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Health benefits of encore careers for baby boomers
Maturitas 78 (2014) 8–10
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Review
Health benefits of encore careers for baby boomers Anya Topiwala, Shivani Patel, Klaus P. Ebmeier ∗ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
a r t i c l e
i n f o
Article history: Received 6 February 2014 Accepted 10 February 2014 Keywords: Retirement Pension Dementia Depression
a b s t r a c t Baby boomers now represent an aging population group at risk of the diseases of older age. Their relatively high education, amongst other attributes, means that they can make a significant contribution to the work force beyond the statutory retirement age. On an individual level, potential health benefits may motivate them to pursue encore careers. We review some of the evidence supporting such a trend. © 2014 Elsevier Ireland Ltd. All rights reserved.
Contents 1. 2.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Health benefits of occupation on psychiatric morbidity and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.1. Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.2. Cognitive impairment and dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3. Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 4. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Competing interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Provenance and peer review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1. Introduction The great population bulge of the 50–68 year olds (the “baby boomers”), has caused some anxiety to policy makers, as the pension-paying younger generations are getting smaller and smaller, and already need to be supplemented in many Western countries by younger overseas immigrants and their children. UK projections estimate that baby boomers will live on average another 15.8–20.9 years [1]. They will thus represent a substantial section of the population (26% in the US) [2]. Yet in the UK, median retirement age is 64.6 for men, and 62.3 years for women, respectively [3]. Public health focus has been on the risk of illnesses common after retirement, such as depression (point prevalence of
4.6–9.3% in >75 year olds) [4] and dementia (5.9–7.0% of >65 year olds) [5]. While pension ages are being increased to catch up gradually with the projected budget deficits, the question arises, if this may not confer benefits on this generation, rather than just representing an economic sacrifice to be made. Certainly, baby boomers are well placed to work on a paid or voluntary basis into older age. US statistics show that as a group they are better educated (28.8% have at least a bachelor’s degree), are more likely to be employed (74.1%) and wealthier (only 8.9% in poverty) than are any other age strata of the population [2]. 2. Health benefits of occupation on psychiatric morbidity and mortality 2.1. Depression
∗ Corresponding author. Tel.: +44 1865 226469; fax: +44 1865 793101. E-mail address: [email protected] (K.P. Ebmeier). http://dx.doi.org/10.1016/j.maturitas.2014.02.005 0378-5122/© 2014 Elsevier Ireland Ltd. All rights reserved.
Prolonged unemployment accounts for a proportion of depression across adult age groups [6–8]. Unemployed, but also part-time
A. Topiwala et al. / Maturitas 78 (2014) 8–10
and retired workers are more likely to be depressed than those in full-time work [6]. In many cases it may be difficult to establish whether unemployment led to depression or vice versa, but some studies have claimed that unemployment is causally related to depression [9,10]. Loss of regular income has been identified as a critical factor contributing toward depressive symptoms. Men at retirement age, who were working for pay, were less likely to be depressed than men who were not being paid for their work [11]. Similarly, the low-income unemployed suffer most with depression, further supporting the idea that loss of financial security is a critical factor [12]. Regularity of work has also been identified as important in reducing reported depressive symptoms. Full-time workers, compared with ‘non-standard’ or temporary workers, reported fewer depressive symptoms, even after adjusting for education, occupational class and income [13]. This suggests that in addition to providing a livelihood, paid employment gives workers a sense of purpose and self-worth that is removed with retirement. Social isolation (particularly the size of the social network and subjective social support) has been identified as important in predicting depression in the elderly retired population [14]. Those who engage in fewer social activities have a significantly higher incidence of depression [15]. Social support appears relevant to chronicity of major depressive illness more than its severity [16]. As going to work is the main form of social interaction for many, retirement may thus predispose older individuals toward depression, which would be mitigated by an encore career. 2.2. Cognitive impairment and dementia A number of studies have demonstrated a link between high lifetime occupational attainment (i.e. non-manual/white collar) and a reduced incidence of all cause [17], vascular [18], and Parkinson’s disease dementia [19]. Duration of employment may determine the strength of such associations [18]. Additionally, one study has hinted at a negative impact of retirement upon cognitive function [20]. No study has to date examined the association between later life careers and dementia risk. However, it seems reasonable to extrapolate from studies of mental activity and social interaction, which would be components of the majority of encore careers. A meta-analysis in 2004 concluded that social and mental activities have a beneficial effect on cognition and a protective effect against dementia [21]. Longitudinal studies associate cognitively stimulating leisure activities (one can argue for a similarity with mental work) with a decreased risk of dementia [22], Alzheimer’s disease [23], vascular dementia [24], as well as with a later age of dementia onset [25]. Similarly, the majority of studies have shown reduced cognitive decline with increasing leisure activity [26]. Such activities are diverse and include computer use [22], odd jobs and knitting [27]. The majority (10/12) of longitudinal studies have shown that increased social interaction is associated with reduced dementia incidence [28] or later onset [25]. Similarly, 17 of 18 studies have demonstrated a significant correlation between increased social activity and reduced cognitive decline [29]. Of course, one must make causal interpretations in such studies with care. The vast majority of participants were >65 years at baseline, hence decreased mental or social activity may be the result of pre-existing subtle cognitive impairments. 3. Mortality There is a substantial evidence base suggesting that unemployment in middle age increases mortality. In one prospective study of 40–59 year olds, those unemployed in the five years after screening
9
had approximately double the risk of dying (from cardiovascular disease or cancer) compared with those continuously employed, even after adjustment for multiple confounders [30]. However, the relationship between employment and mortality is likely to be complicated, and one cannot necessarily extrapolate that encore careers would decrease mortality. Temporary (rather than permanent) employment may actually increase mortality [31] – the relationship between total working hours and mortality may actually be u-shaped [32]. Correspondingly, several studies have found mortality is higher amongst those retiring early (<65 years) [33], although this association may be confounded by those retiring early on grounds of ill health. Following adjustment for this, early retirees spent fewer days in hospital in the preceding two years and had no change in mortality [34]. One can make a compelling argument that encore careers may decrease suicides in baby boomers. Unemployment [35], retirement [36], and a restricted social network [37] are all risk factors for elderly suicide. A meta-analysis found that having a hobby or active participation in an organization decreased the risk of suicide in >65 year olds (although this was not significant following adjustment for life events, psychosocial variables and mental health) [38]. 4. Conclusions Baby boomers now represent an aging population and are at risk from debilitating diseases of older age. Their relatively high education, amongst other attributes, means that they could make a significant contribution to the work force beyond the statutory retirement age. On an individual level, potential health benefits may motivate them to pursue encore careers. Mental and social activities seem to decrease the risk of dementia; employment, income and social contact decrease the risk of depression; and mortality (particularly from suicide) is decreased by employment and social contact. Depression, dementia or lethal morbidity may of course result in early retirement rather than vice versa. However, physical and mental activity seems to improve mood and cognitive performance supporting the argument that employment confers a beneficial impact on health [39,40]. Contributors All authors were involved in the first draft (part) and full revision of the manuscript. Competing interest Anya Topiwala and Shivani Patel both declared no competing interest and Klaus P. Ebmeier reports consultation fees received from Lily in relation to Amyvid TM. Funding Anya Topiwala – UK Medical Research Council (G1001354) – Clinical Lecturer. Shivani Patel – North East Thames Foundation School. Klaus P. Ebmeier – UK Medical Research Council (G1001354), the Gordon Edward Small’s Charitable Trust (SC008962), and the HDH Wills 1965 Charitable Trust. Provenance and peer review Commissioned and externally peer reviewed.
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A. Topiwala et al. / Maturitas 78 (2014) 8–10
References [1] Office for National Statistics. Life expectancy at birth and at age 65 for local areas in England and Wales, 2010–2012; 2013. Available from: http://www.ons. gov.uk/ons/rel/subnational-health4/life-expectancy-at-birth-and-at-age-65by-local-areas-in-england-and-wales/ 2010-12/stb-life-expectancy-at-birth-2010-12.html [2] United States Census Bureau. American Community Survey Fact Finder. American Community Survey [Internet]; 2006. Available from: http://factfinder2. census.gov/ [3] Office for National Statistics. Pension trends; 2012 [chapters 2–4] Available www.ons.gov.uk/ons/about-ons/our-statistics/publications/pensionfrom: trends/index.html [4] Meeks TW, Vahia IV, Lavretsky H, Kulkarni G, Jeste DV. A tune in a minor “can b major”: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 2011;129(1–3):126–42. [5] Matthews FE, Arthur A, Barnes LE, et al. A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet 2013;382(9902):1405–12. [6] Mirowsky J, Ross CE. Age and depression. J Health Soc Behav 1992;33(3):187–205, discussion 6-12. [7] Christ SL, Lee DJ, Fleming LE, et al. Employment and occupation effects on depressive symptoms in older Americans: does working past age 65 protect against depression? J Gerontol B: Psychol Sci Soc Sci 2007;62(6):S399–403. [8] Villamil E, Huppert FA, Melzer D. Low prevalence of depression and anxiety is linked to statutory retirement ages rather than personal work exit: a national survey. Psychol Med 2006;36(7):999–1009. [9] Montgomery SM, Cook DG, Bartley MJ, Wadsworth ME. Unemployment predates symptoms of depression and anxiety resulting in medical consultation in young men. Int J Epidemiol 1999;28(1):95–100. [10] Dooley D, Catalano R, Wilson G. Depression and unemployment: panel findings from the Epidemiologic Catchment Area study. Am J Community Psychol 1994;22(6):745–65. [11] Butterworth P, Gill SC, Rodgers B, Anstey KJ, Villamil E, Melzer D. Retirement and mental health: analysis of the Australian national survey of mental health and well-being. Soc Sci Med 2006;62(5):1179–91. [12] D’Arcy C, Siddique CM. Unemployment and health: an analysis of “Canada Health Survey” data. Int J Health Serv 1985;15(4):609–35. [13] Kim IH, Muntaner C, Khang YH, Paek D, Cho SI. The relationship between nonstandard working and mental health in a representative sample of the South Korean population. Soc Sci Med 2006;63(3):566–74. [14] George LK, Blazer DG, Hughes DC, Fowler N. Social support and the outcome of major depression. Br J Psychiatry 1989;154:478–85. [15] Yamashita K, Kobayashi S, Yamaguchi S, et al. Feelings of well-being and depression in relation to social activity in normal elderly people. Nihon Ronen Igakkai Zasshi 1993;30(8):693–7. [16] Hays JC, Krishnan KR, George LK, Pieper CF, Flint EP, Blazer DG. Psychosocial and physical correlates of chronic depression. Psychiatry Res 1997;72(3): 149–59. [17] Stern Y, Gurland B, Tatemichi TK, Tang MX, Wilder D, Mayeux R. Influence of education and occupation on the incidence of Alzheimer’s disease. J Am Med Assoc 1994;271(13):1004–10. [18] Kroger E, Andel R, Lindsay J, Benounissa Z, Verreault R, Laurin D. Is complexity of work associated with risk of dementia? The Canadian Study of Health And Aging. Am J Epidemiol 2008;167(7):820–30.
[19] Helmer C, Letenneur L, Rouch I, et al. Occupation during life and risk of dementia in French elderly community residents. J Neurol Neurosurg Psychiatry 2001;71(3):303–9. [20] Roberts BA, Fuhrer R, Marmot M, Richards M. Does retirement influence cognitive performance? The Whitehall II Study. J Epidemiol Community Health 2011;65(11):958–63. [21] Fratiglioni L, Paillard-Borg S, Winblad B. An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol 2004;3(6):343–53. [22] Almeida OP, Yeap BB, Alfonso H, Hankey GJ, Flicker L, Norman PE. Older men who use computers have lower risk of dementia. PLoS ONE 2012;7(8):e44239. [23] Akbaraly TN, Portet F, Fustinoni S, et al. Leisure activities and the risk of dementia in the elderly: results from the Three-City Study. Neurology 2009;73(11):854–61. [24] Verghese J, Cuiling W, Katz MJ, Sanders A, Lipton RB. Leisure activities and risk of vascular cognitive impairment in older adults. J Geriatr Psychiatry Neurol 2009;22(2):110–8. [25] Paillard-Borg S, Fratiglioni L, Xu W, Winblad B, Wang HX. An active lifestyle postpones dementia onset by more than one year in very old adults. J Alzheimers Dis 2012;31(4):835–42. [26] Wang HX, Jin Y, Hendrie HC, et al. Late life leisure activities and risk of cognitive decline. J Gerontol A: Biol Sci Med Sci 2013;68(2):205–13. [27] Fabrigoule C, Letenneur L, Dartigues JF, Zarrouk M, Commenges D, BarbergerGateau P. Social and leisure activities and risk of dementia: a prospective longitudinal study. J Am Geriatr Soc 1995;43(5):485–90. [28] Crooks VC, Lubben J, Petitti DB, Little D, Chiu V. Social network, cognitive function, and dementia incidence among elderly women. Am J Public Health 2008;98(7):1221–7. [29] James BD, Wilson RS, Barnes LL, Bennett DA. Late-life social activity and cognitive decline in old age. J Int Neuropsychol Soc 2011;17(6):998–1005. [30] Morris JK, Cook DG, Shaper AG. Loss of employment and mortality. Br Med J 1994;308(6937):1135–9. [31] Kivimaki M, Vahtera J, Virtanen M, Elovainio M, Pentti J, Ferrie JE. Temporary employment and risk of overall and cause-specific mortality. Am J Epidemiol 2003;158(7):663–8. [32] Sokejima S, Kagamimori S. Working hours as a risk factor for acute myocardial infarction in Japan: case–control study. Br Med J 1998;317(7161):775–80. [33] Tsai SP, Wendt JK, Donnelly RP, de Jong G, Ahmed FS. Age at retirement and long term survival of an industrial population: prospective cohort study. Br Med J 2005;331(7523):995. [34] Brockmann H, Muller R, Helmert U. Time to retire–time to die? A prospective cohort study of the effects of early retirement on long-term survival. Soc Sci Med 2009;69(2):160–4. [35] Voss M, Nylen L, Floderus B, Diderichsen F, Terry PD. Unemployment and early cause-specific mortality: a study based on the Swedish twin registry. Am J Public Health 2004;94(12):2155–61. [36] Qin P, Agerbo E, Westergard-Nielsen N, Eriksson T, Mortensen PB. Gender differences in risk factors for suicide in Denmark. Br J Psychiatry 2000;177:546–50. [37] Beautrais AL. A case control study of suicide and attempted suicide in older adults. Suicide Life Threat Behav 2002;32(1):1–9. [38] Rubenowitz E, Waern M, Wilhelmson K, Allebeck P. Life events and psychosocial factors in elderly suicides—a case–control study. Psychol Med 2001;31(7):1193–202. [39] Valkanova V, Eguia Rodriguez R, Ebmeier KP. Mind over matter – what do we know about neuroplasticity in adults? Int Psychogeriatr 2014:1–19. [40] Behrman S, Ebmeier KP. Can exercise prevent cognitive decline? Practitioner 2014;258(1767):17–21.
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Review
Health benefits of encore careers for baby boomers Anya Topiwala, Shivani Patel, Klaus P. Ebmeier ∗ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
a r t i c l e
i n f o
Article history: Received 6 February 2014 Accepted 10 February 2014 Keywords: Retirement Pension Dementia Depression
a b s t r a c t Baby boomers now represent an aging population group at risk of the diseases of older age. Their relatively high education, amongst other attributes, means that they can make a significant contribution to the work force beyond the statutory retirement age. On an individual level, potential health benefits may motivate them to pursue encore careers. We review some of the evidence supporting such a trend. © 2014 Elsevier Ireland Ltd. All rights reserved.
Contents 1. 2.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Health benefits of occupation on psychiatric morbidity and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.1. Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.2. Cognitive impairment and dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 3. Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 4. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Competing interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Provenance and peer review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1. Introduction The great population bulge of the 50–68 year olds (the “baby boomers”), has caused some anxiety to policy makers, as the pension-paying younger generations are getting smaller and smaller, and already need to be supplemented in many Western countries by younger overseas immigrants and their children. UK projections estimate that baby boomers will live on average another 15.8–20.9 years [1]. They will thus represent a substantial section of the population (26% in the US) [2]. Yet in the UK, median retirement age is 64.6 for men, and 62.3 years for women, respectively [3]. Public health focus has been on the risk of illnesses common after retirement, such as depression (point prevalence of
4.6–9.3% in >75 year olds) [4] and dementia (5.9–7.0% of >65 year olds) [5]. While pension ages are being increased to catch up gradually with the projected budget deficits, the question arises, if this may not confer benefits on this generation, rather than just representing an economic sacrifice to be made. Certainly, baby boomers are well placed to work on a paid or voluntary basis into older age. US statistics show that as a group they are better educated (28.8% have at least a bachelor’s degree), are more likely to be employed (74.1%) and wealthier (only 8.9% in poverty) than are any other age strata of the population [2]. 2. Health benefits of occupation on psychiatric morbidity and mortality 2.1. Depression
∗ Corresponding author. Tel.: +44 1865 226469; fax: +44 1865 793101. E-mail address: [email protected] (K.P. Ebmeier). http://dx.doi.org/10.1016/j.maturitas.2014.02.005 0378-5122/© 2014 Elsevier Ireland Ltd. All rights reserved.
Prolonged unemployment accounts for a proportion of depression across adult age groups [6–8]. Unemployed, but also part-time
A. Topiwala et al. / Maturitas 78 (2014) 8–10
and retired workers are more likely to be depressed than those in full-time work [6]. In many cases it may be difficult to establish whether unemployment led to depression or vice versa, but some studies have claimed that unemployment is causally related to depression [9,10]. Loss of regular income has been identified as a critical factor contributing toward depressive symptoms. Men at retirement age, who were working for pay, were less likely to be depressed than men who were not being paid for their work [11]. Similarly, the low-income unemployed suffer most with depression, further supporting the idea that loss of financial security is a critical factor [12]. Regularity of work has also been identified as important in reducing reported depressive symptoms. Full-time workers, compared with ‘non-standard’ or temporary workers, reported fewer depressive symptoms, even after adjusting for education, occupational class and income [13]. This suggests that in addition to providing a livelihood, paid employment gives workers a sense of purpose and self-worth that is removed with retirement. Social isolation (particularly the size of the social network and subjective social support) has been identified as important in predicting depression in the elderly retired population [14]. Those who engage in fewer social activities have a significantly higher incidence of depression [15]. Social support appears relevant to chronicity of major depressive illness more than its severity [16]. As going to work is the main form of social interaction for many, retirement may thus predispose older individuals toward depression, which would be mitigated by an encore career. 2.2. Cognitive impairment and dementia A number of studies have demonstrated a link between high lifetime occupational attainment (i.e. non-manual/white collar) and a reduced incidence of all cause [17], vascular [18], and Parkinson’s disease dementia [19]. Duration of employment may determine the strength of such associations [18]. Additionally, one study has hinted at a negative impact of retirement upon cognitive function [20]. No study has to date examined the association between later life careers and dementia risk. However, it seems reasonable to extrapolate from studies of mental activity and social interaction, which would be components of the majority of encore careers. A meta-analysis in 2004 concluded that social and mental activities have a beneficial effect on cognition and a protective effect against dementia [21]. Longitudinal studies associate cognitively stimulating leisure activities (one can argue for a similarity with mental work) with a decreased risk of dementia [22], Alzheimer’s disease [23], vascular dementia [24], as well as with a later age of dementia onset [25]. Similarly, the majority of studies have shown reduced cognitive decline with increasing leisure activity [26]. Such activities are diverse and include computer use [22], odd jobs and knitting [27]. The majority (10/12) of longitudinal studies have shown that increased social interaction is associated with reduced dementia incidence [28] or later onset [25]. Similarly, 17 of 18 studies have demonstrated a significant correlation between increased social activity and reduced cognitive decline [29]. Of course, one must make causal interpretations in such studies with care. The vast majority of participants were >65 years at baseline, hence decreased mental or social activity may be the result of pre-existing subtle cognitive impairments. 3. Mortality There is a substantial evidence base suggesting that unemployment in middle age increases mortality. In one prospective study of 40–59 year olds, those unemployed in the five years after screening
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had approximately double the risk of dying (from cardiovascular disease or cancer) compared with those continuously employed, even after adjustment for multiple confounders [30]. However, the relationship between employment and mortality is likely to be complicated, and one cannot necessarily extrapolate that encore careers would decrease mortality. Temporary (rather than permanent) employment may actually increase mortality [31] – the relationship between total working hours and mortality may actually be u-shaped [32]. Correspondingly, several studies have found mortality is higher amongst those retiring early (<65 years) [33], although this association may be confounded by those retiring early on grounds of ill health. Following adjustment for this, early retirees spent fewer days in hospital in the preceding two years and had no change in mortality [34]. One can make a compelling argument that encore careers may decrease suicides in baby boomers. Unemployment [35], retirement [36], and a restricted social network [37] are all risk factors for elderly suicide. A meta-analysis found that having a hobby or active participation in an organization decreased the risk of suicide in >65 year olds (although this was not significant following adjustment for life events, psychosocial variables and mental health) [38]. 4. Conclusions Baby boomers now represent an aging population and are at risk from debilitating diseases of older age. Their relatively high education, amongst other attributes, means that they could make a significant contribution to the work force beyond the statutory retirement age. On an individual level, potential health benefits may motivate them to pursue encore careers. Mental and social activities seem to decrease the risk of dementia; employment, income and social contact decrease the risk of depression; and mortality (particularly from suicide) is decreased by employment and social contact. Depression, dementia or lethal morbidity may of course result in early retirement rather than vice versa. However, physical and mental activity seems to improve mood and cognitive performance supporting the argument that employment confers a beneficial impact on health [39,40]. Contributors All authors were involved in the first draft (part) and full revision of the manuscript. Competing interest Anya Topiwala and Shivani Patel both declared no competing interest and Klaus P. Ebmeier reports consultation fees received from Lily in relation to Amyvid TM. Funding Anya Topiwala – UK Medical Research Council (G1001354) – Clinical Lecturer. Shivani Patel – North East Thames Foundation School. Klaus P. Ebmeier – UK Medical Research Council (G1001354), the Gordon Edward Small’s Charitable Trust (SC008962), and the HDH Wills 1965 Charitable Trust. Provenance and peer review Commissioned and externally peer reviewed.
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