Tag Archives: Mental health

Work stress and ill health – what’s the link?

Lots of studies have suggested stress can be a cause of ill health – and that leads to people ceasing to work before they reach retirement age. But most have offered only a snapshot on the issue. José Ignacio Cuitún Coronado and  Tarani Chandola from the University of Manchester describe a major new study, which has shed new light on how work stress can affect an employee’s health over a longer period.

Many animals have the ability to adapt to environmental changes and pressures so that they’re better prepared the next time they happen. Bears can put on fat as winter approaches, for instance, to help them stave off hunger and stay warm.

And human beings can do this too. Stressful situations trigger chemical responses which can help to give us extra resources when things are tough. Our neuroendocrine systems, for instance, trigger hormonal responses which enhance our physical performance when we need it most.

But these valuable systems can have a down-side. In our research, we wanted to look at how repeated exposure to stressful situations might contribute to health problems, particularly in people nearing the end of their working lives. We call this stress-induced effect ‘Allostatic Load’ – the wear and tear” on the body that accumulates as an individual is exposed to repeated or chronic stress because of fluctuating hormonal responses.

Given that many governments are looking for ways to extend working lives, there’s particular interest in finding out how stress can affect the health of older workers. We were able to tap into a rich source of information – the English Longitudinal Study of Ageing (ELSA), which has followed a representative sample of almost 10,000 over-50s since 2002.

These participants have been interviewed regularly and one of the things they’ve been asked to report is whether they’ve experienced a sense of imbalance between the effort they put into their jobs and the rewards they get out.

This gave us a sample of 2663 older adults, all over 50 and living in England, who’d reported these feelings at least once and who’d been assessed as having had an adverse reaction to them. We wanted to know whether repeated episodes had a bigger effect than just one, and whether the effect would be just as strong for past episodes as it was for more recent ones.

Health testing

Between 2004-5 and 2014-16 the group were asked about stress at work, but they also underwent physical tests to see how the various systems in their bodies were bearing up.

They were visited by nurses who carried out a battery of tests including taking hair samples to assess levels of the stress-related hormone cortisol, carrying out blood pressure checks to provide information on their cardio-vascular systems, white blood cell counts to assess their immune systems and cholesterol checks on their metabolic systems. Participants also had measurements taken of their waist to height ratios – a good indicator of coronary heart disease risk factors.

Overall, we found the more occasions of work-stress a participant had reported, the greater their ‘Allostatic Load’ index – that is, the greater the amount of biological wear and tear.

Moreover, the evidence suggests that employees who had experienced stress more recently, towards the end of their working lives, had higher levels of health risk when compared to those who had experienced it earlier in their careers.

This suggests there is an association between repeated reports of stress at work and biological stress mechanisms, which in turn could lead to stress-related disorders such as coronary heart disease, type 2 diabetes or depression. This also suggests that previous cross-sectional studies which reported small or inconsistent associations may have suffered because they were only measuring one effect at one time.

Work-related stress is one of the reasons for labour market exit – and our findings would suggest that earlier, snapshot studies may have underestimated the true effect of work-related stress on health over a lifetime.

As this is an observational study, we cannot make any causal claims. There may be other factors that we have not taken into account that may explain the association between stress and disease risk. For example, sleep problems may be relevant – though they may also be part of the journey from stress to ill-health.

But equally it is possible that cumulative exposure to work stress is resulting in damage to employees’ physical health, which is then leading to disability and an early exit from the world of work. So, if we want to extend working lives then reducing work-related stress could be one of the keys to achieving that goal.

Allostatic Load and Effort-Reward Imbalance: Associations over the Working-Career, by José Ignacio Cuitún Coronado, Tarani Chandola and Andrew Steptoe, is published in the International Journal of Environmental Research and Public Health.

Working after retirement age: who benefits?

Recent reforms have made it unlawful for employers to force their workers to retire. So what are the reasons why some people stay on after state pension age while others choose to leave? How do those decisions affect quality of life for those who stay, and for those who go? A study by Giorgio Di Gessa and colleagues at King’s College London and the University of Manchester sheds new light on the issue.

We know that more of us are working after we reach retirement age – but until now we haven’t known much about how people make that decision, or about what effect it has on their sense of wellbeing afterwards.

In our research, we used English data from a panel study of older people to find out more about who chooses to stay on in work and why. We then went on to ask whether those who chose to work felt differently about their lives when compared with those who felt they had to work.

We took a representative sample of 2,500 men aged 65 to 74 and women aged 60 to 69 who had previously been in work, and we found one fifth of them still had paid jobs. Of those, two thirds had chosen to continue to work because they enjoyed their jobs or because they wanted to keep fit and active. The other third said they worked for financial reasons: either they couldn’t afford to retire or they wanted to improve their pension provision for later.

We placed the retired respondents into three groups: Those who had had a ‘normal’ retirement when they became eligible for a state pension (28 per cent), those who felt they had to retire because of ill-health or redundancy (2 per cent); and those who retired voluntarily – because they could afford to do so or because they wanted to spend more time with their family, for instance (28 per cent).

Quality of life

On average, those who had retired experienced a lower quality of life, when measured on the CASP-19 scale for older people. The highest quality of life was reported by those who had stayed in work voluntarily, while the lowest was reported by those who had retired involuntarily. The gap in quality of life between these two groups is similar to the one observed between respondents who said they had a long-standing illness and those who did not. As expected, respondents who were financially better off also had higher quality of life scores.

When we considered changes in these CASP-19 scores over time, we found that on average people experienced a drop in their quality of life over a six-year period between two ‘waves’ of the study: about a quarter experienced a decrease of 5 points or more whereas just over 16% experienced an improvement of 5 or more points. Those working voluntarily experienced a slight increase in their quality of life when they eventually retired. On the other hand, the wellbeing of those who were working out of necessity did not improve after retirement.

Health benefits

As one might expect, the scores improved among those whose health got better after retirement, and worsened among those whose health deteriorated.

It’s worth noting that our study sample is skewed towards the more advantaged – the proportion with no qualifications is significantly lower than in the census. It is therefore likely that our study underestimates the percentage of people who work out of financial necessity.

What does our study tell us about working after retirement age? In particular, it reminds us how important it is for people to feel they have control over these key decisions about their lives. Those who continue working because they have to have lower quality of life than those who continue working because they want to – and even once those people have retired, this wellbeing gap is likely to persist.

We know that people who experience a higher quality of life tend to be healthier and to live longer.

Government initiatives aimed at helping workers maintain control over their decisions are worthwhile – but policymakers should also consider how people might be given more support throughout their lives to protect their financial and personal wellbeing if they do have to work for longer.

Further information

The decision to work after State Pension Age and how it affects Quality of Life: Evidence from a 6-year English panel study is a research paper by Giorgio Di Gessa of King’s College London, Laurie Corna of King’s College London, Debora Price of the University of Manchester and Karen Glaser of King’s College London. It is published in the journal Age & Ageing.

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.

 

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.

Breastfeeding and the 24/7 economy: can evenings play a unique role?

Making it easier for women to get back to work after having children has been the ambition of successive UK Governments. A £5m career break returner scheme was launched in the budget just a few weeks ago, with the Prime Minister telling the parenting website Mumsnet that it was neither fair nor did it make economic sense, for women trying to get back into the workplace to find the doors closed to them. At the same time, the Government has acknowledged the considerable benefits to babies and mums of being breastfed. So what does this drive to get mums back to work mean for them, particularly if their job isn’t a standard 9-5 Monday to Friday affair? Afshin Zilanawala from the ESRC International Centre for Lifecourse Studies has been looking at what working evenings, nights or weekends might mean for mums and children when it comes to breastfeeding to see if this should be factored into our thinking around helping women back to work.

In the last 50 years or so, many more women with children have gone back to work after having their children. The same time period has seen a huge growth in the service sector and it is these two economic changes, which have been credited to the growing phenomenon of nonstandard work i.e working evenings, nights, or weekend shifts. A 2008 report showed that nearly a third of UK employees work evening, night or rotating shifts and that 1/5 work on the weekends. About a quarter of employed mothers work evenings, nights, or rotating shifts and about 18% of these mothers work on the weekends.

In that time, anecdotal information around the benefits and importance of breastfeeding to a child’s early development and mother’s mental and physical health have been supported by an ever growing and increasingly compelling body of evidence. In short, children who are breastfed develop physically and mentally more quickly and are less likely to develop infections or be obese, whilst mums are less likely to suffer post natal depression or develop breast/ovarian cancer.

Given all that, it would be useful for policy makers and parents to better understand whether any particular work patterns or schedules are more or less associated with women breastfeeding and for us all to get to grips with how working nonstandard hours may complicate work and family life, and may constrain time with children that relates to their health and development. That’s where this research comes in.

Dual potential: opportunities or costs?

When I set out to look at this, it wasn’t easy to imagine a straightforward answer to this question of say whether working evening shifts might be more or less associated with a mum having started to breast feed or how long she breastfed compared with someone who worked weekends. There seemed to be a dual potential for each shift to make it harder or easier depending on how you looked at it.

Evening or night work might make it difficult to schedule consistent breastfeeding patterns. However, at the same time, these shifts might allow for dad or another caregiver to supply pumped milk if a mum is working odd hours.

Using information collected as part of the Millennium Cohort Study, which has followed the lives of children born at the turn of the century, we were able to look at more than 17,000 mothers and their children.

Mums were asked if they had ever tried to breastfeed and, if so, for how long. From this and informed by the UK infant feeding guidelines at the time of the survey, which recommended exclusive breastfeeding for 4–6 months, we were able to create 2 month bands for different breastfeeding duration e.g. ‘intermediate’ (terminated breastfeeding after 2 months but before 4 months).

When their babies were 9 months old, mothers who were working provided information about the sorts of shifts they worked and how often they worked them.

Breastfeeding and work

Nearly 70 per cent of mothers breastfed their child. Thirty percent of them stopped breastfeeding before 2 months and one-third breastfed for at least 4 months. About half of mothers were not working at the time of the survey, nearly 30 per cent were working a standard shift and one in five was working nonstandard shifts.

Looking more closely at nonstandard work, it was possible to see the prevalence of the different types of shifts.

An interesting thing to emerge when we looked just at work patterns and breastfeeding was that women who worked evenings were 70 per cent more likely than women who were unemployed to have breastfed at all. They were also more likely to breastfeed than women who worked other non standard shift patterns i.e. night or weekend shifts.

Women who worked evening shifts were also more likely than their unemployed counterparts to continue breastfeeding across all the different ‘duration bands’ including the longest. They were still also more likely than their peers doing other non standard patterns of work to be breastfeeding i.e. night, weekend and overnight shifts.

Evenings and breastfeeding

So what is it about evening work that appears to be ‘compatible’ with starting and continuing to breast feed (or vice versa?) Perhaps mothers working evening shifts have positive breastfeeding experiences and so keep on breastfeeding and working. Perhaps supportive and flexible working arrangements influence the decision to breastfeed for longer. Evening schedules perhaps have a less disruptive effect on sleep patterns than irregular or night shifts, leaving women feeling more able to manage a job and caring for/breastfeeding their children.

So perhaps evening work schedules have something of a unique role to play in child and maternal health when it comes to helping women back to work without losing the many benefits for them and their children of breastfeeding. There’s a lot more that needs disentangling here, but, nevertheless, food for thought!

Maternal Nonstandard Work Schedules and Breastfeeding Behaviors is research by Afshin Zilanawala and is published in the Maternal and Child Health Journal.

Having any job at all is better than being unemployed, right?

“Bad work just doesn’t fit in 2017!” Those are the words of Matthew Taylor, head of the Government’s recent review of modern work practices, who has called on politicians to make “all work good.” In an interview with the BBC, Mr Taylor, said that, as well as being bad for productivity and the economy, poor quality jobs were bad for people’s health and well-being. Recent research from Tarani Chandola from the University of Manchester has added further weight to those claims, finding that unemployed people who move into poor quality work have worse health than their peers who remain out of work. He explains more about the research findings and how they challenge the idea that having any job is good for your health.

There is considerable evidence to show that being out of work isn’t good for our health and that being in work can bring us a range of benefits, not just financial. It follows, then, that a move out of unemployment and into work is likely to be good for us, but does that hold true if the job we go into is a bad one?

Using rich social, economic and health data from the UK Household Longitudinal Study (UKHLS), our research examined the stress levels of a group of unemployed people aged 30-75, some of whom moved into poor quality jobs, some into good jobs and some who remained unemployed.

We also looked to see if any other factors, including their health at the outset of our study, had any bearing on the likelihood of them moving into a poor or good quality job.

Twelve biomarkers

As well as physical measurements such as height, weight and blood pressure, and self-reported information on their physical and mental health, some participants in the study gave blood samples. These could be tested for a range of markers, high levels of which might indicate diabetes, heart or kidney disease, acute or chronic stress. In total, we had 12 separate biomarkers, providing us with a comprehensive picture of participants’ health and an overall measurement of their stress, something referred to as their allostatic load.

How much people earned, how secure their job was and their working environment were all considered, in order to get a sense of the quality of their employment. Participants were asked how satisfied they were at work, how anxious or worried they felt about their job, how much control they had at work and whether they thought they might lose their job in the coming 12 months.

The people studied were divided into four groups:

  • Remained unemployed
  • Employed in a good quality job
  • Employed in a job with one poor quality measure
  • Employed with at least two poor quality measures

Stress levels

When we looked at the stress levels of the different groups, a clear pattern emerged. Unsurprisingly, people who moved out of unemployment and into a good job had the lowest levels of stress. People who went from being unemployed to working in a bad job (with more than two poor quality job measures) had the highest stress levels. These were 1.5 times higher than for those people who remained unemployed.

We took into consideration a host of other factors that might have had some role in propelling an unemployed person into a good or bad job, but even when we looked at their health at the outset of the study, this did not really play a role, other than to note that the people in better health moved into both good and bad jobs. In other words it wasn’t simply that people already in poor health were moving into the worse jobs.

Although numbers for this research were relatively small, the methods and analysis were extremely robust and we can, with some confidence, challenge the widespread belief that any employment, even poor quality work, is better for our health and wellbeing than being unemployed.

The findings serve to illuminate research published by the RSA and Populus recently, showing that three out of four people think we should do more as a country to improve the quality of work. Even more telling was the contrast between the over two thirds who think we can make all work fair and decent, and the less than one in ten who think this is already the case.

Making good work matter

Mr Taylor makes the case that “good work matters” and the RSA’s social media campaign #GoodWorkIs is a laudable effort to engage the wider public in a discussion about what good work looks like.

However, he, like many others, has said that the “worst work status for health is unemployment”. Our research shows that’s not necessarily the case, and our findings, together with more research in this area, should be considered carefully as strategies are hopefully developed to make his call to “make all work good” a reality not a pipedream, especially in the current political climate.

Re-employment, job quality, health and allostatic load biomarkers: Prospective evidence from the UK Household Longitudinal Study is research by Tarani Chandola and Nan Zhang and is published in the International Journal of Epidemiology.

 

Retiring early: the links with childhood

When we think of why someone might retire early, our minds are unlikely to make the leap to their childhood for the answer. But a group of researchers interested in what sorts of things affect our later working lives, believe that early retirement may indeed have some of its roots in our younger years. The research sheds new and important light on worldwide efforts to plug pensions gaps and get more people working longer. Hanno Hoven from the University of Dusseldorf outlines why he and colleagues from the International Centre for Lifecourse Studies at UCL think early retirement can be traced right back to having had a tougher childhood. He goes on to explain what the findings might mean for policy in this area.

All sorts of things are likely to influence the point at which older people stop working. External factors like tax incentives to stay in work or changes to when we can claim our State Pension play a role. Then there are our working conditions, what’s going on with our health and how our personal circumstances change as we get older.

A substantial body of research has shown in recent years that people whose socioeconomic circumstances are poor are more likely to retire early than their better off peers. But in our research, we wanted to see if retiring early can additionally be traced back to earlier stages of the life course, more specifically, to having had a tougher life as a child or during mid adulthood.

In addition we wanted to dig a bit deeper into older people’s working lives, by giving a clearer and more detailed picture that describes entire patterns of employment trajectories (and not retirement timing only). To do this, we took into account the employment history between 50 and 70, including details on type of job people did, whether they worked full- or part-time or whether they were self-employed.

We used information collected by the Survey of Health, Ageing and Retirement in Europe (SHARE), which has carried out interviews with more than 28,000 older people from 14 different countries. For our research, we focused on 5,857 men and women from the survey who wereaged 70 or over and who had provided details of their previous working and personal lives.

Work and retirement

We created clusters of their work and employment histories, and you can see in the table below the proportion of men and women in each cluster. On this basis we could link these clusters or types of employment histories to earlier adversity for both men and women.

Looking at types of employment histories between the ages of 50 and 70, we could see that men were more likely than women working in full-time employment or self-employed.. Women worked more likely in a part-time job or looked after home or family during those years.

Adversity in childhood

After modelling the effect of early life information and taking a range of background factors into account (e.g., among others, health conditions prior and during working life in mid adulthood), we were able to see that men who had experienced adversity in childhood were 5 percentage points more likely to have retired early (around age 55) from full-time employment, but they were less likely self-employed in late life. The same was true of men who experienced adversity in adulthood, although it is important to note that the effects were independent of each other.

Women who had suffered adversity in childhood were also less likely to be self-employed and retire later on. However, it was not related to early (around age 55) retirement from a full-time job. Women who faced adversity in adult life were more likely to work part-time or to look after the home/family than their peers who suffered no adversity during that period. This was not the case for childhood adversity.

Some other interesting things emerged from the research, which we believe provides a more comprehensive picture than has been provided before.

One very notable point was that early retirement was more closely associated with being in full-time employment rather than being self-employed. This could be because employed people have more restricted opportunities to work for longer (even if they want to) compared with their self-employed counterparts who have more freedom in deciding when to retire.

Food for thought

For those, including the Government’s Business Champion for Older Workers, who want to see thousands more older workers in British companies by 2022, this will be food for thought. More flexible retirement arrangements are likely to be necessary for employed workers who want to work longer, for example, through retirement schemes that allow a reduction of working time before leaving the labour market. This argument is further supported by the fact that such a cluster (where employed people reduced their working hours before retiring) was not found in our research.

Interesting differences emerged between men and women when it came to their employment histories and the way in which childhood adversity was linked to them. Whilst men were more likely to follow a path of full-time employment into retirement, women were more likely to have been continuously looking after home or family (without retirement) or have worked part-time.

When we factored in childhood adversity in the women’s lives, there was a close link with discontinuous employment in later life. This link was stronger for women than for men. Other research has suggested that traditional gender roles make it harder for women to gain a foothold in the labour market, a disadvantage that any adversity in childhood is likely to compound.

Looking across the lifecourse in this way sheds considerable new and important light on the timing of retirement, and offers some pointers for policymakers looking to increase the numbers of older workers. One specific implication is that certain measures are likely to work better for different age groups and should address different stages of the lifecourse.

There has been a great deal of focus on pension age and working conditions for older people. However, our research suggests that our childhood circumstances are also important and that policies to tackle childhood poverty and create good stable jobs for young people may also have a key role to play over time.

Early Adversity and Late Life Employment History—A Sequence Analysis Based on SHARE is research by Hanno Hoven, Nico Dragano, David Blane and Morten Wahrendorf and is published in Work, Aging and Retirement.

 

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

Healthy pensioners: Is working in our 60s good for us?

Pension ages in the UK are rising from the traditional 65 for men and 60 for women, as people live longer. But is working in later life good for us? The Government’s Chief Medical Officer Professor Dame Sally Davies says people aged 50-70 are more likely to stay healthy if they stay in work, but what does the evidence show? Dr Giorgio Di Gessa from the London School of Economics and Political Science and colleagues have investigated how being in paid work beyond state pension age affects our physical and mental health and how well we sleep and find a different story.

By 2020, it is estimated that one third of workers will be over 50. By then the state pension age will also have risen to 66 for everyone in the UK, climbing to 67 by 2028.

Figures from the Office for National Statistics reveal more than 1.2 million over-65s remain in work, an increase of nearly 50 per cent since the Default Retirement Age was banned in 2011, meaning employers cannot make staff retire when they reach state pension age.

With so many older people working, and with UK policies, and those of other western nations, designed to extend working lives, it is important to understand how continuing to work might affect our health.

Many studies have shown that working is good for physical and mental health in adults of normal working age. There is also evidence that retirement can be good for health. But little research has focused on the impact on health of working beyond State Pension age.

A previous study using the British Household Panel Survey suggests those working beyond state pension age self-report better health, but their lifetime health history was not studied. Given that healthier people are more likely to stay working, this needs to be taken into account for a more accurate picture.

Previous work history is also important, as there is evidence of poorer health among those with significant periods out of work. This is also likely to affect decisions about whether to continue working in later life.

Working longer

Using information on more than 1,600 people from the English Longitudinal Study of Ageing, we looked at the health and employment histories of men aged 65 to 74, and women aged 60 to 69. After those ages few men or women worked. Around a quarter of the women and 15 per cent of the men worked past State Pension age.

Participants in the study were asked if they had difficulties falling or staying asleep and whether they felt tired on waking up. Their grip strength was measured, and they also rated their own health, reporting any medical problems such as a long standing illness, heart disease, stroke, or loss of mobility.

For those who were employed, we looked at whether they worked more or less than 20 hours each week, and whether they had sedentary or active jobs. We also looked for differences between those in managerial and professional occupations through to those with routine and manual jobs.

Periods of unemployment for men and part-time working and career breaks for women were taken into account, together with the individual’s education, wealth, housing situation, marital status, caring responsibilities and factors like smoking and exercising.

Good health

Men and women in good health were more likely to be working past state pension age, as were those with a better education and those who had been in better health throughout their lives . Among women, those who were divorced or separated, still had mortgages and were not carers were more likely to continue working.

One third of those working beyond state pension age were in managerial positions, 45 per cent worked part-time, and one third of men and 41 per cent of women had a desk job. Men and women who worked throughout their lives were more likely to continue working after state pension age.

Men and women in paid work were less likely to be depressed or to have disturbed sleep, and reported better physical health, than those who didn’t work.

However, when social background, and previous health and employment histories were taken into account, we did not find any significant health benefits of working past state pension age. This is most likely to be because only a select group of healthy older adults work beyond this age.

Population health

What is clear is that the decision and ability to continue working past state pension age is strongly affected by current and lifetime health.

Overall, our study shows that extending our working lives has no effect on our health. However, it remains an open question whether changing the state pension age could worsen population health if everyone, including those in poor health, is required to work longer.

To support policies aimed at extending working lives, it will be essential for governments to focus on health promotion and policies which help to improve the health of the population throughout their working life.

Going forward it would be useful to know more about the reasons people continue working. Is it through choice or because they need the money? It would also be good to look at the timing of previous poor health to see at what stage ill health stops people from working.

Further information

Is being in paid work beyond state pension age beneficial for health? Evidence from England using a life-course approach is research by Giorgio Di Gessa of the London School of Economics and Political Science, Laurie Corna of King’s College London, Loretta Platts of Stockholm University, Diana Worts and Peggy McDonough of the University of Toronto, Amanda Sacker of University College London, Debora Price of the University of Manchester, and Karen Glaser of King’s College London. It is published in the Journal of Epidemiology & Community Health.

Photo credit: Farmer stepping into cab, United Soybean

Who works post State Pension Age?

Across Europe and indeed other parts of the world, we’re being told we need to work longer than in the past. The reason? We’re all living longer and pension systems everywhere are collapsing under the strain. But with age can come poorer health and reduced physical capabilities and what if doing our job is physically or mentally demanding? Raising the State Pension Age for this group of workers compared say with someone working in a less stressful job could end up creating pressure on specific disadvantaged groups, whilst favouring already advantaged groups. Morten Wahrendorf from the University of Dusseldorf and ESRC International Centre for Lifecourse Studies has been investigating.

A number of Governments across Europe have already increased the state pension age beyond 65 and are actively looking to introduce incentives and measures that they hope will get more people of working age to retire later.

Quite a lot of research has looked at what things are going on in people’s lives that might lead them to retire early from work, but far fewer questions have been asked about what might lead to someone working beyond state pension age. What sorts of jobs do they tend to do? What are their working conditions like? How do those compare with people who retire earlier?

It’s important to get a grasp of this if we are to ensure that any changes made to the pension system are fair and just and that they don’t adversely affect specific or already disadvantaged groups.

Using information on nearly 18,000 men and women aged 65 and over from 16 European countries we were able to look into this in some depth and effectively compare prior working conditions of those people who retired early with current conditions of those who worked longer.

Work and conditions

Our information came from the Survey of Health, Ageing and Retirement in Europe (SHARE). We looked at whether the participants were employed or not, their job (at the time of the survey and immediately before retiring), how long they had been doing their job, working hours and how stressful their job was.

In addition we looked at what the participants said about how much freedom they had at work, whether there were opportunities to develop new skills, whether their job was physically demanding or time-pressured and how supported and recognised they felt at work.

As far as survey participants’ health was concerned, we were able to see how they rated their own health, whether they were depressed, their quality of life, and how mentally and physically capable they were.

Workers better-off and better-educated

Of everyone we looked at in the study, 755 (4.3 per cent) were still working between the ages of 65 and 80. They tended, on average, to be better off and better-educated than those who had retired.

Those still working were three times as likely to be self-employed as our retired group, who were also less likely to have been in a managerial or professional job before retiring.

Those who had retired reported higher levels of stress in their last job, particularly when it came to how valued and supported they felt. They also had poorer health across the board on all the measures we looked at.

Figure 1. Prevalence of poor health by labour market situation among older men and women (aged 65 to 80 years) in percentage (n=17625

ICLS-health

These findings were still seen even after accounting for a host of other factors including their sex, education, whether or not they were in a relationship, if they had children and how well off they were, and also country affiliation.

There is robust evidence here that across Europe people who are likely to work longer are those who are self-employed or in a good job where they are in control and feel well supported and valued. They are also in better physical and mental shape than their retired counterparts.

Raising the State Pension Age or offering tax incentives to people to work longer may well favour certain groups who are already doing better than their peers in a number of ways. It could also place increased pressure on people already in poor health and in poor quality jobs.

All this needs to be taken into account by Governments looking to plug the pensions gap and by employers who will need to provide good jobs in a better, less stressful working environment if their workers are to remain productive post 65.

Further information

Photo credit: Fish, nico_enders