1. Issues in Aging Among Farmers University of Kentucky Deborah Reed Lori Garkovich Mary Kay Rayens Susan Westneat Steve Browning University of Minnesota Jan McCulloch Clemson University Charles Privette NIOSH grant # R01 OH04157-01A1

2. Objectives for this session  Understand the normal aging process  Define “health” from a farmer perspective  Examine the health status of older farmers  Describe injury patterns of older farmers  Describe the sociocultural context of farm work  Examine work organization and adaptations  Identify methods to assist older farmers and their families 2/62

3. What makes farmers so old?  Exodus of young people  “retiring” from a nonfarm career into farming  shift from part-time farming to full- time farming.  Gale (2002) estimates that “about 25,000 operators in the 65-and-older age group entered farming each year from 1978 to 1992.” 3/62

4. “Normal” Aging  Decreased respiratory capacity – 20’s  Presbyopia – 40’s  Compromised joints – 50’s  Skin changes – 60’s  Decreased distal sensation – 70’s  Temperature tolerance – 80’s 4/62

5. As age advances...  Prolonged recovery  Morbidity and mortality increases  Co-morbidities increase 5/62

6. Sample Sustained Work Indicators of Farmers Over 50  Farmers and their spouses over age 50 (N=1,423)  African American farmers in South Carolina  Predominantly white farmers in Kentucky  Recruited through household survey, KY FFHHSP, KY African-American ROPS Survey, SCASS 6/62

7. Method  4 survey waves 10/02-3/03 1423 10/03-2/04 1124 6/04- 7/04 992 3/05- 4/05 962  Mailed and/or telephone surveys  67.6% response rate 7/62

8. Summary Demographics CharacteristicWave 1Wave 2Wave 3Total N%N%N%N% Gender Male71451.548150.249451.7168951.2 Female67348.547749.846248.3161248.3 Race White109079.077781.576480.3263180.1 Black27319.816417.217518.461218.6 Other171.2131.3121.3421.3 Currently married Yes126091.187991.987391.5301291.4 No1238.9788.2818.52828.6 8/62

9. Summary Demographics (continued) CharacteristicWave 1Wave 2Wave 3Total N%N%N%N% State of residence Kentucky119085.884187.883186.9286286.7 South Carolina19714.211712.212513.143913.3 Age in years 50-5935326.321123.019120.975523.8 60-6957943.241345.039543.1138743.7 70 and older40930.529432.033036.0103332.5 9/62

10. Older Farmers...  Slowing reflexes  Physical wasting  Accelerated hearing loss  Arthritis  Cataracts  Skin cancer 10/62

11. Self-rated health CharacteristicWave 1Wave 2Wave 3Total N%N%N%N% Health status Excellent/very good46833.945147.136238.0128138.9 Good/fair80358.143044.952755.4176053.5 Poor1107.9767.9636.62497.6 11/62

12. Self-rated Health by Age Groups < 65 N=749 65 - 69 N=267 70+ N=407 Total Sample N=1,423 Excellent12.07.15.79.3 Very good28.425.117.524.7 Good36.733.335.235.7 Fair16.828.129.822.7 Poor6.16.411.87.8 12/62

13. Perspectives on Health Status How would you best define good health? Under 65 N=749 65 - 69 N=267 70+ N=407 Total Sample N=1,423 Absence of pain14.515.310.913.7 Ability to work39.140.041.8 40.0 Absence of major disease25.425.523.424.9 Not having to take medications 17.016.518.117.2 Some other definition3.92.85.94.2 13/62

14. Percent of respondents with each health problem *Calculated as a percentage of male respondents only Prevalence of health problems affecting at least 10% of male respondents 14/62

15. 15/62 Prevalence of health problems affecting at least 10% of female respondents

16. Comparisons of number of health problems by demographic characteristics ** *Comparison significant at p <.05 Average number of health problems 16/62

17. Activity Deficits – part 1 17/62

18. Activity Deficits – part 2 18/62

19. Take Prescription Meds Daily %FrequencyN Male70.9%350494 Female79.6%403506 Total sample 75.3%7531,000 19/62

20. Types of Meds Taken %Frequency Heart17.0129 Diabetes14.0107 Respiratory 2.519 Arthritis17.9135 Blood Pressure59.8450 Glaucoma 1.713 Thyroid 9.370 20/62

21. Depression – CESD Scores  20 items measuring depressive symptoms Possible score range from 0-60 12% scored above 16 (at risk) with half of those above 23 (probable depression) Compares somewhat favorably to general elderly population (14-44%) 21/62

22. “How do you see yourself?” Examples of Questions Asked  I’ve always felt I could make of my life pretty much what I wanted to make of it.  Once I make up my mind to do something, I stay with it until the job is completely done.  Very seldom have I been disappointed by the results of my hard work.  It’s important for me to be able to do things the way I want to do them rather than the way other people want me to do them. 22/62

23. John Henryism Scale  Self-efficacy scale  12 items 4 pt Likert  (completely true → completely false)  Lower score = higher self-efficacy  Sample did extremely well  Mean score 19.25 / 48  Males scored better than females (p=.03) but both in high end 23/62

24. Injury 24/62

25. Results: Injury rates by wave and gender WaveMale (1689) Female (1612) Overall Rate* 116.23.79.5 215.44.49.3 314.33.78.6 * Adjusted for age distribution 25/62

26. Farm Injury Rate Among Older Male Farmers by Age and Wave of Survey. Analysis based on 1689 (observations) of Older Male Farmers from Kentucky and South Carolina. Age in Years 26/62

27. Farm Injury Rate Among Older Female Farmers by Age and Wave of Survey. Analysis based on 1612 (observations) of Older Females from Kentucky and South Carolina. Age in Years 27/62

28. Distribution of Farm Injury for Males (n=282 injuries) n=49 17.4% n=13 4.6% n=20 7.1% n=19 6.7% n=2.7% n=179 63.5% 28/62

29. Distribution of Farm Injury for Older Female Farmers n=5 8.2% n=7 11.5% n=3 4.9% n=6 9.8% n=3 4.92% n=37 60.7% N = 61 Injuries 29/62

30. Preliminary Bivariate Association With Farm Injury CharacteristicN (farm injury)RateOR95% CI Race White2338.9 Black6210.11.160.85-1.57 Other614.31.720.64-4.31 Age 50-598911.71.401.01-1.92 60-691198.60.990.73-1.33 70 & older908.7 30/62

31. Preliminary Bivariate Association (continued) CharacteristicN (farm injury) RateOR95% CI Gender Male24214.34.253.15-5.74 Female613.8 Work Status More time4616.42.941.85-4.66 Same time1899.61.581.11-2.26 Half as much238.31.350.77-2.34 Much less446.3 31/62

32. Percent of respondents injured, by injury type Percent injured within the last 12 months, by type and source Type of Injury *Includes sprains, strains, etc. 32/62

33. Work 33/62

34. Characteristics of the farm respondents and the farm operation Under 65 N=749 65 – 69 N=267 70+ N=407 Total Sample N=1,423 General type of farm Livestock3.53.94.53.9 Crops32.636.532.733.4 Both63.959.662.8 Proportion of farms with the following crops or livestock Hay65.866.764.465.6 Cattle and calves61.457.362.961.1 Tobacco49.750.251.650.3 34/62

35. Farm Work Status Compared to Last Year < 65 N=749 65 - 69 N=267 70+ N=407 Total Sample N=1,423 More time13.98.64.210.2 About the same57.259.155.457.1 Half as much time 8.29.09.28.6 Much less time20.623.431.224.1 35/62

36. Performance of Farm Tasks Over Time In past 5 yearsSince April 2002Total Sample N=1,423 < 65 N=748 65-69 N=267 70+ N=407 < 65 N=748 65-69 N=267 70+ N=407 In past 5 years Since April 2002 Crop Production Activities Till ground (plow, disc) 43.344.941.835.133.730.743.133.6 Plant crops 47.443.836.636.334.526.843.633.2 Apply pesticides, herbicides, insecticides 44.541.139.134.833.329.242.433.0 Bale hay or straw 42.537.838.633.932.631.440.533.0 Hand harvest crop 35.027.326.322.821.316.231.120.7 Transport crops 30.625.521.123.619.917.026.921.0 Operate a combine 9.28.65.45.26.03.48.04.8 Chop silage 4.85.2 2.33.73.45.02.9 36/62

37. Animal Production Activities Feed animals 63.053.952.856.249.144.758.451.6 Mow fields 51.850.953.843.547.247.952.245.5 Herd animals 42.536.736.938.231.831.039.834.9 Transport animals 38.931.529.233.228.824.134.729.8 Other veterinarian work 31.525.823.627.423.617.928.224.0 Castrate animals 23.825.521.918.020.217.723.518.3 Milk animals 4.93.4 2.32.21.24.22.0 In past 5 yearsSince April 2002Total Sample N=1,423 < 65 N=748 65-69 N=267 70+ N=407 < 65 N=748 65-69 N=267 70+ N=407 In past 5 years Since April 2002 37/62

38. In past 5 yearsSince April 2002Total Sample N=1,423 < 65 N=748 65-69 N=267 70+ N=407 < 65 N=748 65-69 N=267 70+ N=407 In past 5 years Since April 2002 Other General Farm Activities Run farm errands 74.967.463.171.264.057.570.165.9 Repair farm equipment/tools 47.149.850.445.7 44.548.645.3 Climbed higher than 8 feet 43.943.839.140.037.834.942.537.9 Operated farm equipment on highways 41.438.236.639.932.632.239.436.3 Farm Management Tasks Paid farm bills 75.273.468.372.266.362.972.968.4 Done farm bookkeeping 66.156.255.564.852.451.161.258.5 Order farm supplies 60.755.855.456.950.250.458.253.8 Purchased major farm supplies or equipment 44.643.143.537.134.133.444.035.5

39. Comparisons of number of farm tasks in last 5 years and last 12 months a by demographic characteristics *Comparisons were made between the levels of the demographic variable for a fixed time; bars with the same letter are not significantly different (p >.05) Average number of farm tasks done a Solid bars give tasks done in the last 5 years; hashed bars refer to tasks in last year a a 39/62

40. Retired from farming? Amount of Farming < 65 N=749 65 - 69 N=267 70+ N=407 Total Sample N=1,423 Completely retired15.320.730.620.7 Partially retired37.654.451.544.7 Not retired47.124.917.934.6 40/62

41. Adaptations to Continue Farming In next 5 years, how likely will you: < 65 N=749 65 - 69 N=267 70+ N=407 Total N=1,423 Stop farming completely Likely47.161.064.354.6 Not likely at all52.939.035.845.4 Change type of farming (e.g. crops instead of livestock) Likely33.631.025.130.8 Not likely at all66.469.174.869.3 Transfer farm management to another person(s) Likely30.641.343.636.2 Not likely at all69.458.756.563.8 Have someone else take over farm tasks Likely39.151.455.546.0 Not likely at all60.948.644.554.0

42. Adaptations to continue farming Under 65 N=749 65 - 69 N=267 70+ N=407 Total Sample N=1,423 In the past 5 years, have you done any of the following to make your farm work easier? Bought newer equipment to make a farm task easier to do 59.850.645.053.8 Reduced the scale of my operation31.933.034.232.7 Stopped raising or producing a particular crop or animal 25.520.026.324.7 Had someone else take over a farm task 17.123.629.221.8 Leased out or sold land19.016.425.820.4 Purchased a computer for farm use24.614.27.417.7 Changed from primarily crop production to livestock production 15.415.716.215.7 Changed from primarily livestock production to crop production 5.95.66.96.1 42/62

43. Farm Work Satisfaction < 65 N=749 65 - 69 N=267 70+ N=407 Total Sample N=1,423 A great deal56.9 67.159.8 Some31.230.823.528.9 Very little7.26.75.06.5 None4.75.54.44.8 43/62

44. “Cutting Back” Transitioning from farmer to retiree … learning from focus groups … 44/62

45. Objective Identify the processes, barriers, and facilitative factors included in the decision of farmers age 50 and over to retire from farm work 45/62

46. Farming – Cradle to Grave  Most rapidly aging occupation in America  Family structured  Historical and cultural context 46/62

47. FACTORS THAT INFLUENCE THE DECISION TO CONTINUE FARMING  Social factors Type of farm enterprise Household composition Economic status  Structural factors Opportunities for labor substitution Availability of hired labor Degree of mechanization Ownership 47/62

48. WORK AND ITS MEANING  To be a farmer is to be a manager, owner, employee and laborer – all simultaneously.  To be a farmer is to “carry on the family tradition”  To be a farmer is to become part of the land itself 48/62

49. SAMPLE (N = 67) CouplesFemalesMalesTOTAL Black8 (16)6628 White14 (28)6539 Total22 (44)121167 Selected counties in Kentucky and South Carolina 49/62

50. PRIMARY CONCEPTS  Farm management and decision making  Physical farm labor  Use of technology in farm practices  Health  Attachment to land 50/62

51. Summary of Findings  Technology and production modifications allowed farmers to remain in physical labor on the farm but decrease the amount of time (“cutting back”)  Attachment to land: major factor in sustained work of older farmers and spouses  Intend to remain active until health forces them to retire 51/62

52. Summary of Findings (continued)  Farming and farm work is a part of the self-identity  When planning occurs for retirement it is most often in the context of the land, not personal wellbeing. 52/62

53. Persistence of Work  Self-defined as “retired” or had “cut back” “I’m retired from the physical part….still do all the management. I drive the tractor. I do the silage and rake the hay. But all I really do is manage the dairy.” ‘Retired’ farmer I help my neighbors and son when they need it. I still do some custom work [ hay]. We do some research plots for seed. Definition of work: “If you love it, it’s not work.” 53/62

54. Meaning of Work  Defines health “I can’t think of a time I wouldn’t be raising cows unless I was dead or disabled.” “We don’t really want to be retired because, truth is, you haven’t got long.” “As long as I can climb onto a tractor I will. If you stop, you set still and die.” Defines self  “farming is a habit, a way of life. We don’t know anything else to do.” 54/62

55. FINDINGS (continued)  Over half of farmers had also held off farm jobs Retired from off farm jobs; increased farm work Felt farm work reduced their overall stress and relaxed them from their off farm job strain “It would be hard to quit farming. It would be depressing. I might end up being a statistic [suicide].” 55/62

56. CONCLUSIONS  Farmers rarely retire completely from farming  Modify work organization and environment  Family members have evolving roles  Health status not as important as attachment to land  Under such conditions, farmers may place themselves and family members at risk for illness and injury 56/62

57. Application to Field Practice  Provide counsel on risk reduction  Develop farm work guidelines for seniors  Assess the whole picture 57/62

58. IMPLICATIONS  Need to be aware of physical and psychosocial factors that influence farmers’ decisions to remain active in farm work  Ask specifics about any farm work- including management  Older farmers and their spouses should be assessed for “work fitness”  Older farmers should be guided to make management and ergonomic changes in their farm operations to optimize their health  Families should be counseled on role transference to minimize stress 58/62

59. Heritage, History, Home, Health “How can you explain to someone, ‘ this used to be a washed out gulley. I put in that waterway’ or ‘that land used to be so tired but look at it now’. How can you explain what this feeling means. It’s our life, our history, our home.” - SC farmer 59/62

60. Persistence “My Doctor, after I cut my leg off, he said just to sell the farm and retire. I was so mad, I’m not going to sell what we worked so hard for! This is what I do. This is who I am, I’ll find a way to do it. I have to.” DB, age 70 60/62

61. Why do you continue to farm? “It’s in the blood. We’ve always liked it. It’s part of who we are.” 61/62

62. Pack and Go 62/62