual’s ability to function from chronological age alone.

 If an impairment does not affect the individual’s knowledge, skill, or abilities, then age by itself may be irrelevant. If the impairment affects these attributes, then some age-related factors may act to delay or prevent recovery. The result will be a person who is less likely to be employable.

 Chronological age is not sufficient to predict the individual’s knowledge, skills, or abilities. Employers often prefer younger workers who have the same or better knowledge, skills, and abilities to older employees. Thus, the likelihood of employment tends to decrease with increasing age.

 Determining an individual’s functional age is more useful as a vocational factor. Functional age, commonly associated with the level of self- sufficiency, is an attribute that is relatively independent of chronological age. Functional age is determined by direct evaluation, and functional age assessments may be taken to be predictive of actual performance.

9Paola S. Timiras, “Aging and Disease,” in Paola S. Timiras, ed., Physiological Basis of Aging and Geriatrics, 2d. (Boca Raton, FL: CRC Press, 1994), p. 23. Timiras defines deleterious as “likely to reduce funcitonal competence.” Her multi-part definition of aging in general is a good one because it logically distinguishes aging from disease.

ii  Physical and cognitive slowing occurs with age, and older individuals should not be expected to make great vocational adjustments. Individuals who must make significant adjustments should be allowed sufficient time to reach satisfactory levels of performance. Failure to meet the necessary level of activity could lead to a disability determination.

 Agemarkers are identifiable characteristics of aging, and include biomarkers, psychomarkers, and sociomarkers. Biomarkers are indications of aging that change with time at a rate that reflects aging. Psychomarkers are indications of mental abilities, such as visual acuity and mental processing speed. Sociomarkers are indicators of how certain characteristics lead to expectations and actions that affect an individual in society.

 Agemarkers provide information about vocational age at a given point in time, and, cumulatively, they can be considered risk factors for potential declines. Agemarkers, as indicators, are valid only if they actually measure an age-related factor; if their measurement is repeatable and accurate.

 A difficulty in the assessment process is determining the normal ranges of agemarkers, which can vary considerably. One possible solution is to assess agemarkers individually and then convert the results to a functional age as an indication of overall health.

 A classic aging pattern is a decline in nonverbal performance with little decline in verbal performance.

 Functional impairments increase monotonically with age for those in the age 58-63 category.

 Older workers are less frequently injured, but injuries are more severe. They are also less likely to return to work after injury, particularly if they are unskilled or semi-skilled manual laborers.

 Adaptive capacity is the ability to maintain performance in the face of altered circumstances and is a biomarker. This capacity tends to be linked with the ability to adapt to changing environmental or exertional conditions. Adaptive capacity diminishes with age and may be insufficient for certain levels of demand. Thus, to accommodate diminished capacity, one must reduce task demands.

 The prefrontal cortex is the primary location of disabling psychological impairments. These impairments may persist even after clinical recovery. Simple, habitual behaviors may be performed, but complex and novel

ii behaviors, particularly those involving delays, cannot be performed by those individuals suffering prefrontal cortex impairments.

 In the psychiatrically disabled individual, dysfunction of the prefrontal cortex may be the primary defect underlying impairments in self-care and self-direction. Chronically mentally ill adults between the ages of 20 and 64 are more likely to be female, older, not currently married, and African- American when compared with the nondisabled population. Approximately 2.8 percent of the U.S. adult population has a severe mental disorder. Overall, one in ten Americans experiences some disability from a diagnosable mental illness in the course of any given year.

 Although an individual’s biomarkers and psychomarkers may indicate a sufficiently low functional age for work, they may be undercut by the individual’s sociomarkers. These may indicate potentially poor socioeconomic prospects caused by visible agemarkers.

 Chronological age alone does not predict performance and is too weak an agemarker to be used as the sole measure of vocational age limitations. Ultimately, gerontologists may discover a reliable set of agemarkers that can be used to evaluate functional age. Until that time, however, a consensus can be reached concerning a small number of well chosen agemarkers that can serve as an objective evaluation tool.

ii AGE AND THE ABILITY TO WORK

People have different genes, different lifestyles, different environments. All of this adds up over time to differences in aging. In fact, our older participants are much more heterogeneous in terms of their health than our younger participants.10

INTRODUCTION

Aging is a complex process. From a subjective point of view, an individual appears to remain fixed at the conscious center of himself or herself throughout life, yet the self undergoes many internal physiological and psychological changes. These changes are the results of complex internal, behavioral, and environmental processes that are experienced as aging. Visible changes in a person cause others to perceive that person differently and to alter their expectations of the person. These expectations often dictate the social and economic roles that people are allowed to play. Many of these expectations are based on misconceptions. Misconceptions about aging vary in degree, from thoughtless belief in stereotypes to ageism. Based on the results of his long-term experience with the "Facts of Aging Quiz," gerontology researcher Erdman B. Palmore found that the average person is full of misconceptions about aging and has a tendency to have a more anti-aged bias than a pro-aged bias. These negative misconceptions cross sex, age, occupation, and most other boundaries, with the exception of education.

10Baltimore Longitudinal Study of Aging: With the Passage of Time (Washington, DC: National Institute on Aging, 1992), p. 40.

ii Other studies have obtained conflicting results about the attitudes of young adults toward older adults (for example, Slotterback and Saarnio). It seems likely that the conflicting information was caused either by the use of different research methods or the use of better educated students as subjects in the later studies. The higher the level of education, the seemingly fewer misconceptions about aged people. In general, however, Palmore's conclusion is that "ageism pervades the culture of the western world."11 The key to the quiz is Table 1. It lists common misconceptions about older people and provides a more realistic profile of the older population than that held by the average person. (See Table A, page 98, in Appendix to Age for mental health quiz.) DIFFERENTIATING AGING FROM DISEASE "It is a central dogma of geriatrics that aging is not a disease and being old does not mean being infirm."12 In their article on the biology of aging, Ershler and Longo review 20 years of MEDLINE data on biomedical gerontology. Researchers have known for many years that cells change as they age and many have devoted their attention to those diseases that seem to be most closely associated with cellular and molecular alteration. In recent years, cancer researchers have focused on cell biology and experts have examined the links between aging and cancer. Erschler and Longo conclude that there is "now a more precise understanding of age-associated changes in cellular and molecular functions," and that there is considerable overlap with changes in the biology of cancer. "At the cellular level, aging and cancer can be considered distinct steps on a spectrum of cell behavior."13 Although aging increases susceptibility to disease, it is not necessarily the cause of it. For example, "Changes in the immune system, although not primarily a problem [of old age], may render an individual susceptible to reactivation of tuberculosis or herpes zoster and less capable of responding to influenza vaccine with protective titers

11Erdman B. Palmore, The Facts of Aging Quiz: A Handbook of Uses and Results ( New York: Spring Publishing, 1988), p. 79.

12William B. Ershler and Dan L. Longo, “The Biology of Aging,” Cancer, 80, No. 7, 1997, 1285.

13Ibid., p. 1284.

ii of antibody."14 Paradoxically, researchers have shown that immune senescence may

14Ibid., p. 1285.

Table 1. The Facts on Aging Quiz

The majority of old people (65+) are senile (have defective memory, are disoriented, or demented). False

The five senses (sight, hearing, taste, touch, and smell) all tend to weaken in old age. True

The majority of old people have no interest in, nor capacity for, sexual relations. False

Lung vital capacity tends to decline in old age. True

The majority of old people feel miserable most of the time. False

Physical strength tends to decline in old age. True

At least one-tenth of the aged are living in long-stay institutions (nursing homes, mental hospitals, homes for the aged, False etc.)

Aged drivers have fewer accidents per driver than those under age 65. True

Older workers usually cannot work as effectively as younger workers. False

Over three-fourths of the aged are healthy enough to carry out their normal activities. True

The majority of old people are unable to adapt to change. False

Old people usually take longer to learn something new. True

It is almost impossible for the average old person to learn something new. False

Older people tend to react slower than younger people. True

In general, old people tend to be pretty much alike. False

The majority of old people say they are seldom bored. True

The majority of old people are socially isolated. False

Older workers have fewer accidents than younger workers. True

Over 15% of the population are now age 65 or over. False

The majority of medical practitioners tend to give low priority to the aged. True

The majority of old people have incomes below the poverty line (as defined by the federal government). False

The majority of old people are now working or would like to work to do (including housework, volunteer work). True

Old people tend to become more religious as they age. False

The majority of old people say they are seldom irritable or angry. True

The health and economic status of old people will be about the same or worse in the year 2000 False (compared to younger people).

A person's height tends to decline in old age. True

More older persons (65 or over) have chronic illnesses that limit their activity than do younger True persons.

Older persons have more acute (short-term) illnesses than do younger persons. False

Older persons have more injuries in the home than younger persons. False

Older workers have less absenteeism than do younger workers. True

Older persons who reduce their activity tend to be happier than those who do not. False

Based on information from Erdman B. Palmore, The Facts on Aging Quiz: A Handbook of Uses and Results (New York: Springer, 1988).

ii actually reduce tumor growth and spread.15 Normal aging includes an increased incidence and susceptibility to diseases, accidents, and stress. Paola S. Timiras differentiates between human disease and aging as follows: Aging is a universal, intrinsic, progressive, deleterious, and irreversible process. Disease is a selective, intrinsic or extrinsic, discontinuous, occasionally deleterious, and often treatable process.16 Nevertheless, it may be difficult to distinguish between the two processes when the disease is characterized by very gradual degenerative changes. The fact that the incidence rate of chronic diseases increases with age may imply that aging is actually a combination of processes and not a single process.17 William Forbes addresses the issue of the measurement of the relationship between aging processes and different diseases.18 He notes that it is very difficult to associate chronological age with particular characteristics of groups of individuals, even such common characteristics as the graying of hair and loss of teeth. Researchers require necessary and sufficient conditions that would justify concluding that an observed process is actually part of the aging process.

15Ershler and Longo, p. 1285.

16Paola S. Timiras, “Aging and Disease,” in Paola S. Timiras, ed., Physiological Basis of Aging and Geriatric, 2d ed. (Boca Raton, FL: CRC Press, 1994), p. 23. See also R. Arking, Biology of Aging: Observations and Principles (Englewood Cliffs, NJ: Prentice-Hall, 1991).

17William F. Forbes, “General Concepts in the Association of Aging and Disease,” in David Hammerman, David, Osteoarthritis: Public Health Implications for an Aging Population (Baltimore: Johns Hopkins University Press, 1997), p. 8.

18Forbes, p. 9.

ii Characteristic measures may remain constant over a long period of time and then change suddenly with the onset of a disability or death.19 Therefore, scientists must make measurements on disease-free individuals to disentangle aging and disease effects. Unfortunately, it is normal for people of all ages to have some underlying pathological conditions without any obvious clinical symptoms. Forbes concludes that "it is almost impossible to identify older individuals who are free from any preclinical signs of disease."20 Donald King defines aging as "a genetic physiological process associated with morphological and functional changes in cellular and extracellular components aggravated by injury throughout life and resulting in a progressive imbalance of the control regulatory systems of the organism, including the hormonal, autocrine, neuroendocrine, and immune homeostatic mechanisms."21 King agrees with the argument for separating disease and the aging process: aging contributes to the susceptibility to disease, but one dies from a distinct pathological event, not the aging process (see Table 2). King also subscribes to the theory that aging has a programmed genetic basis "in which cells in elderly individuals, when compared to younger age-groups, poorly repair cellular and extracellular constituents. This repair deficiency is accentuated by a variety of environmental factors and injury throughout life that affect the genome and other constituents of the cells and extracellular components."22 The risk of death increases as cells lose their resistance to injury, hence making the organism more vulnerable to trauma and infection. Individuals age differently depending upon the condition of their repair system.

19Forbes, p. 9.

20Forbes, p. 11.

21Donald West King, “Pathology and Aging,” in Kent B. Butler and R. N. Butler, eds., Human Aging Research: Concepts and Techniques (New York: Raven Press, 1988), p. 325.

22King, p. 338.

ii BASIC CONCEPTS IN AGING RESEARCH Chronological age is measured in terms of the time elapsed since birth. From the developmental point of view, chronological age is not a cause of aging, just a marker of changes in aging processes.23 See Table 6 for a summary of issues related to adult development and aging. Biological age refers to a person's position within his or her potential life span. Life span refers to the "average age which human beings as a species can survive under optimum conditions (free of disease and accident).” The maximum life span potential (MLP), the length of life of the longest lived members of a species, appears to be 115 years for the human species."24 The life expectancy of an individual is the "average number of years of life remaining at any specified age," which is most commonly taken to be the moment of birth.25 The life cycle (life course) is "the predictable sequence of stages (e.g., infancy, childhood, youth, adolescence, middle age, old age) that individuals follow as they go through life, which roughly coincide with a series of life events beginning with birth and ending with death."26 [Harris; 106] "Strictly defined, the concept is used to represent maturational and generational processes driven by mechanisms of reproduction in natural populations."27 Psychological age "refers to the adaptive capacities of an individual--that is, an individual's ability to adapt to changing environmental demands as compared to the adaptability of other individuals of identical chronological age."28 Functional age "is a measure of a person's ability to function effectively within a given environment or

23John M. Rybash, Paul A. Roodin, and William J. Hoyer, Adult Development and Aging (Dubuque, IA: Brown and Benchmark, 1995), p. 13.

24Diana K. Harris, Dictionary of Gerontology (New York: Greenwood, 1988), p. 108.

25Harris, p. 107.

26Harris, p. 106.

27Angela M. O’Rand and Margaret L. Krecker, “Concepts of the Life Cycle: Their History, Earnings, and Uses in the Social Sciences,” Annual Review of Sociology, 16, 1990, p. 252.

28Rybash, p. 14.

ii society." Functional age is a measure of a person's ability to be self-sufficient.

Table 2. All Races3, Both Sexes, All Ages4*

Cause of death (Based on the Ninth Revision, International Classification of Diseases, 1975), 1 2 2 Rank race, sex, and age Number Rate

. . . All causes 2,312,132 880.0

1 Diseases of heart. . . .390-398,402,404-429 737,563 280.7

2 Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues. . . .140-208 538,455 204.9

3 Cerebrovascular diseases. . . .430-438 157,991 60.1

4 Chronic obstructive pulmonary diseases and allied conditions . . . .490-496 102,899 39.2

5 Accidents and adverse effects. . . .E800-E949 93,320 35.5

Motor vehicle accidents. . . .E810-E825 43,363 16.5

All other accidents and adverse effects. . . .E800-E807,E826-E949 49,957 19.0

6 Pneumonia and influenza. . . .480-487 82,923 31.6

7 Diabetes mellitus. . . .250 59,254 22.6

8 Human immunodeficiency virus infection. . . .*042-*044 43,115 16.4

9 Suicide. . . .E950-E959 31,284 11.9

10 Chronic liver disease and cirrhosis. . . .571 25,222 9.6

All other causes. . . .Residual 440,106 167.5

. . . Category not applicable.

* Figure does not meet standards of reliability or precision (see “Technical Notes,” in Monthly Vital Statistics Report, 45, No. 11, Supp. 2.).

1 Rank based on number of deaths; see “Technical Notes,” in Monthly Vital Statistics Report, 45, No. 11, Supp. 2.

2 Figures for age not stated are included in "All ages" but not distributed among age groups.

3 Includes races other than white and black.

4 Includes deaths under 1 year of age.

*Deaths and death rates for the 10 leading causes of death in specified age groups, by race and sex: United States, 1995 [Rates per 100,000 population in specified group. For explanation of asterisks preceding cause-of-death categories, see “Technical Notes,” in Monthly Vital Statistics Report, 45, No. 11, Supp. 2.]

Based on information from: Anderson R. N., Kochanek K. D.,et al . Report of Final Mortality Statistics, 1995. Monthly Vital

ii Statistics Report, 45 No. 11, Supp. 2, Table 7. Hyattsville, Maryland: National Center for Health Statistics, 1997. Chronological age is not "perfectly related to functional age."29 According to Siegler, functional age is a "construct first used by McFarland in 1973, to suggest that an individual's capacity, rather than chronological age, be used as the marker for ability in the workplace."30 Siegler finds chronological age to be as good an overall summary as functional age, but agrees that functional age "illustrates the importance of understanding that various abilities age at different rates; that all individuals of the same chronological age do not all function at the same level; and that in order to know what a particular person is capable of, there is no substitute for measuring that person directly."31 Chronological age alone cannot provide information about differences among individuals of the same age. These measured differences serve as indicators of a person's vocational abilities and limitations with respect to the demands of a specified level of work. Performance (work) has motivational and ability dimensions: one has to be willing and able to exert effort in the performance of a task. To be willing is to have intent to act while to be able is to have the capacity to act. Given intent based on a person's values and beliefs, his or her capacity can be static or dynamic. Static capacity is structural (related to a person's physiological, psychological, and social health and conditioning). Dynamic capacity to work is the ability to learn, solve problems, and to adapt to new situations with flexibility and creativity.32

29Rybash, p. 14.

30R. A. McFarland, “The Need for Functional Age Measurements in Industrial Gerontology,” Industrial Gerontology, 19, 1973.

31Ilene C. Siegler, “Functional Age,” in George L. Maddox, The Encyclopedia of Aging (New York: Springer Press, 1995), p. 385.

32Roel Cremer, “Matching Vocational Training Programmes to Age-Related Mental Change--A Social Policy Objective,” in Jan Snel and Roel Cremer, eds., Work and Aging: A European Perspective (Bristol, PA: Taylor and Francis, 1994), p. 276.

ii Functional age as used here is a direct measure of performance that is expressed as an age. Functional age will frequently be different from a person's chronological age. In 1991 an interdisciplinary task force was commissioned by Congress to review aging and related data with respect to public safety officers in 500 cities. They concluded that "Tests of specific psychological, physical and perceptual-motor abilities can predict job performance far better than a person's age."33

In a study by the National Research Council, the Age-60 rule for retiring pilots was investigated. The scientific panel concluded that for the "characteristics that are identified as important to performance and for which measures exist, changes with age often can be determined on an individual basis. Unfortunately, reliable measures are not available for the assessment on an individual basis of some factors that may be most salient to pilot performance, particularly intellectual function and processing of perceptual information."34 However, in general there is a degree of scientific agreement that changes in agemarkers are best measured on an individual basis, even at the highest performance levels, and that chronological age is insufficient.

33Diane E. Papalia, Cameron J. Camp, and Ruth Duskin Feldman, Adult Development and Aging (New York: McGraw Hill, 1996), p. 299. See also F. J. Landy, “Research on the Use of Fitness Tests for Police and Fire Fighting Jobs,” Second Annual Scientific Psychology Forum of the American Psychology Association. Washington, DC, 1993.

34Airline Pilot Age, Health, and Performance: Scientific and Medical Considerations (Washington, DC: National Academy Press, 1981).

ii The usefulness of the assumptions and arguments made in this review will depend on gerontological research on markers for various facets of performance. There are many possible approaches being explored.35 One approach is the use of cluster analysis to discover natural groupings of people, based on their assessments on functional age tasks. Cluster analysis36 is a relatively assumption-free methodology for grouping data and can be used to construct a classification tool that assigns new assessments to natural groups. A number of other computational techniques exist that can be applied to this problem, including expert systems (that would imitate experts in functional age assessment), neural networks, and genetic algorithms.

FUNCTIONAL AGING AND WORK Public intervention in cases of disability seems to have "two primary functions: establishing mechanisms to achieve the appropriate sharing of the costs of impairments and sponsoring programs to achieve an optimal reduction in the aggregate cost of disability.”37 There are three aspects of impairment that affect a person's participation in the labor market: "the extent to which the person is limited in the specific work-related functions, the severity of these limitations, and the requirements in terms of functional performance which are imposed by a person's occupation."38 In addition to impairments, the vocational factors of aging, education, and work experience are acknowledged elements that affect a person's ability to work.

35Pamela J. Maxson, Stig Berg, and Gerald McClearn, “Multidimensional Patterns of Aging: A Cluster-Analytic Approach,” Experimental Aging Research, No. 23, 1997, p. 13.

36Michael R. Anderberg, Cluster Analysis for Applications (New York: Academic Press, 1973).

37Richard V. Burkhauser and Robert H. Haveman, Disability and Work: The Economics of American Policy (Baltimore: Johns Hopkins University Press, 1982), p. 21.

38Burkhauser and Havemen, p. 8.

ii In order to better understand the relative relationships among vocational factors and an individual's ability to work, consider the following model. Figure 1 ( Appendix to Age, page 94) shows that age, education, and work experience each contribute a rating that can be either positive or negative. A physical or medical impairment results from "anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques" [Public Law 90-248]. Impairments always contribute negative ratings since they put limitations on a person's ability to work. The main pathway in the disablement process is from disease to impairments and then to disability, at which point normal activities of daily life become difficult.39 The vocational factors provide information that helps to assess the progress of the transition to disability. (See Appendix to “Age” Figure 2 page 94, for a conceptual model of the disablement process. Note that the “risk factors” in the first column could be supplemented with “work experience,” revealing connections with the vocational factors in Figure 1.) The circular region labeled "ability to work" expands or contracts as vocational and impairment ratings are summed together. This simple model assumes that the vocational ratings can be combined into a single value and can be tested against a threshold value. The threshold value is equivalent to the rating of an individual who can perform a generic minimum (sedentary) job available in sufficient quantity in the national economy. Changes in the ability to work change the size of the corresponding job pool. If the job pool is restricted to just those jobs that have some specified minimum level of requirements, then the ability to work need match only the specified minimum level and will have little subsequent effect on the job pool. If the job pool is taken to be unrestricted, then significant changes in the kinds of jobs available will have an impact on a person's ability to work by altering the value of a person's age, education, and work experience; this feedback link is not shown in the figure.

39Renee H. Lawrence and Alan M. Jette, “Disentangling the Disablement Process,” Journal of Gerontology: Social Sciences, 51B, No. 4, p. S173.

ii The intent of considering vocational age as a factor in the evaluation of a person's ability to work was to recognize the fact that there is a direct relationship between age and the likelihood of employment. The goal, however, was not to consider an individual's likelihood of obtaining employment, but rather to determine his or her age-related vocational limitations. The competing theories of aging are not yet able to provide guidance on exactly how to evaluate age-related vocational limitations. They do, however, suggest many possibly useful agemarkers that could be incorporated into an evaluation of age-related vocational limitations. One approach to accomplish this goal is to base the evaluation of "vocational age" on a determination of "functional age." Functional age is a concept commonly associated with a person's basic self-sufficiency, an attribute that has been found to be relatively independent of chronological age, except at the extremes of age. (See Basic Concepts above.) Functional age has also been used to describe an individual's current ability to perform in the workplace. The main idea is that a person, regardless of age, who can perform work-related tasks with regularity and without aggravating a medical impairment is of a sufficiently young functional age that he or she may be expected to have the ability to work. The first step in such an evaluation would be to obtain an individual's functional age from his or her performance on a variety of standardized tasks and to use the result as the contribution of the individual's age vocational factor toward the individual's ability to work. Once all vocational factors have been evaluated, the result can then be used to match against established mean functional ages required for jobs in the job pool. The testing might be simplified if a single task could serve as a measure of more than one capacity. For more discussion of functional age see the Basic Concepts section. Older people are capable of learning new things (see Table 1) given sufficient time and practice. If it is expected that an older worker may be capable of regularly performing the tasks demanded by a job for which he or she has no prior work experience, then the expectation must be tempered by expecting only minimal adjustment or adaptation. That is, an older worker should not be expected to make large vocational adjustments, and any adjustments that are essential should be allowed

ii sufficient time to reach satisfactory levels of performance. The adjustments might be eased if it is possible to 1) select a job that maximizes the transferability of the person's skills from a former job; 2) select a job that requires the abilities of someone of the same functional age; that is, match the person's functional age with the functional age of someone whose competence does not exceed the level of that job; 3) select a job that an individual can adapt to even without prior skills; 4) select a job that requires the same level of skills as the person has for self-sufficiency. Whatever the type of work selected, the demands of work on the capacities of the older individual should be somewhat less than his or her full capacity, to allow for the effects of fatigue and slower cognitive processing. Overloading a person's capacity will lead to failure; reducing the load to lie within the range of his or her adaptive capacity will allow them to adjust. Performance may improve over time as the person compensates for personal impediments and job demands. Compensation processes tend to relieve stress on adaptive capacity. Functional age may be preferable to chronological age as a way of evaluating age-related vocational limitations. Knowing whether a particular person is a younger individual, closely approaching advanced age, or of advanced age, has little predictive value for his or her performance. A 20-year old may have the functional age of an average 44-year old, and a 44-year old may have the functional age of an average 20-year old on the performance of some tasks.40 Functional age measures performance on tasks thought to be predictive of actual performance. The vocational factors may be viewed as aspects of an individual’s personal history. These factors may be expressed in terms of an age-like measure of the individual’s biomarkers, psychomarkers, and sociomarkers. For example, “functional age” expresses how well a person has “aged.” A person has aged well if, given his chronological age, the performance on certain tasks compares well with persons of the

40Waneen W. Spiriduso, Physical Dimensions of Aging (Champaign, IL: Human Kinetics, 1995), p. 234.

ii same age or younger. A person’s “educational age” describes his expected performance on a standardized test of educational achievement appropriate to his age group or younger. A person is, then, relatively well educated if he does well on this test. A person’s work experience might be measured overall in terms of primary occupation. How long did he have the occupation and how well did he perform relative to others with the same occupation? A person’s “occupational age” is a measure of how well the person performs that occupation relative to those who are of the same age or younger in the same occupation. An individual’s “vocational age” is a composite of these three age-like equivalents. The idea of age-equivalents may ultimately be too crude for practical use, but it is suggestive of a conceptual framework that may unify the vocational factors. Functional age is related to functional adequacy, a "social definition of health, initially proposed by Parsons."41 Parsons took the position that health is a state of "optimum capacity for the performance of the roles and tasks for which a person has been socialized." Health is fitness in relation to a social, ecological, and cultural network. This model has been "operationalized" in terms of mobility, self-maintenance, role performance, and disability in a seminal work by L. K. George and L. B. Bearon. These functional concepts are attempts to measure what a person can do at any given age, not just in later years. Functional age is related to capacity in that it is presumed that a particular job requires a particular functional age to meet its requirements. In the context of disability evaluation, the primary interest would be to determine the range of functional ages that correspond to minimum-level jobs.

THEORIES OF AGING--SENESCENCE Aging is "an increased liability to die, or an increasing loss of vigor, with increasing chronological age, or with the passage of the life cycle."42 This old definition

41Mary G. Kovar, “Health Assessment,” in George L. Maddox The Encyclopedia of Aging, 2d ed. (New York: Springer, 1995), p. 433. See also T. Parsons. The Social System (New York: Free Press, 1951).

42A. Comfort, “The Biology of Aging,” in B. L. Strehler, ed., The Biology of Aging. Discussion

ii is based more on ordinary observation and social perception than on any theory of aging, of which there are now dozens. Some of the theories are based on evolution, others attempt to identify biological causes or the dynamics of changes. Many of the theories seem incompatible, and the discrepancies have not yet been resolved.43 Table 3 lists some of the better-known theories and their proponents.

Session. I. Definition and Universality of Aging, AIBS (Washington, DC: American Institute of Biological Sciences, 1960).

43Gerald E. McClearn, “Biogerontological Theories,” Experimental Gerontology, 32, No. 1/2, 1997, p. 4.

ii Ramesh Sharma divides aging theories into molecular-, cellular- and systems-level theories.44 Molecular theories The codon restriction theory focuses on the impairment with aging of the fidelity/accuracy of the mRNA message translation system, caused by the cell's inability to decode the triple codons (bases) in mRNA molecules. The somatic mutation theory holds that exposure to radiation shortens lifespan

Table 3. Theories of Aging

Theory Proponent Bibliographic Reference1

Collagen Verzar (1957) 19

Cross-Linking Bjorksten (1968) 1

Endocrine Korenchevsky and Jones (1947) 10

Error catastrophe Orgel (1963) 12

Free-radical Harman (1955) 5

Immunological Walford (1969) 20

Metabolic Carlson et al. (1957) 2,9 Johnson et al. (1961)

Programmed senescence Hayflick (1968) 7

Rate of living Pearl (1928) 15

Somatic mutation Szilard (1959) 18

Waste product Carrell and Ebeling (1923) 3

Wear-and-tear Pearl (1924) 14

1See Appendix to Age and the Ability to Work, page 97, for complete bibliography.

Based on information from: Edward L. Schneider, "Theories of aging: A perspective," in Warner, H. et al., Modern Biological Theories of Aging (New York: Raven Press, 1987), pp. 1-4.

44Ramesh Sharma, “Theories of Aging,” in Paola S. Timiras, ed., Physiological Basis of Aging and Geriatrics, 2d ed. (Boca Raton, FL: CRC Press, 1994).

ii because of increased incidence of mutations and loss of functional genes. The error catastrophe theory holds that errors in information transfer, caused by alterations in RNA polymerase and tRNA synthetase, may increase exponentially with age, resulting in increased production of abnormal proteins. The gene regulation theory holds that the expression of the genes regulates both development and aging. The antagonistic pleiotropy theory, holds that genes that were beneficial during development become deleterious at later ages. The dysdifferentiation theory holds that the gradual accumulation of random molecular damages impairs regulation of gene expression. The disposable soma theory points to the preferential allocation of energy resources for reproductive cells to the detriment of the maintenance and survival of somatic cells. Cellular Theories The wear-and-tear theory refers to the intrinsic (e.g. oxidative processes) and extrinsic (e.g. ambient temperature) influences on the lifespan. The free radical accumulation theory holds that free radicals formed by oxidative reactions accumulate and damage membrane, cytoplasm, and nucleus. The age pigment theory holds that accumulation of lipofuscin (fluorescent age pigment) causes pathophysiologic complications and is inversely correlated with aging. The cross-linking theory holds that cross-linkages among molecules develop with aging and alter the chemical/physical properties of cell molecules. System-Level Theories The endocrine-immunological relationship theory holds that with aging some of the efficiency of hypothalamo-pituitary interaction is lost or altered, leading to decreased function and increased pathology of most organs and tissue systems. The neuroendocrine control theory views aging as part of a lifespan program regulated by neural and hormonal signals. That there are hormonal and neural influences on the immune system (i.e., the endocrine-immunological relationship) has long been known; for example, the involutionary action of glucocortioids on the thymus

ii and lymphatic system has been used for the treatment of allergies and in organ transplants. Sharma agrees with Forbes and others that aging is complex and is probably caused by the interaction of several underlying processes: "None of the theories proposed explains all the cause(s) for aging; rather aging seems to be a mutifactorial process. Growing evidence suggests that a multitude of parallel and often interacting processes govern the aging of an organism, many of them controlled by a combination of genetic and environmental factors."45 One of the implications of the evolutionary theory of aging is that as medical progress inevitably leads to higher survival rates, it will uncover more and more diseases and disorders associated with senescence.46 The genome is inherently vulnerable to the accumulation of genes that are expressed in later life as "lethal and disabling senescent diseases."

AGEMARKERS

45Sharma, p. 44.

46Bruce A. Carnes and S. Jay Olshansky, “Evolutionary Perspectives on Human Senescence,” Population and Development Review, 19, No. 4, 1993, p. 803.

ii An identifiable characteristic of aging is called an agemarker. Agemarkers include biomarkers, psychomarkers, and sociomarkers. The model in Figure 1 (page 94) shows that age is assumed to affect a person’s ability to work. In what ways is this assumption valid? Changes in agemarkers reflect changes in a person’s biomarkers, psychomarkers, and sociomarkers. The values of these variables describe a person’s ability to perform physically, mentally, and socially. A direct parallel exists between the risk factors in Figure 2 (page 95) and the vocational factors in the model. The Lawrence and Jette model is focused on the progressive decline in agemarkers that describe the disablement process. To be useful, a person’s functional age should be correlated with how far along the disablement process they may find themselves.47 Gerald McClearn quotes Arking's summary of expectations of biomarkers. According to Arking, biomarkers should: "(a) change with time at a rate that reflects the rate of aging; (b) reflect physiological age; (c) be monitoring some basic, important process; (d) be crucial to the maintenance of health; (e) serve as a predictor of lifespan and/or; (f) serve as a retrospective marker of aging; (g) be highly reproducible; (h) display change over a relatively short period; (i) be measurable in a variety of species; and (j) be nonlethal, and preferably noninvasive and minimally traumatic."48 Agemarkers are variables that acquire certain values. The goal of gerontological research is to identify variables that are validly related to functional performance and then to determine “normal” values of those variables. The following list of mostly biomarkers (Table 4) identifies the changes that can be expected in physiological variables with normal aging. Other normal signs of aging include atrophy (loss of cells), and a compensatory hyperplasia (increase in the number of dividing cells) that is often found in the liver, kidneys, and lungs and that can occasionally lead to cancer. Changes in the

Table 4. Symptoms of Normal Aging

47Lawrence and Jette, p. S173.

48Lawrence and Jette, p. S173.

ii Fewer taste buds Decline in speech Decreased response Reduced renal Delayed discrimination to antigens function tumescence

Increased Slowed colonic transit Graying of axillary hair Decreased Decreased response adipose tissue proprioception to beta-blockers

Decreased bone Yellowing of lens of eye Reduced response of Decreased vital Reduced febrile mass heart to work capacity response

Interrupted sleep Decreased temperature Increased residual Impaired Less rapid learning regulation lung volume adaptation to dark

High frequency Decreased tactile Decline in stature Decreased Decreased skin turgor hearing loss sensation olfactory acuity Based on information from: S. Colleen Beall, Lorin A. Baumhover, Alan J. Maxwell, and Robert E. Pieroni, "Normal Versus Pathological Aging: Knowledge of Family Practice Residents," The Gerontologist, No. 1, 1996, pp. 113-17.

ii extracellular matrix and in the vascular system are also observed. The architecture of the cell suffers changes because of replacement of cells in lesions by mesenchymal supportive structures (collagen, elastin, lipids, etc.) by inflammatory cells.49 Biomarkers alone cannot capture a complete description of functional age as an age vocational factor. For example, one might want to include the fact that a person is likely to be subject to "ageism" in seeking employment. This "sociomarker" is based on observations and may be considered a predictor, even though it cannot be determined by the direct measurement of any individual. A numerical rating for this sociomarker might be assigned on the basis of the frequency of age-based complaints or a similar statistic. Psychomarkers, such as cognitive style or self-reports by individuals about their mental states, are not considered biomarkers. Agemarkers describe any individual with respect to his or her physical, psychological, or social health, fitness, or ability. One of the problems of assessment is to determine which agemarkers are normal and which are not. This evaluation is not easy because the variance in agemarkers can be considerable (see discussion of the Baltimore Longitudinal Study of Aging below). Thus, agemarker values for an individual should be based on measures of what a person can actually do and then be converted into a functional age value for purpose of comparison. The result should be an indication of overall health and of how much effort the person needs to exert to perform minimum-level tasks--the less effort, the lower the person's functional age. Measures of health can be presented in the form of descriptive statistics that summarize large data sets, or they can be multidimensional measures such as those produced by the Older American Resources and Services Multidimensional Functional Services Questionnaire that provides an “index” of the form: social resouces, economic resources, mental health, physical health, capacity for self care.50 Functional age incorporates both measures. Table 5 lists some of the more common measuring instruments used primarily with older people. Similar instruments might be applicable when estimating functional age for any age group.

49Forbes, p. 327.

50Kovar, p. 434.

Table 5. Health Assessment

Instrument Dimensions

Older Americans Resources and Services Social and economic resources, mental health, physical health, capacity for self-care

Comprehensive Assessment and Referral Psychiatric, medical, social status Evaluation

SHORT-CARE Psychiatric impairment, physical impairment

Activities of Daily Living Index Sociobiological function in chronically ill, aging; severity of chronic conditions

Instrumental Activities of Daily Living Telephone use, shopping, preparing food, house- keeping, doing laundry, using transportation, taking medications, handling finances

Source: Compiled from information in Mary G. Kovar, "Health Assessment," in George L. Maddox, ed., The Encyclopedia of Aging, 2d ed. (New York: Springer, 1995), pp. 433-36.

The Baltimore Longitudinal Study of Aging [BLSA], which was founded in 1958, has provided some insight into the problem of selecting age-related variables and their changes or "transitions" with normal and disease-related processes. Some of the BLSA's major findings on normal aging are listed in Table 6. The BLSA has found that "no two people age in the same way. In fact, individual differences increase as we age, according to studies which show that older people differ from each other to a greater degree than do younger people."51 Evaluations of vocational age must allow for increasing variance of age-related factors and their affect on performance with increasing chronological age. Health and fitness may be better indicators of performance than chronological age.52 Aging may also be viewed as a developmental process (see Table 7). Those attributes that are reversible, or "plastic," would not be considered to be age-related if Timiras's definition is applied. Development, disease, and aging are fundamental aspects of the biology of the life cycle, each having a role in the unfolding of the individual's potentials within his or her environment.

51Baltimore Longitudinal Study of Aging, p. 13.

52Anne E. Dickerson and Anne G. Fisher, “Age Differences in Functional Performance,” The American Journal of Occupational Therapy, 47, No. 8, 1993, pp. 686-92.

Table 6. Major Findings of the BLSA

The heart adapts with age. Treadmill tests have shown over the years that the older heart adapts to the effects of age. While it is unable to increase its pumping rate during exercise as much as a young heart, it makes up for this by expanding to a greater extent, delivering more blood per beat. [BLSA; 29] Heart rate during maximal exercise declines by 25% between ages 20 and 75.

Coronary artery disease (CAD) increases as people age. [BLSA; 29] Arterial walls thicken; systolic blood pressure increases 20-25% between 20 and 75.

High blood cholesterol at older ages remains a risk factor for cardiovascular disease. [BLSA; 30]

Bones continually lose cells and replace them throughout life, but around age 35, the rate of bone loss speeds up, gradually gaining on and outstripping bone replacement. Loss speeds up in women in menopause. [BLSA;31]

Physical fitness declines about 5 to 10 percent per decade on the average."[BLSA; 32]

Fat around the abdomen is linked to heart disease [and diabetes] risks. [BLSA; 33]

Moderate weight is linked to longer lives. [BLSA; 34]

Lung capacity falls about 40% between ages 20 and 80. [BLSA; 34]

Aging cells are less sensitive to insulin. [BLSA; 36]

Muscle mass declines and with it oxygen consumption during exercise by 5-10% per decade. Hand-grip strength declines by 45% by age 76.

Memory and reaction time may begin to decline around age 70.

Difficulty focusing on close objects begins in 40s; ability to see fine detail declines in 70s. From age 50, susceptibility to glare increases, ability to see in dim light decreases, and ability to detect moving targets decreases.

Ability to hear high-frequency tones decreases in 20s, low-frequency in 60s; men lose hearing more than twice as quickly between ages 30 and 80.

Based on information from: Baltimore Longitudinal Study of Aging: With the Passage of Time (Washington, DC: National Institute on Aging, 1992).

Table 7. A Summary of Theoretical Issues in the Study of Adult Development and Aging

Development is a lifelong process. [Note: Hence development is subject to age-related factors.]

All ages or periods of development are equally important.

Development refers to both increases and decreases, and gains and losses, in behavior.

Development is modifiable or reversible; the individual is active in determining the course of development, and there is plasticity in how an individual develops and changes throughout the life span. [Note: Compare with the reversibility of some diseases and the irreversibility of aging processes.]

Development can take many different paths, as reflected by age-related inter-individual differences.

Development is multidirectional, in that there are different rates and directions of change for different characteristics within the individual and across individuals.

Developmental change can be gradual or continuous, or qualitative, relatively abrupt, and stage like.

Developmental changes are considered to be relatively durable, to distinguish them from temporary fluctuations due to motivation, short-term memory or other nondevelopmental processes.

Development is contextual in that it can vary substantially depending on the historical and sociocultural conditions in which it takes place. [Note: Implies that developmental level may be a quasi-sociomarker.]

Development is an outcome of the interactive effects of nature and nurture; the contributions of environmental and biological influences vary for different aspects of development and for different points in the life span.

The study of development is multi disciplinary in that it involves combining the perspectives of anthropology, biology, psychology, sociology, and other disciplines.

Based on information from: John M. Rybash, Paul A. Roodin, and William J. Hoyer, Adult Development and Aging (Madison: Brown & Benchmark, 1995), p. 5.

Some diseases increase in frequency with age. The diseases most related to or that are "normal" for old age are atherosclerosis and cancer. However, some survivor traits can be seen in the decline in the incidence of some diseases in the very old; for example, cancer declines from 29 percent occurrence in the 65-69 year range to 24 percent in the 80+ range.53 Other age-related diseases are osteoporosis, osteoarthritis, adenocarcinoma of the prostate, temporal arteritis, polymyalgia rheumatica, adult-onset diabetes, Alzheimer's disease, Parkinson's disease, neoplasms, emphysema, and hypertension.54

53Timiras, p. 27.

54Timiras, p. 27.

ii Timiras cites other indications of age-related declines. For example, after age 60, the average number of days spent in hospitalization (per person per year) increase from 2 days to 2 weeks.55 Disease presentation is often atypical: sepsis without fever, myocardial infarction without chest pain, pneumonia without coughing. "Characteristic of the elderly is that diseases tend to be chronic and debilitating rather than acute and self-limiting; symptomatology tends to be subtle and vague."56 Saad Nagi proposed a model for disability that suggests that disuse (i.e. inactivity) might be used as an agemarker. Nagi's model focuses on interactions between disease/pathology and disuse that lead to impairments and their subsequent functional limitations, with disability as the final outcome. Disuse is an agemarker and is a predictor of poor performance, except in those cases where disuse is reversible, and the underlying causes and limitations are more disease-like than age- like. The ability to perform prior work after recovery from the effects of reversible disuse will depend, in part, on when the relevant skills were acquired and the level of experience attained.57 Nagi's focus on disuse raises the general topic of prevention. Laurence Branch argues for more sophisticated, evidence-based data that can be used to improve the lives of the aging population and to influence skeptical government program managers. He cites, among others, the work of Lawrence and Jette as an example of gerontological research that should go to the clinical trial stage because it may lead to intervention in the disability process by minimizing functional limitations.58

THE COMPONENTS OF AGING AND THEIR RELATIONSHIP TO DISABILITY Age has physiological, psychological, and sociological components. Each component has an

55Timiras, p. 27.

56Timiras, p. 27.

57Saad Z. Nagi, “Disability Concepts Revisited: Implication for Prevention,” in A. M. Pope and A. R. Tarlov, eds., Disability in America: Toward a National Agenda for Prevention (Washington, DC: National Academy Press, 1991), pp. 309-27. See also Roberta Riki and C. Jessie Jones, “Assessing Physical Performance in Independent Older Adults: Issues and Guidelines,” Journal of Aging, 5. 1997, pp. 244-61.

58Laurence G. Branch, “Research on Disability: Where Is It Leading?” Journal of Gerontology: Social Sciences, 51B, 4, p. S171.

ii associated set of agemarker ranges in which an individual is considered normal. When any component's values fall outside of the normal range, the individual is considered to have suffered a temporary or permanent loss. This section will provide a preliminary account of some potentially useful variables that might be included among a person's agemarkers. Physiological Component  Nervous System

Table 8. Aging of the Nervous System

Brain Region Age Range Normal Aging Alzheimer's Disease (years) (% decrease) (% increase)

Frontal Lobe

Precentral gyrus 18-95 22-44 19-37

Association areas 19-95 15-51 22-40

Anterior cingulate gyrus 68-95 15-16 22

Temporal lobe

Superior gyrus 18-95 34-57 33-53

Middle gyrus 19-97 23-50 25-67

Inferior gyrus 18-95 18-36 11-63

Parietal lobe

Inferior parietal lobe 19-NA 15 9-37

Occipital lobe

Area 17 18-95 31-54 17-22

Area 18 19-NA 14 14-30

Hippocampal cortex 45-90 27-80 47

Cerebellum

Purkinje cells 60-100 25 NA

Subcortical areas

Locus ceruleus 60-80 43 60-70

Substantia nigra 20-65 35 35-40

Nucleus basalis of Meynert 50-66 Unchanged? 75-80

ii Based on information from: Paola Timiras, "Aging of the Nervous System," in Paola S. Timiras, ed., Physiological Basis of Aging and Geriatrics, 2d ed., (Boca Raton, FL: CRC Press, 1994), pp. 89-101. The aging of the nervous system has been investigated extensively. Timiras provides an overview of the regions of the brain that experience normal neuronal losses with aging (see Table 8). Ivy also provides a review and commentary on causes of age-related changes in the nervous system.59 Some of the mechanisms of functional changes caused by the aging of the nervous system are imbalance of neurotransmitters (see Table 9), membrane alterations, metabolic disturbances, and intra/intercellular degeneration.

Sensory Systems

The sensory systems of the body, especially vision and hearing, degrade with chronological age. Both intrinsic and extrinsic factors are present. Vision Among the intrinsic vision factors are changes in the cornea (which lead to astigmatism) and changes in the lens in the fourth decade of life that lead to progressive decline in color perception. Vision declines with age even in the absence of disease. The lens of the eye becomes cloudier with age. Contrast sensitivity also declines with age.60 (See Meisami for a detailed list of age-related factors that contribute to the normal decline of the human sensory systems.) Hearing Age-related hearing losses (presbycusis) is experienced as a loss of hearing in

59Gwen O. Ivy, Colin M. MacLeod, Ted L. Petit, and Etran J. Markus, “A Physiological Framework for Perceptual and Cognitive Changes in Aging,” in Fergus I. M. Craik and Timothy A. Salthouse, The Handbook of Aging and Cognition (Hillsdale, NJ; Lawrence Erlbaum Associates, 1992).

60Baltimore Longitudinal, p. 39.

ii the high frequency range above 1 kHz.61 If the maximum frequency of sound capable of being heard is used as the variable, then "this frequency is 20 kHz for children (10 years) decreasing to only 4 kHz for the elderly (80 years); the decline is steady and linear, occurring at the rate of about 2.3 kHz per decade."62 "On the average, low frequency hearing begins to fade between the ages of 60 and 70" and "men lose their hearing more than twice as fast as women."63

Table 9. Imbalance Among Neurotransmitters

Amines Amino Acids Peptides Others

Acetylcholine Glutamate Enkephalin Nitric Oxide

Catecholamines Aspartate Cholecystokinin Carbon Monoxide

Norepinephrine Glycine Substance P Zinc

Epinephrine GABA Vasoactive Intestinal Polypeptide Synapsins

Dopamine Taurine Somatostatin Miscellaneous

Serotonin Histamine Thyrotropin-Stimulating Hormone

Based on information from: Paola Timiras, "Aging of the Nervous System," in Paola S. Timiras, ed., Physiological Basis of Aging and Geriatrics. 2d ed., (Boca Raton, FL: CRC Press, 1994), pp. 89-101.

Other Senses

In addition to the declines in hearing and vision, there are also age-related declines in touch sensitivity and vibrotactile sensation, especially in the lower extremities.64 The ability to detect and identify odors peaks in the teens and declines considerably in the sixth decade.65 Taste is less

61Esmail Meisami, “Aging of the Sensory Systems,” in Paola S. Timiras, ed., Physiological Basis of Aging and Geriatrics, 2d ed. (Boca Raton, FL: CRC Press, 1994), p. 121.

62Meisami, p. 121.

63Baltimore Longitudinal, p. 38.

64Meisami, p. 124.

65Meisami, p. 127.

ii affected than olfaction, but the sensitivity and discrimination of taste qualities also decline with age.66

 Strength and Mobility In a 1987 study, Kovar and LaCroix surveyed 55-74 year olds who had worked some time since the age of 45. Thirty-eight million workers were evaluated on the basis of five activities: 1) walking a quarter mile and walking up 10 stairs without resting; 2) standing and sitting for 2 hours; 3) stooping, crouching, or kneeling and lifting or carrying 10 or 25 lb; 4) reaching overhead and reaching out to shake hands; and 5) grasping with fingers. Fifty-eight percent of the population executed the activities successfully; 42 percent had difficulties with lower-body strength. As age increased from 55 to 74 years, the percentage of the population that had difficulty performing mobility, endurance, and lower body strength activities doubled. Those activities dependent on freedom of movement and fine motor skills were much less affected by age. Kovar and LaCroix (1987) concluded that when the physical demands of most jobs were considered, many of the people who had retired for reasons other than health could have remained in the work force had they chosen to do so.

66Meisami, p. 129.

ii See Table B (see Appendix to “Age,” page 99) for an operational methodology for assigning partial disability on the basis of physical work capacity. Disability is defined here as the summation of the role consequences of functional limitations, and occupational disability is defined as an individual's uncompensated shortfalls in responding to work demands.67  Chronic and Acute Diseases Even though aging and disease are best kept distinct, it is true that chronic and acute disease have an impact on functional age. People with histories of hypertension, arthritis, angina pectoris, coronary heart disease, stroke, congestive heart failure, cancer, bone injuries, obesity, or diabetic conditions are more likely to become disabled.68 Hypertension and arthritis have been consistent predictors of disability while the others and lifestyle behaviors are significant predictors. See Table C (see Appendix to “Age,” page 100) for a summary of changes in skeletal and inflammation markers in osteoarthritis. See Table 10 for a review of decline in function in coordination and functional tasks.

67Leonard N. Matheson, Vert Mooney, Janet E. Grant, Scott Leggett, and Kevin Kenney, “Standardized Evaluation of Work Capacity,” Journal of Musculoskeletal Rehabilitation, No. 6, 1996, pp. 249-50.

68Spiriduso, p. 344.

ii Maddox and Clark characterized the course of impairments over a decade (1969-1979) in a nationally representative probability sample of 11,000 employed males and unmarried employed females taken from the Longitudinal Retirement History (LRHS) data set. When a three-factor Index of Functional Impairment (IFI) was applied to measure physical mobility, capacity for self-care, and subjective well-being, Maddox and Clark found that during the 10-year period functional impairment "increased monotonically both for the panel as a whole and for the male/female, poor/non-poor, and more/less education sub-panels studied.” They concluded that although IFI is not a comprehensive measure of human functioning and the age-related trajectories they obtained are not "normative," that the trajectories may be a first step in that direction at least as a baseline for the age group between 58 and 63.69

Table 10. Reliability and Decline in Function in Coordination and Functional Tasks1

Test Name Reliability Coefficient Decline in function from age 20 to 80 years (percentage)

Rising from chair with support .55 31

Putting on shirt .63 40

Managing large button .65 27

Managing small button .70 22

Manipulating safety pins .47 21

Zipping garment .54 34

Tying bow .66 24

Rotating large peg .78 27

Handwriting speed .84 30

Cutting with knife .62 43

1 The measure is tasks completed in 100 seconds.

Based on information from: Waneen W. Spirduso, in Physical Dimensions of Aging (Champaign, IL: Human Kinetics, 1995), p. 227. Adapted from A.R. Potvin, et al., "Human Neurologic Function and the Aging Process," Journal of the American Geriatrics Society, 28, 1980, p. 5.

69George L. Maddox and Daniel O. Clark, “Trajectories of Functional Impairment in Later Life,” Journal of Health and Social Behavior, 33, No. 2, 1992, pp. 114-25.

C. M. Brodsky70 attempts to provide an overview of work-related disability factors in a 1987 article. According to Root (1981), older workers in general are less likely to return to work following an occupational injury or illness, particularly if they are unskilled or semiskilled manual laborers in physically demanding jobs.71 Not only do social expectations about aging affect the perceived capacities and self-perceptions of older workers, but an employer's personnel practices, seniority systems, and rate of technological change also may prevent older persons from returning to work even if they desire to do so. Occupational exemptions through disability, then, may seem the only feasible alternative, especially for an older, unskilled, physically impaired worker with limited opportunities.72 In reviewing the effects of age on occupational injuries, Root (1981) found that although the rate of injury decreases with age, the consequences of injury, specifically the rate of fatalities, the severity of injuries, and the rate of permanent disabilities, are highest among older workers. Powell (1973) observed that one explanation for the negative association between age and accidents is that older workers who are less physically capable of meeting job demands leave physically demanding and hazardous jobs.73

Psychological Component

70C. M. Brodsky, “Compensation Illness as a Retirement Channel,” Journal of the American Geriatric Society, 19, 1971, p. 56.

71N. Root, “Injuries at Work Are Fewer Among Older Employees,” Monthly Labor Review, 104, 1981, pp. 3-34. See also C. Safilios-Rothschild, The Sociology and Social Psychology of Disability and Rehabilitation (New York: Random House, 1970).

72Brodsky, p. 56.

73Brodsky, p. 56.

ii Key to a person is his personality. “Personality is a constant in our lives. BLSA studies have produced conclusive evidence that age does not alter it, even in the face of serious physical problems.”74 The factors of the five-factor model (FFM) of personality (neuroticism, extroversion, openness, agreeableness, and conscientiousness) “are powerful predictors of psychological well being.”75 For example, the ability to cope with stress does not decline with age because personality traits for coping with stress do not change with aging.76 “There is some evidence that personality change is among the earliest markers of dementia.” From these findings we may conclude that FFM ratings are good candidates for psychomarkers involving stress and the possible onset of dementia.  Adaptation Psychological age "refers to the adaptive capacities of an individual--that is, an individual's ability to adapt to changing environmental demands as compared to the adaptability of other individuals of identical chronological age."77 Presumably, relative higher adaptability implies qualities associated with younger individuals and lower adaptability implies more rapid relative aging. Table 11 shows trends in a number of psychological agemarkers. The table shows a pattern of decline in the body’s primary systems as human beings age. The body will, in response, adapt within its reserve capacity, by shifting loads to other systems; for example, poor vision will cause an individual to rely more on hearing. Some combinations of declines may overwhelm reserve capacity and prevent an individual from performing set tasks. They become disabled with respect to that task. There are patterns of agemarkers that correspond to these disabled states. A time series of these patterns of agemarkers constitutes a trajectory that describes the disablement process. Recent research seems to indicate the possibility of a simplified approach to measuring psychomarkers. Salthouse tasked subjects with making quick comparison or substitution operations. He found that "measures of performance in tasks of this type shared 75 percent or more of

74Baltimore Longitudinal, p. 46.

75Baltimore Longitudinal, p. 46.

76Baltimore Longitudinal, p. 47.

77Rybash,p. 14.

ii age-related variance from a variety of cognitive measures, speed of processing has been postulated to be centrally involved in the hypothesized common factor."78 He also found that "measures of visual acuity and processing speed share a very large proportion of age-related variance in measures of working memory, associative learning, and concept identification."

78Timothy A. Salthouse, Holly E. Hancock, Elizabeth J. Meinz, and David Z. Hambrick, “Interrelations of Age, Visual Acuity, and Cognitive Functioning,” Journal of Gerontology: Psychological Sciences, 51B, No. 6, 1996, p. P317.

Table 11. Age Trends Relevant to Human Factors

PERCEPTUAL MIDDLE AGE (45-64) OLD AGE (65-74) LATE OLD AGE (75+)

Vision Near focus declining, hence Little focusing ability left, Significant loss of visual acuity needs reading glasses or and loss of acuity even with (dynamic and static), color bifocals. Increased corrective lenses. Less (1/3 discrimination, and extent of susceptibility to glare. Less compared with young adult) the visual field. Significant risk successful dark adaptation. transmission of light through of visual dysfunction from Some decline in static and to the retina. Greater cataracts, glaucoma, and dynamic visual acuity. Some susceptibility to glare. Slow macular degeneration. loss in ability to discriminate dark adaptation. Significant colors. declines in static and dynamic visual acuity, in useful visual field, and color discrimination ability.

Hearing Some loss at high Significant loss at high Significant loss at high and frequencies. frequencies and some loss middle frequencies. Likely at middle frequencies. Can needs a hearing aid. be helped by hearing aid. Greater susceptibility to masking by noise.

Taste, Smell, Cutaneous Minimal loss. Minor loss. Significant loss. Sensitivity

COGNITIVE

Response Time Some slowing in response Significant slowing in Pronounced slowing in time. response time. response time.

Working Memory/ Minor decline in learning Moderate slowing in Learning rate is halved from Attention ability and ability to divide learning rate and ability to the twenties, and significant attention. divide attention. declines are observed for dual task performance.

Knowledge Base Little change in fluid Some decline in fluid Significant declines in fluid and intelligence, and stability or intelligence and stability or crystallized intelligence. increases in crystallized slight decreases in intelligence. crystallized intelligence.

PHYSICAL AND MOTORIC

Size changes Limited height loss and Significant height and Cohort is significantly smaller some weight gain. weight loss coupled with and there is significant loss of cohort differences that height and weight. exaggerate these effects.

Physical Strength Modest decline in strength Moderate decline in strength Significant declines in physical and aerobic capacity. and aerobic capacity. Some strength and aerobic capacity. bone density loss. Significant bone density loss.

Balance and Mobility Slight declines in balance Significant declines in Balance likely to be impaired ability with little mobility balance ability and some and mobility likely to be loss. difficulties with mobility. restricted.

Health Fairly robust. Greater susceptibility to The presence of multiple chronic conditions (e.g., chronic conditions is highly arthritis, diabetes, likely. osteoporosis, hypertension).

Based on information from: N. Charness and E. A. Bosman, "Age and Human Factors," in F. I. M. Craik and T. A. Salthouse, eds., The Handbook of Aging and Cognition (Hillsdale, NJ: Lawrence Erlbaum, 1992), pp. 495-551.

"In spite of its popularity, there is no consensual definition--either conceptual or

ii operational--of adaptation as it is used in aging research."79 George attempts a two-part definition that covers an individual's capacity to meet the requirement of his or her environment (objective component) and to do so without losing a sense of well-being (subjective component). The environmental component is based on the idea of "environmental press"80; that is, a given level of capacity may be insufficient for certain levels of demands. Maladaptation is treated by attempting either to improve capacity or to reduce the demands of the environment. From the functional age point of view taken in this review, adaptation is a measure of the change in an individual's reserve capacity when engaged in a different task. A small change in reserves implies easy adaptation. Exhausting reserve capacity implies failure to adapt. There is a related notion of adaptive capacity, the ability to maintain performance in the face of altered circumstances. Adaptive capacity is a biomarker; it tends to be linked with the ability to adapt to changing environmental or exertional conditions. Adaptive capacity diminishes with age.81 It has been shown, however, that "older subjects perform about as well as middle-aged and young subjects in adapting to repeated exposure to exercise."82 Older individuals may achieve the same functional age as middle-aged or younger individuals after adaptation to exercise, if they have sufficient adaptive capacity. Adaptive capacity is similar to physiological reserve capacity.  Attention

79L. K. George and L. B. Bearon, Quality of Life in Older Persons: Meaning and Measurement (New York: Human Sciences, 1980).

80M. P. Lawton and L. Nahemow, “Ecology and the Aging Process,” in C. Eiserdorfer and M. P. Lawton, eds., Psychology of Adult Development and Aging (Washington, DC: American Psychology Association, 1973).

81N. W. Shock, “Adaptive Capacity,” in George L. Maddox, The Encyclopedia of Aging, 2d ed. (New York: Springer, 1995), p. 14.

82Ibid.

ii Hartley's survey of the age-related effects in attention provide another useful set of psychomarkers that includes visual and memory search tasks.83 (See Table 12.) These findings suggest that a small number of tests might be sufficient to establish objective ratings for broadly significant cognitive agemarkers. According to BLSA findings, "Some mental skills do begin to decline at about age 70, but this is highly variable. At the BLSA, more than a quarter of the volunteers over age 70 show no decline in memory. Some continue to perform well on the cognitive tasks as they move into their eighties."84 "At age 65, men appear to be as vigilant [i.e. able to respond to infrequent and unpredictable stimuli], or more so, than those who are younger. After age 70, vigilance declines sharply in many people, and more time is needed to respond to the stimuli. This observation suggests that a reduction in the ability to react is a true effect of aging, though it may occur at a later age than was once believed."85  Perception of Control In addition to attention, the subjective perception of control has also been found to be a significant factor in performance. Anne Dickerson and Anne Fisher studied

59-81 year olds with the Assessment of Motor and Process Skills (AMPS), a criterion-based observational assessment tool. They compared the participants’ functional performance on both familiar and unfamiliar tasks under two conditions of perceived control. They found little differences in performance on familiar tasks, but found a significant difference on unfamiliar tasks, suggesting that older adults demonstrate age-related decline, "even with activities that take motivational,

83Alan Hartley, “Attention,” in Fergus I. M. Craik and Timothy Salthouse, eds., The Handbook of Aging and Cognition (Hillsdale, NJ: Lawrence Erlbaum Associates, 1992), p. 35.

84Baltimore Longitudinal, p. 43.

85Baltimore Longitudinal, p. 44.

ii experiential, and ecological validity components into account. Even with this decline,

Table 12. Summary of Age-Related Effects in Attention1

Phenomenon Age-related effect Evidence

Semantic priming Reaction-time benefit is approximately 1.5 times larger in older adults strong

No consistent age difference in time course limited

Negative priming Reaction-time cost for targets that had been distractors in younger adults; not for limited older adults

Time course has not been investigated none

Stroop-type effects Irrelevant stimuli produce larger reaction time costs (incongruent) and benefits strong (congruent) for older adults.

Time course has not been investigated none

Location cuing Reaction time costs and benefits larger in older adults moderate

When the cue also primes the location, costs and benefits are the same or larger in moderate older adults

Some studies show no difference in time course; others consistent with longer time mixed course in older adults

Identity cuing Reaction-time costs and benefits are the same or larger in older adults limited

One study found longer time course for older adults; another found no difference mixed

Expectancy Reaction-time benefits of expected targets are larger for older adults; another found moderate no difference

Visual search Both younger and older adults show "pop-out" in single-feature search moderate

Conjunction search rates are qualitatively similar, about twice as large in older adults strong

After extended practice with consistent mapping, display size effects are significantly limited larger for older adults; for varied mapping display size, effects were the same

Memory search Memory set size effects are greater for older adults for reaction time; they are similar strong for the P300 component of the event-related potential

After extended practice with consistent mapping, memory size effects are small and limited are similar for younger and older adults; for varied mapping memory set size has significantly larger effect for older adults.

Dichotic listening Younger adults perform better. strong

Dual-task vigilance Younger adults perform better. strong

For perceptual tasks and infrequent targets, sensitivity and the decline of sensitivity moderate over time do not differ.

For cognitive tasks and frequent targets, sensitivity is lower for adults, but the decline moderate over time is similar.

1 Overall reaction times are longer for older adults in each task type.

Based on information from: Alan Hartley, "Attention," in Fergus Craik and Timothy Salthouse, eds., The Handbook of Aging and Cognition (Hillsdale, NJ: Lawrence Erlbaum, 1992), pp. 3-49.

ii both younger and older adults show improved performance when given their choice of tasks.86 This study seems to indicate that motivation is positively influenced when the performer has the perception that he or she has control over which tasks they perform, although it cannot fully make up for age-related cognitive deficits.  Intelligence Intelligence is still a highly controversial issue for theorists. The seemingly innocuous claim that general intelligence is the best predictor of job success provoked an intense controversy in 1992.87 There does seem to be, however, a fairly well-accepted "classic aging pattern" in which older adults decline almost entirely in nonverbal performance, while vocabulary, information, and comprehension seem to decline only slightly and very gradually.88 Fluid intelligence (the capacity to process novel information) begins to decline in young adulthood; crystallized intelligence (the ability to apply learned information and experience) typically improves through middle age and often until near the end of life. "In fact, up to age 55 to 65, the improvement in crystallized intelligence is about equal to the decline in fluid intelligence."89 The Seattle Longitudinal Study of Adult Intelligence (SLS)90 found that "most fairly healthy adults apparently experience no significant impairment in most abilities until after age 60."91 The 30-year study showed that there was no uniform pattern in the changes--various participants improved in some areas while none of the participants declined in all areas. Table E (see Appendix to “Age,” page 102) summarizes some of the the major findings of the Seattle Longitudinal Study. The overall functioning of intelligence seems to be optimized by a compensation-like process.

86Dickerson and Fisher, p.686.

87Papalia, Camp, and Feldman, p. 212.

88Papalia, Camp, and Feldman, p. 216.

89Papalia, Camp, and Feldman, p. 217.

90K. Warner Schaie, “The Seattle Longitudinal Study: A Twenty-One-Year Investigation of Psychometric Intelligence,” in K. W. Schaie, ed., Longitudinal Studies of Adult Personality Development. (New York: Guilford Press, 1983), pp. 64-155.

91Papalia, Camp, and Feldman, p. 220.

ii For the purposes of evaluating a person's ability to work, a baseline or minimal intelligence requirement should be satisfactory as a psychological agemarker. A minimal intelligence requirement would be the capacity to solve the types of problems that typically arise in performing work corresponding to the person's functional age. The higher a person's functional age, the lower the expectation of satisfactory performance in work that requires quick nonverbal responses to changing (i.e. unfamiliar) situations.  Competence Competence is knowing how in addition to knowing what .92 Competence includes the "ability to select features from the total environment that are required information for initiating a course of action, to initiate a sequence of movements designed to achieve the planned objectives, and to learn from successes and failures in order to formulate new plans.93 Schaie characterizes competence as involving combinations of factors that permit adaptation within a class of situations, whereas intelligence involves combinations of factors that permit adaptation across situations.  Other Psychological Factors (expressed as excesses or deficits) In this section, a brief digression will round out the discussion of psychomarkers with a review of the most prevalent psychologically disabling diseases, other than Alzheimer’s. These diseases are expressed as excesses or deficits that can lead to functional,94 and, as we have seen (see Figure 2, page 95 in Appendix to “Age”), functional limitations can lead to disability. Table D (see Appendix to “Age,” page 101) gives a comparison of neurologically based psychomarkers: schizophrenia, alcoholism, and bipolar disorder.

92K. J. Connolly and J. C. Bruner, The Growth of Competence (New York: Academic Press, 1974).

93K. Warner Schaie, “Age Changes in Intelligence,” in R. L. Sprott, ed., Age, Learning Ability, and Intelligence (New York: Van Nostrand Reinhold, 1980), p. 44.

94Charles A. Kauffmann and Daniel R. Weinberger, “The Neurobiological Basis of Psychiatric Disability,” in Arthur T. Meyerson, and Theodora Fine, eds., Psychiatric Disability (Washington, DC: American Psychiatric Press, 1987), p. 24.

ii The prefrontal cortex is the primary location of disabling impairments. Impairments consistent with prefrontal dysfunction are found in approximately 30 percent of patients, most commonly older patients, and they persist even after clinical recovery.95 The prefrontal cortex combines sensory inputs and internal motivations and generates behavioral programs. "Simple, habitual behavioral patterns can be performed without the prefrontal cortex; more complex, novel behaviors, especially those which are punctuated with long delays, cannot;96 damage to the prefrontal cortex can result in severe disorders in social and affective functioning because of the loss of relevance filtering (schizophrenia), impairments in motor behavior, and in instrumental functioning. "In sum, dysfunction of the prefrontal cortex can be considered as the primary defect underlying impairments in self-care and self-direction which characterize the psychiatrically disabled."97 Howard Goldman and Ronald Manderscheid found that "chronically mentally ill adults between the ages of 20 and 64 are more likely to be female, older, not currently married, and black when compared with the nondisabled population."98 According to the National Institute of Mental Health, approximately 2.8 percent of the U.S. adult population (18+) has a severe mental disorder (see Figure 3, page 95), and "overall, one in ten Americans experience some disability from a diagnosable mental illness in the course of any given year (see Figure 4, page 95).99 Psychiatric illness ranks fifth among major disease categories contributing to limitations in activity. An estimated 900,000 chronically ill individuals reside in institutions. An additional 350,000-800,000 severely disabled and 700,000 moderately disabled individuals reside in the community, of whom 550,000 receive Supplemental Security Income payments. Clearly, chronic psychiatric illness represents a major public health problem.100

95Kauffmann and Weinberger, p. 34.

96Kaufmann and Weinberger, p. 36.

97Kaufmann and Weinberger, p. 37.

98Howard H. Goldman and Ronald W. Manderscheid, “The Epidemiology of Psychiatric Disability,” in Arthur T. Meyerson, and Theodora Fine, eds., Psychiatric Disability (Washington, DC: American Psychiatric Press, 1987), p. 19.

99NIMH Website

100Kauffmann and Weinberger, p. 23.

Sociological Component The life cycle confers changing status on individuals:101 Age distinctions are expressed in normative expectations, privileges, and rewards. As socially recognized divisions of the life course, whether generalized across society or restricted to institutional domains, age grades are defined by norms that...specify appropriate behavior, roles, and schedules.102 Chronological age and visible agemarkers, as perceived by society, create expectations about an individual's personal, family, and social obligations and rewards. How should this fact be taken into account when evaluating an individual's ability to work? If ageism in employment practices is to be disregarded as a factor that shrinks a person's matching job pool, then it should be included as a disadvantage in vocational age determination because it amounts to an overestimate of a person's functional age by the evaluator. That is, the official functional age determination might conclude that a person is able, while the socioeconomic evaluation is that the person is not able on the basis of chronological age or appearance. Assessing visible sociomarkers directly may not be feasible. Perhaps a variation of the 45-50-55-year-old categories that indicate a person’s increasing difficulties in finding employment might be used instead. Ageism may simply be a part of how society functions. Societies tend to be made up of dynamic, hierarchically organized systems of roles that only certain individuals can fill at specific times in their life cycle: the President of the United States must be at least 35 years old; teenagers are not allowed to sit on the Supreme Court; there are no 90-year-old brain surgeons; and recently a seven-year-old who tried to pilot a plane died tragically in a small plane crash. In general, people seem to have common-sense expectations mixed in with the occasional damaging ageist stereotype.

101Leonard D. Cain, “Age Status,” in George L. Maddox, The Encyclopedia of Aging, 2nd ed. (New York: Springer, 1995), pp. 39-41.

102G. H. Elder, “Age Differentiation and the Life Course,” Annual Review of Sociology, No. 1, 1975, pp. 165-89.

ii Stereotypes of aging are not uniformly ageist. The National Council on Aging polls (1975, 1981) found that 74 percent of those polled saw those aged 65+ as “very warm and friendly” and “very wise from experience.” The attitudes shifted negatively to 35 percent, however, when asked if older people (65+) are “very good at getting things done,” and 29 percent when asked if they are “very bright and alert.”103 Many supervisors in the workplace seem to be above stereotypes. Warr surveyed over 100 research investigations on age and job performance. He found that "there is no significant difference between the job performance of older and and younger workers." And, again, it was found that the variations within an age group exceed average difference between age groups.104 Most of these investigations assessed performance solely through supervisor's ratings of "specific competences and of overall effectiveness." Warr stresses that the apparent conflict between laboratory assessments of cognitive decline with aging and the equally good ratings of younger and older workers stems from the laboratory focus on maximum intellectual performance. Maximum speed is rarely required in the workplace. Older workers may effectively compensate for slower speed by using their abilities, knowledge, and skills to maximize productivity. Warr defines four categories of age-related job activity (see Table 15 below).

Table 15. Four Categories of Job Activity and Expected Relationship of Performance with Age

Basic capacities and Performance can Expected Task Category more exceeded with be enhanced by relationship with Illustrative job content increasing age experience age

1 Yes No Negative Continuous paced data processing; rapid learning; heavy lifting

103Fay L. Cook, “Age Stereotype,” in George L. Maddox, The Encyclopedia of Aging, 2d (New York: Springer, 1995), pp. 41-42.

104P. B. Warr, “Age and Job Performance,” in Jan Snell and Roel Cremer, eds., Work and Aging: A European Perspective (London: Taylor and Francis, 1994), p. 309.

2 Yes Yes Zero Skilled manual work

3 No No Zero Relatively undemanding activities

4 No Yes Positive Knowledge-based judgements with no time pressure

Based on information from: P.B. Warr, "Age and job performance," in Jan Snel and Roel Cremer, eds., Work and Aging: A European perspective (London: Taylor & Francis, 1994), pp. 309-22.

CONCLUSION

Aging is a complex process that can be potentially described at some point in time by a combination of biomarkers, psychomarkers, and sociomarkers. It seems clear that chronological age does not predict performance and that it is too weak an agemarker to be used as the sole measure of vocational age limitations. Gerontological researchers may eventually sift through the thousands of possible agemarkers and arrive at a necessary and sufficient set that can be used to evaluate an individual's functional age with great reliability and accuracy. Until then, perhaps a consensus can be reached on a small number of well-chosen agemarkers to serve as part of a practical and objective evaluation tool. Future research should address the issue of how best to select and measure agemarkers that capture the essence of an individual's functional age. Such an index might have applications in both vocational assessment and disability evaluation.

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1. Figures 2. Tables

Figure 1.

Figure 2.

ii Figure 3.

Figure 4.

ii Bibliographic References to Table 3

1. Bjorksten, J. “The Crosslinkage Theory of Aging,” Journal of the American Geriatrics Society, 16, 1968, 408-27.

2. Carlson, L. D., W. J. Scheyer, and H. B. Jackson. “The Combined Effects of Ionizing Radiation and Low Temperature on the Metabolism, Longevity, and Soft Tissues of the White Rat. I.” Metabolism and Longevity. Radiation Research, 7, 1957, 190-97.

3. Carrell, A., and A. H. Ebeling. “Antagonistic Growth Activity and Growth Inhibiting Principles in Serum,” Journal of Experimental Medicine, 37, 1923, 653-59.

4. Comfort, A. The Biology of Senescence. North Holland, NY: Elsevier, 1979.

5. Harman, D. “Aging--a Theory Based on Free Radical and Information Theory,” UCRL Publication 3078. University of California Press, 1955.

6. Harman, S. M., and M. Blackman. Personal Comments.

7. Hayflick, L. “Human Cells and Aging,” Scientific American, No. 218, 1968, 32-37.

8. Helfman, P. M., and J. L. Bada. “Aspartic Acid Racemization in Dentine as a Measure of Aging,” Nature, 262, 1976, 279-81.

9. Johnson, H.D., L. D. Kintner, and H. H. Kibler. “Effects of 480F and 830F on Longevity and Pathology of Male Rats,” Gerontology, 18, 1961, 29-36.

10. Korenchevsky, V., and V. E. Jones. “The Effects of Androsterone, Oestradiol, and Thyroid Hormone on the Artificial Premature ‘Climacteric’ of Pure Gonadal Origin Produced by Ovariectomy in Rats. III. Effects on Histologic Structure of Vagina, Uterus, Adrenals, and Thyroid,” Journal of Gerontology, 2, 1947, 116-34.

11. Martin, G.M. “Genetic Syndromes in Man with Potential Relevance to the Pathology of Aging,” Birth Defects, 14, 1978, 5-39.

12. Orgel, L. E. “The Maintenance of the Accuracy of Protein Synthesis and its Relevance to Aging,” Proceedings of the National Academy of Sciences USA, 49, 1963, 517-21.

13. Paul, W. E., ed. Fundamental Immunology. New York: Raven Press, 1984.

14. Pearl, R. Studies in Human Biology. Baltimore: Williams and Wilkins, 1924.

15. Pearl, R. The Rate of Living. New York: Alfred A. Knopf, 1928.

ii 16. Sacher, G.A. “Evolution of Longevity and Survival Characteristics in Mammals.” In E. L. Schneider, ed., The Genetics of Aging. New York: Plenum, 1978, 151-67.

17. Schneider, E. L. “Cytogenetics of Aging.” In C. E. Finch and E. L. Schneider, eds., Handbook of the Biology of Aging. 2d. New York: Van Nostrand Reinhold, 1985, 357-73.

18. Szilard, L. “On the Nature of the Aging Process,” Proceedings of the National Academy of Sciences USA, 45, 1959, 30-45.

19. Verzar, F. “Aging of Connective Tissue,” Gerontologia, 1, 1957, 363-78.

20. Walford, R. L. The Immunologic Theory of Aging. Copenhagen: Munksgaard, 1969.

21. Walford, R. L. Maximum Life Span. New York: Norton, 1983.

Table A. Facts on Aging and Mental Health Quiz (parts)

The majority of persons over 65 have some mental illness severe enough to impair their abilities. False

Cognitive impairment (memory loss, disorientation, or confusion) is an inevitable part of the aging process. False

The prevalence of neurosis and schizophrenia increases in old age. False

Suicide rates increase with age for women past 45. False

Suicide rates increase with age for men past 45. True

Fewer of the aged have mental impairments, when all types are added together, than other age groups. True

The primary health problem of older age is cognitive impairment. True

Alzheimer's disease (progressive senile dementia) is the most common type of cognitive impairment among True the aged.

Most patients with Alzheimer's disease act the same way. False

Organic brain impairment is easy to distinguish from functional mental illness. False

The prevalence of cognitive impairment increases in old age. True

Isolation and hearing loss are the most frequent causes of paranoid disorders in old age. True

Poor nutrition may produce mental illness among the elderly. True

Mental illness is more prevalent among the elderly with less income and education. True

The elderly have fewer sleep problems than younger persons. False

Major depression is more prevalent among the elderly than among younger persons. False

More of the aged use mental health services than do younger persons. False

Psychotherapy is usually ineffective with older patients. False

Based on information from: Erdman B. Palmore, The Facts on Aging Quiz: A Handbook of Uses and Results (New York: Springer, 1988).

Table B. Guidelines for Work Capacity, State of California Division of Industrial Accidents, 1978

Disability Category Performance Description Standard Rating

Very heavy lifting Loss of approximately one-quarter of pre-injury 10% capacity for lifting

Very heavy work Loss of approximately one-quarter of pre-injury 15% capacity for performing such activities as bending, stooping, lifting, pushing, pulling and climbing or other activities involving comparable physical effort

Heavy lifting Loss of approximately one-half of pre-injury 20% capacity for lifting

Heavy lifting, repeated bending Loss of approximately one-quarter of pre-injury 25% capacity for lifting, bending and stooping

Heavy work Loss of approximately one-half of pre-injury 30% capacity for performing such activities as bending, stooping, lifting, pushing, pulling and climbing or other activities involving comparable physical effort

Light work Able to work in a standing or walking position, with 50% a minimum of demands for physical effort

Semi-sedentary work Able to work approximately one-half the time in a 60% standing or walking position, with a minimum of demands for physical effort

Sedentary work Able to work predominantly in a sitting position, with 70% a minimum of demands for physical effort and with some degree of walking being permitted

Based on information from: Leonard N. Matheson, Vert Mooney, Janet E. Grant, Scott Leggett, and Kevin Kenney, "Standardized Evaluation of Work Capacity," Journal of Musculoskeletal Rehabilitation, 6, 1996, pp. 249-64.

Table C. Summary of Changes in Skeletal and Inflammation Markers in Osteoarthritis

Marker Synovial Fluid Serum

Aggrecan keratan sulfate epitope Not markedly increased over serum Elevated

Aggrecan chondroitin sulfate 846 epitope Inversely related to inflammation Decreased or unchanged

Cartilage oligomeric protein (COMP) Markedly elevated over serum, Directly correlated with particularly in advanced disease; keratan sulfate epitope; inversely related to keratan sulfate elevated in about 20% of epitope (r=0.510,p=0.0004,n=49) patients with chronic disease

C-propeptide of type II procollagen of Elevated over serum levels Increased with time in patients cartilate exhibiting disease progression

Deoxypyridonoline and pyridinoline Not detectable in urine, both crosslinks of cartilage are elevated Not detectable (pyridinoline only) and bone In urine, related to joint degeneration

Osteocalcin Elevated in patients with positive Elevated scintigraphic scans

Bone sialoprotein Not studied Increased in patients during early disease progression

Hyalouronan Not studies Elevated and associated with more rapid joint destruction

Based on information from: A. Robin Poole, "Skeletal and Inflammation Markers in Aging and Osteoarthritis," in David Hammerman, Osteoarthritis: Public Health Implications for an Aging Population (Baltimore: Johns Hopkins University Press, 1997), pp. 187-214.

Table D. A Comparison of Schizophrenic, Alcoholic, and Bipolar Dementia

Neurobiological marker ^ -- Prefrontal cortex Schizophrenic Alcoholic Bipolar # -- Nondominant hemisphere

Neuropsychological (HRB)1 impaired + + + abstraction

Neurological soft signs + + +

Neurochemical (CSF)2 decreased HVA,3 + + + MHPG4

Neuroradiological (PEG,5 CT6) cortical + +  atrophy ventricular enlargement

Neurophysiological EEG7--slowing + + + PET8--hypofrontality + . + rCBF9--decreased flow +^ +^ +#

Treatment response + + + Refractory

Prognosis + + + Impaired functioning

Based on information from: Charles A. Kauffmann and Daniel R. Weinberger, "The Neurobiological Basis of Psychiatric Disability," in Arthur T. Meyerson and Theodora Fine, eds., Psychiatric Disability (Washington, DC: American Psychiatric Press, 1987), pp. 23-47.

1 HRB--Halstead-Reitan battery 2 CSF--cerebrospinal fluid 3 HVA--homovanilic acid 4 MHPG--3-methoxy-4-hydroxyphenolglycol 5 PEG--pneumoencephalography 6 CT--computerized axial tomography 7 EEG--electroencephalography 8 PET--positron emission tomography 9 rCBF--regional cerebral blood flow

Table E. Intellectual Development in Adulthood

Seattle Longitudinal Study (SLS)

There is no uniform pattern of age-related changes across all intellectual abilities.

Studies of an overall index do not suffice to monitor age Does intelligence change uniformly through adulthood, or are changes and age differences in intellectual functioning for there different life course ability patterns? either individuals or groups.

Fluid abilities tend to decline earlier than crystallized abilities.

Crystallized abilities show steeper decrement in the late 70s.

Reliably replicable average age decrements in psychrometric At what age is there a reliably detectable increment in ability, abilities do not occur prior to age 60. and what is its magnitude? Such decrements can be found for all abilities by age 74.

There are substantial generational (cohort) differences in psychrometric abilities. These cohort trends differ in magnitude and direction by ability and can therefore not be determined from composite IQ indices. What are the patterns of generational differences, and what is their magnitude? Cross-sectional studies used to model age change will show negative cohort gradients prior to the 60s for those variables that show negative cohort gradients and underestimate age changes for those variables with positive cohort gradients.

The variables that have been implicated in reducing risk of cognitive decline in old age:

absence of cardiovascular and other chronic disease

favorable environment mediated by high socioeconomic What accounts for individual differences in age-related change status in adulthood? involvement in a complex and intellectually stimulating environment

flexible personality at midlife

high cognitive status of spouse

maintenance of high levels of perceptual processing speed

Decline may be a function of disuse. Cognitive training in community-dwelling older people Can intellectual decline with increasing age be reversed by resulted in approximately two thirds of the experimental educational intervention? subjects showing significant improvement; and about 40% of those who had declined significantly over 14 years were returned to their predecline level.

Source: Compiled from data in K. Warner Schaie and Paul B. Baltes, Intellectual Development in Adulthood: The Seattle Longitudinal Study (New York: Cambridge University Press, 1996).

Executive Summary: Education and the Ability to Work

 Evidence from the literature indicates that the skill requirements for workers today are much higher than ever and steadily increasing.

 Education directly impacts on workers’ ability to acquire the needed skills.

 The acquisition of basic skills is at the center of national concern about education. At the same time, studies indicate that between one-third and one-half of all adults in the United States are functionally illiterate.

 A significant number (approximately 83 percent) of the new workers are expected to be women, ethnic and racial minorities, and immigrants. A large percentage of these groups will be poorly prepared by our educational system for employment.

 Globalization of the economy is most telling on high school students who either fail to graduate or graduate with skill levels insufficient to pursue a college education. They fill the unskilled or semi-skilled jobs that mostly make up the U.S. labor market. They are unable to compete with better educated workforces in other nations or the less well educated foreign workforces performing semi-skilled work for lower wages.

 The level of education determines job availability and income. In 1992, 62.5 percent of the labor force had high school diplomas or some college and a majority of these (about 55 percent) had a high school diploma only. Options for students without high school diplomas or special training tend to be grim. Education has an increasing effect on earning power. Earnings for college educated males increased 10 percent between 1975 and 1990 while earnings for those with only high school diplomas declined by 9 percent.

 Individuals with a high school diploma are better educated than those with a General Educational Development certificate (GED). Exam-certified persons are indistinguishable in many labor market dimensions from high school dropouts who are uncertified.

 For all workers, the wage gap between persons with and without disabilities is high. However, the salary gap for college-educated disabled workers and persons without disabilities is not very significant.

ii Furthermore, persons with disabilities who have graduated from universities tend to invest in more education than average students.

 One may infer that individuals with impairments who have lower levels of education are less likely to find well paying jobs and more likely to seek disability compensation.

 The National Adult Literacy Survey defines literacy as “being able to use printed and written information to function in society, to achieve one’s goals, and to develop one’s knowledge and potential. This definition encompasses a broad range of skills that adults use in accomplishing the many different types of literacy tasks associated with work, home, and community contexts.”

 The 1993 Adult Literacy in America survey established five levels of literacy: level 1 individuals displayed limited skills; level 2 individuals experienced considerable difficulty in responding to higher level reading and problem-solving skills (these two levels equate to adults whose skills are below high school diploma level); levels 3, 4, and 5 individuals displayed much higher level of literacy proficiency.

 The sample results indicate:

 21 to 23 percent--40-44 million of 191 million adults in the United States--are at level 1. Of this group, 62 percent had not completed high school; 25 percent were immigrants lacking good working knowledge of English; 34 percent were age 65 or older; 26 percent were physically or mentally impaired.

 25-28 percent--50 million adults--had skills at level 2.

 The level of education attained had the strongest relationship with literacy proficiency:

 16-20 percent of high school graduates performed at level 1; 33-38 percent at level 2; 33-37 percent at level 3; 10-13 percent at the highest levels.

 42-46 percent of adults with 9-12 years of education performed at level 1; 34-38 percent at level 2.

 75-80 percent of adults with 0-8 years of education performed at level 1; 18-20 percent performed at level 2.

ii  Racial and ethnic minorities were more likely than white adults to perform at the two lowest literacy levels. Many of these individuals were born outside the United States and learned English as a second language. This fact is particularly true for adults of Asian and Hispanic origin.

 Twelve percent of all respondents reported a physical or mental impairment. Some 46-49 percent of all adults in this group performed at level 1; 26-30 percent performed at level 2. The smallest performance difference between impaired individuals and the population as a whole was found among those with hearing impairment; the largest gap was found among those suffering from some sort of mental impairment.

 The survey results showed that individuals with more limited literacy skills were less likely to be employed.

 More than 50 percent of all adults who performed at level 1 literacy proficiency were out of the labor force; 34-35 percent of those at level 2 were out of the labor force; 23-25 percent of those at level 3 were out of the labor force. Only 10-18 percent of adults at levels 4 and 5 were out of the labor force.

 Some 30 percent of individuals at level 1 were employed full time (working 18-19 weeks in the year prior to the survey); 43-44 percent of those in level 2 were employed full time (working 27-29 weeks); 55 percent or respondents in level 3 (34-35 weeks) and 64- 75 percent at levels 4 and 5 (38-44 weeks) were employed “full time”.

 Median weekly earnings reported for individuals in level 1 were $230 to $245; in level 2--individuals earned $274-$288; level 3-- individuals earned between $339 and $350; level 4--individuals earned between $462 and $472; level 5--individuals earned between $618 and $681.

 Adults at the lowest level of the literacy scale were much more likely to receive food stamps; nearly half lived in poverty; only slightly more than half reported voting in a national or local election in the previous five years (compared to 80 percent for the higher level), indicating a low level of initiative.

 Adults with lower educational achievement and corresponding lower level of literacy will continue to represent a high proportion of potential SSA disability applicants.

ii IV. EDUCATION AND THE ABILITY TO WORK

The question of the relationship between the issues of education and training and those of employment, earning potential, and quality of life is complex; the data covering these relationships are often contradictory. When the subjects of education and training are combined with disability, the relationship between them and the issues of employment, earning potential, and quality of life becomes even more obscure. However, a search of sources on these topics provides some useful conclusions. An examination of available sources indicates an almost total lack of literature directly addressing the question of education as a vocational factor in disability determination. Research, however, revealed the presence of considerable literature dealing with the relationship between levels of education and job availability. For the purposes of this study, we will assume that this relationship, which applies to the entire workforce, is also valid for workers with impairments seeking new employment. Most experts agree that two basic facts govern the relationship between education and job availability. First, skill requirements of workers today are much higher than ever and are steadily increasing, and, second, education directly impacts on workers' ability to acquire the needed skills. According to a National Assessment of Vocational Education report, published in July 1994 by the Department of Education's Office of Educational Research and Improvement, Final Report To Congress, Volume II, Participation In And Quality Of Vocational Education, since the 1970s, three major developments have affected worker skills: "the emergence of a global economy, the growth of high-performance work places, and the continuing impact of new technology." As Daniel A. Wagner and Donald Hirsh have pointed out, "Globalization of economic exchange, industrial production, and worker retraining have put acquisition of basic skills--of which literacy is clearly the most critical--at the center of national and international concern about education."105 This development comes at a time when, according to recent studies, between one-third and one-half of all adults in the United

105Daniel A. Wagner and Donald Hirsh, What Makes Workers Learn: The Role of Incentives in Workplace Education and Training (Cresskill, NJ: Hampton, 1995), p. 37.

ii States are functionally illiterate. Using the criteria of the National Adult Literacy Survey (NALS), combining those adults in level 1 and level 2 literacy (21 percent and 26 percent, respectively), up to half of the population falls into that category. Although the individuals in level 2 demonstrated a higher level of proficiency, their repertoire was still quite limited and they might never be successful in a knowledge-driven society.106 In addition, the workforce itself is changing--growing older, more female, and more economically disadvantaged. According to Charles J. Law, Jr., the average age of American workers today is 36 and will rise to 39 by the year 2000. Moreover, 83 percent of the new workers are expected to be women, ethnic and racial minorities, and immigrants, a large percentage of whom will be poorly prepared by our educational system for employment.107 The impact of the so-called global economy has been particularly telling on high school students who either fail to graduate or graduate with skill levels insufficient to pursue a college education. They fill the unskilled or semi-skilled jobs that mostly make up the U.S. labor market. They are unable to compete with the better educated workforces of other nations or the less well educated foreign workforces performing semi-skilled work for lower wages. Their employment opportunities are, therefore, limited to such non-transportable sales and service jobs as "cashier, restaurant worker, janitor, and beautician," which are not subject to foreign competition.

106Irwin S. Kirsch, Ann Jungeblut, Lynn Jenkins, and Andrew Kolstad. National Center for Education Statistics: Adult Literacy in America. Washington, DC: GPO, September 1993, xiv.

107Charles J. Law, Jr., Tech Prep Education: A Total Quality Approach (Lancaster, PA: Technomic, 1994), p. 124.

ii The second general principle on which most experts agree is that the level of education determines job availability and income. According to W. Norton Grubb, the proliferation of post-secondary education and training programs--vocational schools, community colleges, technical institutes, and a variety of job training programs--has provided high school graduates with greater variety of employment options.108 In 1992, 62.5 percent of the labor force had high school diplomas or some college and a majority of these (about 55 percent) had high school diploma only. The proportion of these students is decreasing steadily as more and more high school graduates seek some sort of post-high school education or training. On the other hand, the options for students without high school diplomas or special training tend to be grim. Table 1 shows the relationship between education and earning potential of males, ages 25 to 64, in the U.S. workforce for the years 1984, 1987, and 1990. According to a recent report published by the National Governors Association, jobs with higher, family- supporting wages and benefits are tied more closely to educational attainment than ever before, making them further out of reach for undereducated and low-skilled workers.109 Recent data from the Department of Labor’s Bureau of Labor Statistics indicate that unemployment data segregated by education ranged from 7 percent for those with less than a high school diploma, to 1.8 percent for those with a college degree (those who had completed high school had an unemployment rate of 4 percent and those with some college but no degree were unemployed at a rate of 2.8 percent). Data segregated by age showed that men aged 25-54 were unemployed at a rate of 3.3 percent, aged over 55 -- 2.5 percent. Women aged 25-54 were unemployed at a rate of 3.6 percent, aged over 55 -- 2.8 percent. Data segregated by race (all over the age of 20) showed that white men were unemployed at a rate of 4 percent (with men at 3.3

108W. Norton Grubb, Working in the Middle: Strengthening Education and Training for the Mid- Skilled Labor Force (San Francisco: Jossey-Boss, 1996), pp. 51-52.

109Susan Golonka, “Strategies to Promote Education, Skill Development, and Career Advancement Opportunities for Low-Skilled Workers,” NGA Online, July 28, 1998, p. 2. (Available at )

ii percent and women at 3.5 percent), African-Americans were unemployed at a rate of 9 percent (with men at 7.8 percent, and women at 7.6 percent). Hispanic-Americans were unemployed at a rate of 7.5 percent. Table 1. Education and Earning Potential

Educational Level* 1984 1987 1990

Ph.D. $38,438 $36,883 $49,911

Professional Degree 44,205 46,272 57,030

Masters 26,355 31,238 35,967

B.A./B.S. 24,939 27,601 31,967

Associate Degree 20,030 23,904 25,080

Vocational 21,775 20,584 21,664

certificate

Some college, no

degree

Four years 20,066 22,237 27,338

ii Three years 20,230 22,620 25,086

Two years 18,121 19,922 21,798

One year 18,574 21,541 22,139

High School 16,815 18,233 19,811

diploma

9-11 years’ 12,647 12,457 13,907

schooling

0-8 years’ schooling 10,265 11,661 12,609

Source: W. Norton Grubb, Working in the Middle: Strengthening Education and Training for the Mid-Skilled Labor Force. (San Francisco: Jossey-Bass, 1996), p. 88.

*For females in the labor force, earning potential decreased with the descending level of education at about the same rate as it did for males. However, females earned about half the salary of males at each corresponding level of education.

The table clearly indicates the correlation between education and earning power. It suggests that education has an increasing effect on earning power. It also suggests that there is a considerable difference in earning power between high school graduates and those who fail to graduate. According to National Center on Education and the

ii Economy report, America's Choice: High Skills or Low Wages! The Report of the Commission on the Skills of the American Workforce, between 1975 and 1990, "The gap in earnings between professionals and clerical workers has grown from 47 to 86 percent while the gap between white collar workers and skilled tradespeople has risen from 2 to 37 percent.”110 During the same period, earnings for college educated males increased 10 percent while earnings for those with only high school diplomas declined by 9 percent. Two additional studies, one by Marjorie Baldwin, Paul R. Flacco, and Lester A. Zeagler, and the other by Wallace Hendricks, Chrisann Schiro-Geist, and Emir Broadbent imply the same conclusion for impaired individuals. The first study suggests that for all workers the "wage gap between persons with and without disabilities is quite high."111 The second study found that the salary gap for college-educated disabled workers and persons without disabilities was not very significant. Furthermore, the authors of the second study point out that "persons with disabilities who have graduated from the university tend to invest in more education than average students."112 By implication it also indicates that the lower the education level of an individual, the fewer are the employment opportunities. Therefore, the following inference can be made about individuals with impairments seeking to qualify for SSDI: the lower their education levels, the less likely they are to find well paying jobs, the more inclined they are to seek disability compensation, and the less likely they are to try to obtain new jobs.

110United States Commission on the Skills of the American Workforce. America’s Choice: High Skills or Low Wages! The Report of the Commission on the Skills of the American Workforce. June, 1990, p. 20.

111Marjorie Baldwin, Paul R. Flacco, and Lester A. Zeagler, “Gender Differences in Wage Losses from Impairments: Estimates from the SIPP,” Journal of Human Resources, Summer 1994, pp. 865-87.

112Wallace Hendricks, Chrisann Schiro-Geist, and Emir Broadbent, “Long-Term Disabilities and College Education,” Industrial Relations, 36, No. 1, January 1997, pp. 46-60.

ii The importance of at least a high school diploma for an individual's earning power is further demonstrated by the failure of job training programs to substantially increase those individuals' earning potential. As W. Norton Grubb points out, job training programs are most common among high school dropouts. Yet, although the Job Training Partnership Act, the major job training program in the 1980s, did increase earnings by about $1,000 a year for both men and women, their earnings continued to be low and they remained among the "working poor.”113 Also, a General Educational Development (GED) does not, in many cases, bring the same earning potential as a high school diploma. An article in the Journal of Labor Economics, "The Nonequivalence of High School Equivalents," concludes that individuals with a high school diploma are better educated than those with a General Educational Development certificate and that "exam-certified persons are indistinguishable in many labor market dimensions from high school dropouts who are uncertified." Compared to high school graduates, GED recipients are "more likely to be working in lower skilled jobs, [performing tasks] more similar to the work of a high school dropout."114 The above discussion underlines the importance of literacy and advanced skills in the job market. Because there are conflicting opinions about the skills individuals need to function successfully in society and as a result no consensus as to the definition of "literacy," the U.S. Congress, in its Adult Education Amendments of 1988, mandated the Department of Education to come up with a workable, comprehensive definition of literacy and a statement on "the nature and extent of literacy among adults in the nation." As a result, the National Adult Literacy Survey was initiated by the Department of Education's National Center for Education Statistics and the Division of Adult Education and Literacy. The national panel of experts assembled in 1985 for this project constructed a definition of "literacy" that took into account some criticisms of

113W. Norton Grubb, Working in the Middle: Strengthening Education and Training for the Mid- Skilled Labor Force (San Francisco: Jossey-Bass, 1996), pp. 115-17.

114"The Nonequivalence of High School Equivalents,” Journal of Labor Economics, 11, No. 1, Pt. 1, 1993.

ii previous surveys and incorporated new advances in educational assessment methodology. They rejected such arbitrary standards as signing one's name, completing five years of school, or using a school- based measure of reading achievement. Instead, they drafted the following definition of literacy, cited in Adult Literacy in America: Using printed and written information to function in society, to achieve one's goals, and to develop one's knowledge and potential.” Rejecting traditional definitions of literacy that focused on decoding and comprehension, this definition "encompasses a broad range of skills that adults use in accomplishing the many different types of literacy tasks associated with work, home, and community contexts." Reflecting this view, the National Literacy Act of 1991 defined literacy as "an individual's ability to read, write, and speak in English and compute and solve problems at levels of proficiency necessary to function on the job and in the society, to achieve one's goals, and to develop one's knowledge and potential." The Survey conducted by the National Center for Education Statistics, Adult Literacy in America (1993), consists of interviews conducted in 1992 with 13,600 individuals aged 16 and older and randomly selected. In addition, 1,000 individuals were interviewed in each of 12 states in a comparable state-level survey. Some 1,100 inmates from federal and state prisons were also interviewed, making for a total of over 26,000 interviews.115 Each participant was given a series of diverse literacy tasks and was asked about his or her demographic characteristics, educational background, reading practices, and other questions related to literacy. Based on their responses, participants were given proficiency scores reflecting a degree of skill in prose, document, and quantitative literacy. Finally, based on their test scores, participants were assigned to one of five literacy levels.

115Irwin S. Kirsch, Ann Jungeblut, Lynn Jenkins, and Andrew Kolstad, National Center for Education Statistics: Adult Literacy in America (Washington, DC: GPO, 1993), p. 5-6.

ii All adults in Level 1 displayed limited skills. Some in this group could perform such simple, routine tasks as "total entries on a deposit slip, locate time or place of a meeting on a form, and identify a piece of specific information in a brief news article.”116 On the other hand, some in this group had such limited skills that they were unable to respond to much of the survey. Participants assigned to the group in Level 2 demonstrated more varied skills than those in group Level 1, but experienced considerable difficulty in responding to the "more challenging literacy tasks,...requiring higher level reading and problem-solving skills."117 For the purpose of this paper, the adults in Level 1 and Level 2 are equated with those adults whose literacy skills are below high school diploma level and who comprise the unskilled and semi-skilled workers in the labor force. Workers in the next three levels performed at a much higher level of literacy proficiency and are of little interest for this report (for complete listing of literacy proficiency required at each level, see below). Based on the sample surveyed in the National Center for Education Statistics study above, the literacy skills of 21 to 23 percent--40 to 44 million out of the 191 million adults in the United States--were at Level 1. Closer analysis of the survey shows that 62 percent of the respondents in this group had not completed high school; 25 percent were immigrants lacking the knowledge of or just beginning to speak English; a third were age 65 or older; and 26 percent were physically or mentally impaired, preventing them from fully participating in work or school. According to the survey, some 50 million, or 25 to 28 percent, of all adults in the United States had skills in the higher level (Level 2) of literacy proficiency. Together with the adults in Level 1, they made up some 90 million American workers performing unskilled or semi-skilled work. The survey demonstrated that, among all variables tested, the level of education attained had the strongest relationship with literacy proficiency. Between 16 and 20 percent of high school graduates performed at Level 1, between 33 and 38 percent performed at Level 2, between 33 and 37 percent at Level 3, and between 10 and 13

116Kirsch, et al., p. xiv.

117Kirsch, et al., p. xv.

ii percent at the two highest levels. Of adults with 9 to 12 years of education, 42 to 46 percent were in Level 1 and 34 to 38 percent in Level 2. Some 75 to 80 percent of adults with 0 to 8 years of education were in Level 1, while 18 to 20 percent performed at the Level 2 of literacy proficiency.118

118Kirsch et al., pp. 25-27.

ii The survey also indicated that "racial/ethnic" minorities "were more likely than White adults to perform in the two lowest literacy levels." One reason for this finding may be that many of these individuals were born outside the United States and learned English as a second language. This situation is particularly true for adults of Asian and Hispanic origin. Also, with the exception of Asian/Pacific Island immigrants, individuals in this group tended to have fewer years of schooling in this country than Whites.119 Twelve percent of all respondents reported a physical or mental impairment that kept them from fully participating in work, school, or other activities. Some 46 to 49 percent of all adults in this group, compared to 21 to 23 percent of the total population, performed at Level 1 of literacy proficiency. Another 26 to 30 percent of adults in this group, compared to 25 to 28 percent for the total population, performed at Level 2 along the scale of literacy proficiency. The smallest performance difference between individuals with impairments and the population as a whole was found among those individuals who had hearing impairment. The largest gap was found among individuals having some form of mental impairment and the population as a whole.120 The National Adult Literacy Survey clearly indicated the connection between adults' literacy skills and their socio-economic status. As expected, the survey results showed that "individuals with more limited literacy skills were less likely to be employed than those who demonstrated more advanced skills."121 More than half of the adults who demonstrated Level 1 literacy proficiency were out of the labor force; at Level 2, the figure was 34 to 35 percent; at Level 3, it was 23 to 25 percent; and only 10 to 18 percent for the adults performing at the two highest levels. Conversely, some 30 percent of the individuals in Level 1 and 43 to 44 percent of those in Level 2 were employed full time, compared with about 55 percent of respondents in Level 3, and 64 to 75 percent in the two highest levels (p. 63).

119Kirsch, et al., pp. 32-41.

120Kirsch, et al., pp. 42-45.

121Kirsch, et al., p. 62.

ii Individuals in Level 1 of literacy proficiency reported working only 18 to 19 weeks in the year prior to the survey, those in the next Level 27 to 29 weeks, while Level 3 individuals reported working 34 to 35 weeks. Individuals with higher skills, in Levels 4 and 5, reported working between 38 and 44 weeks in the same period (p. 65). Also, individuals in the first group reported median weekly earnings of about $230 to $245, while individuals in the second group reported weekly earnings of $274 and $288. Individuals in group Level 3 earned between $339 and $350 a week, those in group Level 4, $462 to $472 a week; individuals in the highest level earned between $618 and $681 a week (p. 66). Other findings showed that adults on the lowest level of the literacy scale (17 to 19 percent of the labor force) were far more likely than those on the higher level to receive food stamps. Only 23 to 27 percent of the first group received interest from savings or a bank account, compared to 70 to 85 percent of individuals in the second group. Nearly half of the individuals on the lowest level lived in poverty and only slightly more than half reported voting in a national or local election in the last five years (compared to 80 percent for the higher level), possibly indicating a low level of initiative and incentive (pp. 54-55; 62). A similar pattern developed with respect to occupations held by individuals in different levels of literacy proficiency. Only 6 percent of adults performing in Level 1 and 13 percent of those performing in Level 2 held managerial, professional, or technical jobs. About 15 percent of individuals in Level 1 and 29 percent in Level 2 held sales and clerical jobs. Thirty-four to 43 percent of individuals in Level 1 and 23 to 36 percent of individuals in Level 2, held semi-skilled or unskilled jobs (pp.66-67). The data from this survey supported the conclusion that "lower literacy skills meant a lower quality of life and more limited employment opportunities." A recent report from the American Society for Training and Development reached a similar conclusion that "the association between skills and opportunity for individual Americans is powerful and growing.... Individuals with poor skills do not have much to bargain with; they are condemned to low earnings and limited choices." If literacy skills are vital for success, physically and mentally impaired individuals

ii are particularly adversely affected by learning disabilities. An article by H. Stephen Kaye, titled "Education of Children with Disabilities," points out that, according to U.S. Department of Education Statistics, some 4.7 million students (12.2 percent of the total number of students in American schools) enrolled in American primary and secondary schools in 1993-94 were designated as having disabilities and that 51.2 percent of these were identified as having learning disabilities. Together with students who had emotional problems and mental impairments, they made up 71 percent of "American students identified as having disabilities" (p. 1). According to the U.S. Department of Education statistics, in the 1991-1992 school year, 57.3 percent of students with disabilities graduated from high school. The same statistics show that students with hearing impairments are most likely to graduate (73.0 percent), to be followed by students with visual impairments (72.6 percent), orthopedic impairments (66.2 percent), mental retardation (63.8 percent), multiple disabilities (63.0 percent), and learning disabilities (60.5 percent). However, only 36.1 percent of students with mental retardation and 38.7 percent of students with multiple disabilities receive ordinary diplomas. The rest receive a certificate of completion or a "modified diploma" (p. 2). Furthermore, only 51.3 percent of students with "speech or language impairments" and 34.6 of students with "serious emotional disturbances" graduate. According to Department of Education statistics from 1992-93, students with disabilities are less likely to continue their education past secondary schools. Only 6.3 percent of college undergraduates and 4.0 percent of graduate and professional school students identify themselves as having physical or mental impairments. Visually impaired students made up the largest group (53.9 percent) of students to go to college, while those with mental retardation and multiple disabilities are least likely to attend college (2.5 and 8.0 percent). In 1990, 16.5 percent of "former special education students" went to college, and another 14.7 percent attended vocational schools. Although the National Adult Literacy Survey indicated that literacy skills are essential for most individuals to succeed in this society, it is not the only factor that determines the individual's employment opportunities, earning potential, degree of initiative, or the overall quality of one's life. As the authors of the National Center for

ii Education Statistics survey indicate, literacy is not the only factor that determines one's employment record. Such personal characteristics as country of birth and race/ethnicity, languages spoken or read, marital status, age, size of household, educational attainment of parents, and labor market experiences are other important factors determining one's employment record. They point out that some adults with limited skills reported working in managerial and professional jobs, earning high wages, while others with "high levels of proficiency" were unemployed.

Conclusion The research supports existing assumptions concerning the relationship between education and economic success. Statistics indicate a direct relationship between increased earning potential and level of educational achievement. The wage gap between individuals with and without disabilities is quite high; however, the salary gap narrows with the increase in education. A higher level of educational achievement also generally means higher level of literacy. Data show that 80 percent of high school graduates are at level two and higher on the literacy scale. However, only 57 percent of those individuals with physical or mental impairments graduated from high school, and they are less likely to pursue higher education. Students with disabilities constitute 12 percent of secondary students, and only 6 percent of undergraduates in college. Statistics further show that individuals with less education have higher levels of unemployment (over 50 percent of those classified in level one literacy and 35 percent of those in level two), lower weekly earnings, and are more likely to receive public benefits. Roughly half of the lowest educated in society live below the federally established poverty level. Therefore, an individual with more education may be expected to earn more and be employed longer during his or her lifetime. Approximately one-fourth of the population is at the lowest level of literacy, the group made up of those who have not completed high school, immigrants, the elderly, and physically or mentally impaired individuals. Many of those at level one literacy are members of racial and ethnic minorities, many of whom are not native Americans (they are usually of Asian or Hispanic origin) and have had comparatively fewer years in

ii American schools than native-born Americans. Although literacy is not the sole factor in employment or earning power, research nevertheless indicates that for the Social Security Disability Program, those with lower educational achievement and corresponding lower level of literacy will continue to represent a high proportion of potential applicants.

ii Bibliography

Baldwin, Marjorie, Paul R. Flacco, and Lester A. Zeagler. “Gender Differences in Wage Losses from Impairments: Estimates from the SIPP,” Journal of Human Resources, Summer 1994, 865-87.

Brown, Rebecca, Evelyn Ganzglass, Susan Golonka, Jull Hyland, and Martin Simon. Working Out of Poverty: Employment Retention and Career Advancement for Welfare Recipients. NGA Online, July 1998, 59 p. (Available at: )

Brown, Rebecca, and Evelyn Ganzglass. “Serving Welfare Recipients with Learning Disabilities in a ‘Work First’ Environment,” NGA Online, July 28, 1998, 9 p. (Available at: )

Burge, Penny L., and Steven M. Culver, "Gender Equity and Empowerment in Vocational Education." In Richard D. Lakes, ed. Critical Education for Work: Multi disciplinary Approaches. Norwood, NJ: Ablex, 1994, 200 p.

Golonka, Susan. “Strategies to Promote Education, Skill Development, and Career Advancement Opportunities for Low-Skilled Workers.” NGA Online, July 28, 1998. (Available at: )

Grubb, W. Norton. Working in the Middle: Strengthening Education and Training for the Mid-Skilled Labor Force. San Francisco: Jossey-Bass, 1996, 304 p.

Hendricks, Wallace, Chrisann Schiro-Geist, and Emir Broadbent. “Long-Term Disabilities and College Education,” Industrial Relations, 36, No. 1, January 1997, 46-60.

Kirsch, Irwin S., Ann Jungeblut, Lynn Jenkins, and Andrew Kolstad. National Center for Education Statistics: Adult Literacy in America. Washington, DC: GPO, September 1993, 150 p.

Law, Charles J. Jr. Tech Prep Education: A Total Quality Approach. Lancaster, PA: Technomic, 1994, 243 p.

Linn, Dane. “Preparing Students for the Twenty-First Century.” NGA Online, April 13, 1998, 9 p. (Available at: )

“Literacy: Economic Key for the New Millennium,” ETS Policy Notes, 7, No. 1, 1998, 12 p.

“The Nonequivalence of High School Equivalents,” Journal of Labor Economics, 11 No. 1, Pt. 1, 1993.

Pautler, Albert J. Jr. Vocational Education in the 1990s: Major Issues. Ann Arbor: Prakken, 1990, 302 p.

Raudenbush, Stephen W., and Rafa W. Kasim. “Cognitive Skill and Economic Inequality: Findings from the National Adult Literacy Survey.” Harvard Educational Review, 68, No. 1, 1998, 33-79.

Rehm, Marsha L., "Critical Pedagogy and Vocational Education: A Search for New Metaphors." In Richard D. Lakes, ed., Critical Education for Work: Multi- disciplinary Approaches. Norwood, NJ: Ablex, 1994, 200 p.

United States Commission on the Skills of the American Workforce. America’s Choice: High Skills or Low Wages! The Report to the Commission on the Skills of the American Workforce. Washington, DC: GPO, June 1990.

Wagner, Daniel A. and Donald Hirsh. What Makes Workers Learn: The Role of Incentives in Workplace Education and Training. Cresskill, NJ: Hampton, 1995.

Wirth, Arthur G. Education and Work for the Year 2000. San Francisco: Jossey-Bass, 1992, 232 p.

ii V. WORK EXPERIENCE AND THE ABILITY TO WORK

EXECUTIVE SUMMARY ...... 123

INTRODUCTION ...... 129

CHANGES IN THE WORKPLACE ...... 131

SKILL TRANSFERABILITY ...... 153

TRAINING ...... 159

CONCLUSION ...... 165

THE ROADS NOT TAKEN ...... 169

BIBLIOGRAPHY ...... 171

ii Executive Summary: Work Experience and the Ability to Work

 The nature of “prior work experience” in the context of the SSA disability evaluation process has changed since the 1970s in ways that affect the fairness and/or accuracy of considering information about an applicant’s prior employment activities.

 The average workplace remains either unaffected by the high- performance concept or is in some stage of transition toward it; for the foreseeable future, the emergence of high-performance workplaces will have little impact on the size or qualifications of the unskilled workforce, as the demand for both highly skilled and unskilled workers continues to be strong.

 The physical and temporal distribution of jobs is becoming less focused and predictable.

 Employers tend to deal with increasingly deficient basic skills among workers by training in an ad hoc manner that may not improve the long- term skill level of the majority of employees.

 The requirements of skills transferability analysis have been substantially altered because both traditional and evolving workplaces feature combined and overlapping work activities that defy strict definition.

 The disappearance or blending of specific job descriptions affects the SSR82-41 prescription for evaluating work experience (“In many cases, the skill level of past relevant work will be apparent by comparing job duties with the regulatory definitions of skill levels”) because jobs may be less uniformly describable. The description of job duties cannot capture the activities for comparing with the SSA ‘skill level.’

 The broadening of skills in the manufacturing sector has occurred, in which there is no depth of skill, but a wider variety of basic skills. Workers begin as specialists and become generalists.

 Job stability has decreased most noticeably for workers with the lowest skills and the lowest education levels. Between 1983 and 1991, the chances of a worker with no college education holding the same job for more than four years decreased from 64 percent to 58.5 percent.

 “Worker traits” (rather than work skills) derive more from an individual’s general education or personality than from specific job experience. In a

ii given work environment, they combine with and influence the contribution of the worker’s specific skills. The O*NET system of job descriptions is based on the characteristics of the individual who would fill the job satisfactorily rather than on those of the job itself.

 “Learning to learn” is the least teachable of the fundamentals, but it is also the most transferable. It is often identified as the most important single attribute of a worker in the new work environments. It opens the door to all other learning and facilitates the acquisition of other skills from literacy to leadership.

 Approximately 90 million American adults have what are classified as low- level literacy skills. Given the estimated proportion of 14 percent unskilled workers in the workforce, that figure would mean that at least 10 percent of workers classified as semi-skilled or higher fall into this low-literacy category.

 Communications skills assume greater importance in a work environment that requires the regular, accurate transmission of decisions and other types of information. The service sector requires more employees who can receive, process, and send verbal messages as their primary function. Employees who suffer from various types of psychological impairments could find it difficult to perform in these work environments.

 The literature indicates that employers place substantially more emphasis on the possession of “basic skills” in identifying new employees. Because SSA regulations note specificity and isolation as factors working against skill transferability (20CFR 404.1568c), the trend toward valuing more general characteristics may be significant as a factor beyond the specific match up of work activities.

 If a new worker with a relatively complete set of basic skills enters a job where a significant number of those abilities go unused for an extended period, we may conjecture that the basic skills package that emerges from that experience has been diminished. This supposition is the converse of the assumption that prolonged activity in a skilled position with high cognitive requirements provides an inherent advantage in transferability. The retention over time of usable skills from an abandoned career depends largely on how fast the methodology and equipment in that field have changed in the interim. As high technology invades more workplaces, substantial technical change negates the usefulness (hence the transferability) of more workers’ retained skills in a relatively shorter time.

 According to the Bureau of Labor Statistics (BLS), in 1996 the four largest

ii groups of workers were in administrative support occupations (24m);service occupations (21.3m)--an aggregation featuring varied skill levels but tending toward the lower end of the scale; professional specialty (18.2m)--those with the highest degree of skills development; and operators, fabricators, and laborers (17.8m). The largest projected growth in workers through 2006 is in professional specialty occupations, expected to add 4.8m; the second-largest growth will be in service occupations (growth of 3.9m), with corresponding increase in percentage of the total workforce, by 1.5 and .6 percent, respectively. The workforce share of administrative support occupations is expected to decrease by 1 percent; the manufacturing sector is expected to lose .7 percent of its workforce. The unskilled category “helpers, laborers, and material handlers, hand” is expected to maintain its 3.7 percent share of the workforce.

 Occupational forecasts of the BLS provide no evidence to expect the proportion of unskilled workers to decrease in the foreseeable future. The main categories of unskilled labor will remain steady. Expansion of service-sector jobs will have little effect because the fastest-growing areas of the sector are not unskilled.

 Whatever upgrading of skills occurs at the semiskilled and skilled levels in the movement toward high-performance workplaces will not have an appreciable effect on the majority of disability applicants, assuming that the present dominance of the unskilled in the claimant population will continue.

 The traditional definition of skills transferability (expressed in SSR 82-41) may be deficient given new developments in the field of skills transferability analysis. The Vocational Diagnosis and Assessment of Residual Employability (VDARE) system uses a systematic examination of individuals’ work histories, functional limitations and capacities, and occupational and labor market information in order to generate potential alternatives. According to experts, The Dictionary of Occupational Titles (DOT) is deficient because it is based on tasks rather than skills. The DOT work descriptions are too restrictive to assess adequately skill transferability. SSA’s transferability system relies on the same approach. Aptitude testing together with work history analysis should be used when the DOT system is used.

 In the current grid system, the lack of skills available for transfer is a factor in elimination in age categories beginning at 45. For skilled claimants, nontransferability is a component of positive disability decisions in upper age groups. Individuals limited to sedentary work who are of advanced or closely approaching advanced age with nontransferable skills are declared disabled. However, for claimants in the lower age groups SSR

ii 82-41 notes that skill transferability will be a factor in a relatively few instances because remaining ability to do unskilled work often will result in a denial even if there are no transferable skills. The continuing validity of that assumption rests on the existence of unskilled jobs in the pool of under-45 claimants. Evidence is that these jobs will exist in the same numbers for the future.

 The transferability factor might work in the direction of denial in those cases when past work experience has been broadened by workplace flexibility. If impairment eliminates a claimant’s exertional activities but the claimant has picked up sufficient non-exertional skills in the multiple activities of a team-oriented environment to qualify for a sedentary position, such an adaptation would narrow the real-life basis for nontransferability.

 According to the 1996 report by the American Society for Training and Development (ASTD), in 1995 employers spent $55.3B for training their employees. However, most of that money went to executive or higher- level salaried employees, much less to hourly workers. One-third of workers in small and medium-sized companies (fewer than 10,000 workers) had skill deficiencies that retarded productivity, but less than 5 percent of employers addressed the problem with onsite training.

 The average training period for an unskilled worker is about five days (far short of the 30-day maximum training period prescribed by SSR 82-41 for a worker to function in an unskilled occupation). Training policy has not yet adjusted to the disconnect between the changing nature of the labor pool and expectations of the new workplace. Organizations will have to dig into the pool of workers who were formerly considered unemployable. The differences among them in experience, educational levels, skills, abilities, and attitudes will call for a different set of training parameters.

 If the training dollars continue to be spent on workers with skill and/or education levels high enough to promise a return on investment, the split between high-performance workers and those with fundamental gaps will increase. Upward mobility of lower-level workers will be blocked. The principal driver of change will be the nexus between the education system and work training programs. Unskilled workers are dependent on continued market demand for them as they are.

 Downsizing has forced more workers to move to smaller companies where training is less consistently available. This movement would result in a continued net decrease in workforce training. The business cycle and tightness of the job market affects training decisions by employers. A tight labor market has reduced the incentive for workers to seek training that

ii would be a competitive advantage if demand shrinks.

 For workers at lower skill levels, pragmatic training aimed at filling gaps as they are identified is the predominant trend. From the SSA standpoint, ad hoc training is more difficult to identify and evaluate than more formalized training, particularly if its ensuing application to work activity is not clear. SSA might want to broaden its understanding of work activity in accordance with descriptions of the workplace.

 The installation of more automated equipment may effectively further “dumb down” already low-skill jobs if the lower levels of the workforce do not become integrated into the new systems. If, however, workers are integrated into the production process and ipso facto upgrade their job experience, transferability would be enhanced for disability claimants. A decrease in the now steady percentage of unskilled workers in the workforce might ensue, providing less basis for denying disability claims by referring to unskilled jobs available in the economy.

 Arguably the most important factor in transferability remains the quality of individual job experiences and of the training associated with them, rather than the increasing number of such experiences.

 Much that was true in 1978 remains true today--especially in the realm of the unskilled workforce. The bulk of the economy is locating and preparing its lower-skilled workers in an ad hoc, short-term manner that does not promise to change fundamentally the assumptions of the 1978 grid. Powerful change drivers also are present.

 Although it is difficult to generalize, a given claimant will bring one or more of the following: a history of multiple training and multiple jobs held; experience in an interactive service or manufacturing occupation where some type of “people skill” was required; a flawed package of “basic skills” that has been patched pragmatically along the way; experience in a job, some aspect of which (order, time, place of work) was determined at some points by the employee rather than the employer; and time spent in an unskilled job in which existing skills eroded because they were not applied.

 Workforce changes described in the literature tend strongly to concentrate on the skilled workforce, apparently with the assumption that unskilled workers are not affected by the trends being described. Because of the central role of the unskilled worker population in the SSA program, the report has speculated about the validity of such neglect. Many factors influencing the work experience package of unskilled workers remain theoretical and circumstantial.

ii WORK EXPERIENCE AND THE ABILITY TO WORK

INTRODUCTION

The concept of considering an individual's prior work experience as a primary factor in the decision to approve or deny a disability claim dates back at least to 1942. At that time, Arthur Altmeyer of the Social Security Advisory Board urged that vocational experts be consulted to analyze claimants' remaining functional capacity in light of skills or experience they might have gained at some previous stage of their working years. After a Social Security disability program had been shelved in 1954, the Medical Advisory Board recommended that vocational factors, including work experience, be considered in addition to medical information about a disability claimant's condition. When the first Social Security disability amendments were passed in 1956, they contained language mandating consideration of work experience in the decision process, in cases where medical evidence alone was not sufficient. Since that time, that vocational factor has remained a part of amendments and regulations prescribing the standards for disability decision making. In 1978 disability regulations were amended to consolidate all policies for the utilization of vocational factors (age, education, and work experience) in disability decisions. The resulting "grids," together with their explanatory texts, provided specific guidance on how various levels of work experience were to function together with the other two vocational factors and the assessed degree of the individual's physical impairment, at a stage following consideration of medical condition, in cases where medical evidence is not deemed sufficient to reach a decision. To eliminate misapplications and misinterpretations of the 1978 regulations, Social Security Ruling SSR 82-41 was issued, with specific definitions of the concepts "work skill" and "skill transferability," which are key items in the use of the work-experience provisions of the grids. The grids were published in the mid-1970s, and SSR 82-41 was created around

ii 1980. The research done in that period on the nature of the workforce and the workplace, aimed at determining the relevance of work experience to a claimant's "ability to work" after impairment, presumably reflected the workplace conditions and trends of the time. Today's literature on that subject overwhelmingly concludes that substantial changes have occurred in those areas in the past twenty years, predicting that changes will continue in the foreseeable future. This conclusion leads to the proposition that current information on the state of the American workforce and the American labor market should provide evidence about the shape of the workplace post-2000, hence to a possible revision of the understanding of the term "prior work experience" as it conditions the assumption that an individual having an impairment can transfer skills (or just himself/herself) to another position in the economy rather than being granted disability status. This information should help to answer questions such as, what new kinds of "experience" (providing skills and other characteristics relevant to the ability to work) is the current or future worker/claimant likely to have had? What changes have there been in the capability for changing jobs and the attitude toward that eventuality? What parts of the workforce are most (and least) affected by recent changes? How have the needs for training and the availability of training affected workforce characteristics? The subject of prior relevant work experience is important for SSA because of the requirement that the disability evaluators determine whether a claimant’s disability disqualifies him/her from contributing substantial gainful activity in the national economy. Under §404.1508 of the Code of Federal Regulations, “Work experience as a vocational factor,” the term is defined as “skills and abilities acquired through work previously performed by the individual which indicates the type of work the individual may be expected to perform.” If the individual has changed jobs numerous times in his/her working lifetime prior to the onset of a disability but those job skills have been fleeting (in other words, the individual has been trained and re-trained repeatedly for several, short-term jobs), then which skills will the applicant bring to the determination process? The Regulations state, “Work performed 15 years or more prior to the point at which the claim is being considered for adjudication...is ordinarily not considered

ii vocationally relevant.” If, as research suggests, the work place is demanding that workers re-tool their skills more frequently and that (higher-order) skills lose their shelf- life sooner, then the viability of skills is a question for disability evaluators. (The "Work Experience" section of the 1978 Regulations says: "...previous experience, particularly if it resulted in work skills that are transferable to other jobs, is treated as a substantial vocational asset in accordance with sources which reflect that workers with skills tend to have fewer and shorter periods of unemployment, and that skilled workers are often in demand even at age levels when some workers without acquired skills are experiencing difficulty in the labor market." However, the list of sources backing that conclusion is very short; it cites only three items, two of which are Department of Labor publications and the third of which is a California state publication; the respective dates of the publications are 1956, 1957, and 1964. All three sources concern only older workers and are also cited in the "Age" section. If this is an inclusive or representative list, it does little to back the general work-experience conclusions upon which the grid was based; at best, the brevity of these citations makes impossible a full comparison of the literature that lay behind the 1978 procedures with current literature on the subject. Thus what follows here infers what the 1978 source materials said about working conditions and draws a comparison of those inferences with the direct evidence available on the same subject from today's literature.)

CHANGES IN THE WORKPLACE According to Ruy Texeira and Lawrence Mishel (1993), two kinds of changes in the national job structure affect the demand for job skill levels. The two drivers are changes in the relative distribution of job types within the economy and changes in the work activities required within each job.122 In assessing the role of prior work experience, both factors will be examined. Frederick Taylor's widely accepted model of the conventional industrial

122Ruy A. Texeira and Lawrence Mishel, “Whose Skills Shortage--Workers or Management?” Issues in Science and Technology, 9, No. 4, Summer 1993, pp. 70-1.

ii workplace, which evolved in the early 20th century, features a large number of workers with limited skills, reliable and willing to follow directions, doing simple, repetitive tasks, and directed by a small number of educated managers. In that model, worker productivity increases by means of technological advances and streamlined organization of the production process. However, later observers have noted that as products become more complex (as they must to keep the market in a competitive, high-wage nation), more planners, supervisors, and many more diverse support people become necessary; as the whole process becomes more complex, bureaucracy and mistakes retard productivity in the Taylor model. Theoretically, the answer to this dilemma is giving more authority to onsite workers, letting them make onsite decisions, relieving the need for several layers of managers to oversee all aspects of a complex process, and moving in the direction of smaller numbers of skilled workers replacing larger numbers of unskilled ones123--or, alternatively, adding to the skill levels of those already in the workforce.

123Commission on the Skills of the American Workforce. America’s Choice: High Skills or Low Wages! (Rochester, New York: National Center on Education and the Economy, 1990), p. 2.

ii The theory of this adjustment process has been described in various ways in several seminal books, including Shoshana Zuboff's In the Age of the Smart Machine (1984) and Peter Drucker's Post-Capitalist Society (1993). Zuboff draws a distinction between "automating" (the introduction of more complex machines that simply replace workers or further "dumb down" their already repetitive tasks) and "informating" (the generation by machines of new information that workers then put to a new use, which is the enhancement of the process they are working on). According to Zuboff, the latter process will emerge only if workers become interactive in developing new machine applications.124 Drucker expresses the same idea in different words, identifying a new production model to supersede the conventional application of "knowledge to work," the term by which Drucker identifies the technical upgrading of the production process by automation or other knowledge-derived hardware in the Taylor system. Drucker calls his fundamentally new stage the application of "knowledge to knowledge," where information itself becomes the central commodity and the people with critical skills are those who are able to receive and interpret that commodity, gaining maximum advantage from the information-based technologies in which their employers have invested.125

124Shoshana Zuboff, In the Age of the Smart Machine: The Future of Work and Power (New York: Basic Books, 1984), p. 10; p. 71.

125Peter Drucker, Post-Capitalist Society (New York: Harper Business, 1993), pp. 181-93.

ii Other writers of the period have identified a similar phenomenon under a variety of names: the 1990 report of the Commission on the Skills of the American Workforce refers to the "high-performance work organization" as the primary goal for the reorganization of the American workplace, and a 1996 article in Training and Development summarizes: "Simply put, more sophisticated machinery and work processes require more sophisticated workers."126 The strongest driver of the trend seems to be summarized in the word "competitiveness," with frequent notations that other advanced nations (especially Japan) are far ahead of the United States in developing high-tech workplaces with compatible workforces. Estimates about the actual speed of domestic workplace reorganization (and hence about the number of workers exposed to such change) have varied greatly. In 1990 the Commission on the Skills of the American Workforce estimated that only 5 percent of the workforce was in a high-skill workplace, but a 1994 survey showed that about 35 percent of employers had made "substantial use" of the flexible workplace concept (which is considered a key element of this type of reorganization).127 It is important to note, however, that for unskilled workers in the bulk of manufacturing and service workplaces, conventional standards of a worker's productivity and pace remain key factors in 1998, limiting the possibility that workers at that level can achieve greater flexibility.

126Commission on the Skills of the American Workforce, Op. cit., p. 7; J. Bassi Lurie, George Benson, and Scott Cheney, “The Top Ten Trends,” Training and Development, November 1996, p. 29.

127W. Norton Grubb, Working in the Middle (San Francisco: Jossey-Bass, 1996), p. 230.

ii There seems to be little disagreement that a fundamental shift is occurring in the nature of skills deemed critical to what has been termed the "high-performance workplace"128 for at least the manufacturing sector of the 21st-century workforce. Many experts deal either explicitly or implicitly with manufacturing, which is the most formalized of workplace types; the applicability of the changes they identify to other sectors of the economy, particularly the service sector (which will continue to grow fastest in the foreseeable future, and many parts of which are less affected by technological change) is less clear, and will be addressed separately. Although theoretical change is quite evident within the narrower scope of the manufacturing workplace, the main question in our context is how fast it actually has occurred and what parts of the workforce it is affecting as it happens. The fundamental fact that seems to emerge (although with some dissent) is that the procurement of workers having particular new characteristics has fallen quite short of the identified need for those workers. The result is that many experts identify a "job-skill gap"129 or an "educational skill gap"130 that features a diminishing overall supply of work-ready workers compared with the increasing prevalence of "basic workplace deficiencies"131 that detract from employability in high-performance organizations. Many experts forecast that, without some major alteration in the basic education and/or training of the average entry-level worker, this qualitative gap between the supply and the demand side of the American labor picture will continue to exist and will continue to retard the development of this desirable new workplace in the United States. The gap is most obvious in information-technology firms, where the United States Department of Commerce predicts a demand for more than 1 million new skilled workers in the next

128Commission on the Skills of the American Workforce, p.2.

129Bassi, p. 29.

130Edward E. Gordon, Ronald R. Morgan, and Judith A. Ponticell, Futurework: The Revolution Shaping American Business (Westport, CN: Praeger, 1994), p. 9.

131Anthony P. Carnevale, Leila J. Gainer, and Ann S. Meltzer, Workplace Basics: The Essential Skills Employers Want (San Francisco: Jossey-Bass, 1990), p. 3.

ii decade but a current shortage of 350,000 has been identified in 1998.132 The expansion and diversification of the service sector in recent decades have complicated traditional formulations of workplace evolution by leading to the development of nontraditional workplaces, working relationships, and schedules. As listed by the Bureau of Labor Statistics, subcategories under "service occupations" range from janitors to dental assistants, from bakers to barbers. (It also is important to note that the scope of this sector varies widely according to the source. For example, some literature includes professionals such as lawyers and doctors, although the United States Bureau of Labor Statistics' often-cited occupational listings place those individuals in a separate category.) Lewis Solmon estimates that of the 38 million new service jobs created in the 1970s and the 1980s, two of three were "low-level" rather than "high-level" jobs--about the same ratio, he says, as obtained in earlier times.133 In attempting to describe work at the lower end of the scale in the service sector, the literature identifies several worker characteristics that often are labeled "skills" but may or may not meet the definition of that term set out in SSR 82-41: "knowledge of a work activity which requires the exercise of significant judgment that goes beyond the carrying out of simple job duties...." The importance of those newer characteristics is increasing as various parts of the service economy change or assume greater prominence and the workplace changes to accommodate them.

132Paul Van Slambrouck, “Key Import: Keen Minds,” Christian Science Monitor, 90, No. 80, March 23, 1998, p. 1.

133Lewis C. Solmon and Alec R. Levenson, eds., Labor Markets, Employment Policy, and Job Creation. (Boulder, CO: Westview, 1994), p. 7.

ii An example is the increasing number of jobs in the service sector requiring low (or no) skills in the traditional sense but requiring a certain type of cognitive ability that enables the individual to meet and serve the public. In this "interactive service work," typified by food service and retail sales jobs, the public becomes an immediate part of the work operation, in effect a direct supervisor in a specific transaction, requiring the worker to use judgment even as the other aspects of the job may be completely routinized.134 (The BLS classifies "marketing and sales" separately from "service occupations.") Serving hamburgers at McDonald's stands at one end of the spectrum of such jobs, and that position often is cited as the standard model for this type of work; McDonald's trains its employees to perform a routine transaction with all customers, leaving little of the interactive process to individual discretion.135 However, even such a simplified environment has an implicit need for the use of individual judgment; there are anecdotes about chaos resulting from a breakdown of computerized, graphic-enhanced cash registers in fast-food outlets, forcing counter workers to rely on simple reading and arithmetic skills.136

134Cameron Lynne Macdonald and Carmen Sirianni, eds., Working in the Service Society (Philadelphia: Temple University, 1996), pp. 32-33.

135Macdonald and Sirianni, p. 35.

136Arthur G. Wirth, Education and Work for the Year 2000: Choices We Face (San Francisco: Jossey-Bass, 1992), p. 30.

ii In service work situations where more complex transactions are done and supervision is less complete, much greater worker discretion is required. In fact, revelations of lack of fundamental skills in such positions have caused considerable concern among employers, who realize the limitations of such workforce inflexibility. The availability of such interpersonal discretion would not be a factor in solitary, unskilled jobs in the manufacturing sector, but there is abundant evidence that even the prototypical industrial positions actually involve at least some interpersonal contact. Also, the continuing expansion of the service sector, especially in food and health services,137 indicates that baseline "people skills" are more likely to be a component of the "average" claimant's work experience than was the case in 1978.

137The BLS forecasts that five of the eight fastest growing occupations between 1994 and 2005 will be in health care, led by “personal and home care aides” and “home health aides.” Figures cited in Vernon G. Zunker, Career Counseling: Applied Concepts of Life Planning (Pacific Grove, CA: Brooks/Cole, 1998), p. 288.

ii Another trend, seen in both manufacturing and services, is toward greater worker discretion over job pace and job organization. The classic Frederick Taylor production line featured rigid time demands that tightly constrained both the worker's distribution of "personal" time through the day and the schedule on which work functions were performed. In many cases, increased worker discretion, self-regulation, and autonomy are the result of changes in the physical location of work. Already in the mid-1980s, one source identified 35 million workers as "part-time, temporary or contract employees."138 In 1996 some 9 million workers characterized themselves as telecommuters, and another 6 million were employed as contingent or on-call workers; the former total was expected to triple within the next 20 years.139 The impermanence of the employment relationship also has changed the requirements that an individual "take charge" of part or all of the work routine. The employment of individuals by temporary services companies has increased steadily in recent decades; the BLS projected annual growth there is 4.3 percent through 2005. In that time, the type of work covered by temporary personnel also has changed, as indicated by a jump in total payroll for temporary technical and professional workers between 1991 and 1995, from $2.2 to $4.9 billion.140 Worker autonomy at those levels also has increased greatly because of the ubiquitous tendency to shrink the middle-management group that previously made most of the important decisions affecting the activities of the workers beneath it. Nevertheless, a substantial proportion of unskilled jobs in the United States now are filled by temporary employees, and at that level workplaces tend to much more regimented.141 In some cases, these trends, which require larger amounts of the autonomy and

138"John J. Sweeney and Karen Nussbaum, Solutions for the New Work Force: Policies for a New Social Contract (Washington: Seven Locks, 1989), p. 55.

139"Signs of the Times,” Training and Management, February 1996, pp. 33-4.

140Bassi, p. 31.

141Samuel Osipow, comment in Vocational Factors Workshop, Library of Congress, February 9, 1998.

ii learning/flexibility characteristics mentioned in the literature, may have little or no effect on the vast majority of disability claimants--telecommuters, for example, already exhibit substantial flexibility and ingenuity in customizing job scenarios for themselves, minimizing the potential that they would find themselves in a disability claim situation. The disappearance of the structure provided by mid-level supervisors, however, would arguably have an impact on the adaptability of significant numbers of at least semiskilled workers in some environments. TABLE 1. LABOR FORCE PERCENTAGES OF LARGEST JOB CATEGORIES, SELECTED YEARS, 1960-2006 ______Category 1960 1970 1978 1996 2006 ______Administrative support 14.1 16.8 18.2 18.1 17.1 Crafts 13.8 12.8 12.0 10.9 10.2 Machine operation1 13.6 12.6 14.6 13.5 12.8 Professional specialties2 10.5 13.5 14.4 13.7 15.2 Services 11.6 11.8 14.8 16.1 16.7 ______1 Category expanded by 1986 to include tenders and related workers. 2 Does not include technicians for any year, although they were included in this BLS category through 1978. Sources: Based on information from Constance Bogh Dicesare, "Changes in the Occupational Structure of U.S. Jobs," Monthly Labor Review, 98, No. 1, 1975, pp. 24-29; Max L. Carey, "Occupational Employment Growth through 1990," Monthly Labor Review, 104, No. 8, 1981, pp. 49-53; George T. Silvestri, "Occupational Employment Projections to 2006," Monthly Labor Review, 120, No. 11, 1997, pp. 58-75.

The disappearance or blending of specific job descriptions may affect the SSR 82-41 prescription for evaluating work experience: "In many cases, the skill level of PRW [past relevant work] will be apparent simply by comparing job duties with the regulatory definitions of skill levels." If work activities become more autonomous and more dependent on individual initiative and interpretation, hence performed in less uniformly describable fashion, anybody's description of job duties (even those of the worker, upon whom SSA often

ii depends for such information) cannot accurately capture the activities for the purpose of comparison with SSA's established skill levels. Nor can the "regulatory definitions" capture what is happening in the real world. More cognitive, subtle concepts such as initiative, time management, etc. already are seen in job descriptions, but the question is whether those terms have the same meaning when the quality is intermixed fragmentarily into what is perceived as a noncognitive work routine. Increased worker autonomy is linked with changes in the nature of work in conventional manufacturing workplaces, where new forms of task organization are being tried by many corporations. A frequently cited example is General Motors' Saturn work-team concept, a borrowing from the Japanese that showed significant productivity increases when instituted in the early 1990s.142 W. Norton Grubb provides an example of work activities broadening because of technological changes: the distinction between the job descriptions "machinist" and "electronics technician" has begun to blur with the advent of computer numerically controlled (CNC) industrial machines, making it necessary for a traditional machinist to understand electronics as well.143

142Wirth, p. 139.

143W. Norton Grubb, Working in the Middle: Strengthening Education and Training for the Mid- Skilled Labor Force (San Francisco: Jossey-Bass, 1996), p. 18.

ii Another example of broadening a skills base in manufacturing at the basic level is the creation of a position called "manufacturing technician," combining the functions of laborer, materials handler, operator/assembler, and maintenance person with work activities that do not require the "depth of skill" of any of those positions. In such a position, what the individual does need is a "wider variety of basic skills" that include higher basic levels of reading, writing, and computation, and personal management.144 In extreme forms of that phenomenon, as described for example by William Bridges in his book Job Shift, workers move constantly within an organization from one short-term task to another in "a world driven and networked by electronic data."145 Another writer describes the worker in this environment as an acrobat who must be ready to catch the next trapeze and swing out into something new.146 In that world, workers who began as specialists become generalists as such factors as mid-management downsizing extend responsibilities, obliterating standard prescriptions for work activities. In his article "Skill Requirements at Work," Charles Darrah takes issue with the concept of rigid "skill requirements" as descriptors of work and the changing workplace. He finds that education now aims at preparing individuals for prescribed job functions, but he argues that descriptions of job content should be more flexible, taking into account "the person as an active coproducer of the workplace" as well as the way work activities go in the real world. He also argues for greater recognition of interpersonal skills because of the "social nature of work," which moves more efficiently given harmonious communication among its participants. He backs his argument with workplace studies showing that in the real world a given job is accomplished successfully many ways by pragmatic organization of individual,

144Carnevale, Gainer, and Meltzer, p. 9.

145William Bridges, Job Shift: How to Prosper in a Workplace without Jobs (Reading, MA: Addison-Wesley, 1994), p. 15.

146Stephen L. Cohen, “The Challenge of Training in the Nineties,” in American Society for Training and Development, Workforce Trends Affecting HRD (Alexandria, VA, 1992), p. 28.

ii overlapping activities.147

147Charles Darrah, “Skill Requirements at Work: Rhetoric versus Reality,” Work and Occupations, 21, No. 1, February 1994, pp. 65-73.

ii As described by Lawler, Mohrman, and Ledford in their Creating High Performance Organizations (1995), the new world of the high-performance workplace is characterized by the sharing of information between management and employees, in systems variously labeled employee involvement, participative management, democratic management, and total quality management.148 Edward Lawler frames the question this way: "Instead of thinking of people as having a job with a particular set of activities that can be captured in a relatively permanent and fixed description, it may be more appropriate and more effective to think of them as human resources that work for an organization."149 (The implications of this idea go beyond the scope of this paper and into the question of using standardized job descriptions in SSA's comparison of an individual's competency with existing jobs in the economy; however, if such a change actually occurs, or is occurring, it also has major impact on the initial assessment of competency prior to that comparison.) Research has been conducted on the validity of the assumption that the new trends toward flexibility would increase job instability (more frequent job shifts) as well as variation in work activities within a given job. According to the National Commission for Employment Policy, in the 1970s 12 percent of male workers changed employers four times or more; but in the 1980s the figure had nearly doubled, to 23 percent (although no figures were available for women in the 1970s, in the following decade 20 percent of them switched four times or more). However, in both the 1970s and the 1980s, about two-thirds of male workers stayed within the same occupation or industry, except that more workers in manufacturing left positions after relatively long stability.150

148Edward E. Lawler, III, Susan Albers Mohrman, and Gerald E. Ledford, Jr., Creating High Performance Organizations (San Francisco: Jossey-Bass, 1995), p. 1; p. 9.

149Edward E. Lawler, III, “From Job-Based to Competency-Based Organizations,” Journal of Organizational Behavior, 15, 1994, p. 4.

150National Commission for Employment Policy, Declining Job Security and the Professionalization of Opportunity (Washington: GPO, 1995), p. iii.

ii In 1995 Dave Marcotte reported that job stability had decreased most noticeably for workers with the lowest skills and the lowest educational levels. Between 1983 and 1991, the chances of a worker with no college education holding the same job for more than four years decreased from 64 percent to 58.5 percent. Marcotte also found contradictory data on job stability in the 1980s and early 1990s for individuals with higher education and skill levels--some studies show increasing four-year retention rates, others show a negative trend similar to that for less-educated workers.151 In the 1990s, experts have quantified and classified the basic skills that employers most desire for their employees to function in reorganized, high-tech workplaces such as the ones described by Drucker and Zuboff. In contrast with work skills that are developed in and associated with the performance of a specific job, these are more properly called "worker traits." They derive more from an individual's general education or personality than from specific job experience, but in a given work environment they combine with and influence the contribution of the worker's specific skills. None of these traits is new; their recognition seems to have increased for two reasons: the increased complexity and modification of the workplace and the increasing scarcity of new workers possessing such characteristics. The importance of such attributes also has been recognized by the Department of Labor's adoption of the O*NET system of job descriptions, based on characteristics of the individual who would fill the job satisfactorily rather than on those of the job itself, which was the focus of the Dictionary of Occupational Titles (DOT) system, now being replaced by the O*NET. Typical lists of "critical skills" have been compiled by Carnevale, Gainer, and Meltzer in their book Workplace Basics (1990) and by Lawler, Mohrman, and Ledford. A summary of these skills follows: 1. Organization and leadership skills 2. Learning skills 3. The "three R's" and cognitive skills

151Dave E. Marcotte, “Declining Job Stability: What We Know and What It Means,” Journal of Policy Analysis and Management, 14, No. 4, 1995, pp. 590-92.

ii 4. Communication skills 5. Creative thinking and problem solving 6. Self-development and motivation152 The second item on this list, which often is rephrased as "learning to learn," is perhaps the most amorphous and the least teachable of the fundamentals, but by definition it is also the most transferable. It often is identified as the most important single attribute of a worker in the new work environments that are described in the literature because it maximizes the individual's adaptability. Says Anthony Carnevale, "It opens the door to all other learning and facilitates the acquisition of other skills from literacy to leadership."153 From the viewpoint of the employer, it also minimizes training time. According to the definitions of Drucker and Zuboff, rapid and accurate exchange and utilization of information, both verbal and mathematical, are critical characteristics of the new workplace. Because a much larger share of the workforce is active in this exchange than would have been the case under traditional systems, functional--rather than theoretical--literacy and computation skills are an urgent requirement. These skills differ from the others on the list because they are measurable, they are defined in rather universal terms, and they have more explicit applications in job situations. Because the skills can be quantified through testing, we have data (whose message is rather discouraging) on the current American workforce's grasp of them.

152Carnevale, Gainer, and Meltzer, p. 3; Lawler, Mohrman, and Ledford, p. 14.

153Lawler, et al., p. 17.

ii According to the 1993 National Adult Literacy Survey, 90 million American adults have what are classified as low-level literacy skills: they cannot balance a checkbook, cannot make inferences from printed material or write compound sentences; more than 30 million of them,154 or about 24 percent of the total labor force, were employed full- time. Given the estimated proportion of 14 percent unskilled workers in the workforce, that figure would mean that at least 10 percent of workers classified as semiskilled or higher fall into this low-literacy category. A chart compiled in 1991 from data of the Hudson Institute and the Department of Labor (see Table 2) compares the availability of new workers having various levels of reading skills with the labor-market demand for those levels. The chart, which covers the period 1985-2000, shows that supply far exceeds demand for the lower levels but that demand outstrips supply by increasingly wide margins as the level of competency rises. Thus there is an oversupply of workers for jobs requiring an ability to read and write simple materials, but there is a drastic undersupply for jobs stipulating "can read journals and manuals and write business letters and reports."155

154Bassi, Benson, and Cheney, p. 30.

155As reported in Bassi, p. 29.

ii TABLE 2.

SUPPLY AND DEMAND FOR LEVELS OF READING AND WRITING SKILL AMONG WORKERS, 1985-2000 (in percentages) ______2 3 Level 1 Actual Skill Levels Skill Levels Needed ______1 7 2 2 71 38 3 17 21 4 3 31 5 1.5 7 6 0.5 1 ______1 Level definitions: 1. Reading vocabulary of 2,500 words, reading rate 95-125 words per minute, can write simple sentences. 2. Reading vocabulary of 5,000 words, reading rate 190-215 words per minute, can write compound sentences. 3. Can read rules and instructions, write simple reports. 4. Can read journals, write business letters and reports. 5. Can read technical journals and reports, write articles and speeches. 6. More advanced development of Level 5. 2 Percentage of new workers 21 to 25 years old entering labor market 1985-2000 posssessing this level. 3 Percentage of jobs created 1985-2000 needing this level.

Source: Based on information from David W. Hornbeck and Lester M. Salamon, eds., Human Capital and America's Future. (Baltimore: Johns Hopkins University Press, 1991). Communications skills--listening and speaking--assume greater importance in a work environment that stresses teamwork or that requires the regular, accurate transmission of decisions, feedback, and other types of information. In that milieu, experts estimate that hundreds of millions of dollars are lost annually because of misunderstandings and mistakes caused by poor interpersonal communications. And the service sector, with its reliance on successful interaction with customers in a wide variety of settings, needs employees who can receive, process, and send verbal messages as their primary function. Closely connected with communications skills are interpersonal and teamwork skills--the ability to "fit" with and adjust to a variety of individuals, especially in the team-oriented work relationships that have become commonplace in the 1990s. From the list of critical skills listed above, the last two items, creativity and

ii motivation, differ fundamentally from the others because they are inherent qualities that a person brings to any workplace, and thus do not belong under the accepted definition of a skill as an acquired ability. The new workplace, in which a worker receives much less direct supervision and at the same time is expected to perform successfully in a larger variety of functions, also places a premium on individual problem-solving and creativity to keep things running smoothly and contribute to the constant innovation and improvement that theoretically is a fundamental aspect of the new work organization. Anthony Carnevale observes, "Even routine jobs are evolving as the demands of the workplace expand. Competitive pressures compel employers to shift employees between jobs and responsibilities, putting a premium on the ability to absorb and process new information quickly and effectively...."156 As exemplified by the Saturn team concept, workers have input into both technical and administrative questions; it is assumed that they are able to translate their proximity to the manufacturing process into useful improvements and function autonomously when problems arise. Running parallel to communications and problem-solving skills are a worker's self-management and motivational qualities. Once in the workplace, a worker must have the sense of active internal direction that leads to the independent collection of information and to taking the initiative in self-development needed to remain effective as the workplace changes.

156Bassi, p. 30.

ii The consensus of literature discussing these standards is that large portions of the American workforce remain unprepared to function in the sort of high-performance workplace that is recommended and forecast. The rate at which that condition will change is a matter of speculation; it will be determined largely by changes in the training programs of individual enterprises (to be discussed later in this section), and in the national education system. However, the literature indicates clearly that employers now place substantially more emphasis on the possession of "basic skills" in identifying new employees.157 Because the SSA regulations note specificity and isolation as factors working against skill transferability (20CFR 404.1568c), the trend toward valuing more general, teamwork-oriented characteristics may be significant as a factor beyond the specific matchup of work activities.

157For example, one conclusion of a mid-1990s survey of more than 3,000 employers was: “Most jobs available to less-educated workers require the daily performance of one or more cognitive/social tasks, such as dealing with customers, reading and writing, arithmetic calculations, and the use of computers.” (Harry J. Holzter, What Employers Want: Job Prospects for Less-Educated Workers (New York: Russell Sage Foundation, 1996), p. 127.)

ii The literature does not hold out hope that increasingly prevalent development of specific skills, such as computer operation, significantly softens the negative effect of basic-skills shortages. The workplace's increased demands for flexibility and communication seem to overshadow individual technical capabilities that doubtless already are more available in the younger cohorts of workers than they were in preceding generations. This point is made in Shoshana Zuboff's distinction between "automating," defined as the introduction of new automated machinery into the workplace, and "informating," defined as the endowment of workers with sufficient knowledge and judgment to enable them to manipulate creatively the information gotten from their automated machines. This distinction is accepted either implicitly or explicitly by the great majority of the other writers on the topic. For example, Arthur G. Wirth notes the exponential growth of electronics in all types of workplace in the 1990s, and prescribes the best preparation for today's children: "Clearly there is no specialized 'job training' that will equip them to cope....the best bet will be to provide young Americans with learning environments that prepare them to be flexible, creative learners with self- confidence about handling the unknown challenges of the electronic path ahead."158 In the 1990s, there also has been a school of thought that minimizes the "skills mismatch" that has been much-publicized as an obstacle to creating the high- performance workplace. In his 1993 article, "The Myth of Public School Failure," Richard Rothstein points to the Saturn plant in the United States and to successful American high-performance work organizations in third-world countries as examples of effective workforces based on workers with limited input skills.159 Texeira and Mishel contend that "work-force skill levels actually have been rising rapidly." They note that in 1991 some 87 percent of the labor force had finished high school, as opposed to 75 percent in 1973, and that the percentage of college graduates rose from 16 to 24 in that

158Arthur G. Wirth. Education and Work for the Year 2000: Choices We Face. (San Francisco: Jossey-Bass, 1992), p. 131.

159Richard Rothstein, “The Myth of Public School Failure,” The American Prospect, 4, Spring 1993, p. 23.

ii period. Furthermore, standardized cognitive testing showed that quality had not varied significantly, either. Texeira and Mishel blame not the lack of smart workers but the lack of "smart jobs," created by imaginative managers to optimize the workforce talent at their disposal.160 This logic places the burden of change back on the workplace, contrary to the assumption that it is the workplace that already has gone "high performance" and is waiting for the workforce to catch up. Still at the base, however, is the idea that the nature of work is not evolving as fast as the experts think it should. Another question arises in the application of basic skills: if a new worker with a relatively complete set of basic skills enters a job where a significant number of those abilities go unused for an extended period, we may conjecture that the basic skills package that emerges from that experience has been diminished. (This is the converse of the assumption that prolonged activity in a skilled position with high cognitive requirements provides an inherent advantage in transferability.) Of course, the same erosion is likely to occur with specific skills that go unused over an extended work period. However, unlike specific skills the "shelf life" of the basic skills is not subject to shortening by accelerated technological change.

160Texeira and Mishel, p. 70.

ii Samuel Osipow draws a distinction between job change and career change, which is relevant to the question of skills transferability. Osipow explains the connection thus: Jobs require specific skills that may well transfer to other jobs in the same field. Careers, however, involve a larger chunk of work history (or a person's entire work history), making consideration of skills transferability from within that context a much more complicated matter. Osipow observes further that at the low end there is likely to be significantly more disjuncture in an individual's job and career history, making consideration of skill transferability very problematic.161 Both job and career changes are occurring more often in the 1990s, but only the former normally entails major retraining or acquisition of new skills. However, the distinction between job change and career change begins to disappear over longer periods of time during which a worker may have been unable to work or left his/her position. The retention over time of usable skills from an abandoned career depends largely on how fast the methodology and equipment in that field have changed in the interim. As high technology invades more workplaces--including many in the service sector--substantial technical change negates the usefulness (hence the transferability) of more workers' retained skills in a relatively shorter time. In order to understand the meaning of such trends and statistics, we must characterize the composition of the former, current, and prospective workforce. Measurements can be made from a number of directions, using both general and specific data. In 1960 the five largest categories of workers, as defined by the BLS, were administrative support and clerical workers (9.1 million, 14.1 percent of the total workforce); craftsmen and skilled workers (8.9 million, 13.8 percent); non-transport machine operators (8.8 million, 13.6 percent); professional and technical workers (6.8 million, 10.5 percent), and service workers (7.5 million, 11.6 percent). By 1970, three of the "big five"--administrative support and clerical, professional and technical, and services--had gained 2.7, 3.0, and 0.2 percent respectively, while the two

161Constance Bogh DiCesare, “Changes in the Occupational Structure of U.S.Jobs,” Monthly Labor Review, 98, No. 3, March 1975, pp. 24-30.

ii manufacturing-oriented groups, craftsmen and skilled workers and non-transport machine operators, each lost 1 percent of the workforce during the 1960s (see Table 1). Figures for 1978 show that all categories except craft and skilled workers grew relative to the total workforce, with the service occupations gaining 3.0 percent, machine operators 2.0 percent, administrative support 1.4 percent, and professional and technical 0.9 percent, between 1970 and 1978. In absolute numbers, administrative support remained the largest (17.8 million), followed by professional and technical (15.6 million) and services (14.4 million). The "laborer" category, which in 1970 included 3.2 million workers--a drop of 100,000 from 1960, was revamped by 1978 to include a major new subgroup, "trades helpers," which added nearly 1 million workers, bringing the "laborers" up to 5.9 million in 1978 and making comparison of 1978 figures with those of earlier years impossible for this key category.162 By 1996 the category again had changed, adding service station and parking lot attendants and some machine tenders. Now called "helpers, laborers, and material movers, hand," the group contained 5.0 million workers in 1996, with a projection of 5.7 million (a loss of 0.1 percent compared with the total workforce) in 2006.163 Comparison of the five largest categories between 1960 and 1978 indicates that already in the seventies service sector growth was picking up and manufacturing- oriented jobs were flattening out or declining. Despite nomenclature problems with the "laborer" category, it is clear that through 1996 no significant decline occurred in that fundamentally unskilled and semiskilled group, nor was a decline expected to occur through 2006. According to the BLS, in 1996 the four largest groups of workers were in administrative support occupations (24 million), service occupations (21.3 million),

162Max L. Carey, “Occupational Employment Growth Through 1990,” Monthly Labor Review, 104, No. 8, August 1981, pp. 49-53.

163George Silvestri, “Occupational Employment Projections to 2006,” Monthly Labor Review, 120, No. 11, November 1997, p. 76.

ii professional specialty (formerly "professional and technical") occupations (18.2 million), and operators, fabricators, and laborers (17.8 million). (This group, which contains many subcategories of the former non-transport machine operators whose figures for 1960-78 are noted above, had been substantially expanded by 1986, adding the terms "tenders" and "related workers" to most of the specific machine types on the list. Thus both the overall category and each specific subcategory within it now are combinations of skilled, semiskilled, and unskilled positions.) Of all the major groups, the largest projected growth in workers through 2006 was in professional specialty occupations, which were expected by the BLS to add about 4.8 million; the second-largest growth would be in service occupations, anticipating growth of 3.9 million in that period. The two groups also were expected to grow in percentage of the total workforce, by 1.5 and .6 percent, respectively. (As defined by the Department of Labor, the major subcategories in the professional specialties are engineers; architects and surveyors; scientists; computer and mathematical research workers; social, recreational, and religious workers; lawyers; teachers; librarians; health diagnostic and treatment workers; and writers, artists, and entertainers--people with arguably the highest degree of skills development. The services group includes cleaning and building services, food preparation and service, health services, personal services ranging from barbers to flight attendants, private household workers, and protective service workers--an aggregation featuring varied skill levels but tending toward the lower end of the scale.)164 The ongoing and projected growth in the professional and service groups points to another type of division that is occurring in the workforce--a division that overlaps with the disparity discussed above between the demand and the supply of workers with skill levels high enough to function in high-performance workplaces. As the present system continues to demand more highly prepared, specialized individuals, similar growth is expected at what might be considered the other end of the occupational

164Silvestri, pp. 62-69.

ii spectrum, most notably in the health services and personal services subcategories.165 (The large subcategories of kitchen workers and janitors, each of which occupies more than 2 percent of the workforce, are expected to grow slightly in numbers but not in percentage of the workforce as a whole--their projected shares in 2006 are 2.6 and 2.2 percent, respectively.) Meanwhile, the workforce share of administrative support occupations (such as clerical help, computer operators, and unspecialized secretaries) is expected to decrease by 1 percent (although that category will remain the largest in total numbers). The BLS explains that change mainly as the result of office automation. The manufacturing sector (which includes precision production occupations, operators and fabricators, and general laborers) is expected to lose .7 percent of its workforce share because of automation and an overall decrease in manufacturing employment; the only major growth in this group will occur in materials transport done by vehicle, machine, and by hand. The unskilled category "helpers, laborers, and material workers, hand" is expected to have a 3.7 percent share of the workforce (down slightly from the 1997 share but remaining the second-largest subcategory in the manufacturing sector).166

165Silvestri, p. 69.

166Silvestri, pp. 59-62.

ii Despite uniformly pessimistic pictures of the present and future supply of labor possessing critical skills, at the demand end of the picture the overall importance of employment qualifications is forecast to increase. Hopkins, Nestleroth, and Bolick (Help Wanted) see basic skill demands increasing at many entry-level jobs, citing these statistics: in 1990, 1 in 5 jobs could be done with less than a high school education, but by 2000 the ratio will only be 1 in 7; in the same period, the ratio of jobs in the labor market for the "least educated" will go from 1 in 11 to 1 in 25.167 Similarly, W. Norton Grubb notes that in 1992 workers with an education less than a bachelors degree made up more than 76 percent of the total, but that within that group, the average level of education was slowly but steadily climbing, with the "less than high school" category shrinking from 39 percent in 1969 to 13.8 percent in 1992.168 To put that trend in a different perspective, according to the BLS in 1990 more than one-third of jobs (about 40 million) required only an eighth-grade education, and an additional third (42 million) required that level plus some non-college skills; by 2000, more than 70 percent of all jobs still are not expected to require a college education. The logical conclusion from these statistics is that the majority of the workforce is being elevated quite gradually by the demand of the labor market into positions of higher performance. If we accept that proposition, questions still remain about the speed at which this elevation process may take place as well as the possible size of the unskilled force expected to remain. In the real world, a continued mismatch between supply and demand may put many more than the 1 in 25 jobs forecast by Hopkins, Nestleroth, and Bolick in the hands of the "least educated" for a prolonged period.

167Kevin R. Hopkins, Susan L. Nestleroth, and Clint Bolick, Help Wanted: How Companies Can Survive and Thrive in the Coming Worker Shortage (New York: McGraw-Hill, 1991), p. 28.

168Grubb, p. 3.

ii The occupational forecasts of the BLS provide no evidence to expect the proportion of unskilled workers to decrease in the foreseeable future, and occupational experts Samuel Osipow and Kevin Hollenbeck concur that the figure is likely to remain stable. According to Osipow, the main categories of unskilled labor--inspectors, hand packers, janitors, cashiers with light exertion function, some assembly personnel, counter attendants, dining room helpers, food servers, kitchen workers, maids, some security guards, and individuals holding a number of jobs tending machines for forming, packing, molding, extrusion, and conveying--will remain steady; automated replacements for machines are expected for the most part to require similar kinds of unskilled tenders (although the overall trend toward mechanization likely will lower the average level of exertion in unskilled jobs). The overall expansion of service-sector jobs will have little effect because the fastest-growing areas of the sector are not unskilled.169 Thus, whatever upgrading of skills occurs at the semiskilled and skilled levels in the movement toward high-performance workplaces that has been described above would not have an appreciable effect on the majority of disability applicants, assuming that the present dominance of the unskilled in the claimant population will continue. However, like the present system, a new system of disability determination also must account for prior work experience as a vocational factor for the minority of claimants who do have skills. For this purpose, it becomes important to speculate about how changes in the workplace and in the supply and demand of labor may affect that population of workers.

SKILL TRANSFERABILITY In evaluating a claimant's ability to find significant gainful employment elsewhere in the national economy once an impairment blocks continuation of his/her present job, the possibility of adjustment to a new work environment has been accepted as an important factor. That adjustment is conditioned by the answers to several questions:

169Telephone conversation with Samuel Osipow, January 13, 1998.

ii Does actual job experience equip the individual with a skill or skills that match the work activities profile of some other job whose exertion level is satisfactory given the impairment? Does some aspect of the individual's training history provide such skills, and, if so, can they be assumed to be still usable without an undue amount of "refresher" training? What other parts of the individual's work experience are indicators of adaptability, given the known linkages of adaptability with prior job skill level, number of jobs held, and training history? What workforce and workplace changes might have changed the answers to these questions in the last 20 years? SSR 82-41 defines skill transferability thus: "Transferability means applying work skills which a person has demonstrated in vocationally relevant past jobs to meet the requirements of other skilled or semiskilled jobs." The definition further says that transferability is most likely among jobs where "(i) the same or a lesser degree of skill is required; (ii) the same or similar tools and machines are used; and (iii) the same or similar raw materials, products, processes, or services are involved." The range of transferability is defined as between very close similarities and remote and incidental similarities, and some skills are so specialized as to be classified nontransferable. SSA vocational expert Elbert Spivey has refined that definition by adding that, for a skill to be considered transferable, it must involve minimum adjustment from the job that the claimant has lost the ability to perform; with advancing age, the fit must be closer. The relatively new field of skills transferability analysis specializes in identifying an individual's skills (or, in the case of a worker with an impairment, remaining skills) and determining how they can be used in other work once an impairment or displacement has occurred. Timothy F. Field and Jack M. Sink developed a pioneering system of skills transfer analysis, called Vocational Diagnosis and Assessment of Residual Employability (VDARE). The first stage in this process is the collection of data about the individual's vocational background, expressed in the terms of the Department of Labor's Dictionary of Occupational Titles (DOT) and its two companion occupational guidebooks, which are also the basis of SSA job descriptions. But Field and Sink have carried their analysis procedure several steps beyond the use of DOT's standardized descriptors of worker functions; the procedure "uses a systematic examination of

ii individuals' work histories, their functional limitations and capacities, and occupational and labor market information to generate potential alternatives."170 The VDARE process applies basic DOT information in a special worksheet that synthesizes and analyzes available skills, evaluates their transferability, and identifies potential. In the opinion of some experts, the DOT system, eventually to be replaced by the computerized O*NET occupational directory, is deficient because it is based on tasks rather than skills, making it particularly unsuited for matching the skills of unemployed and disabled workers with jobs. Vocational rehabilitation specialist Larry Kontosh has noted that the SSA system's definition of skill transferability is closely tied to the criteria stated in the DOT coding system--a harmful relationship because, he says, the DOT is not updated often enough to accurately reflect current workplaces, and DOT work descriptions are too restrictive to adequately assess skill transferability.171 According to Kontosh, the SSA definition is mistaken because it states that skills transfer can occur only from one skilled or semiskilled job to another skilled or semiskilled job, a concept that ignores the innate abilities that workers bring to many occupations, especially at the entry level. Kontosh also finds that the requirement of equal or higher skill level in the job of origin may conceal skills that are not evident in an individual's work history, but which may be transferable. Workers displaced by technological change are placed at a similar disadvantage. To remedy this problem, Kontosh recommends skills testing together with work history analysis when the DOT system is used.172

170Edna Mora Szymanski and Randall M. Parker, eds., Work and Disability: Issues and Strategies in Career Development and Job Placement (Austin, TX: Pro-Ed, 1996), p. 262.

171Larry G. Kontosh, “Should there be a National Standard of Assessing Transferable Work Skills: The Limits of the Social Security Model,” p. 67. Seventh National Forum on Issues in Vocational Assessment, Menomenie, Wisconsin, 1995.

172Kontosh, p. 68.

ii Kontosh and vocational specialists Edward Hester and Karl Botterbusch have expressed the hope that a job classification system that concentrates on skills rather than job tasks will be more conducive to accurate skill transferability assessment. According to Botterbusch, the Australian Standard Classification of Occupations is superior to the DOT because it is based on jobs that share common skills and use the same tools and equipment.173 SSR 82-41 states that, in general, transferability is greater at the higher skill levels. The future validity of that assumption will depend in part on whether specialization/compartmentalization is increasing or decreasing at the higher skill levels; if it increases, then SSR 82-41's caveat on the transferability of remaining job skills, "except when the skills are such that they are not readily usable in other industries, jobs, and work settings" would assume more importance. Today's and tomorrow's higher frequency of retraining may or may not influence this: if workers simply move sequentially from one skilled job to another, leaving the usability of previous skills behind, then it would only be the degree of specialization of each job that would determine transferability; but if workers accumulate usable skills as they retrain, then the retraining process would broaden the job experience package, hence increasing the likelihood of transferability of skilled claimants. As the activities of a given skilled job emphasize more versatility, flexibility, and personal initiative, those qualities, like the generally higher cognitive abilities assumed to be inherent in skilled individuals, would reinforce transferability because they are non-technical, "attitudinal" attributes with no "shelf-life" limitation. In the existing grid system, the lack of skills available for transfer is a factor in kickouts in the age categories beginning at 45 (in those groups the adjectives "transferable" or "not transferable," used throughout the grids as qualifiers every time the "previous work experience" column of the grid lists "skilled or semiskilled," play a direct role in the final decision reached in the right-hand column); so, for skilled

173Karl F. Botterbusch, “Job Analysis: Where Do We Go from Here?” Fifth National Forum on Issues in Vocational Assessment, Menomonie, Wisconsin, 1993, p. 122.

ii claimants nontransferability is a component of positive disability decisions in the upper age groups. Specifically, as the three vocational factors interact with the impairment severity factor in the grids (for example, limitation to sedentary work), individuals limited to sedentary work who are of advanced age (55 or older) or closely approaching advanced age (50 to 54) with nontransferable skills are declared disabled (the latter group being further limited to those having less than a high-school education or a high- school education not "providing for direct entry into skilled work"). Among those whose impairment limits them to light or sedentary work, the 55-plus category can be declared disabled by virtue of nontransferability of skills that they do have (in combination with the age factor). However, for claimants in the lower age groups SSR 82-41 says that skill transferability will be a factor in "a relatively few instances" because remaining ability to do unskilled work often will result in a denial even if there are no transferable skills. The continuing validity of that assumption seems to rest mainly on the continuing existence of unskilled jobs in which the former pool of under-45 claimants lacking transferable skills could reasonably find employment. As has been noted above, the evidence is that unskilled jobs will exist in approximately the same numbers for the foreseeable future. Samuel Osipow believes that the available data support his opinion that the unskilled labor force will not diminish significantly--if at all--in the coming years. If, employing the grids, one combines the “unskilled” worker with limitation to sedentary activity, there is no real employment possibility. He suggests that the available jobs for individuals in this category total roughly one-half percent of all jobs in the labor force.174 However, for other groups of workers the transferability factor might work more strongly in the direction of denial because their past work experience has been broadened by the tendency toward workplace flexibility. For example, a 50-year-old worker on the Saturn assembly line whose impairment eliminates his previous exertional activities might have picked up enough non-exertional skills (of the basic rather than specific

174Samuel Osipow, Comments at Social Security Administration teleconference, September 25, 1998.

ii kind) in that team-oriented work environment to qualify for a sedentary position requiring small-group leadership and organizational skills together with knowledge of assembly-line procedures. (New conclusions about age as a vocational factor, which are described elsewhere in this report, also may change the fate of such a worker.) The flexibility quality, which is becoming more prevalent in skilled and semiskilled jobs of many types, would seem to work consistently in the direction of more denials by narrowing the real-life basis for nontransferability. A potential indicator of skill transferability within various age cohorts is a statistical breakdown of the reemployment experience of workers who have been displaced from their jobs for reasons other than disability. According to figures from the Employee Benefit Research Institute (EBRI), several distinct trends emerge among workers displaced between 1993 and 1995. By age, older workers were much less likely to return to work (for all workers younger than 55, the rate of return to work was consistently close to 80 percent; for those between 55 and 64 it was 59.3 percent). EBRI figures also showed that, on the average, the older the worker, the greater the chance that earnings after return to work were lower than in the previous job. By profession, workers in managerial and professional occupations were the most likely to return to work (84.2 percent), while service workers (77.0 percent) and unskilled laborers (72.1 percent) were substantially less likely to do so. Earning levels provide a less clear distinction: those earning less than $20,000 had a distinctly lower likelihood of return to work (76.1 percent) than any higher earning group; all groups earning between $20,000 and $100,000 fell between 81.5 and 84.6 percent, with earners above $100,000 showing less likelihood of return (77.3 percent), presumably because that group has greater financial independence. Workers with less than one year of job tenure had distinctly the lowest likelihood of returning (73.5 percent), but the tenure groups above one year were quite evenly dispersed within the range of 78.2 to 81.7 percent.175

175Paul Yakobaski. “Worker Displacement, 1993-1995: Demographics and Implications,” EBRI Issue Brief, No. 186, June 1997, 7-8.

ii Insofar as these general transferability trends can be applied to the transferability of workers displaced by impairment, they would signal that the nature of work experience differentiates the likelihood of return quite strongly across a wide range, that duration of experience and earnings have significant influence only at the lowest level, and that age 55 is a downward turning point in likelihood of return when considered by age cohort. Another complication in the transferability issue is the increasing share of claims based on psychiatric illness and mental retardation, which together accounted for 57.6 percent of SSI recipients, with a similar growth trend seen in SSDI recipients, in 1993.176 For claimants in those categories, evaluation of the capability to do the "full range of unskilled sedentary functions," which lies at the end of the consideration process for most claimants under 50 in the present system, is much more complicated than a simple analysis of residual functional capacity in a physical sense. As noted in Appendix 2, however, the same correlation of work-experience level with transferability may well exist for individuals with psychiatric and mental disorders as for those with physical impairments.

TRAINING Given the new emphasis on changes within and between jobs and employers' perceptions of gaps in the critical basic skills of the available labor force, employers and workplace experts have placed new focus on worker training and retraining. It is reasonable to assume that changes in training patterns, frequency, intensity, and focus influence the skill mix and the adaptability of workers claiming disability. Motivation for such changes may come from either the supply or the demand side of the labor market.

176Satya Kochhar and Charles G. Scott, “Disability Patterns Among SSI Recipients,” Social Security Bulletin, 58, No. 1, 1995.

ii Kevin Hollenbeck observes that an employer may face a situation in which a given factor of production becomes unprofitable. In the case of the workforce, that would happen if the basic skill level (literacy, in Hollenbeck's treatment) did not match job activity requirements, either because the worker entered the job without having the necessary skill, or because technological change rendered the existing skill inadequate. In that situation, three choices exist: accept the losses from continued operation with no change, replace the factor of production, or attempt to upgrade it (in the case of workers, by training). In each individual case, the choice is ruled by a cost-benefit analysis of the options.177 The present application of those options to situations of unsatisfactory basic skills in the real-life workforce seems to depart significantly from what the literature prescribes as the solution to the "job skills gap" (more effective preparation in basic knowledge at the general education level, plus fuller and more appropriate job-specific training). Various forms of measurement show uneven movement toward the option of upgrading the existing workforce, even in a time when qualified replacement workers often are not available and keen competition precludes maintaining the status quo. According to the American Society for Training and Development (ASTD), for the year 1996 the overall average days of training in service industries was 4.63, and for manufacturing it was 4.52. Between 1993 and 1996, the number of companies with separate training departments increased by 8 percent (although there is substantial evidence that more companies also are outsourcing their training operations); in 1996 about 40 percent of large companies (those with 10,000 or more employees) offered basic skills training, and since 1990 some 50 percent more of all companies have offered or sponsored some form of remedial training.178

177Kevin Hollenbeck, “A Framework for Assessing the Economic Benefits and Costs of Workplace Literacy Training,” I “Workplace Learning: The Strategic Advantage” Conference, Milwaukee, 1996.

178"Signs of the Times,” p. 34.

ii Surveys by Lawler, Mohrman, and Ledford of company training policies for 1990 and 1993 showed significant increases between those dates in the number of employees who had received training in the prior three years. In 1993 nearly half of companies were providing at least 60 percent of their employees with job-skills training, but the equivalent percentages for training in problem-solving skills, leadership skills, and statistical analysis skills were only 16, 8, and 22, respectively. According to a 1996 Business Week/Louis Harris poll, 40 percent of large-company workers rated their company as "only fair" in training new employees in new job skills, 19 percent characterized it as "poor," and only 8 percent answered "excellent."179 Part of the problem may be the average return on training investments. According to one estimate, in manufacturing the 1985 average total training cost for a production worker was $2,000; by 1992 it had risen to $10,000. That figure was expected to rise to $20,000 by 2000, with substantially higher expenditures for training at the higher levels of a company. At the same time, the average time for a worker to reach full efficiency was 13.5 months, of which the employer gained an estimated equivalent of 8.5 months of full production.180 At the other end of the scale, Kevin Hollenbeck estimates that the average training period for an unskilled worker is about five days181 (far short of the thirty-day maximum training period prescribed by SR82-41 for a worker to function in an unskilled occupation).

179Cited in Bassi, p. 32.

180Susan Herman, Hiring Right: A Practical Guide (Thousand Oaks, CA: Sage, 1994), p. xv.

181Telephone conversation with Kevin Hollenbeck, January 27, 1998.

ii Another part of the training problem may be that training policy has not yet adjusted effectively to the disconnect between the changing nature of the labor pool and the expectations of the new workplace. Stephen Cohen sees a future stock of potential workers who are less talented overall, but who will have a wider range of skills. "Organizations will have to dig deep into the bin of workers who were once considered unemployable. The vast difference among them in experience, educational levels, skills, abilities, and attitudes will call for a different set of training parameters. The whole idea of competency assessment will be seriously reviewed and significantly altered....Minimal standards will become the norm....Training will have to take into account individual backgrounds and needs more than ever before. Employers will find more variation in propensities to learn, learning styles, basic literacy skills, and functional life skills."182

182Cohen, pp. 26-27.

ii According to a 1996 ASTD report, in 1995 employers spent a total of $55.3 billion for training their employees183--but most of that money went to employees at the executive or other high levels, much less to hourly workers. Although the amount spent for training increased 20 percent between 1983 and 1996, it didn't keep pace with workforce growth184 (which was 32 percent in that period).185 According to a survey by Kevin Hollenbeck, an average one-third of the workers in small and medium-sized companies (employing fewer than 10,000 workers) had skill deficiencies that retarded productivity, but less than 5 percent of employers in those companies addressed this problem with onsite training.186 If training dollars remain at least as scarce as previously, they will continue to be spent on workers whose existing skill and/or education levels are high enough to promise a return on the investment--hence further promoting the split between "high-performance" workers and those with fundamental gaps. This process would seem to block the upward mobility of lower-level workers, leaving most of the population of unskilled labor untouched by whatever "upskilling" goes on above them. The main driver of change in that situation is the nexus between the education system, which has received strong criticism for the incomplete general preparation of the incoming workforce, and work training programs. There are movements in that area aimed at more efficient and complete preparation (in both knowledge and training) of new workers;187 these movements and their potential impact are discussed in the Education section of this report. Lacking major change in the present, however, unskilled workers are dependent on continued market demand for

183Richard Koonce, “The Changing Landscape of the American Workplace: An Interview with Labor Secretary Robert Reich,” Training and Development, December 1996, p. 26.

184Bassi, p. 29.

185United States Department of Labor, Bureau of Labor Statistics, Employment and Earnings, June 1997, p. 65.

186Telephone conversation with Kevin Hollenbeck, January 27, 1998.

187See, for example, Commission on the Skills of the American Workplace, pp. 5-9 and Grubb, pp. 51-59.

ii them as they are; as was noted above, for the foreseeable future that demand likely will remain steady. Other significant training trends are identifiable. The more consistently available training programs of larger companies have been predicated on the prospect that an employee will justify a training investment by remaining with the company for a relatively long period. However, the recent era of downsizing has damaged the validity of such assumptions and forced more workers to move to smaller companies, where training is less consistently available. Assuming that other variables remain constant, this movement would result in a net decrease in workforce training. Also, in decisions about how and whether to provide training, employers are greatly affected by the business cycle and the tightness of the job market, which are short-term considerations that will continue to be relevant (and fundamentally unpredictable) regardless of other factors. From the worker perspective, a tight labor market reduces the incentive to independently seek training that would be a competitive advantage if the demand for labor shrinks.188

188Hollenbeck, January 27, 1998.

ii TABLE 3. COMPARISON OF LABOR SUPPLY AND DEMAND CHARACTERISTICS IN THE 1990s ______Requirement Demand Supply Category ______Predominant job type Service-oriented Manufacturing-oriented

Numbers 24 million additional 16 million additional jobs workers

Demographic qualities Younger, skilled, Diverse, older, unskilled, literate semiliterate

Education Greater education Fewer high-school and required college graduates available

Job level More advanced job Fewer workforce entrants opportunities to fill advanced jobs

Job type Cognitive and complex Procedural and predictable ______Source: Based on information from Stephen L. Cohen, "The Challenge of Training in the Nineties," in American Society for Training and Development, Workforce Trends Affecting HRD (Alexandria, VA: ASTD, 1992), p. 27.

Assuming that the increased rate of job and career changes in the workforce continues, the phenomenon of multiple retraining will remain a significant aspect of the American workforce's experience package. As time goes on, we might expect that the older parts of the workforce, which already have undergone several retraining cycles, should be more "transferrable" than they were in the past because of the greater psychological flexibility that is associated with experiences of job change. The largest cohorts of workers, cumulatively labeled the "baby boomers," aged 34 to 52 in 1998, will not start leaving the workforce in large numbers until 2010, and many not until around 2030. In the meantime, they and their work-experience packages will constitute a growing percentage of the workforce, considering the smaller size of each entry-level worker group in the next few decades.

ii But these expectations of a correlation between training and transferability also depend on how ad hoc and specific each round of training is. For workers at the lower skill levels, the trend now is toward onsite, pragmatic training aimed at filling gaps as they are identified, meaning that the average worker may not bring much except a flexible attitude to transfer elsewhere despite having undergone training multiple times. According to Kevin Hollenbeck, however, much of the training is “not reaching the low- skill jobs at all.”189 From the SSA standpoint, a claimant's ad hoc training also is more difficult to identify and evaluate than more formalized training, particularly if its ensuing application to a work activity is not clear. In fact, if the workplace evolves to the amorphous condition where more workers are "trapeze artists," training and work activities are likely to merge and become indistinguishable. Even if the O*NET job descriptions are used, SSA might want to broaden its understanding of work activity in accordance with descriptions of the workplace (e.g. the hidden cognitive functions required by many combinations of work activity) described recently by observers such as Charles Darrah and Stephen Cohen.

CONCLUSION In the past ten years, much literature has been devoted to describing the working conditions and expectations of the "new workplace" that theoretically will enable the United States to compete technologically with its foremost international rivals in the 21st century. Many of the changes that are described would have significant impact on the quality and quantity of prior work experience that SSA disability claimants bring to the decision process. However, an evaluation of the literature yields few clear-cut road signs for redesign of this aspect of the SSA disability system. Rather than assembling a preponderance of evidence to back a particular position on the subject, this report has endeavored to set out choices of likely scenarios, based on trends described by the experts, and to deduce implications for the elements of the disability system as it now

189Kevin Hollenbeck, Teleconference Call at Social Security Administration Headquarters, September 25, 1998.

ii exists. Thus the report's intent is to be descriptive rather than prescriptive. Undoubtedly, significant changes have occurred in the nature of work and of work activities, especially in the twenty-year period since the grids officially combined vocational factors with degree of impairment in the last stage of the disability decision process. However, many conclusions to be drawn from the information in this section of the study depend on the speed and completeness with which reported trends take place, and this is a point on which experts disagree. A key factor is the increasing versatility, flexibility, and initiative that are now required and learned (and assumedly will be so at increasing rates in the future), in order to meet the demands of an increasingly competition-conscious and technologized workplace. At present, it appears that those changes are occurring only in selected groupings of the workforce, largely excluding unskilled and semiskilled workers. The installation of more automated equipment may have the effect of further "dumbing down" already low-skill jobs if the lower levels of the workforce does not become integrated into new systems as Drucker and Zuboff have prescribed and worker interface with machines is confined to routine button-pushing. If, however, workers at those levels are given access to more data with which to make more independent decisions in both services and manufacturing--thus integrating them with the production process and ipso facto upgrading their job experience-- transferability would be enhanced for many disability claimants. It would also decrease the now steady percentage of unskilled workers in the workforce, providing less basis for denying disability claims by referring to unskilled jobs available in the economy. At the least, however, the increased demand for non-specific work attributes such as problem-solving and communications skills--as well as the tendency to broaden work activities that previously had more finite boundaries--will have an effect on the job- experience packages and transferability of many workers possessing specific skills. The nature of "high-performance" technical work--as well as a significant part of the jobs in the service sector--already demands such qualities. The increased trend toward multiple job changes and multiple retraining, especially among lower-skill groups, also may have an impact on transferral attitudes and skill transferability. The mere experience of having changed jobs and/or being

ii retrained several times (particularly, as is most often the case, within the same overall occupation) does not necessarily impart a more positive attitude toward change in general, and the retention of skills learned in past iterations of the process may be too fragmentary or outdated to have meaning at the point of disability determination. Arguably the most important new factor here remains the quality of individual job experiences and of the training associated with them, rather than the number of such experiences. The nature of future job training is a key driver of change. If employers continue the present trend of pragmatic, customized, job-specific training aimed at the most investment-responsive workers, the schism between unskilled and skilled workers is likely to remain or deepen, and past training will not play an increased role in the job- experience packages of most claimants. Again, in this area there is the distinction between the low-skill majority and the skilled minority of claimants. For the latter, rapid technological change will shorten the shelf-life of accumulated skills. The definition and quantification of the term "skill" also come into question in light of recent literature citing flexibility and integration as primary qualities of the new workplace and at least of the upper and middle echelons of the new workforce. Specific skills will doubtless continue to be associated with specific job titles, especially in manufacturing, but the overall description of a worker or a work position that he/she has occupied or is being considered for seems destined to include more general qualities now known as "attributes." The intention of this report is to describe conditions that are likely to be of importance to an SSA evaluation of prior work experience over the next few decades. Arguably, in 1998 the American workplace is not as far along the continuum from the Taylor model to the "high-performance workplace" as many have hoped and even proclaimed--meaning that perhaps there is less spectacular change in factors of influence to a claimant's job-experience package than one might have expected. Much that was true in 1978 remains true today--especially in the realm of the unskilled workforce--but powerful change drivers also are present. Among them is the generally accepted proposition that somehow the United States must reshape its workforce

ii dramatically, locating or creating workers that conform at least with a generic "high- performance" model. At present, the bulk of the economy is locating and preparing its lower-skilled workers in an ad hoc, short-term manner that does not promise to fundamentally change the assumptions of the 1978 grid. The prospect of a large-scale "upskilling" of significant parts of that currently stationary pool of unskilled labor remains theoretical. This report has cited significant examples of upskilling and other workplace shifts now visible in the United States. They include the formation of manufacturing work teams, the merging of hitherto disparate skills in more inclusive groupings of work activities, the physical and temporal displacement of the traditional 40-hour job station, and the ever-wider application of "people skills" in interactive service work as well as manufacturing. But there is much less evidence for large-scale involvement of the low end of the skill ladder in these processes. It is increasingly difficult to generalize about the "typical worker," even one found at the lower end of the skill ladder. But, based on current literature, there is an increased likelihood that a given claimant will bring with him/her one or more of the following: a history of multiple training and multiple jobs held; experience in an interactive service or manufacturing occupation (either traditional or revamped) where some type of "people skill," undefinable in conventional skill terms, was required; a flawed package of "basic skills" that has been patched pragmatically along the way; job experience where information was shared between management and the worker, who then made some cognitive contribution to adjusting the job process; experience in a job some aspect of which (order of work, time of work, place of work) was determined at some points by the employee rather than the employer; or time spent in an unskilled job in which existing skills eroded because they were not applied. Although the amount of quantifying evidence varies, each of those characteristics has the potential to alter the current understanding of the content and the role of past work experience in disability claims.

THE ROADS NOT TAKEN

ii In the process of compiling this report, a number of hypotheses were formulated and later proven either incorrect or lacking documentary support upon which to expand them. The first strategy was to seek literature specifically describing the impact of workplace changes on the type of work experience that individuals might retain in usable form after having suffered an impairment. It was quickly discovered that little or no literature covers a combination of information that would provide empirical support to conclusions about the movements of workers with impairments in today's economy. Therefore, the topic was broken down into sections--such as the nature of workplace changes in the last twenty years, trends in worker training and hiring, and the statistical tendency of individuals with particular types of impairment to return to work--that the literature covers in sufficient depth and breadth, from a variety of viewpoints, to piece together likely scenarios. As is mentioned in the body of the report, it was not possible to determine what sources were used in the formation of the 1978 procedural "grids," with the exception of the few items mentioned in the 1978 SSA rules and regulations. Consultation with Elbert Spivey, chief author of those procedures, likewise yielded no substantive information on this subject. Therefore, comparison of contemporary workplace and workforce conditions with those that presumably generated the 1978 language has been inferential rather than direct, based on our own comparison of literature describing conditions of the two eras. Another quest was for specific characterization of the population of unskilled workers and of the job types that they occupied, based on the assumptions that the unskilled portion of the workforce will continue to constitute the majority of SSA disability applicants in future years and that the existence of "significant numbers" of appropriate, unskilled job positions will continue to be an important factor in denial of disability claims. Accordingly, the goals of that strategy were to compare today's situation with that of 1978 and to project changes that might emerge in the next few decades. Although lists of the job types in this population are available from various sources, including Samuel Osipow and the Bureau of Labor Statistics, it has not been possible to define training or employment trends specific to that group--perhaps

ii because in fact that part of the workforce has been rather insulated from many of the changes influencing worker groups at higher skill levels. Likewise, workforce changes described in the literature tend strongly to concentrate on the skilled workforce, apparently with the assumption that unskilled workers are not affected by the trends being described. Because of the central role of the unskilled worker population in the SSA disability process, this report has speculated rather heavily about the validity of such neglect. However, because they seldom are addressed directly, factors truly influencing the work experience package of unskilled workers remain theoretical and circumstantial. Given relatively full accounts of changes and conditions in some parts of the skilled workforce, the decision was made to use information from such accounts as ingredients in the formulation of general trends, rather than to provide detailed descriptions of individual sectors. The goal of that strategy was to preserve balance and avoid skewing the overall impression by giving too much attention to phenomena that may be isolated rather than typical.

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ii CONCLUSION

The chapters on age, education, and work experience have separate executive summaries of the key judgments reached by the researchers. Many of the points enumerated reflect both the individual vocational factor discussed and the interaction of factors. Nevertheless, this chapter will attempt to reach some general conclusions regarding the interaction of these vocational factors in the disability decision process. The review of the literature may be summarized in the following key points: AGE:  Aging is not disease: one must distinguish between agemarkers and disease markers.  Variance of the population increases with age.  Likelihood of new employment declines with age.  Functional age assessment is a more useful criterion than chronological age.  Cognitive decline is mostly seen in nonverbal areas.  Adaptive capacity declines with age.

EDUCATION:

 Education impacts the ability to acquire new skills.  Special groups in the population will be poorly educated in the future.  Earning power is related to educational level.  About one-quarter of US adults are at level one (lowest) literacy.  Mental impairments have the greatest impact on educational attainment.  One-half of adults at level one literacy are unemployed.

WORK EXPERIENCE:

 Job stability has declined for those at the lowest skill levels.  Worker traits are a function of education more than experience.  Basic skills are a priority with employers.  Upgrading in skill levels for semi-skilled and skilled workers will have little effect on employability for the majority of disability applicants if unskilled workers continue to dominate the claimant population.  Jobs for unskilled workers in the under-45 category will remain constant.

A key finding of the research on aging concerns the use of chronological age as a functional marker in evaluation. As Robert Garian explains, experts Timiras and

ii Forbes show that it is difficult to associate chronological age with the particular characteristics of individuals. In fact, research from the Baltimore Longitudinal Study of Aging indicates that the differences among individuals increase with age. McFarland wrote in 1973 that individual capacity, not chronological age, is the marker for ability in the workplace. Therefore, functional age (and testing for functional age) will be key to understanding whether an individual may be able to work given his/her age status. Functional age, a concept associated with an individual’s self-sufficiency, assumes that a person, regardless of age, who can perform work-related tasks with regularity and without aggravating a medical impairment, is of a sufficiently young functional age that he/she may be expected to have the ability to work. McFarland’s findings, plus the more recent research, show that all individuals at the same chronological age do not all function at the same level. Older workers may be capable of performing tasks demanded by a job for which they have no prior work experience. But the expectation of success in that job must be tempered by expecting only minimal adjustment or adaptation. No large vocational adjustment may be required. Research indicates that a potential employer should not overload a person’s capacity. With time, the older individual will compensate to improve job performance. However, Brodsky points out that older workers are less likely to return to work following occupational injury or illness. This fact is especially true for those individuals who are unskilled or semi-skilled in physically demanding jobs. In addition, even if an employee who was injured on the job wants to return to work, personnel practices may prevent older workers from doing so, and disability may be the only feasible alternative. Root found that the rate of injury decreases with age, but the consequences of injury increase with age. He also found that many older workers leave physically demanding and hazardous jobs for fear of injury. A second finding from the research on aging concerns the ability of the individual to adapt. Adaptation is the measure of change in an individual’s reserve capacity when engaged in a different task. N. W. Shock reports that older subjects perform about as well as middle-aged and young subjects in adapting to repeated exposure to exercise. Like physiological reserve capacity, the individual needs adaptive capacity. An

ii important factor in this consideration is motivation: the individual needs choice. If the individual being tested is given even a limited amount of choice, then the test results improve. Third, according to the Seattle Longitudinal Study, most fairly healthy adults apparently experience no sign of impairment in most abilities until after age 60 (in SSA parlance, “nearing retirement age”). The 30-year study showed no uniform pattern in the changes--various participants improved in some areas while none of the participants declined in all areas. The research indicates that the higher a person’s functional age, the lower the expectation of satisfactory performance in work that requires quick nonverbal responses to changing (i.e., unfamiliar) situations. Research into education and work experience indicates that the workplace today changes frequently and presents unfamiliar situations to workers of all ages. According to Glenn Curtis, the expansion and diversification of the service economy have complicated traditional formulations of workplace evolution by leading to the development of nontraditional workplaces, working relationships, and schedules. These nontraditional workplaces may complicate the ability of SSA examiners to evaluate the work experience of claimants. The disappearance or blending of specific job descriptions may affect the SSR 82-41 prescription that requires comparing the job duties with regular definitions of skill levels. If work activities become more autonomous and more dependent on individual initiative and interpretation, the description of job duties cannot accurately capture the activities for the purpose of comparison with SSA’s established skill levels. Regulatory definitions cannot capture what is happening in the real world. The research clearly shows that education impacts the ability to learn new skills and that earning power is related to educational level. However, the length of time that the education endures is not clear. Evidence points to the fact that a GED certificate does not place an individual in the same category as a bona fide high school graduate. Employers regard the holder of a GED as having lower skills and group him with the class of high school dropouts. This circumstance does not bode well for those who do not complete the traditional K-12 curriculum.

ii Another key finding stems from a national study of literacy, which shows that the level of education is linked to literacy proficiency. Level one and level two individuals face lifetimes of lower earnings (one-half are unemployed) and the increased likelihood of physically demanding unskilled and semi-skilled employment. Statistics show that these individuals are most likely to become disabled and apply for benefits. The literature indicates that employers place substantially more emphasis on the possession of “basic skills” when identifying potential employees. Two of three service jobs created in the economy in the decade of the 1990s have been low level jobs. Hopkins et al., see basic skill demands increasing at many entry-level jobs, with the market for those possessing less than high school education shrinking from 1 in 11 jobs to 1 in 25. If, in fact, employers are demanding higher basic skills, SSA may have even more difficulty placing these claimants in gainful employment. Many of the job characteristics found in the fast-growing service sector include communications and inter-personal skills--those skills that stress the team approach to job accomplishment, how the individual “fits” with and adjusts to a variety of co- workers? Given that employers are placing more emphasis on these worker traits, will those individuals with mental impairments be more difficult to place in even unskilled and semi-skilled positions? If one considers the key judgments listed above, one may evaluate how these factors may interact to affect a claimant’s case. For example, demographically, the baby-boom generation is the largest worker cohort. Its oldest members are now over age 50. Therefore, any linkages that occur in connection with the age factor will apply to an increasingly larger group in the next two decades. If the principal age group of claimants is in the “approaching advanced age” or “nearing retirement age” groups, then the upward “spike” in the number of claimants is likely to grow. Likewise, for the present, and for the foreseeable future, the average (impaired) worker will have undergone more training iterations than in previous years. Older claimants will increasingly have the most training history. To the extent that adaptability to other work is reduced by aging (physical and cognitive slowing occur with age and older individuals should not be expected to make great vocational adjustments), will the

ii work experience and training factor offset the negative aspects of age? Or, because training and re-tooling occurs more frequently on the job today than in previous years, will the ad hoc nature of the training (learning just enough to perform a given job) combine with the frequency of training to render the learning less important to the process? Should the current (grids) limitation of work performed in the previous 15 years be reduced to five years since the frequency of job change and complexity of some training will have been forgotten after five years’ neglect or non-use? On the other hand, if younger workers are found increasingly lacking in basic skills (unprepared for the workforce by today’s education system), will employers give higher consideration to the education factor for older workers who have (potentially) more work experience and better basic skills from previous years, thereby balancing a probably negative aspect of aging? It is likely that the principal pool of claimants will continue to be those with the lowest level of literacy and least work experience. Therefore, the absence of good basic skills will be a given for many jobs in the national economy at levels other than unskilled. Workers with lower education achievement tend to change jobs more often. At the unskilled level, the lack of education is likely to prevent the gathering of meaningful work experience or advancement at any one job. The additional training iterations gained in multiple jobs are less likely to provide skills of use later in the form of work experience. Research shows that foreign-born ethnic and racial minorities constitute a high percentage of those whose literacy levels are on the lowest level. These groups are at a disadvantage in the workforce because they have been at a disadvantage in the education system. The Census Bureau reports that in 1995, the foreign-born population of the United States reached 22.6 million people, about 9 percent of the total population. Unemployment in this group was higher, and median income in the group was lower. This large pool of foreign-born workers could increase the number of claimants. The skills now identified most often by employers as critical but lacking are not job-specific ones but general ones, such as being able to use English properly and well, doing simple arithmetic, and being able to read instructions. These basic skills would

ii come from the education process. Individuals who lacked basic skills when hired likely received job-specific training that would not improve the basic skills available as disability claimants. In other words, work experience is not likely to be a substitute for education in improving transferability. Given steady or increased demand for basic skills, the lack of education may increase in importance. Will SSA revise its assumptions about what a given education level means for transferability? Research into the current literature concerning age, education, and work experience has raised these and other questions. How the Social Security System will attempt to apply this new information in its evaluation process remains to be determined.

ii APPENDICES

ii PRIVATE DISABILITY INSURANCE

The traditional industry definition of disability is "inability to fulfill the substantive parts of the work for which the individual was trained or educated." According to insurance spokesmen, clear-cut cases dominate the field, as they do for the SSA. However, disability claims decisions are not based on strict standards when they involve cases in the "gray areas." The two most important such gray areas are those involving some type of mental impairment and physical conditions leading to only intermittent or partial ability to function in a job situation. Such a condition would be a debilitating muscular condition that is severe some days but bearable and functional on others or a fatigue disorder that causes widely varying energy levels. In many such claims, an insurance company’s' procedure is to refuse disability allowance for as long as possible, hoping that the claimant eventually will give up the claim. The residual functional capacity issue is a big one, and it is not always decided in favor of the claimant even in seemingly clear cases; for example, a surgeon who is diagnosed as HIV positive may not be declared disabled as long as some hospitals still permit him/her to work (which in fact they do!) Vocational factors come into play after the expiration of the insurance policy's stated period of coverage (normally two years) for loss of function in the job performed by the individual at the time of impairment (called "OwnOcc"). Once that period is over, the company considers the individual's ability to function in other jobs in the national economy, usually taking into consideration the person's existing skills and work experience. But there seem to be no firm standards for such consideration, or for the frequency of follow-up medical examinations to confirm continuing disability--which is a necessary determination to avoid unnecessary payments. (In clear-cut cases where no improvement is to be expected, follow-up is eliminated.) Disability categories and follow-up requirements have been changed by the decreased mortality of many conditions, most notably those involving the heart, as well as by the increased identification of nonphysical impairments.

Companies consulted: Sun Life of Canada, Massachusetts Mutual Life, and Provident Life and Accident

ii THE MILITARY DISABILITY SYSTEM The overall goal of the military disability system is to ensure efficient operations of military forces, especially the continuous readiness of personnel for combat. Disability determinations are made with the use of documentation submitted by medical facilities that treat and evaluate personnel, both on an ongoing basis and as they are consulted in specific disability cases. The following procedure is that prescribed for the Army; the convening of boards varies somewhat by branch, but the logic and sequence is basically the same for all. Upon entry into the armed forces, all individuals must pass the six-part PULHES fitness test, which includes five phases of physical function (physical capacity or stamina; upper extremities; lower extremities; hearing and ear; and eyes) and one of psychological function. If they meet the PULHES requirements for their assigned specialty, they are assumed to be fit until a new condition appears or a pre-existing condition deteriorates. An active-duty individual may have one or more PULHES numbers exceeding the norm (1 being the highest, 5 the lowest), with a notation in his/her permanent file of a medical problem "that may limit their ability to perform the full range of PMOS or specialty code duties in a worldwild field environment." An example of a PULHES military occupational specialty (enlisted) prescription, from AR 611-201, Enlisted Career Management Fields and Military Occupational Specialty: Recruiter, physical profile 232221. Disability decisions begin when an individual's commanding officer refers him/her for evaluation to a medical treatment facility (MTF); if an examination there finds the individual not medically qualified to perform assigned duty, the MTF commander refers the case to a Medical Evaluation Board, which is composed of members of an Army Medical Department. The MEB "documents the soldier's medical status and duty limitations," using standards prescribed in AR40-501 (an MEB must include two doctors, with one dentist or psychiatrist in specialized cases; a psychiatric MEB must have at least three members); if the individual is deemed not to meet the retention standards of AR40-400, he/she is referred to a Physical Evaluation Board (PEB, provided by the Army Physical Disability Agency), which applies the standards of AR

ii 635-40 (the Army Physical Disability Evaluation System) in evaluating for retention, retirement, or separation according to match-up of the individual's physical condition with the needs of the current duty position. The initial PEB stage is informal; then if the individual appeals its decision a formal board is convened. Both the MEB and the PEB use medical evidence prepared by physicians who use the Veterans' Administration's Physician's Guide for Disability Evaluation Examinations. The PEB stage is where medical evidence is linked with duty requirements, along with personnel documents, job evaluations, the commanding officer's mandatory statement on the impact of the impairment on duty performance, and other relevant information. The process is to "compare the nature and degree of physical disability present with the requirements of the duties the soldier reasonably may be expected to perform because of his or her office, grade, rank, or rating." At that stage, only documents are used, the person never is seen. A physical examination board liaison officer (PEBLO) from the MTF, is the link of the individual under consideration with the disability authorities, and as such is responsible for getting all relevant information to the PEB. Per AR 611-201, a profile with one or more 3's or 4's cannot be the sole reason for a reclassification or separation decision based on disability. In many cases, if the individual still is performing the job effectively despite the impairment, that may preclude a disability decision. Currently there is much uncertainty on the issue of world-wide deployability and ability to serve in a combat zone if the duty slot is a noncombat one; earlier, the inability to be deployed anywhere worldwide was an overriding factor driving a disability decision, but now this issue cannot be the sole reason for such a decision. The role of deployability is in the process of further clarification by policy makers. Waivers are sometimes given, especially for individuals with rare specialties. In quantifying the extent of injuries and disorders, the Veterans Administration Standard for Rating Disabilities (VASRD) is the basic guide, using a 100-percent scale graduated in increments of 10 percent. These ratings are based on the average impairment in civilian earning capacity resulting from certain diseases and injuries and their residual conditions.

ii There also are "combined ratings"--if there is more than one condition, the respective percentages aren't added but combined (multiplied together), so two coexisting 40-percent impairments would total 64 percent (40 percent plus 24 percent, which is 40 percent of the 60 percent remaining capacity deduction for the first impairment). Sixty-four percent then would round to 70 percent. The application of age, education, and work experience in the reclassification vs. separation decision on someone disabled for his/her present position: A decision may be made that an individual with an impairment that prevents performance in his/her current specialty is to be reassigned to another specialty. The locus of this decision varies widely--a number of formal and informal boards are used, depending on the service and on the stage in the determination process. In this decision, age per se is not a factor, but time in service and time in grade are important in deciding whether the military is likely to have this person's services for an appreciable amount of time relative to the expense and time of retraining (before retirement, for example). Aptitude also is considered, based on scores on general or specialized tests and on the person's military training and civilian education history. (Training and service experience take precedence over formal education, however, as more direct evidence of potential.) Unlike the SSA process, often the individual desires or requests reassignment rather than separation, in order to continue his/her career. In the Navy, a person found disabled for a combat job (for example, a pilot) always can request reassignment to a less demanding combat job (for example, ship's navigator) or to a noncombat job. The decision on an request is taken by an ad hoc board convened by Officer Lateral Transfer and Redesignation or by the regular quarterly board of the Disability Retirement Branch. The former uses in-service work experience and relevant civilian education, especially specialized/technical, extensively in its decisions, but age seldom is a factor. For personnel with more than 20 years in service, options are permanent disability retirement (with a minimum 30 percent permanent disability (eligibility for disability retirement supersedes separation for disability), or temporary disability

ii retirement (under the same conditions except that the disability is not expected to remain at the same level for five years or more, and periodic follow-up examinations are done to monitor the impairment); with less than 20 years of service and less than 30 percent disability there is separation with disability severance pay; if an impairment pre- existed before service began or was contracted while the individual was AWOL or pursuing a prohibited activity, the determination is separation without severance pay.

ii MEDICAL SURVEYS: CASE STUDIES

This section of the SSA study reviews 48 articles that report on surveys of the factors that influence the return to work of persons afflicted with a number of physical or psychiatric impairments. The surveys vary with regard to the number of persons surveyed, the period of time covered, the degree of statistical and/or scientific sophistication, and the reasons for their being carried out. Some articles report on a single survey; others mention a survey only in passing because they deal mainly with another subject; other articles are themselves reviews of numerous surveys. The criteria for selecting these articles have been whether they reported on surveys that examined how one or more of the vocational factors of age, education, and work experience influenced or predicted a person's return to work. These surveys of indicators of the likelihood of someone's return to work are being reviewed to determine if they provide empirical evidence of the actual importance of the vocational factors used by the Social Security Administration (SSA) in its disability review process. It is generally assumed that age, education, and work experience significantly affect a person's vocational outlook. However, is there evidence to substantiate these assumptions? A review of dozens of surveys covering thousands of persons with a variety of physical and psychiatric impairments indicates that there is substantial evidence that these assumptions are well founded. Because the findings of most surveys are so similar, this report usually cites only the statistics of the most extensive surveys and does not mention articles dealing with smaller or less complete surveys. However, when a survey contains data that contrasts with that of other surveys, the reporting article is cited, no matter how small it is. Because of this practice, a number of articles listed in the report are not mentioned in the report's text. A “*” before the bibliographic entry denotes a discussion follows in the text.

General

198

*Akabas, Sheila H., and Lauren B. Gates. Disability Magement: Labor Initiative in Early Intervention: Final Report. New York: Center for Social Policy and Practice in the Workplace, Columbia University School of Social Work, March 1991.

*Baldwin, Marjorie L., William G. Johnson, and Richard J. Butler. "The Error of Using Returns-to-Work to Measure the Outcomes of Health Care," American Journal of Industrial Medicine, 29, 1996, 632-41.

*Northwestern National Life Insurance Company. "Back to Work: Managing Disability, Recovery and Re-employment." April 1994, 19 p.

*Tate, Denise G. "Workers' Disability and Return to Work," American Journal of Physical Medicine and Rehabilitation, 71, No. 2, April 1992, 92-96.

The Northwestern National Life Insurance Company examined 9,747 long-term disability claims filed between January 1987 and December 1993. The report found that the rate of disability increased with age. For example, 10.3 percent of the claimants between the ages of 45 and 54 had disabilities that prevented them from working; between the ages of 55 to 64 the disability rate rose to 22.3 percent (p. 5). The company also found that workers aged between 25 and 45 were the most likely to recover from a disability and return to work (p. 20). Although it offered no supporting data, the report contends that it found that more education usually translates into greater employability and less disability. The reports also suggests that work experience helps keep workers off the disability rolls in that a varied work history increases the number of transferable skills and job options (p. 20). The Tate report (1992) has similar findings. It looked at 200 blue-collar workers involved in workers' compensation cases and found that the mean age and education of workers returning to work was 40.2 years and twelfth grade, compared to 47.3 years and tenth grade completed for those not returning. Work experience also had a positive effect on return to work in that returnees had 15.5 years seniority compared to 12.0 for those who did not return (p. 93). Those who returned also had higher wages (implying a higher level of skills): returnees earned an average of $453 a week compared to $367 for those who did not return (p. 93).

199 The Akabas and Gates (1991) report on 252 newly disabled persons also found that older workers are significantly less likely to return to work, that persons with higher incomes are more likely to return to work, and that the higher the education level the more likely a person is to return to work (Akabas, 19-20). However, Baldwin et al. (1996) warn that return to work is not an accurate indicator of health because many factors not related to health, unemployment rates for example, affect a worker's ability or desire to return to work. Another problem with this indicator is that the return to work may be of short duration (p. 632). Despite their caution about what a return to work can mean, the authors agree that age, education, and occupation are important factors in determining who does again become employed after illness or accident (p. 640).

Cancer *Weis, Joachim, Uwe Koch, Peter Kruck, and Andreas Beck. "Problems of Vocational Integration After Cancer," Clinical Rehabilitation, 8, No. 3, August 1994, 219-25.

This article reports on a survey of 566 patients with an average age of 50.8 years at two rehabilitation centers in Germany. It found that older persons were much more likely to retire than return to work. It also found that blue-collar workers were less likely to return to work than white-collar workers. This was perhaps true because in addition to the greater physical demands of blue-collar jobs, white-collar employees had more flexibility in how they could perform their work and hence a greater likelihood of resuming their previous employment. Blue-collar workers would often be offered inferior work (less well paid and with lower status) (p. 224).

Cardiac Disease and Surgery

*Boudrez, H., G. De Backer, and B. Comhaire. "Return to Work after Myocardial Infarction: Results of a Longitudinal Population Based Study," European Heart Journal, 15, 1994, 32-36.

200

*Danchin, N. "Work Capacity after Myocardial Revascularization: Factors Related to Work Resumption," European Heart Journal, 9 (Supplement L), 1988, 44-47.

Denolin, H., G. A. Feruglio, F. Gobbato, and G. Maisano. "Guidelines for Return to Work after Myocardial Infarction and/or Revascularisation," European Heart Journal, 9 (Supplement L), 1988, 130-31.

*Fitzgerald, Sheila T., Diane M. Becker, David D. Celentano, Robert Swank, and Jeffrey Brinker. "Return to Work after Percutaneous Transluminal Coronary Angioplasty," American Journal of Cardiology, 64, November 15, 1989, 1108-12.

*Gehring, J., W. Koenig, N. W. Rana, and P. Mathes. "The Influence of the Type of Occupation on Return to Work after Myocardial Infarction, Coronary Angioplasty and Coronary Bypass Surgery," European Heart Journal, 9 (Supplement L), 1988, 109-14.

Giordano, A. A Agostoni, L. Ambrose, M. Cafiero, V. Ceci, G. C. Cesana, F. D'Adda, A. Grieco, G. Maisana, D. Mazzoleni, C. Schweiger, P. Seghizzi, R. Zanettini, and A. M. Zotti, "The Proposal of the Italian Committee on Occupational Cardiology," European Heart Journal, 9 (Supplement L), 1988, 115-19.

*Hlatky, Mark A., Thomas Haney, John C. Barefoot, Robert M. Califf, Daniel B. Mark, David B. Pryor, and Redford B. Williams. "Medical, Psychological and Social Correlates of Work Disability among Men with Coronary Artery Disease," American Journal of Cardiology, 58, November 1, 1986, 911-15.

*Kalbfleisch, Karen R., Michael H. Lehmann, Russell T. Steinman, Ken Jackson, Kathi Axtell, Claudio D. Schuger, and Patrick J. Tchou. "Reemployment Following Implantation of the Automatic Cardioverter Defibrillator," American Journal of Cardiology, 64, July 15, 1989, 199-202.

*Kavanagh, T., and V. Matosevic. "Assessment of Work Capacity in Patients with Ischaemic Heart Disease: Methods and Practices," European Heart Journal, 9, (Supplement L), 1988, 67-73.

McGee, H. M., T. Graham, B. Crowe, and J. H. Horgan. "Return to Work Following Coronary Artery Bypass Surgery or Percutaneous Transluminal Coronary Angioplasty," European Heart Journal, 14, 1993, 623-28.

*Mark, Daniel B., Lai Choi Lam, Kerry L. Lee, Nancy E. Clapp-Channing, Redford B. Williams, David B. Pryor, Robert M. Califf, and Mark A. Hlatky. "Identification of Patients with Coronary Disease at High Risk for Loss of Employment: A Prospective Validation Study," Circulation, 86, No. 5, November 1992, 1485-94.

201 Marshak, Laura E., David Bostick, and Lawrence J. Turton."Closure Outcomes for Clients With Psychiatric Disabilities Served by the Vocational Rehabilitation System," Rehabilitation Counseling Bulletin, 33, No. 3, March 1990, 247-250.

*Monpere, C, G. Francois, C. Rondeau du Noyer, and J. Phan Van. "Return to Work after Rehabilitation in Coronary Bypass Patients: Role of the Occupational Medicine Specialist During Rehabilitation," European Heart Journal, 9 (Supplement L), 1988, 48-53.

*Mulcahy. R, C. Kennedy, and R. Conroy. "The Long-term Work Record of Post- Infarction Patients Subjected to an Informal Rehabilitation and Secondary Prevention Programme," European Heart Journal, 9 (Supplement L), 1988, 84- 88.

*Speziale, Giuseppe, Federico Bilotta, Giovanni Ruvolo, Khalil Fattouch, and Benedetto Marino. "Return to Work and Quality of Life Measurement in Coronary Artery Bypass Grafting," European Journal of Cardiothoracic Surgery, 10, 1996, 852- 58.

*Stanton, Babette A., David Jenkins, Phillip Denlinger, Judith A. Savageau, Ronald M. Weintraub, and Richard L. Goldstein. "Predictors of Employment Status After Cardiac Surgery," Journal of the American Medical Association, 249, No. 7, February 18, 1983, 907-11.

Turkulin, K., D. Cerovec, and F. Baborski. "Predictive Markers of Occupational Activity in 415 Post-myocardial Infarction Patients after One-year Follow-up," European Heart Journal, 9 (Supplement L), 1988, 103-08.

*Walter P.J. "Return to Work after Coronary Artery Bypass Surgery," European Heart Journal, 9 (Supplement L), 1988, 58-66.

The oldest article on cardiac surgery included in this report is Stanton et al. (1983). It deals with a survey of 228 patients and the results of examining the records of the 150 who were employed during the year before surgery. Of these, they found that 97 percent of college graduates returned to work, as did 75 percent of high school graduates, and 51 percent with less than a high school education. Because of this evidence, the article concluded that education, along with income, "were among the strongest independent predictors of postoperative return to work (p. 909)." However, more important than either of these factors were the patient's preoperative expectation, his fatigue scores, and angina levels (p. 910).

202 This last observation is contradicted by Mark et al. (1992), which reports on a survey of 872 coronary disease patients. By means of logical regression, the authors developed "a multi variable model for predicting 1-year work status (p. 1485)." They found that standard clinical variables provided only 20 percent of data for predicting return to work; and functional measures provided 27 percent, while demographic and socioeconomic measures provided 45 percent (p. 1485). The authors also state that most studies have found that nonmedical factors are at least as important if not more important than medical factors (p. 1486). The authors note that the fact that persons who have not worked for pay in the six-month period before the study were excluded may have influenced their findings. Age was found to be a factor in predicting employment: those employed after one year had a median age of 54 compared to 58 for those unemployed (p. 1487). Education was also a factor: those employed had a median education of 12 years, compared to 11 years for the unemployed; and 21 percent of the employed group were college graduates compared to 9 percent in the other group (p. 1487). Hlatky et al. (1986), using a large survey (814 men), also reported on the medical, psychological, and social correlates of work disability among men with coronary artery disease. They found that education was the single most important correlate of disability, followed by the number of previous myocardial infarctions, and the degree of psychological depression. The disabled (those who did not return to work) had an average of almost three years less education than the nondisabled, and only 36 percent of the disabled patients had 12 or more years of education compared to 67 percent for those working (p. 913). Two other American studies, Fitzgerald et al. (1989) and Kalbfleisch et al. (1989) also found that education is the best predictor of a return to work. The latter study also cites other studies with the same finding (p. 201). Foreign studies have had more varied results. Kavanagh and Matosevic (1988) report on a large Canadian survey (1150 persons). They found that the physical requirements of the job were the first nonmedical factor for return to work, followed by education (p. 68). A report done in Ireland by Mulcahy, Kennedy, and Conroy on a survey of 405 persons found that education made "little or no difference" on return to

203 work. Much more important were "age, initial employment status, social class, type of occupation, and domicile of patient (p. 87)." Monpere et al. (1988) found that in a small survey (57 persons) 97 percent returned to jobs of low physical demands and 46 percent to work of high physical demands (p. 50). Walter (1988) reviews numerous foreign and American surveys and concludes that the "main factors which influenced postoperative work resumption were age, relief of anginal symptoms and the preoperative employment status (p. 65)." Danchin (1988), a French specialist, reviewed two dozen European and American studies dealing with work resumption after myocardial revascularization. He found that return-to-work rates were consistently higher in the United States, Canada, and Great Britain than in France, Germany, and Switzerland: usually more than 60 percent in the first group and sometimes as high as 85 percent; on the Continent return- to-work rates rarely exceeded 50 percent (p. 45). According to Danchin, the two dozen studies reviewed generally showed that two types of data are important in determining who returns to work: medical (the success of the medical procedure), and nonmedical (the most important being the length of preoperative unemployment; if a patient has been unemployed for a year before surgery, the chance of returning to work is very unlikely to occur). The reviewed surveys also found that age at the time of surgery is also important. Also shown is that the higher the level of education, the higher is the return-to-work rate (p. 46). Gehring et al. (1988) report on a large West German survey (423 patients) that examined the effect of occupation on the return to work. They found that age, occupation, and preoperative absence from work allowed a prediction of 80 to 90 percent of patients who would return to work (p. 113). These results matched the results of earlier surveys (p. 113). Age was an important factor for blue-collar workers, but not for white-collar workers. Sixty percent of blue-collar workers under age 45 returned to work, compared to over 90 percent of white-collar workers of this age group. For those over age 54, the difference was much greater: less than 20 percent of the former returned to work after age 54, while more than 60 percent of the latter did (p. 113).

204 Boudrez, De Backer, and Comhaire (1994) looked at 295 Belgian patients who had a first myocardial infarction before the age of 60 years. They found that among nonmedical factors age was the most important factor in determining who returned to work. They found that there "was no association between return to work and several variables: civil status, income, education, compliance with diet, physical activity before and after the AMI [acute myocardial infarction], smoking habits (cigarettes, cigars, pipes) (p. 34). Noting the differences they found in various other surveys dealing with work-resumption rates, they state that these differences are probably explained by cultural differences, population selection characteristics, and selection of parameters to be studied (p. 35). Speziale et al. (1996) looked at 446 patients in Italy and found that of the nonmedical factors, work status before surgery was the best predictive variable of return to work. Age was the second best indicator. They found that "there was a significant relationship between a patient's educational level, employment status before CABG [coronary by-pass surgery] and socio-demographic characteristics, so that patients in professional and executive positions returned to work more frequently than others (p. 857)."

Psychiatric Disabilities *Anthony, William A. "Characteristics of People with Psychiatric Disabilities That Are Predictive of Entry into the Rehabilitation Process and Successful Employment," Psychosocial Rehabilitation Journal, 17, No. 3, January 1994, 3-11.

*Cook, Judith A., and Lisa Razzano. "Discriminant Function Analysis of Competitive Employment Outcomes in a Transitional Employment Program for Persons with Severe Mental Illness," Journal of Vocational Rehabilitation, 5, No. 2, May 1995, 127-39.

*Marshak, Laura E., David Bostick, and Lawrence J. Turton. "Closure Outcomes for Clients With Psychiatric Disabilities Served by the Vocational Rehabilitation System," Rehabilitation Counseling Bulletin, 33, No. 3, March 1990, 247-250.

*Rogers, E. Sally, William A. Anthony, Jean Toole, and Mary Alice Brown. "Vocational Outcomes Following Psychosocial Rehabilitation: A Longitudinal Study of Three Programs," Journal of Vocational Rehabilitation, 1, No. 3, July 1991, 21-29.

205

Aside from agreeing that persons with psychiatric disabilities have more difficulty finding employment than those with physical disabilities (with the exception of the Northwestern National Life study), surveys of the employment of persons with psychiatric disabilities have not elicited much data that permit reliable predictions of their employment. Over the years, Anthony (1994) has reviewed numerous surveys of patients with these disabilities and has found that many surveys contend that prior work history is the best indicator of a patient's employability. In some surveys, "employment history...accounted for 50 percent of the vocational outcome variance (p. 9)." A 1992 survey of surveys cited by Anthony found that persons with more work experience benefited more from vocational programs than those with little or no work experience. However, according to Rogers et al. (1991), a study in which Anthony himself was involved found that the only demographic differences between those employed and unemployed (a total of 214 subjects) were "marital status, symptoms, and work adjustment skills (p. 24)." Anthony conjectures that this result stemmed from the fact that the subjects of this study were highly motivated (p. 9). The study reported on by Cook and Razzano (1995) found that higher educational achievement was a slight advantage in finding competitive employment (p. 133). However, Marshak (1990), reporting on a study of 500 persons with psychiatric disabilities, found that educational level did not aid in finding employment, but that those between the ages of 26 to 40 did significantly better in this regard than those of other age groups (p. 248-49). Spinal Cord Injury

DeVivo, Michael J., and Philip R. Fine. "Employment Status of Spinal Cord Injured Patients 3 Years After Injury," Archives of Physical Medicine and Rehabilitation, 63, No. 5, May 1982, 200-03.

*DeVivo, Michael J., Richard D. Rutt, Samuel L. Stover, and Philip R. Fine. "Employment after Spinal Cord Injury," Archives of Physical Medicine and Rehabilitation, 68, No.8, August 1987, 94-98.

*Goldberg, Richard T., and Murray M Freed. "Vocational Development of Spinal Cord

206 Injury Patients: An 8-year Follow-up," Archives of Physical Medicine and Rehabilitation, 63, No. 5, May 1982, 207-10.

James, Magna, Michael J, DeVivo, and J. Scott Richards. "Postinjury Employment Outcomes Among African-American and White Persons with Spinal Cord Injury," Rehabilitation Psychology, 38, No. 3, 1993, 151-64.

Krause, James S. "Adjustment to Life after Spinal Cord Injury: A Comparison among Three Participant Groups Based on Employment Status," Rehabilitation Counseling Bulletin, 35, No. 4, June 1992, 218-29.

McShane, Steven L., and Jeffrey Karp. "Employment Following Spinal Cord Injury: A Covariance Structure Analysis," Rehabilitation Psychology, 38, No. 1, 1993, 27- 41.

Murphy, Gregory C., and James A. Athanasou. "Vocational Potential and Spinal Cord Injuries: A Review and an Evaluation," Journal of Applied Rehabilitation Counseling, 25, No.3, Fall 1994, 47-52.

Noreau, L., and R. J. Shephard. "Return to Work after Spinal Cord Injury: The Potential Contribution of Physical Fitness," Paraplegia, 3, No. 8, August 1992, 563- 72.

Young, Mary Ellen, Wayne G. Alfred, Diana H. Rintala, Karen A. Hart, and Marcus J. Fuhrer. "Vocational Status of Persons with Spinal Cord Injury Living in the Community," Rehabilitation Counseling Bulletin, 37, No 3, March 1994, 229-43.

The surveys dealing with the employment of persons with spinal cord injury (SCI) furnish generally clear indications of the importance of the vocational factors. James et al. (1993) reported on one large study dealing with a total of 1,238 persons between the ages of 16 and 61 who were employed when afflicted with SCI. The authors found that with regard to the 1,042 white subjects, age and education were clear indicators of employment. Age: Of those between the ages of 15 and 30, 37.2 percent had returned to work; of those between the ages of 31 and 45, 49.8 percent had returned to work; and of those between the ages of 46 and 61, 20.6 percent had returned to work. Education: Of those without a high school diploma, 27.6 percent were employed; of those who were high school graduates or had at least two years of college, 36.7

207 percent were employed; of college graduates and postgraduates, 69.9 percent were employed. The figures for the African-American subjects of the report corresponded closely to those for whites. All the other studies cited above have much the same data showing that the educational achievements of those with SCI is a very strong indicator of who will be employed. There is argument about what vocational factor is the most important. According to Goldberg et al. (1982), a study from the 1960s contended that "pre- disability employment was the best predictor of post-disability employment (p. 209). DeVivo et al. (1987), in a survey of 154 patients, found that being employed at the time of injury did not give an indication of the likelihood of employment later (p. 495). Goldberg et al. found that achieved education grade along with vocational development were the best indicators (p. 210). McShane et al. (1993), in a study of 120 persons in British Columbia, writes that educational attainment is the stronger direct predictor of employment (p. 36). The same article, however, cites other articles claiming that a person's age at the time of injury is a significant indication of post-injury employment (p. 29).

Stroke Black-Schaffer, Randie M., and J. Scott Osberg. "Return to Work after Stroke: Development of a Predictive Model," Archives of Physical Medicine and Rehabilitation, 71, No. 5, April 1990, 285-90.

*Howard, George, J., Stanwood Till, James F. Toole, Claire Matthews, and B. Lionel Turscott. "Factors Influencing Return to Work Following Cerebral Infarction," Journal of the American Medical Association, No. 253, January 11, 1985, 226- 32.

Saeki, Satoru, Hajime Ogata, Toshiteru Okubo, Ken Takahashi, Tsutomu Hoshuyama. "Factors Influencing Return to Work after Stroke in Japan," Stroke, 24, No. 8, August 1993, 1182-85.

*Saeki, Satoru, Haijime Ogata, Toshiteru Okubo, Ken Takahashi, and Tsutomu Hoshuyama. "Return to Work after Stroke: A Follow-up Study," Stroke, 26, No. 3, March 1995, 399-401.

208

Surveys of stroke victims found that the vocational factors of age and education clearly affected the rates of return to work for this population. With regard to work experience, it was found that those employed in professional or managerial positions returned to work at much higher rates than those in blue-collar or farm work. An American study, Howard et al. (1985) found that of 379 patients employed before cerebral infarction and employed one year later, age, education, and occupation were significant. Age: Of those 55 and younger, 30 percent had returned to work; of those aged 56 to 66, 27 percent had returned to work; of those 66 and older, 9 percent had returned to work. Education: Of those with less than a high school education, 10 percent had returned to work; of high school graduates, 14 percent had returned to work; of college graduates, 32 percent had returned to work. Occupations: Of those employed in professional-managerial positions, 35 percent had returned to work; of those in blue-collar jobs, 13 percent had returned to work; of those in farm work, 10 percent had returned to work (p. 227). The Japanese studies of 230 workers found that younger workers returned to work at greater rates than older workers; that white-collar workers returned to work more often than blue-collar workers; that 70.6 percent of college graduates returned to work, compared to 63.2 percent for high school graduates, and 44.0 percent for those with less than a high school education (p. 1183).

Traumatic Brain Injury *Crisp, Ross. "Return to Work After Traumatic Brain Injury," Journal of Rehabilitation, 58, No. 4, October-November-December 1992, 27-33.

*Dikmen, Sureyya S., Nancy R. Temkin, Joan E. Machamer, Ann Lu Holubkov, Robert T. Fraser, and H. Richard Winn. "Employment Following Traumatic Head Injuries," Archives of Neurology, 51, No. 2, February 1994, 177-86.

Haffey, William J., and Frank D. Lewis. "Rehabilitation Outcomes Following Traumatic Brain Injury," State of the Art Reviews: Traumatic Brain Injury, 3, No. 1,

209 February 1989, 201-18.

*High, Walter M., Jr., Wayne A. Gordon, L. Don Lehmkuhl, C. Nina Newton, David Vandergoot, Linda Thoi, and Linda Courtney. "Productivity and Service Utilization Following Traumatic Brain Injury: Results of a Survey by the RSA Regional TBI Centers," Journal of Head Trauma Rehabilitation, 10, No. 4, August 1995, 64-80.

*Kraft, Joan F., Karen A. Schwab, Andres M. Salazar, and Herbert R. Brown. "Occupational and Education Achievements of Head Injured Vietnam Veterans at 15-Year Follow-Up," Archives of Physical Medicine and Rehabilitation, 74, No.6, June 1993, 596-601.

Rao, Noel, and Mitchell Rosenthal. "Study Assesses Factors That May Signal Outcomes for People with Brain Injuries," Physicare, November-December 1987, 5.

Crisp (1992) is a review of 29 studies that deal with return to work after traumatic brain injury (TBI). Crisp reports that all surveys found that age was an important factor in determining whether someone with TBI returned to work. In general, persons over 40 years of age required more time to return to work than younger individuals. This was the case even for those suffering minor head injury (p. 30). Some studies found a correlation between greater education and greater return to work, but others did not. For example, one study found that "failure to return to work six months after injury was greatest among semi- or unskilled manual workers (p. 30)." Dikmen et al. (1994) surveyed 366 head-injured patients and found that age and education and stable employment were accurate indicators of employment after injury. Age: Of those aged 20 years and younger, 77 percent returned to work; for those aged 21 to 30 years, the figure was 69 percent; for those aged 31 to 40, 78 percent; for those aged 41 to 50, 73 percent; and for those aged 51 and above, 46 percent. Education: for those with less than a high school education, the return-to-work rate was 46 percent; for those with a high school education, 76 percent; those with an associate arts/vocational degree, 71 percent; those with a bachelor's degree or more, 87 percent. Employment: Those who had had stable employment before injury, 80 percent

210 returned to work; those with unstable employment, 60 percent (181). High et al. (1995) found education a decisive factor in employment. The study surveyed 763 persons with TBI and found that of those who were working at the time of the accident, only 6 percent of those with less 12 years of education were employed full-time, compared to 27 percent of those with graduate degrees (p. 70). Kraft et al. (1993) in their survey of 520 veterans also found that the greater the education level of a person, the higher the employment rate: elementary school, 26 percent employed; high school, 50 percent; college, 77 percent. This was the case for both those classified as less than 100 percent disabled and those seen as completely disabled (p. 599). Another likely indicator of the importance of education was that 54 percent of formerly enlisted men were employed, compared to 86 percent of former officers (p. 598). Roa et al. (1987) looked at 79 consecutive closed-head injury patients and found that patients who were hired did not differ significantly with respect to age or level of education. Numerous surveys of individuals with physical impairments resulting from cancer, cardiac disease, psychiatric illness, spinal cord injuries, strokes, and traumatic brain injury showed the decisive role played by the SSA's vocational factors in a person's return to work. These surveys showed repeatedly that in general, age, education, and work experience are good indicators of a person's likelihood of securing competitive employment. In two categories of impairment, however, those stemming from cardiac disease and cardiac surgery and psychiatric illness, the SSA's vocational factors played a less decisive or clear-cut role, and other factors frequently were found to be more important. The survey results indicate that an older individual is generally less likely to return to work and will retire. The most important nonmedical factor in return to work is the job’s physical requirements. The second most important factor is education. For example, results from German studies show that blue collar workers are less likely to return to work because the work requirements are less flexible. White collar workers, usually having a higher level of education, are able to alter the demands of work and

211 return to employment. One particularly telling statistic is that 97 percent of college educated cardiac patients were able to return to work. The survey results seem to indicate that vocational factors are an important consideration when determining disability status.

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