Tag Archives: Disability

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

Organisational change: impact on early retirement

Motivating older employees to stay working longer is seen as a key way of tackling the current pensions crisis facing many countries. Something of a fly in the ointment for those looking to address the problem is the option to take voluntary early retirement, especially where among those who are in good health and best placed to continue working. Dr Nina Breinegaard and colleagues at the University of Copenhagen have been researching the situation in Denmark and, as Nina explains here, they find that a key area of focus for employers and policymakers could be organisational change.

A whole host of things influence our decision around when to retire. These include obvious things like our finances, the state of our physical and mental health and what’s going on with our family and close friends.

Another key influence is what is happening in the workplace. A job may have become too physically demanding for example. A number of studies have shown that when a company is restructuring or downsizing, employees may feel less secure about their position. This in turn can be a catalyst for early retirement, sometimes on the grounds of ill health.

In our research, however, we wanted to try to get to the bottom of how organisational change might influence those without any health problems to retire early. We also wanted to take a close look at the combined influences of the psychological and social sides of work on that decision.

Claiming benefits

In Denmark, men and women who have paid into an early retirement benefits insurance fund can claim those benefits between the ages of 60-64 even if they are in good health. At the end of 2012, 34 per cent of women and 27 per cent of men aged 60-64 received these early retirement benefits.

We linked Denmark’s DREAM database, which collects information on all public benefit payments, with a survey collected over a two month period in 2011 from more than 28,000 public sector workers. This enabled us to look at which employees decided to take early retirement benefits and whether changes at work were linked to that decision.

All this information was then linked to administrative data to take a range of social and economic background factors into account.

We ended up with a group of 3254 employees aged 60-64 who were entitled to early retirement benefits. Details of any changes at their workplace: a change of manager, a merging or demerging of departments or workgroups, moving to a different office or having a new base, were collected independently from current or previous managers.

They also rated the quality of their work environment e.g. how good their managers were at leading, how positive relationships were with other colleagues and how fairly and well concerns and conflicts were dealt with (organisational justice). The answers to all these questions were then used to create overall scores for each employee’s work environment.

Follow-up

When we followed up with our survey participants, we found that one in five women and one in seven men had taken early retirement benefits with early retirement being common in all occupational groups except for doctors and dentists.

65.1 per cent of the 2206 employees for whom we had information about all types of organisational change had experienced one or more changes. Change was most frequent among social and healthcare workers (74.9 per cent) and least frequent among laboratory technicians (46 per cent).

Employees whose workplace had undergone a change of management or a merger were much more likely to have taken early retirement than those who had not. After taking background factors including age, marital status, gender etc. into account where a change in management had occurred, the likelihood of early retirement increased even more. Adjusting for the same factors for those whose workplace had experienced a merger made no difference to the likelihood of early retirement.

Relocation was linked somewhat less closely to early retirement and the demerging of departments or workgroups had no effect at all.

On their own, poor quality work relationships and networks and low levels of organisational justice were also associated with early retirement. How well people felt they were managed had an effect only once background factors (apart from age) were taken into account. When any organisational change was factored in as well as the quality of the work environment variables, the likelihood of an employee retiring early increased further.

Organisational change matters

Taking everything into account, we can say, for the first time, and with considerable confidence, that when it comes to early retirement, organisational change makes a difference, particularly where it involves a change of management. Organisational changes on top of a work environment that is perceived to be poor compounds the likelihood of an employee retiring early.

Given that our research focuses on people who are not retiring because of poor health or disability – the very employees that organisations and policy makers want to encourage to work for longer – our findings are likely to be of considerable interest.

Key would seem to be careful consideration of the impacts of any restructuring within a business or organisation. Improving the workplace environment could also have a role in reducing the numbers of employees calling time on work before the age of 65.

The frequent occurrence of organisational change in the Danish healthcare sector is interesting in the light of medical doctors, nurses and other health and social care workers recently being identified as shortage occupations in Denmark. Managing those changes and improving the working environments of people working in these occupations could be a priority, not least because ageing populations not just in Denmark, but the world over, clearly need these groups of workers more than ever before.

Organizational change, psychosocial work environment, and non-disability early retirement: a prospective study among senior public employees
 is research by Nina Breinegaard, JH Jensen and JP Bonde and is published in the Scandinavian Journal of Work, Environment and Health.

Photo credit: Workers, Justin Lynham

Are permanently sick people less sick nowadays?

Brexit aside, there have few topics more hotly contested in recently years than who should get incapacity benefits. The steady rise in the incapacity benefits bill over several decades led some to question whether greater numbers of people could actually be sick and whether this group is actually healthier, with less serious health problems, than had been the case in decades past. But what does research evidence tell us? Bola Akinwale from Public Health England and colleagues at the ESRC International Centre for Lifecourse Studies have looked at 30 years’ worth of data to see.

In the last 30 years of the 20th century, life expectancy for those aged 65 increased more than it had in the previous 70 years. A job market that had been almost completely dominated by men became dramatically more diverse. By the turn of the century, very few men aged 60-64 were in paid work, although that number has since increased.

On the face of it, many of these changes represent good news, but they have also created new challenges around funding pensions and how to keep increasing numbers of older people healthy and active for longer.

Our research looked at the proportions of men and women around State Pension Age who were employed, unemployed, permanently sick (those we might expect to claim incapacity benefits) or retired. We went on to look at their health immediately after retirement age to see if they had died prematurely or had a limiting long-term illness or disability.

When we compared the labour market positions of 60-64 year-old men in 1971 compared with 2001, we saw some big changes:

  • Working – 78.4 percent v 47.5 percent
  • Retired – 7.2 percent v 24.7 percent
  • Permanently sick – 9 percent v 19.7 percent

By 2001, women were almost as likely as men to describe themselves as retired after State Pension Age and 12.4 percent of 55-59 year-old women described themselves as permanently sick in 2001 compared with 3.4 percent back in 1971.

So we see the proportions of permanently sick men doubling over 30 years and quadrupling for women.

Across the same time frame, the risk of dying just before State Pension Age decreased substantially – by more than 60 percent for men and by more than 50 percent for women, irrespective of whether they are in work or permanently sick. In other words, both groups benefited equally from these changes – staying healthier and living longer than their counterparts 30 years previously.

Are sick people less sick nowadays?

 The answer is no and yes – it depends on the comparator.

To try to get to the bottom of this idea that people who are permanently sick are less sick than their historical predecessors, we compared the likelihood of them dying prematurely with that of their working peers.

On the one hand, if they were less sick, we would expect to see the gap between the chances of dying prematurely for these two groups get smaller over the 30-year period. We don’t see that.

Permanently sick men aged 65-69 were three times more likely to die prematurely than their working peers in 2001 and this was an increase on the 1971 figure. For women, the figure was between four and five times over the period we looked at.

On the other hand, it’s clear that this 30 year period brought about some remarkable changes in the working lives and general health of older people, including among permanently sick group. Their life expectancy has increased in line with other people of their age.

But despite these improvements in life expectancy among permanently sick people, compared with employed people their likelihood of dying has, if anything, slightly increased and certainly not decreased.

So, taken together, our research does not support the argument that the permanently sick have less serious health conditions nowadays than they used to.

A key plank of the Government’s policies for people who are unable to work due to illness is to try to support them back to work wherever possible. Our research shows that achieving this aim, requires careful consideration of the types of jobs and working environments that might be suitable for people with chronic illnesses.

If we don’t create enough jobs that older people with chronic illness can sustain and thrive in, life expectancy gaps between those in work and those who leave the workforce prematurely due to ill-health may widen further.

Work, permanent sickness and mortality risk: a prospective cohort study of England and Wales, 1971-2006 is research by Bola Akinwale, Kevin Lynch, Richard Wiggins, Seeromanie Harding, Mel Bartley and David Blane. It made use of linked census and death records in the ONS Longitudinal Study.

Photo credit: ILO in Asia and the Pacific

Working longer: is it good for your health?

Across Europe we are all living and working longer. Many of us in the UK are working past state pension retirement age. But what sorts of jobs do older workers opt for and why and what does all this mean for our health, especially in the context of changes to the age at which we can collect our state pension?  In this policy presentation from the ESRC International Centre for Lifecourse Studies at UCL, Professor David Blane looks at what these changes mean for our quality of life as we get older and the implications for those working in occupational health.

A full transcription of David Blane’s talk is also available on the ICLS website.

Photo credit: Scott Lewis