Tag Archives: Frailty

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

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.