As the American workforce ages, the workers’ compensation industry is increasingly encountering claims involving injured workers who experience cognitive decline, either as a natural part of aging or exacerbated by injury-related complications. This shift presents unique challenges in claim management, clinical coordination, and return-to-work planning, especially when cognitive function impacts an injured worker’s ability to participate in treatment, follow care plans, or make informed decisions about their case.

The Aging Workforce and Cognitive Decline

The Bureau of Labor Statistics projects that by 2032, workers aged 65 and older will represent over 9% of the total labor force—a significant increase from previous decades [1]. With age comes a natural reduction in cognitive performance, particularly in areas such as processing speed, working memory, and executive functioning [2]. These changes may be mild and non-disruptive for many. However, in the context of a workers’ compensation injury—especially complex or chronic claims—these impairments can contribute to miscommunication, non-adherence to treatment, prolonged disability, and even increased litigation.

Impact on Decision-Making Capacity

Cognitive impairments can undermine an injured worker’s:

• Ability to comprehend medical advice
• Recall of treatment instructions or medication regimens
• Evaluation of risk vs. benefit in care decisions
• Understanding of legal documents (e.g., settlements, MSAs)

Research has shown that decision-making becomes less effective in older adults when tasks involve ambiguity, complex trade-offs, or delayed outcomes [3]. This directly impacts a worker’s capacity to navigate workers’ compensation claims, especially those involving multiple providers, prolonged recovery paths, or permanent impairment ratings.

Injury-Related Cognitive Complications

Beyond age-related changes, cognitive decline may be injury-related. Traumatic brain injuries (TBIs), chronic pain, and post-operative complications—especially in orthopedic or neurologic cases—can contribute to confusion, poor concentration, and diminished judgment.

Challenges for Claims and Clinical Teams

From a claims management perspective, cognitive decline complicates:

• Consent and capacity discussions
• Return-to-work evaluations
• Negotiation of settlements
• Completion of independent medical examinations (IMEs)

For nurse case managers and clinicians, ensuring comprehension and consistent engagement in care plans becomes more complex, requiring repeat education, caregiver involvement, and clearer communication strategies.

Practical Recommendations

To manage these claims effectively, workers’ comp professionals should consider:

• Early cognitive screening in aging claimants with prolonged or complex injuries
• Simplified communication strategies, such as written instructions or visuals
• Involving family members or legal guardians when decision-making capacity is impaired
• Utilizing geriatric care managers or specialists for aging claimants with layered needs
• Multidisciplinary review of care plans to ensure realistic recovery and RTW expectations

Conclusion

Cognitive decline—whether due to aging or injury—represents a growing and underappreciated factor in the management of long-tail workers’ compensation claims. Awareness, early identification, and tailored intervention can prevent poor outcomes, protect reserves, and ultimately support better recovery trajectories for older injured workers.

References

1. U.S. Bureau of Labor Statistics. Older workers: Labor force trends and career options. https://www.bls.gov/careeroutlook/2019/article/older-workers.htm
2. Harada CN, Natelson Love MC, Triebel KL. Normal cognitive aging. Clin Geriatr Med. 2013;29(4):737–752. doi:10.1016/j.cger.2013.07.002
3. Finucane ML, et al. Aging and decision-making competence: An analysis of comprehension and consistency skills. Psychol Aging. 2002;17(3):353–367.