Frailty: what is the connection with our working lives?

People are living longer, and the number of over-65s is expected to reach around one in four of the UK population by 2050. But is retirement a golden age, or will we be dogged by poor health? Wentian Lu from University College London and colleagues investigated how our working pattern throughout our lives affects our health after we retire, and found interesting differences between men and women.

Government policies are focused on extending our working lives, and record numbers of people are now working beyond state pension age. But what effect is it having on our health?

The UK government’s former older workers champion, and pensions expert, Dr Ros Altmann argues that raising the state pension age is a blunt instrument for managing old-age support, which could compound existing social and health inequalities.

With people being expected to work for longer, it is critical to understand whether and how people’s working lives affect their later life health.

A recent study led by colleague Dr Giorgio Di Gessa found no significant health benefits from working beyond state pension age, once social background, previous health and employment histories were taken into account.

Our investigation was the first in England to focus on the impact of earlier working patterns on health in later life.

We used information on more than 1,600 men and nearly 2,800 women from the English Longitudinal Study of Ageing. Health-related information on a range of things such as chronic conditions, pain, depression, heart disease, falls, fractures and joint replacement was used to develop a frailty index.

Using detailed work histories between the ages of 16 and 64 for men (16 and 59 for women), they were divided into groups which ranged from ‘full-time employment throughout’ to ‘unemployed throughout’. For men, we considered those who left work early, at either 60 or 49 years, and those who started work late (e.g because they went to University or spent time gaining other qualifications) and retired at 60.

For women’s employment histories, we also took account of part-time working, long and short career breaks, family care, and those who only had occasional work and retired early.

Frailty over time

The study confirmed that frailty increased with age, accelerating after 65 for women and 70 for men.

The findings showed that women who took a short break for family care and then worked part-time until they were 59 had better health at retirement age than those who were mostly in full-time work. Experiencing long career breaks or only working occasionally also appeared to be more detrimental for women’s health. This finding supports the importance of work-life balance for women’s health in later life.

Women who returned to work part-time after a short career break were healthier than those who went from family care to full-time work. If further studies confirm this result, it would indicate that working part-time while their children are young can have long-term positive benefits for women’s health. The key to maintaining the long-term health of today’s generation of working mothers will be to promote flexible working policies, such as flexible start and finish times, allowing women to balance work and childcare.

Consistent with previous studies, our investigation found that women who have never worked tend to have poorer health than those who worked full-time until the age of 60. What was more surprising was that women who never worked experienced a slower decline in their health beyond the age of 60, even when social background and health-affecting behaviours such as smoking and drinking were taken into account.

Early retirement

Men who retired early at either 49 or 60 had poorer health than those who worked until they were 65. However, leaving paid employment before the age of 65 slowed down the progress of poor health in later life.

This supports the findings of previous studies which show that the burden of ill-health is substantially relieved by early retirement. With Government policies encouraging older people to work longer, our research lends further weight to concerns that this may not be good for those already suffering poor health.

Another unexpected finding was that men who started working later in life and retired at around 60, who tended to be those more highly educated and with greater social advantage, actually experienced more rapid declines in health after the age of 65 than those who worked full-time from an earlier age and retired early. This was a small group, so further research is needed to explore this in more depth.

Despite limitations imposed by some of our employment history groups being quite small, as well as possible biases coming from participants’ subjective reporting of health issues, our findings offer important pointers for developing effective strategies to improve health for older people in the UK.

If, as Dr Altmann suggests, the government could replace the blunt instrument of raising state pension age with more finely-tuned policies, allowing those who can and want to extend their working lives to do so in a flexible way, this would be fairer and give the most vulnerable a better chance of enjoying a healthy retirement.

Further information

Relationship between employment histories and frailty trajectories in later life: evidence from the English Longitudinal Study of Ageing is research by Wentian Lu, Rebecca Benson and Amanda Sacker of University College London, Karen Glaser and Laurie Corna of King’s College London, Loretta Platts of Stockholm University, Diana Worts and Peggy McDonough of the University of Toronto, Giorgio Di Gessa from the London School of Economics and Political Science, and Debora Price of the University of Manchester. It is published in the Journal of Epidemiology & Community Health.

 

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