Tag Archives: Disability

Young woman sat by window

Are some types of job bad for your mental health? And how can employers ensure poor mental health does not lead to early retirement?

Mental illness is a major cause of early retirement – but do those who are forced to leave work early for this reason get better afterwards? What is the relationship between work stress and mental health? A new study of public sector workers in Finland suggests there is a link – and there are important lessons for employers. Tarani Chandola from the ESRC International Centre for Lifecourse Studies was among the authors of the study.

One way in which we can track the prevalence and level of mental illness is by looking at the use of psychotropic medication – that is, medication which can alter one’s mental state. This group of drugs includes common antidepressants, anti-anxiety drugs and antipsychotic medication. 

If there is a link between work stress and mental illness, then we should expect those forced to leave work for this reason to get better after retirement. So by tracking the levels of psychotropic medication among a group of workers before and after retirement, we could find out the extent to which there was such a link.

We were able to use data from a long-term study of Finnish public sector workers to examine the issue more closely. 

It matters because previous studies have shown an increase in the use of this group of drugs among all those who take disability retirement, particularly those whose retirement was due to mental ill health. Those from higher social classes saw the biggest drop in medication use after retirement, suggesting there are social factors at play here, too.

Global issues

The effect does seem to vary around the globe, though – some studies from Asia found an increase, rather than a decrease, in mental health problems after leaving work. But in Europe, retirement has often been found to be followed by an improvement in both mental and physical health. Retirees have reported sleeping better, feeling less tired and generally feeling a greater sense of wellbeing. 

We were able to use data from the Finnish Public Sector study cohort study, which followed all employees working in one of 10 towns and six hospital districts between 1991 and 2005. The study included participants from a wide range of occupations including administrative staff, cleaners, cleaners and doctors, and they were followed up at four-year intervals regardless of whether they were still in the same jobs. Their survey responses were linked to a register of medication purchases for at least two years before retirement and two years after.

We had information on 2,766 participants who took retirement because of disability. Uniquely, the data included both participants’ use of medication and their perceived levels of work stress. So we were able to ask whether there were differences in this pre and post-retirement effect between those in low and high-stress jobs.

Specifically, we looked at something called effort-reward imbalance – that is, when workers put in too much effort at work but get few rewards in compensation: according to a recent review, this carries an increased risk of depressive illness. 

If our theories were correct, we would see a decline in the use of psychotropic medication after disability retirement, and it would be greatest among those with high levels of effort-reward imbalance. Along with mental illness the other major cause of disability retirement in Finland is musculoskeletal disease, so we categorised our sample in three groups – mental illness, musculoskeletal disease and ‘other.’ Eight out of 10 in the sample were women, and three out of 10 reported high effort-reward imbalance before retirement.

Unsurprisingly, those who retired due to a mental disorder had the greatest increase in psychotropic drug use before retirement. And those who were in high-stress, low-reward jobs had higher levels of medication use than those who were not. But after retirement, there was no difference in psychotropic drug use between those with high vs low effort-reward imbalance. It looked as though stopping work in high stress jobs reduced the need for higher psychotropic medication use among those workers who exited the labour market for mental health reasons.  

Retirement because of musculoskeletal disease or other causes was not associated with any similar link between stress level and psychotropic medication.

Lessons for employers

Our study showed that among people retiring due to mental disorders, those in high-stress, low-reward jobs benefited most from retirement. So it’s likely that they could benefit from the alleviation of work-related stress before retirement, too.

In conclusion, if employers could find ways of reducing the levels of stress suffered by employees suffering from mental ill-health, their early exit from paid employment might be prevented and their working lives might be extended. 

Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress was published in the European Journal of Public Health, Vol. 0, No. 0, 1–6. 

The other authors were Jaana Halonen, Taina Leinonen, Ville Aalto, Tuula Oksanen, Mika Kivimäki and Tea Lallukka of the Finnish Institute of Occupational Health; Hugo Westerlund and Marianna Virtanen of the Stress Research Institute, Stockholm University; Martin Hyde of the Centre for Innovative Ageing, Swansea University; Jaana Pentti, Sari Stenholm and Jussi Vahtera of the Department of Public Health, University of Turku; Minna Mänty of the Department of Public Health, University of Helsinki; Mikko Laaksonen of the Research Department, Finnish Center for Pension.

These authors also have the following additional affiliations: Jaana Halonen; Stress Research Institute, Stockholm University; Jaana Pentti; Department of Public Health, University of Turku; Minna Mänty; Statistics and Research, City of Vantaa, Finland; Mika Kivimäki, Department of Public Health, University of Helsinki and Department of Epidemiology and Public Health, University College London; Marianna Virtanen, School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu; Tea Lallukka, Department of Public Health, University of Helsinki.

Are universal state pensions discriminating against those in lower-skilled jobs?

With the state pension age likely to rise further in coming years, are policymakers right to link pension eligibility to average life expectancy? In a one-size-fits-all system, which social groups will lose out? Dr Emily Murray and colleagues* used census data to look at who lives longest after leaving work.

In most industrialised countries, the eligibility age for state pensions is being increased. Between 2011 and 2018, the United Kingdom government raised the State Pension Age for women from age 60 to 65, to match that for men, and a further increase to age 67 for both genders is planned by 2028. A further increase to age 68 by 2039 has been mooted.

Yet our state pension system ignores some very basic facts – it doesn’t take into account the wide disparities in health and life expectancy between different social classes. Those in professional occupations can expect to live longer and to enjoy good health for longer than those in manual jobs. For example, the average 50 year-old man in a professional job can expect to enjoy a further 25 years of good health, while a man the same age in a manual occupation can only expect 18: a seven-year difference. That is why lower social class groups are more likely to find themselves on disability benefit.

We wanted to look more closely at these occupational social class differences in the amount of time older adults live after they stop work, and in particular at the extent to which these differences are due to health.

We used the Office for National Statistics Longitudinal Study, a one per cent representative sample of respondents to the English and Welsh censuses since 1971.  For our analysis, we included respondents who were aged 50-75 at the time of the 2001 census and who had stopped work by 2011 – the average age of stopping was 58 for women and 60.2 for men. These workers were born in 1951 or earlier, so men would have been eligible for state pension at 65 and women at 60.

That gave us a sample of 76,485 people, and over the next 10 years we were able to monitor deaths  – by 2011 14.6 per cent of the women and 25.1 per cent of the men had died.

We could see that for both genders, those in lower social classes tended to die younger – professional women lived two years longer than unskilled women, and professional men three years longer than unskilled men.

We estimated professional women in good health would live five years longer than unskilled women in poor health, while for men the gap would be five and a half years.

But despite these longevity gaps, those from lower social groups were facing more years between leaving work and being able to draw their state pensions – because they left work earlier.

We estimated that if two women were 65 in 2001, the woman who had worked in an unskilled occupation would live five years longer after leaving work than the professional woman with good health – because the unskilled woman would have left at a younger age. Two men in the same circumstances would live on average 25.0 and 19.5 years from stopping work to death.

The most likely explanation is that poor health has a greater impact on the ability of manual workers to continue working than it does on non-manual workers.  It is however important to note that associations between social class and post-work years were not entirely explained by health, and we feel more research is needed on this.

Poor health

But the conclusion is clear: our results show that a uniform state pension age disproportionately affects the poorest among us, because on average they must wait longer between stopping work and qualifying for their state pension, at a time when they are likely to be in poor health. This is despite the fact that they are likely to have started work younger and therefore to have worked and paid contributions for just as many years as their better-off peers.

The solution to this inequality is not straightforward. The preferred strategy for UK policymakers is to support individuals to stay in work for longer, and there is evidence that the average age of leaving work exit is increasing.  However, over half of women and two-fifths of men  still fall out of the labour market before state pension age.

Some researchers have suggested that pension ages should directly reflect life expectancy differences.  Alternatively the age requirement could be dropped and pension eligibility could be based solely on the number of years in work.

We believe a two-year earlier pension age may be more appropriate for individuals who work in manual occupations, given that they leave work earlier than professional workers not in good health.  With rises in pension age already in law, and evidence of stalling life expectancy, it is vital that researchers and policy-makers assess how these rises will influence financial security and health for the most vulnerable in society.

Inequalities in time from stopping paid work to death: findings from the ONS Longitudinal Study, 2001 to 2011 is by Emily T Murray,  Ewan Carr, Paola Zaninotto, Jenny Head, Baowen Xue, Stephen Stansfeld, Brian Beach and  Nicola Shelton.

*Emily T Murray, Ewan Carr, Paola Zaninotto, Jenny Head, Nicola Shelton and Baowen Xue are based at the Department of Epidemiology and Public Health, University College London.

Ewan Carr is also based at the department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London.

Stephen Stansfeld is based at Queen Mary University of London, Wolfson Institute of Preventive Medicine, Centre for Psychiatry, London, EC1M 6BQ, UK

Brian Beach is based at the International Longevity Centre – UK, SW1P 3QB, London, UK.

Would reducing social inequality lead to more years of healthy life?

Across Europe, there’s good news for older people – life expectancy is on the rise and levels of disability among older people are falling. But there are concerns that a longer life may not be a better life for all. So who benefits from increased life expectancy?  Jenny Head and colleagues from the IDEAR network find those with a higher occupational status can expect the greatest number of years of healthy, disease-free life.

We know from lots of studies that there are big differences in life expectancy between different social groups. And we know that those in higher social positions tend to benefit more from that rise in healthy life expectancy.

But, given that many governments expect people to extend their working lives, we specifically need to know about the different expectations of people in different occupational positions – which is slightly different.

Together with colleagues in the IDEAR networK, we looked at what those from different occupational backgrounds might expect in later life – to be precise, how many years with good health can they expect to enjoy between the ages of 50 and 75?

The data came from four cohort studies in England, Finland, France and Sweden.

We were able to look at data from 9,213 people in the English Longitudinal Study of Ageing from 2002 onwards. We also had information on 42,978 people who took part in the Finnish Public Sector study between 1997 and 2013. In France, we used the GAZEL Cohort Study, which gathered information from 18,263 people working for the national utility company from 1989 onwards. And in Sweden, we looked at a sample of 8,186 people who responded to the Swedish Longitudinal Occupational Survey of Health between 2003 and 2014.

Health measures

We used two health measures: whether participants rated their own health as good or poor, and whether they had ever been diagnosed with heart disease, stroke, chronic lung disease, cancer or diabetes.

In all the cohorts, people in lower occupational positions could expect fewer years of life than those in higher occupational positions – and they could expect to spend fewer of those remaining years in good health.

So in England, both men and women in high-grade occupations could expect more than four years’ extra healthy life when compared with men and women in lower-grade occupations. In Finland that gap was wider, with those in high-grade jobs expecting at least six and a half years more good health. In France the difference was around two and a half years, while Sweden had the smallest gap of a little more than two years.

This pattern was consistent across the four countries and for both men and women. There were also socioeconomic inequalities in chronic disease-free life expectancy, although these differences were less marked than for self-rated health.

Better understanding

Why does this matter? A better understanding of the future health of older people is crucial to policy-makers because it affects public expenditure on income, health and long-term care. It also matters because governments want to extend working lives and increase State Pension ages, and in order to do that they need older workers to stay healthy.

Our results indicate that those in lower socioeconomic positions may be doubly disadvantaged because they have worse health but may also need to work longer for financial reasons. To achieve extended working lives for all, policy-makers will need to find ways of reducing those social class differences in health expectancies.

Socioeconomic differences in healthy and disease-free life expectancy between ages 50 and 75: a multi-cohort study, by  Jenny Head, Holendro Singh Chungkham , Martin Hyde, Paola Zaninotto, Kristina Alexanderson, Sari Stenholm, Paula Salo, Mika Kivimäki, Marcel Goldberg, Marie Zins, Jussi Vahtera and Hugo Westerlund, is published in the European Journal of Public Health.

 

Early retirement – can welfare systems help ease the transition?

The post-war baby boomgeneration in developed countries is reaching retirement age and this is placing strain on welfare systems. Sol Richardson and colleagues from the ESRC International Centre for Lifecourse Studies at UCL find the type of welfare system under which we live can affect our prospects of having a happy and fulfilled retirement.

We know stopping work can lead to changes in our sense of personal wellbeing both positive and negative. And we know this can be influenced by a range of factors, such as whether an individual has left work at the usual age or has stopped early.

There are other factors which can make a difference to how we fare after retirement, too: If we were dismissed, retired through illness or through unemployment, for instance, the change is more likely to hit us hard.  

But how much difference do the different types of welfare system which exist in different countries make to those who leave work early? Until now we havent had much clear evidence on this point.

Data

We looked at a sample of people from 16 countries, using data from the Study of Health, Ageing and Retirement in Europe (SHARE) between 2004 and 2013, and from the English Longitudinal Study of Ageing (ELSA) between 2002 and 2013 these are studies which revisit their participants over time.

Our subjects were aged 50 years and over and had been visited before and after they left work.

We looked at a total sample of 8037 respondents who had left work between 2002 and 2013 and for whom we had information not only on work history but also on personal wellbeing.

We categorised how people left work according to the type of benefit they received afterwards: Were they receiving disability benefit, unemployment benefit, sickness benefit, social assistance, early retirement pension, old age pension or none of those?

Retirement age is different in different countries it can depend on gender or on the number of years worked, and its been rising in many countries. So we defined retirement as the earliest age at which an individual can draw a full pension if he or she has been working since the age of 20.

And we looked at the wellbeing of our subjects, using a validated scale called CASP-12 (control, autonomy, self-realization and pleasure.)

And then we compared these findings according to the type of welfare regime the participants had in their home countries again using an internationally-recognised scheme that relates to how social benefits are granted and organized.

Negative effects

We found that those who left the labour market because of unemployment or disability and who left outside of the typical time-frame tended to experience negative effects on their personal wellbeing.

How much difference did country of residence make? We found this was significant, but that only a small proportion of the difference was down to the country itself. Almost two thirds of the wellbeing gaps we found between individuals in different countries could be accounted for, we found, by the type of welfare system they had.

Those living in Scandinavian social democratic welfare systems experienced the most positive transitions but this effect is unlikely to be down to expenditure alone. Other factors could be important for instance, employment rules guiding the ways people left work. Different finance mechanisms, the extent of benefit coverage and the eligibility regime for those benefits could also have an effect.  

When we looked at the different types of welfare system we found people in systems which could be described as Bismarckian,such as France or Germany, or  Scandinavian,such as Sweden or Denmark, did better than those in systems which could be categorised as Mediterranean,such as Italy or Greece.

As a generalisation, Scandinavian systems can be described as Social Democratic. They spend the most, they have high levels of cash benefits and a strong emphasis on services.

Bismarckian countries emphasise earnings-related cash benefits like pensions and they provide reasonable services, but not at the level of Social Democratic countries.

In Mediterranean countries, the pensions system is fragmented and services are rudimentary. People living in Mediterranean systems are more likely to rely on family and the voluntary sector for support.

Policy implications

What lessons should policy-makers draw from our study? We found that higher expenditure per head, particularly expenditure on non-healthcare services such as home help, did help our participants to feel better after they left paid work.

And our results have important implications for welfare policy: They underscore the importance of welfare services as greater numbers of workers approach retirement age and leave the labour market.

Country-level welfare-state measures and change in wellbeing following work exit in early old age: evidence from 16 European countries, by Sol Richardson, Ewan Carr, Gopalakrishnan Netuveli and Amanda Sacker, is published in the International Journal of Epidemiology, 2018, 113.

Does education and job status affect the length of our working lives?

Who is most at risk of leaving work due to poor health? In a major international research project, Ewan Carr from the renEWL team has worked with colleagues at UCL, King’s College and Queen Mary University of London in the UK, INSERM and Paris Descartes University in France and the University of Turku in Finland to find out more about social inequalities and extended working life. Based on information from nearly 100,000 employees from seven studies in four countries, the research found employees with low levels of education or low occupational grade (e.g. unskilled or manual jobs) to be more likely to leave work for health reasons. While past studies have shown there is socioeconomic inequality in the ways that working lives come to an end, few have compared these trends across different countries.

Across Europe, ageing populations have forced governments to look at ways of extending working lives. As people stay healthier for longer, raising the state pension age has become a priority in a number of countries – in the UK this reform has already been implemented.

But this change is likely to be particularly challenging for those from lower socioeconomic backgrounds, who are known to lose both physical and mental ability more quickly as they age.

Planning for later life

There’s a double-bind here for this group. They’re more likely to be unable, through ill health, to continue to work in later life. But they’re also less likely to have the resources they need to keep them out of poverty in retirement.

People from lower socioeconomic backgrounds may have contributed less to their pension funds, and so may have to work even if they don’t want to, or if their health makes it difficult for them to do so.

Meanwhile those from higher socioeconomic backgrounds are likely to have bigger pension pots but also to have better health, which allows them to work for longer. They have a further advantage in that they are likely to have jobs they enjoy and which have more security – so they’re less likely to be forced into retirement or unemployment.

We wanted to find out more about this: would similar levels of poor health have a disproportionate effect on those who were less well educated, or who had lower-status jobs? If two people had the same health issues but had different social status, would one be more likely than the other to stay in work for longer?

Other studies have looked at these issues, but they had limitations. They tended to focus on single countries – or in some cases on the Nordic countries as a group – and weren’t necessarily applicable elsewhere. They often used things like disability benefit as a measure of work exit, and again these weren’t always the same from one country to another.

Work exit

Previous studies found people at both ends of the occupational ladder were more likely than those in the middle to extend their working lives, but for different reasons. Put bluntly, those at the top chose to continue working; those at the bottom were forced to do so.

We looked at data from seven independent studies in Finland, France, the UK and the USA. Some of these were drawn from representative samples of the whole population, while others looked at specific groups – for instance, the Whitehall II study in the UK followed a large group of civil servants over several decades. All the studies were based on people who were in paid work at around the age of 50. In total, our study covered almost 100,000 people.

We considered two measures of social status – level of education, and level of occupation. We assessed retirement age and route (i.e. whether it was for health reasons or not) using respondents’ own reports of their retirement as well as company and administrative records and benefits information.

Overall,wefound those with lower levels of education were more likely to leave work for health reasons – this effect could be seen for men in all the studies and for women in most. Lower occupational grades were also strongly linked to leaving work for health reasons.

These findings have important implications for policymakers, who usually calculate retirement age by sex but who don’t take into account factors such as family circumstances or social status. Policies which seek to extend working lives for all are likely to place those with lower socioeconomic status at a disadvantage – especially in countries where the benefits system doesn’t do much to help those who must leave because of ill-health. This study underlines a need both for greater flexibility in polices that extend working life and for greater recognition of the barriers faced by those from less privileged backgrounds.

Further information

Occupational and educational inequalities in exit from employment at older ages: evidence from seven prospective cohortsis research by Ewan Carr, Maria Fleischmann, Marcel Goldberg, Diana Kuh, Emily T Murray, Mai Stafford, Stephen Stansfield, Jussi Vahtera, Bowen Xue, Paola Zaninotto, Marie Zins and Jenny Head. It was first published in the journalOccupational & Environmental Medicine on March 12, 2018.

The studies used in the research were:

British Household Panel Survey https://www.iser.essex.ac.uk/bhps

English Longitudinal Study of Ageing http://www.elsa-project.ac.uk/

1946 National Survey of Health and Development http://www.nshd.mrc.ac.uk/

Whitehall II study http://www.ucl.ac.uk/iehc/research/epidemiology-public-health/research/whitehallII

Finnish Public Sector study, Finnish Institute of Occupational Health https://www.ttl.fi/en/

GAZEL cohort http://www.gazel.inserm.fr/en/

Health and Retirement Study http://hrsonline.isr.umich.edu/

Never too early to intervene to get us working longer

Working for longer is something we are all having to get our heads around. It’s certainly a priority for the Government, which wants to encourage more older people into satisfying jobs that will help them stay happy and healthy as they age. For older people already in good jobs that they enjoy, who have been fit and active for most or all their life, this could be a great opportunity for them and their families. Of course that’s not the case for everyone. Dr Charlotte Clark has been looking at what having poor mental health as a child could mean for our working life in our mid fifties. Here she explains why policy makers and businesses need to pay close attention to the mental wellbeing of the nation if they want to extend people’s working lives successfully.

Working beyond traditional retirement age has been the focus of much attention in recent years as policy makers, businesses and working people across the UK get used to the idea that more of us need to work for longer to take account of the fact that more and more of us are living longer and that this reality comes at a cost.

As things stand, by their mid fifties, many people are not in work because of early retirement, long-term sickness or disability, being or becoming unemployed or because they are long term homemakers. So the onus for working longer tends to fall on those who stay employed through all or most of their lives. But could more be done to encourage and support those most likely not to be working at 55 to do so and then to continue to do so?

Looking right across people’s lives to track what may have influenced a person to leave or not be working at 55 provides us with a much clearer and more nuanced picture than a simple snapshot in time. We wanted to see whether having poor mental health as a child or as an adult might be an important part of that picture and give us some ideas for interventions that could extend the working lives of this group of people in a way that would benefit them and society more widely.

Increasing psychological support

It’s fair to say that the Government’s ambitions to get more people working for longer have been laid out quite clearly already, as has their commitment to putting people’s physical and mental health on an equal footing. Saying that, their commitment has been called into question recently in a report from The King’s Fund, which says parity is a long way off.

When it comes to specific groups not working, the Department for Work and Pensions has tended to focus its attention on benefit claimants rather than other groups who, for one reason or another may choose not to work – housewives and husbands for example.

Government initiatives to try to help people with mental health problems find work have included the ‘Improving Access to Psychosocial Therapies’ (IAPT) programme, which has increased provision of therapies for benefit claimants with depressive and anxiety disorders.

Evaluations of IAPT suggest that ‘Nationally, of [adult] people that finished a course of treatment in IAPT, 45% recover. . . and a further 16% show reliable improvement’. Encouraging results that have led to modest increases in employment, and it’s hoped there will be more positive news on this front.

However, things don’t look quite so encouraging when it comes to younger people with mental health problems and that’s what our research is shining a spotlight on. It’s also an area we believe should be a focus for policy makers and those working with young people including parents and schools. After all, successfully extending people’s working lives can only be done once they successfully enter and then remain in employment. This is less likely for youngsters with poor mental health.

55-year survey

We used information from the National Child Development Study which has followed the lives of thousands of people born in 1958, and collected detailed information about their lives and circumstances.

This included their employment situation and, first and foremost, we were able to see that, at age 55, nearly 19 per cent of the 9,000 participants in the study were not working: 2.8 per cent were unemployed, 5.2 per cent were permanently sick, 3.3 per cent were retired and 7.5 per cent were homemaker/other.

From a very young age, the study also collected information on whether the individuals in the study exhibited signs of depression or worry, whether they were hostile, disobedient or aggressive.

Even when we took account of a wide range of other things such as whether they suffered poor mental health as young or older adults, numbers of other children in the household, whether their partner was employed, qualifications etc. the association with problems as a child were still really strong.

Drilling down into whether those mental health issues were ‘internalized’ or ‘externalized’, we were able to see that those who were depressed or anxious as children were about one and a half times more likely to be unemployed or permanently sick as their peers without problems.

It was a similar story for those who had shown externalised signs such as aggression. They were more than twice as likely to be unemployed or permanently sick, and also more likely to fall into the homemakers/other category too.

Interestingly there was no strong link between poor mental health in childhood and taking early retirement or being employed part-time.

Children’s mental health

Of course there is a lot more at play in children’s lives than we have taken account of in this study. Nevertheless, it is clear from our research that addressing the mental health problems of the very youngest in society could and should be an area for focus and schools, together with parents and those with a responsibility for the wellbeing of young children have key roles to play here.

It seems it is never too early to intervene proactively to try to help young people get and stay on a healthy happy path that will lead to them a productive and satisfying working life that extends well beyond the age of 55. Equally, given that people identifying themselves as ‘homemakers’ rather than unemployed are the largest group not working at age 55, policy makers could consider ways to get this economically inactive group into the workplace, in tandem with its efforts to support the mental health of those people on benefits.

There is also a message here for policy makers about just how important it is to make those promises about parity of esteem between mental and physical health a reality sooner rather than later.

Impact of childhood and adulthood psychological health on labour force participation and exit in later life is research by Charlotte Clark and colleagues and is published in Psychological Medicine. The research is part of the ESRC funded Research on Extended Working Lives (RenEWL) programme at UCL.

 

Staying at work longer – a matter of geography?

There are lots of reasons why people end their working lives early, and the relationships between those reasons are complex. We know, for instance, that if you’re a carer for someone close to you, if you’re unwell yourself or if you don’t have higher level qualifications then you’re more likely to stop working sooner. But how does the area in which you live affect your prospects of working for longer? What if you live in an area of high unemployment, for instance? A new report by George Holley-Moore and colleagues at the International Longevity Centre – UK highlights how people in such areas are less likely to extend their working lives – even when those other factors are taken into account.

All too often the debate about how best to help people to work into later life stops at physical health. But research from the renEWL project suggests there is much more to be considered. In a new report, Working for Everyone – Addressing Barriers and Inequalities in the Working Lives Agenda, we look at these complex relationships – and we find there’s a great deal more policymakers could be doing to help.

Interlinking factors such as physical and mental health, working conditions, family life and lifestyle are all important. And it’s vital that regions should use their devolved powers to ensure that people in all parts of the population have the opportunity to extend their working lives.

The importance of geography

But how does where you live affect the length of your working life? We know older workers living in areas of high unemployment tend to leave work earlier: A study by Emily Murray and others looked at a one per cent sample of the population, aged between 40 and 69 and working in 2001, and at the same sample again 10 years later. Using local area statistics on unemployment, it mapped whether they left work, and their reasons for leaving, against the level of joblessness in their area.

It found that people who rated their health as poor in 2001 were almost six times more likely not to be in work 10 years later.

Thinking about this, it’s perhaps unsurprising that older workers in areas of high unemployment were less likely to be in work 10 years on – after all, if you live in an area with high unemployment you’re more likely to suffer from a long-term health issue. And that’s bound to affect your ability to work. Furthermore, if you have poor health earlier in life you are more likely to be sick or disabled later in life.

But was there a geographical factor even after these health inequalities were taken into account? Murray and colleagues found that even those in good health were more likely to be out of work a decade on if they lived in an area of high unemployment – that is to say, this economic factor operates separately from all those other things that can affect the length of a person’s working life. People in poor health were more likely to be out of work regardless of where they lived.

Evidence-based planning

It’s clear that there is a need for strong regional and national planning on these inter-related areas of work, health and geography. Creating policies tailored to the unique pressures faced by the local population will be necessary to address the scale of the problem:

National Government should focus infrastructure spending on areas of higher unemployment with a view to increasing job opportunities and making employment more accessible for older workers.

Regions need to use devolved power to tailor their own integrated strategies to enable fuller working lives.

Local authorities should be given power and funding to coordinate local partnerships that tackle employment challenges. These should include councils, businesses, health and social care providers and charities: supporting fuller working lives in at-risk areas would require a joined-up approach that targets the various at-risk groups.

Fundamentally, policy must move away from focusing exclusively on physical health conditions. We need a holistic approach which incorporates physical and psychological health, growing care needs and socio-economic disparity if we are to extend working life for everyone.

 

A question of support: working longer and what works

As more of us work for longer, it’s important to recognise the needs of older workers: and that includes the fact that as we age we are more likely to suffer from long-term illnesses. To what extent do our working conditions affect our decisions about whether or not to continue in a job despite having a chronic disease? Maria Fleischmann, research associate in the Department of Epidemiology and Public Health at University College London, has been asking what might help to prolong working life for older people. Could factors such as having supportive colleagues and managers, or a clear understanding of who does what, make a difference?

There is strong evidence that people with long-term illnesses leave work early. While three quarters of healthy European 50-somethings have jobs, the figure from those with chronic disease is much lower. Among those with one condition such as diabetes or heart disease, the employment level is around 70 per cent – and for those with two or more that drops to around 50 per cent. Conversely, those who are able to stay well are significantly more likely to continue working beyond pensionable age.

As our working lives grow longer, it’s important to acknowledge that older workers with chronic diseases may have different needs from those who are well – they may not be able to work such long hours, for instance.

So, what are the factors that can make a difference? We know, for instance, that people are likely to remain in work for longer if they have a high level of control over their own hours. Shift workers, on the other hand, are more likely both to become unwell and to leave work early.

Deciding to stay on at work

But what about the factors that are harder to see? What about a worker’s sense of his or her own job stability, or of how harmonious the relationships are between co-workers? Does it help if an employee feels he or she generally knows who does what, or how to respond to a given situation? These types of factors – collectively known as ‘psychosocial factors’ – are also believed to affect peoples’ decisions about whether to stay on at work.

We used data from the Whitehall II study, which has been following the lives, work histories and health experiences of just over 10,000 London-based civil servants since the mid-1980s, when they were all aged 35-55. We looked at the participants in mid-life, around 14 years before retirement age, to see how factors such as levels of autonomy and of support from supervisors or co-workers might affect their decisions if they became ill with diabetes, coronary heart disease, stroke or malignant cancer.

And we found that while good ‘psycho-social’ working conditions were helpful generally in supporting workers to stay on in their jobs, they didn’t appear to make any extra difference for those who became ill.

The participants in the Whitehall II study were asked questions such as: ‘Do you have to do the same thing over and over again?’ and ‘Do you have a choice in deciding how to do your work?’ They were also asked whether they felt they had good support from colleagues and superiors and how demanding they felt their job was. They were also asked to describe their level of education, their mental health and whether they had a partner who worked.

We were able to use their answers to assess whether these factors made a difference when they developed illnesses later in life.

Chronic illness

We could see that six out of 10 participants left work between the first phase of the study in 1985 and the last one used for this study, in 2007-9. During the same period the proportion suffering from chronic illness had increased from less than two per cent to almost 30 per cent.

So why had they left, and how might those ‘psychosocial’ working conditions have affected those decisions?

Among the whole group of participants, we found clear evidence that those who felt they had reasons to be happy in their work were more likely to stay on. Specifically, those who felt they were using a wide range of job skills – known as skill discretion – and those who felt they had good social support at work were more likely to stay on for longer.

However, we did not find evidence that those ‘psychosocial’ factors would make more of a difference in whether or not a worker stayed on if he or she were chronically unwell. Or rather, good working conditions were equally important for workers both ill and well.

So, we know that good social and psychological conditions at work are likely to be helpful in keeping employees at work as their careers near their end. And we know that chronic illness is a major reason why people leave work early. But from our study, we cannot say that such good working practices will be a particular deciding factor for those who become unwell.

How and why people leave work

There were some interesting factors in our results: first, we were able to look at the different ways in which people left their jobs, and the reasons why they did so. So those who used a wide range of skills had a reduced risk of leaving work earlier through retirement or ill-health, but this was not related to the risk of leaving work earlier through unemployment; while those who had good social support had a reduced risk of leaving earlier through ill health or unemployment, but not so much when we looked at leaving earlier through retirement.

And while previous studies had tended to measure working conditions at the time of leaving, ours looked at those conditions several years beforehand.

There is certainly scope for more detailed research on this issue – and there is plenty of reason for both researchers and policy advisors to continue to focus on how employers can help chronically ill workers to stay in their jobs.

Can favourable psychosocial working conditions in midlife moderate the risk of work exit for chronically ill workers? A 20-year follow-up of the Whitehall II study is research by Maria Fleischmann, Ewan Carr, Stephen A Stansfeld, Baowen Xue and Jenny Head. It is published in the BMJ Journal of Occupational and Environmental Medicine and is part of the renEWL project on Extended Working Lives.

Downshifting and long-term part-time work could be key to a healthy retirement

A secure, comfortable and healthy retirement is something most of us aspire to. But, as we live longer, we are all being encouraged to work later, increasingly well into our late 60s, so what might that mean for those aspirations, particularly the desire to be fit and healthy? Whilst the number crunchers have done their homework about how the sums add up around the available money to support more retired people for longer, very little is known about how working longer will impact on our health and what the knock on personal, societal and economic costs of that might be. Peggy McDonough at the University of Toronto, together with colleagues at UCL and Kings College, has been using US data to get a clearer picture of what the latter part of working life and health look like for men and women. Here she explains the research and why flexible working policies, particularly those concerning part-time work, could be key to ensuring a healthy retirement is a reality as well as an aspiration.

Across the developed world falling birth rates and the so-called ‘baby-boom’ cohort’s retirement have raised the spectre of unsustainable State pension costs. This has led to a range of reforms, many of which have seen a rise in the age at which we can collect State Pension. In the UK in 2020, men and women will have to wait till they are 66; this will rise to 68 by 2028. In the States, the age will be 67 in 2027. In addition, other incentives to work longer and disincentives to take our pensions earlier have been trialled or introduced.

What we don’t know much about is what the health consequences are of stepping up the workplace participation of older adults. Will working longer make our health better or worse? And what if those consequences undermine other social and economic goals, such as those around wellbeing and inequality? In addition, are there differences in the way these things play out for women and men?

Research to date has tended to focus on retirement as an exact or single point in time, which doesn’t necessarily reflect the more complex things happening during the run up to and after retirement. Findings are also ambiguous and it’s not clear whether retiring early, partial retirement or working longer is generally associated with better health.

Our research looks across a much longer period, viewing retirement more as a project that unfolds over time and drilling down into what is going on as we move from the ‘family- and career-building years’ to the ‘frailty years of old age’. This way we hope to get a better and more nuanced picture of how our work and our health interact over this part of our life and get some pointers about what seems to work best when it comes to staying as healthy as possible into the Third Age.

Patterns of work

Our data come from the Health and Retirement Study, which has collected information from more than 25,000 Americans aged 50 + since 1992. Working with the original cohort, all of whom were born between 1931-41, we examined the working lives and health of some 6,500 men and women over 18 years.

It was interesting to see that only 14 per cent of the men in our study followed a ‘conventional’ path involving full-time work until retirement at around 65 years of age. More of them (21 per cent) acted in line with recent policy initiatives and worked longer or did the complete opposite and retired in their early 60s (18 per cent). Slightly less than one in ten men stayed working but shifted from full to part-time work; it was rare for men to have had a substantial period of the time in part-time work.

Less than half as many women (10 per cent) worked full-time throughout the period. They were three times more likely than the men in the study to have worked part-time from the outset. The largest proportion, double that for men, was not working across this period, but, if they were, they were more likely to retire around the age of 62 than 65.

Health at 70

 When we took into consideration a range of other background factors, like education, income, marital status, and minority background, we could start to get a picture of the most ‘advantaged’ people in terms of health.

One group of men stood out: those who downshifted from full-time to part-time work around age 65 had the lowest chance of being in poor health at age 70. Women were slightly different: being in work (either part-time or full-time) was associated with the best health, as was retiring in the early to mid 60s. Women in long-term part-time work were especially advantaged.

At the other end of the spectrum, men retired early or worked very little in middle age were more likely to have poor health than others. The same was true for women.

 Downshifting is key for men; long-term part-time work, for women

Whilst it was interesting to note that long-term part-time work for men was not linked with better health for men when it was for women, we think that is probably because for this generation, women (traditionally caregiver) would have perhaps engaged in part-time work through choice, whilst for men (traditionally breadwinner) the reason may have been linked to earlier poor health.

Our research certainly provides a more detailed picture of how people’s working lives pan out in their fifties and sixties and shows quite clearly that men who are able to shift to part-time work in their 60s are most likely to have better health in their 70s whilst for women a long-term part-time arrangement seems to reap the most health benefits.

In short, it seems there may be considerable health benefits to part-time work but in ways that play out slightly differently for men and women. It should provoke interesting discussions among employers, unions, policy makers in the areas of employment and health and, of course workers themselves as they think about the sort of retirement they want and the options they have (or don’t have) when it comes to flexible working.

Given that less than 10 per cent of men and less than 5 per cent of women in our study followed these ‘optimum’ pathways for better health in their 70s, it’s an area that could serve as a real focus in the coming months, preferably before the pension reforms outlined earlier come into force.

Later-life employment trajectories and health is research by Peggy McDonough, Diana Worts, Laurie M. Corna, Anne McMunn, and Amanda Sacker and is published in the journal, Advances in Life Course Research.

Could frailty screening help extend our working lives?

The Government’s Business Champion for Older Workers, Andy Briggs, has called for one million more older people to be in work by 2022. But to enjoy the benefits of working longer, we need to remain in good health. Professor Keith Palmer from the University of Southampton and colleagues investigated whether signs of frailty in mid-life can predict difficulties in continuing to work later on. Here he outlines their findings and makes the case for developing screening to identify those workers most in need of support.

By 2020 the over-50s will comprise almost one third of the UK’s working age population, and more recent Government policies, including changes to the age at which we can claim our State Pension, have been focused on extending our working lives.

But, according to the Centre for Ageing Better, the single biggest reason for people leaving the workforce before retirement age is health, and nearly half of all people between ages 50 and 64 have a long-term health condition. The charitable foundation has been highlighting the need for more support to allow older people to continue to work.

For people with poor health, previous studies have shown that extending their working lives may not be in their best interests. Our research is the first to measure frailty and symptoms of pre-frailty in people aged 50-65 and determine whether and how it is associated with employment difficulties. The idea was to see if there is a way to identify early those people most likely to find it difficult to continue working.

We used information about more than 8,000 people collected through the Health and Employment After Fifty (HEAF) Study, which involves patients from 24 geographically-dispersed GP practices in England.

They answered a range of questions about whether they suffered from exhaustion, had a slow walking speed, a weak grip (determined by whether they had problems opening new jars), low levels of physical activity and whether they had unintentional weight loss in the past year.

People with more than three of the above symptoms were classed as ‘frail’, while those with one or two symptoms were classed as ‘pre-frail’.

They were also asked employment-related questions: were they currently working and, if not, had their previous job ended for health reasons?

Those in work were asked:

  • their total sickness absence over the past 12 months
  • had they needed to cut down at work because of their health?
  • were they coping with the physical and mental demands of their work?
  • Did they expect to be able to do the same work in two years’ time?
  • Was their job secure?
  • Did their work affect their sleep?

Information about their well-being, including back and other pain, was also collected, and participants’ jobs were classified as higher managerial, intermediate or routine/manual.

Health problems

More than one third of the women, and 27 per cent of the men studied were no longer working. Of these, around one third of both sexes said they had left their job because of a health problem.

Disorders or pain affecting movement, such as bone, joint or nerve problems, and mental illness, were the most common reasons for stopping work.

Many of those still working reported difficulties with their jobs, with between 6 and 7 per cent having taken 20 or more days’ sick leave in the last year. Around one third reported problems coping with work’s physical demands, and 20 per cent said their job was insecure.

Four per cent of the group studied were classed as ‘frail’ and, within this group, more than three-quarters reported low physical activity, weak grip and slow walking speed, with women more likely to report symptoms. Nearly one third of the participants were classed as ‘pre-frail’.

When work situations were taken into account, we found three quarters of those classified as ‘frail’ were no longer working, with 60 per cent of these leaving their job for a health reason. Only a quarter of the ‘non-frail’ participants had stopped working.

The odds of not being in paid work were more than ten times higher for frail compared with non-frail participants, while the likelihood of leaving work for health reasons was higher still (up 30-fold). In frail people who were in work, the odds of prolonged sick leave, cutting down a lot at work and struggling with work’s physical demands were about 11 to 17 times greater than for non-frail workers.

‘Pre-frail’ subjects also had more work problems, although not to the same extent as frail subjects. For example, their odds of health-related job loss were up 3.7-fold, and their odds of having prolonged sick leave or having to cut down a lot at work in the past year were up 2.5 to 3-fold.

Frailty effect

The impact of frailty on not being in work, taking more sick leave, and not coping with work demands was about 2–3 times greater among those from poorer backgrounds. However, we found ‘frailty’ was strongly associated with poor work outcomes even for those in higher managerial positions.

Looking at the frailty symptoms individually, we found most of the work problems to be most strongly linked with slow walking speed. Strong links were also found with poor grip strength and exhaustion.

Our findings showed strong associations between certain symptoms, for example those with slow-walking speed also tended to be exhausted or have a weak grip. Similarly, there were links between weak grip and exhaustion, and slow walking speed and low physical activity.

Strong associations

While our findings need further follow up, assessing the same group of patients over time to confirm the links between different physical symptoms and future work problems, our large sample size has confirmed frailty symptoms are common in people aged 50-65.

As the first study linking frailty and pre-frailty symptoms to work outcomes, we have shown strong associations with worklessness, health-related job loss, sickness absence and not coping at work.

Through further study, these symptoms could be refined to form the basis for simple screening tests for older workers, and spearhead the development of targeted support to improve physical function in those most at risk.

To realise the call of the Government’s older workers’ champion for one million more older people to be in work in five years’ time, identifying those most likely to struggle to remain in the workplace will be crucial.

The Government, NHS and employers will need to heed the call from the Centre for Ageing Better to develop workplace adaptations and age-friendly practices, and extend occupational health support and targeted preventive approaches that help people stay in work and stay well.

Further information

Frailty, prefrailty and employment outcomes in Health and Employment After Fifty (HEAF) Study is research by Keith Palmer, Stefania D’Angelo, Clare Harris, Cathy Linaker, Catharine Gale, Maria Evandrou, Holly Syddall, Cyrus Cooper, Avan Sayer, David Coggon and Karen Walker-Bone of the University of Southampton and Tjeerd van Staa of the University of Manchester. It is published in Occupational and Environmental Medicine.

Photo credit: Roberto Trombetta