One major health consequence of a longer lifespan is the increase in prevalence of dementia. This places considerable demands on the health care system, on long-term care, and on wellbeing of family members, especially the primary carer. The World Health Organisation notes that the risk of dementia rises sharply with age with an estimated 25—30 per cent of people ages 85 years or older showing some evidence of dementia. What do we know about health and retirement?
Is finally quitting the workplace good for you or not? Research indicates that mental health issues occur relatively infrequently post-retirement but physical health problems are relatively common, although often associated with ageing rather than retirement per se. Is retirement associated with physical health improvements? A recent prospective study by the highly regarded Harvard School of Public Health investigated the association between transition to retirement and risk of stroke and heart attack.
They followed participants aged 50 and over who were in the paid workforce and free of major cardiovascular disease up to 10 years until they retired. After adjusting for a wide range of factors age, sex, socio-economic status, behaviour and co-morbidities , the researchers found that retirees were 40 per cent more likely to have had a heart attack or stroke than those who were still working at the same age. There were no differences between men and women in these outcomes.
Outcomes of a large UK study showed almost twice the number of retired individuals compared to those still employed at the same age suffered chronic conditions such as diabetes, stroke or cancer. Women retirees had a higher risk than the overall sample of being diagnosed with cancer and a lower risk of developing cardiovascular diseases. Male retirees were more at risk than the overall sample for heart attack, stroke and psychiatric problems. However, the author notes that poorer health outcomes among retirees compared to those still working cannot be regarded solely as the result of retirement, even after adjusting for age.
Poor health is often one of the reasons people retire, rather than a result of the process of retirement. Nevertheless, as we discuss later in the chapter, there may be some factors associated with retirement that lead to worsening health, for example an increase in social isolation or adoption of bad health habits. Not all research shows detrimental effects of retirement. Consistent with a number of studies, one recent study, across 12 Western European countries, using rigorous methods, showed that retirement can lead to improvements in self-reported health, across educational levels and for men and women alike.
Equally positive are the findings from recent German research. In retirement, people are more likely to rate their health as satisfactory. Mental health improves, even after allowing for age-related medical problems and for those retired early due to ill health. The author estimated that the number of doctor visits reduced by 25 per cent for retirees compared to non-retirees of the same age, an important finding for the economics of the German health system.
It would be interesting to see this research replicated in other countries. Nevertheless, as both the proportion of older people in communities and the length of life increase throughout the world, key questions arise. Will population ageing be accompanied by a longer period of good health, a sustained sense of wellbeing, and extended periods of social engagement and productivity?
Or will it be associated with more illness, disability and dependency? These questions are important not only in terms of providing best practice preparation for retirement and subsequent health care but also because of policy moves in some countries to raise the age at which state pensions become available, with a view to inducing postponed retirement. I did not expect retirement to be this good. I feel that I am fortunate to be in good health, and able to enjoy life as it is.
I expected my health to be better, and to be more mobile than I am. This is restricting me in many ways. I can no longer join some friends for brisk walks, hikes with backpacks etc. What is behind these two contrasting experiences of health in retirement? As we saw earlier, there is equivocal evidence regarding the health consequences of retirement with some studies showing positive effects, others negative.
One thought-provoking link with poor health is the experience of loneliness and social isolation.
While not specifically a problem of retirees, retirement may trigger increased loneliness and decreased social connections. There is strong evidence that social isolation and loneliness heighten the risk for premature mortality and that this risk exceeds that of many key ill-health indicators. Researchers have shown that loneliness can be a bigger killer than obesity and should be considered a major public health issue. A review of studies into the health effects of social isolation and loneliness [iv] found that lonely people have a 50 per cent higher chance of premature death, while obesity increases the chance of early death by 30 per cent.
The team found that the risk of early death associated with loneliness, social isolation and living alone was equal to or greater than the premature death risk associated not only with obesity but with other major health conditions. Another factor relates to lifestyle changes post-retirement. Some people improve their nutrition and exercise regimes; others do not.
These positive effects were linked to increased physical activity post-retirement and reduced smoking. On the other hand a Finnish study demonstrated that while women tended to improve their dietary habits when they retired, this was not the case for retired men. A long-term study of British civil servants reinforces the need for care in concluding that retirement affects health, either positively or negatively. On-time retirement and voluntary early retirement were both related to better physical functioning and mental health when retirees were compared to those who remained in the workforce.
The authors suggested that there might be a causal relationship between voluntary retirement and positive health outcomes. However we need here to consider the possibility of including selection bias. For example, those who choose earlier retirement may do so either because their health is compromised or because they are healthy and want to enjoy retirement activities while still fit enough to do so.
Certainly, there is evidence from our study of Australian women that a significant minority retire voluntarily, but many do so for health reasons 15 per cent , because of work stress 19 per cent or the ill health of family members 11 per cent. A number of studies have used careful methodologies, including sophisticated sampling methods, and analyses that adjust for selection bias e.
In the analysis of data from seven waves of the US Health and Retirement Study [vii] these biases accounted for most of the observed differences in health between retirees and non-retirees over time. The authors concluded the adverse health effects are mitigated if the individual is married and has social support, continues to engage in physical activity post-retirement or continues to work part-time upon retirement. There was also some evidence that the adverse health effects are larger in the event of involuntary retirement, a finding consistent with other studies.
Is early retirement a healthy idea? Some studies have similarly shown that early retirement has negative consequences for post-retirement physical and emotional health and cognitive functioning, although, in respect of the last, there is recent evidence that work that requires higher mental demands is protective against cognitive decline in retirement independent of education level and socio-economic status.
At least one study has shown that people who retired at age 55 had almost twice the risk of death compared to people who retired at age The link between early retirement and early death was greater for men than women; men who retired at 55 had an 80 per cent greater increase risk than women who retired at In the relatively narrow age range of older women in our study mostly in their 60s , age was not related to health per se , but it was related to changes in health.
But there are large individual differences in when this process begins. For example, those whose health got better on retirement were more likely to have retired younger than those whose health stayed the same, but then so were those whose health got worse post-retirement. This fits with the idea that women who choose earlier retirement may do so either because their health is compromised or because they are healthy and want to enjoy retirement activities while still fit enough to do so. There are many challenges with estimating the impact of retirement on health apart from the confounding of retirement with ageing as we have seen.
The difficulty in establishing clear links between physical health and retirement suggests it may prove more productive to examine psychological health.
I thought that I was ready to retire mentally — but found that it actually took me three years to adjust — I grieved for my job and that process took that long. There was no help or recognition about the grieving process. I had to work through that myself, and it was only after I came out the other end that I realized what had happened to me. Most rely on life satisfaction or satisfaction with retirement as a surrogate for this.
The majority of retirees report little or no change in psychological wellbeing post-retirement. Our study of retired women measured two adjustment-like measures, self-esteem and stress levels. Higher levels of self-esteem were associated with significantly better health post-retirement, as well as greater satisfaction with their health. Asked about stress, three-quarters reported being less stressed and only 7 per cent were more stressed after they retired. An extensive review of the literature [viii] noted that research into the association between life satisfaction and retirement has produced inconsistent findings and is partly dependent on pre-retirement levels of life satisfaction.
What of depression in retirement? Depression is an important health problem in many countries.
It reduces productivity at work and is the fastest increasing reason for early retirement. There is convincing evidence that depression is associated with increased risk of early retirement, and depressed individuals retire at a significantly younger age than those without depression.
Post-retirement depression has also been documented but less convincingly. For example, while an Institute of Economic Affairs report [ix] showed being retired increased risk of clinical depression by 40 per cent, not all studies have demonstrated such a strong effect and some, none at all.
There is clearly more research needed here to tease out the effects of pre-retirement psychological health, retirement, social isolation, ageing and lifestyle factors on depression. Psychological wellbeing and adjustment are greatly dependent on all the resources that individuals bring to the retirement transition. These resources can be personal, material or social and are drawn on to help individuals manage stressful or difficult situations.
It can be tedious, boring and even though I am a loner, more solitary than I would sometimes like. The gendered expectations of caring mean that women are more likely to regard caring for a partner as an obligation and spend more time doing so than men, a state of affairs that has been linked to increased stress.
Another concern for retirees who have spent many years in the workforce, with tasks clearly prescribed, is the lack of structure to their day. Additionally, for those whose sense of self is tied to their work identity, retirement can be a daunting prospect. The lack of challenges and excitement that daily work brought to their lives is reflected in loss of self-esteem and sense of contributing to society.
I absolutely hate it. I find it financially challenging, lonely and boring. I feel as though I am brain dead, and I am being left further and further behind in learning new technologies and discovering new interests. I find I am sinking into apathy and the less I do the less I want to do.
While these issues affect some but by no means the majority of retirees, the loss of financial resources is a major concern for many, especially women, as we have seen in Chapter 3. Inadequate finances can affect many aspects of life satisfaction, for example through limiting access to secure housing and adequate health care, and reducing opportunities to engage in new roles and activities because of their cost. Since , a number of reviews addressing the determinants of adjustment to life during retirement have been published, reflecting the growing interest in this field. A recent thorough review of predictors of adjustment to retirement [xi] identified four groups of predictors.