Presenteeism can be viewed from two distinct perspectives. It is, of course, the literal antonym of absenteeism, and UK and European researchers in management, epidemiology, and occupational health [1
] have investigated this positive aspect of the term, i.e.
, when employees remain at work, even when they are sick, or overstate their attendance, because of job insecurity due to downsizing and restructuring forces. However, presenteeism can be regarded as an indicator of lost work productivity, and US medical researchers and consultants [4
] are concerned about the adverse effects that sickness and specific medical conditions might have on work productivity in organizations.
In this article, we discuss presenteeism from the perspective of lost work productivity, because such analysis can address gray gaps between the absence of productivity and full productivity [5
] and between healthy and unhealthy persons [6
]. Moreover, previous studies suggest that further research is needed in order to better understand the potential differences between absenteeism and presenteeism [7
Presenteeism was initially defined in the field of occupational health as the act of attending work while unable to perform effectively due to health problems [12
]. The increasing attentions has been attracted is because presenteeism is responsible for 3 times and 1.8 times the financial burden of medical illness and absenteeism, respectively [14
]. However, with the development of definition of presenteeism, more recently the definition has been extended to include other conditions and events that limit productivity, as suggested by Johns [15
]. Advances in public health, medicine, science, and technology have greatly improved the health and life expectancy in developed and developing countries [16
]. However, although retirement age is now older [18
], physical and cognitive capabilities nevertheless deteriorate with age. This could lead to productivity loss and increased employer concerns regarding organizational competitiveness. Unfortunately, the extent of presenteeism among aging workers is not well understood.
Employees who have demanding jobs, low decision latitude, job strain, and/or low social support tend to have more sickness absences [20
] and, consequently, severe presenteeism [21
]. Job stress occurs when an individual ability cannot meet job demands [24
]. The job demand–resources model (JD-R) holds that when job demands are high and there are few job resources, employees may suffer more job stressors, which results in high job stress and other consequences. Because job demands must be satisfied if a worker is to remain employed, employees pretend to work hard at the workplace and forgo absences, even while they are sick or not fully productive. The greater the job requirements, the more efforts employees make in meeting them and the greater the probability that they will work while sick, to ensure full-time presence [26
Fortunately, strong support from co-workers and supervisors improves work environments by relieving employee stress [27
], which enhances job satisfaction and performance [29
] and subsequently reduces presenteeism in enterprises and organizations [30
]. Supervisors are in positions that can address employee complaints and help employees obtain necessary resources [32
]. Co-workers can successfully finish work tasks and reduce stress and presenteeism [33
]. In agreement with the buffering model of social support, Cummins [34
] reported that employees that had good relationships with supervisors and co-workers are usually successful and productive at work, even when job stress is severe. Although co-worker support and supervisor support are both important in reducing job stress [35
], most studies have investigated these two support mechanisms separately [36
]. In addition, the relationship between co-worker and supervisor support has rarely been studied. Moreover, the level of co-worker and supervisor support that employees in an aging workforce receive is unclear.
Most previous studies [27
] used linear regression to investigate relationships between co-worker support, supervisor support, job stress, and presenteeism; however, such analysis cannot account for the complicated relationships among these variables. In this study, we used structural equation modelling (SEM) to examine the complicated effects of co-worker and supervisor support on job stress and presenteeism in an aging workforce. We hypothesized that there would be a direct buffer effect of supervisor support on job stress and presenteeism, a direct buffer effect of co-worker support on job stress and presenteeism, and a direct positive effect of job stress on presenteeism (Figure 1
Initial model of how co-worker and supervisor support affect job stress and presenteeism.
Initial model of how co-worker and supervisor support affect job stress and presenteeism.
Presenteeism was low in this representative sample of older US workers. Job stress was moderate, and co-worker and supervisor support were high. SEM revealed that job stress had a significant direct positive effect on presenteeism (β = 0.30). Co-worker support had significant direct negative effects on presenteeism (β = −0.11) and job stress (β = −0.10). Supervisor support had an insignificant effect on presenteeism but a significant negative effect on job stress (β = −0.40). Co-worker support and supervisor support were highly correlated (β = 0.67).
The path with the highest standardized maximum-likelihood estimation was the inter-relation between co-worker support and supervisor support (β = 0.67). Social capital theory [52
] holds that both co-worker support from the horizontal dimension (that is, social contacts and level of trust in relation to co-workers) and supervisor support from the vertical dimension (that is, the relation with a supervisor across different levels of power dimensions) indispensably contribute to a supportive work environment by reducing job stress and strain [58
]. This supportive work environment not only leads to trusting relations at work, thereby enabling employees to access resources—it was also associated with better health status in both individual-level [60
] and multilevel [61
] studies. This is consistent with our findings and the results of subgroup analyses. However, to our knowledge, the correlation between co-worker and supervisor support has not been carefully examined previously [62
], although studies have separately studied the effects of co-worker and supervisor support in different industries [63
]. Our findings indicate that aging US workers have good relationships with their colleagues and supervisors and therefore work in a more supportive work environment and have better health status, perhaps because of their long work experience in their positions. Thus, the importance and strong correlations of co-worker and supervisor support in the work environment with health status should be simultaneously examined in future studies of the aging workforce.
We investigated the buffering effects of work support on job stress and presenteeism and found that co-worker support significantly affects presenteeism and job stress and that supervisor support has a significant direct negative effect on job stress but not presenteeism. These findings accord with those of previous studies of co-worker support, supervisor support, and presenteeism [35
]. The difference in the effects of co-worker and supervisor support on presenteeism could be due to the differing roles of co-workers and supervisors. The buffering model of social support holds that employees who lack social support shift their resources from current work tasks to managing high levels of job stress [67
]. To cope with these job stresses, employees collaborate with co-workers in reducing their complaints and presenteeism. However, because resources for employees are always limited, and supervisors are the ones responsible for assigning work tasks to employees, it is reasonable to see a strong negative effect of supervisor support on job stress but only a modest negative effect of co-worker support on job stress.
Another reason for the difference in the effects of co-worker and supervisor support on presenteeism may be that the targets of work support differ. Whereas supervisor support more strongly affects job stresses such as workload [68
], co-worker support has a stronger impact on job performance [63
]. One logical interpretation of co-worker support is that employees who believe that they are supported by colleagues enjoy their work environment and thus excel in their work and perform better than those with less support. They feel comfortable requesting co-worker help in completing certain unclear tasks, which decreases presenteeism [69
]. Our findings thus explain why supervisor involvement, especially supervisor support, is essential to the success of stress interventions in enterprises and why co-worker support should be the first priority when attempting to reduce presenteeism. Subgroup analysis showed that the negative effect of co-worker support on job stress was not significant among younger participants and that the negative effect of co-worker support on presenteeism was not significant among participants with above-average health. Studies of the social status of participants in the HRS indicate that more participants rated their social status as higher than middle class in the old group (74.9%) than young group (64.6%), and our results indicate that the main job stress for these older participants had become so organizationally broad (e.g., how to use limited resources to successfully manage an entire team or even the enterprise itself) that only experienced colleague could easily share these challenges, while these younger participants might have no such experienced colleague and still address their job stress relying on the support from their supervisors. Subsequently, from the perspective of the social capital theory [52
], a supportive work environment consisting of good co-worker support and supervisor support enables employees with better health status to have less potential productivity loss due to health conditions, while employees with average-poor health status might choose sickness presenteeism.
The present findings confirm that job stress has a significant direct positive effect on presenteeism (β = 0.30), which is consistent with previous findings. An earlier study [71
] reported a moderate relationship between presenteeism and job stress (Spearman correlation coefficient = 0.353–0.431, estimate with presenteeism) in analyses of a general population survey. That study assessed job stress from the dimensions of interpersonal relations, roles of stress, and intrinsic factors in work. In the present study, we viewed job stress from six dimensions (e.g., physical demands) in a comprehensive SEM model focusing on a representative aging workforce. The resulting findings are likely to be more accurate and specific to aging workers than those of previous studies.
We used SEM to construct a comprehensive model that examined the relationships between presenteeism, job stress, co-worker support, and supervisor support, while considering the job demand–resources and buffering model of work support. In our case, only 22% of the variability in job stress was explained by co-worker and supervisor support, and 13% of the variability of presenteeism was explained by job stress, co-worker support, and supervisor support. Low variability percentages are common when the outcome variables are perceptions, attitudes, and behaviours [72
]. Attitude and behaviour are very subjective and vary a great deal inter- and intra-personally; thus, our model is still robust. Future studies are likely to use this model to investigate different populations.
We believe that presenteeism in an aging workforce has unique characteristics that have not been directly studied previously. The present level of presenteeism was low, job stress was moderate, and co-worker and supervisor support were high. These results indicate that a high level of work support could effectively address the negative effects of job stress and their impact on presenteeism. Previous studies [73
] reported that presenteeism was lower among older adults than among younger adults, but this phenomenon has not been directly studied. There are three possible explanations for the lower presenteeism among older adults. Firstly, older workers may grow accustomed to job stress during the previous 30 to 40 years of work. Job stress might no longer affect their work performance to the extent that it affects younger workers. Secondly, as more than 70% of participants rated their social status as higher than middle class, it indicates that most of the aging workers were supervisors. Thus, as compared with participants who had supervisor-related job stress, they might have had fewer work difficulties, which could lower job stress and presenteeism. Thirdly, aging participants might have stronger social support and responsibility for their work because of their long work experience [75
]. Policymakers should be made aware of the importance of the aging workforce. Because of their reliability and professionalism, aging workers have a key role in addressing the challenges of an aging society.
Therefore, among the aging working population, we suggest that supervisors share difficult work tasks among employees and build a supportive work culture to reduce presenteeism, increase employee job satisfaction [76
] and organizational commitment [77
], and decrease turnover [78
]. Additionally, reciprocation of work support between lower-level employees and managers may decrease job stress and increase productivity [79
]. Combined co-worker and supervisor support is effective in reducing job stress and improving presenteeism among an aging working population. Ultimately, interventions targeting job stress—such as flexible work scheduling, workload sharing among supervisors, co-workers, and employees, and appropriate supervisor behaviour and attitudes toward employees—can substantially reduce stress and presenteeism.
Several limitations warrant attention. Firstly, our results may not be valid for young working populations and other countries because our population was mainly older US employees. Nevertheless, our findings will be helpful to policymakers from countries and regions facing the challenges of an aging society, especially those in Europe, Japan, and China. Secondly, the use of secondary data in the present study limited the selection of target variables for our model. For example, workplace policies are an important issue in presenteeism but were not included in the HRS data. This is a common criticism of social science research, as it nearly impossible to consider all relevant constructs within a model. Thirdly, our use of self-reported presenteeism rather than objective measures may limit the generalizability of our findings. Future research should analyse both subjective and objective data. Fourthly, to differentiate supervisor support and co-worker support at the workplace, we did not consider other aspects of social support in this study, such as work–life enhancement and interference. Fifth, we chose to use a cross-sectional study design because data for some of the investigated variables were only available in 2010. Future research should use longitudinal designs to investigate the relations between co-worker support, supervisor support, job stress, and presenteeism. Finally, we did not consider both the positive and negative aspects of presenteeism and job stress in this study. This also limits the generalizability of our model and conclusions.