Is early retirement good for your health?

Life expectancy is increasing steadily in developed countries. The gap between the common retirement age at 65 and life expectancy at that age has increased substantially; for example, in the Netherlands from 6.4 to 13.3 years in the past 50 years. Governments are seeking to increase the proportion of elderly people in paid employment to balance the ratio of employed people over dependent ones.1 Modern welfare states have created financial incentives to support employment at older age and are pushing the age of statutory retirement upwards. Extending working life is an important societal challenge. There is considerable debate about the timing of retirement and its influence on health: is retirement good or bad for your health? In the linked cohort study (doi:10.1136/bmj.c6149), Westerlund and colleagues assess the association between retirement and the subsequent risk of incident chronic diseases, depressive symptoms, and fatigue⇓.2

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Several studies have shown that retirement at younger age has adverse effects on health. A prospective study in a petrochemical company showed that workers who retired at age 55 had a 37% higher mortality than those who retired at 65.3 A similar result was seen in Swedish construction workers, but detailed analyses showed that increased mortality did not depend on early retirement but on poor health before early retirement.4 The methodological problem of health related selection into retirement may obscure the effect of retirement on health. It is therefore difficult to disentangle the effects of ill health on displacement from the labour market through disability benefits, early retirement, or unemployment from the influence of these different mechanisms of withdrawal from the workforce on health.5

Westerlund and colleagues’ study of employees of the French national gas and electricity company is unique in that annual health measurements were carried out several years before and after retirement. They were therefore able to analyse the influence of retirement on the secular trend in health. The prevalence of mental and physical fatigue decreased greatly one year after retirement compared with one year before retirement (odds ratio 0.19, 95% confidence interval 0.18 to 0.21 and 0.27, 0.26 to 0.30), and this effect was even more pronounced in workers with a chronic disease. They also found a decrease (although less marked) in depressive symptoms (0.60, 0.53 to 0.67).1 These results corroborate earlier findings in the same cohort that the prevalence of less than good self rated health decreased substantially over the time period of retirement. In addition, the gradual increase in the prevalence of suboptimal health before retirement slowed down after retirement.6 In short, retirement may come as a relief to workers.

The results need careful consideration. The health benefits of early retirement were related to a reduction in fatigue and depressive symptoms but had no effect on major chronic diseases. Work related fatigue is common in the workforce. In the European survey on working conditions in 2005, about 23% of all workers reported fatigue as a health problem related to work.7 Fatigue is often a short term effect that requires time for recuperation, but it may become chronic when the period needed for recovery is longer than the time off work. The need for recovery increases with age up to 55 years but decreases in workers in the highest age groups.8 Possible explanations for this are the healthy survivor effect and older workers having less strenuous working conditions, especially less physically demanding tasks; more control over planning and pacing of activities; and a better work-life balance. Most participants in Westerlund and colleagues’ study retired at age 55 (a common occurrence in France), as a result of the company’s generous retirement policy. Research is needed to corroborate these findings in other countries with a substantially higher age of retirement.

In several countries many workers who retire from long service jobs now seek paid employment in bridge jobs before completely leaving the labour force. Bridge jobs are typically part time or of short duration after a long working career, and they are aimed at seeking a second career or simply staying actively involved at work. Such jobs may be taken because of economic pressure but also because of the need to preserve and maintain existing internal and external structures in a fulfilling life.9 The Health and Retirement Study in the United States showed that bridge employment was taken up by people with better mental health and less functional limitations, and that mental health was better in retirees who pursued a second working career.9 These findings seem to contradict Westerlund and colleagues’ observations. It is too early to make definite claims about positive and negative benefits from retirement at a particular age. A recent study in Germany showed a complex pattern, whereby early retirement seemed a necessity for workers with health problems and was an asset for healthy workers who voluntarily retired.10

The results of Westerlund and colleagues’ study highlight the need for longitudinal studies with repeated measurements in the ageing workforce. To help elderly workers maintain good health, efforts are needed to improve working conditions; adapt job activities to the capabilities of ageing workers, especially those with chronic diseases; and adopt primary preventive interventions that will improve the health and health behaviour of workers. Health professionals need to appreciate the importance of health on paid employment and the role of healthcare in supporting workers to continue their work in good health.