WELL-BEING OF RETIREES

You have worked hard for many years and now you are retired. All those stress markers - gone! All that structure to your day - gone! All the effort of trying to fit too many tasks into one day - gone! How will this change affect your health and life expectancy?

It is very complicated. When moving from work to non-work, everything about your daily schedule changes. You may be more relaxed, and your life may slow down. Loss of work-related stress may be a great relief and good for your health, but losing the daily structure and your work relationships can also be stressful and harmful to your health. In fact, retirement is ranked tenth on the list of life’s most stressful events. Predicting how retirement affects health is extremely difficult because retirement goes hand in hand with ageing, and retirees are, for the most part, older than those still working. Thus, what might seem to be a consequence of retirement can be simply part of the ageing process. The relationship between retirement and health is an important one to consider given the shifting trends in labour force attachment, ageing of the population and growth in the cost of health care.

The dramatic increase in life expectancy through the 20th century has resulted in correspondingly longer periods spent in retirement. The remarkable improvements in life expectancy during the past century were part of a shift in the leading causes of disease and death. The advancement in medicine is the main factor responsible for increased life expectancy, including the change in types of illness or disease from communicable diseases to chronic, non-communicable diseases and disability.

Even in low-income countries, the majority of older people die from chronic diseases such as cardiac disease, cancer and diabetes rather than infectious diseases. One major health consequence of a longer lifespan is the increase in the prevalence of dementia. This places considerable demands on the health-care system, on long-term care, and on the well-being of family members, especially the primary caregiver. 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.

Usually, about 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 have a higher risk of being diagnosed with cancer and a lower risk of developing cardiovascular diseases. Male retirees were more at risk for heart attack, stroke and psychiatric problems. Poor health is often one of the reasons people retire, rather than a result of the process of retirement. Nevertheless, there are some factors associated with retirement that lead to worsening health, for example, an increase in social isolation or the adoption of bad health habits.

Retirement can lead to improvements in self-reported health, across educational levels and for men and women alike, if the available free time is well utilised. Retiring from work is good for your health, chiefly due to the benefits of more exercise, less stress and greater sleep enjoyed by people who stop working. In retirement, people are more likely to rate their health as satisfactory. Mental health may improve, even after allowing for age-related medical problems and for those retired early due to ill health. 

What influences retirement health?

What is behind these two contrasting experiences of health in retirement? There is equivocal evidence regarding the health consequences of retirement with some studies showing positive effects while others negative. Issues which may affect health outcomes in retirement include social connectivity/support, participation in physical exercise, post-retirement lifestyle ( like smoking or alcohol use), being married, gender, post-retirement activities, whether retirement was voluntary and whether retirement was earlier than the normative age.

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. Loneliness can be a bigger killer than obesity and should be considered a major public health issue. 

Another factor relates to lifestyle changes post-retirement. Some people improve their nutrition and exercise regimes; others do not. A large study of Australian women in 2016 showed that the retirement status had positive effects on women’s self-reported health, physical and mental health outcomes. 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 with retired men.

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.

Is early retirement a good idea? Early retirement has negative consequences for post-retirement physical and emotional health and cognitive functioning, although, in respect of mental health, there is recent evidence that work that requires higher mental demands is protective against cognitive decline in retirement independent of education level and socioeconomic status.

Women’s health deteriorates as they aged, as shown by worsening health among those who had been retired longer. But there are large individual differences in when this process begins. Those whose health got better on retirement were more likely to have retired younger. 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. 

Psychological well-being

Psychological well-being refers to the extent to which an individual experiences life in a positive way and functions well psychologically.

The majority of retirees report little or no change in psychological well-being post-retirement. A group of retired women measured two adjustment-like measures, self-esteem and stress levels. When asked if their self-esteem was better, the same or worse than before they retired, most reported ‘same’ while one-quarter reported higher self-esteem post-retirement. 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.

What of depression in retirement? Depression is a serious 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 is less convincing. Some have shown an increased risk of clinical depression during retirement.

What predicts psychological adjustment after retirement?

Psychological well-being 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. While many retirees have little or no difficulty in negotiating retirement, some appear not to have the resources to refashion their lives. 

Lower levels of well-being are likely to result from external factors such as a partner’s poor health or because of demanding family caring responsibilities, as these restrict opportunities to take up new roles in retirement. 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 the loss of self-esteem and a sense of contributing to society.

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. 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.

The determinants of adjustment to life during retirement have identified four groups of predictors. The most commonly reported predictors included physical health, finances, psychological health and personality-related attributes, leisure, voluntary retirement and social integration. There was a group of ‘non’ or ‘negative’ predictors of retirement adjustment that included age, sex, household composition, the timing of retirement and ethnicity. 

Actively planning for retirement and retirement at a time of their own choosing are both positively related to retirees’ psychological well-being. People who retire earlier than planned are more likely to experience decreased psychological well-being upon entering retirement.

The consequences of poor psychological well-being can be associated with retirees engaging in maladaptive behaviours. These behaviours can further compromise physical as well as psychological well-being with implications for retirees’ ability to plan and manage their retirement. Some retirees miss the structure, the challenges and the companionship of their working lives, and some find replacement activities that are problematic for their physical and mental health. 

Substance abuse

Nearly a decade ago over one-quarter of women and half the men drank beyond the recommended guidelines for their age. Interestingly, other US data show rates of alcohol abuse and dependence increased almost 10-fold over a decade in women ages 65 and older. In contrast, among men ages 65 and older there was a four-fold increase. To the extent that retirement is often framed by older adults as a major life event and by some a significant stressor, it may act as a risk factor for alcohol misuse. On the other hand, one could speculate that retirees have more leisure time to drink, among other activities, so alcohol use starts as positive enjoyment – providing a sense of freedom and lessening of responsibility. In fact, the link between retirement and alcohol misuse is not straightforward. Two areas of consensus seem to be emerging. First, a variety of individual attributes and situational factors influence this link probably by influencing the way in which retirement is framed. If retirement is framed as ‘loss’, alcohol misuse may be initiated or made worse, while a frame of ‘relief’ may result in a decline in misuse. Second, the consensus is that retirement does not directly affect drinking behaviour, but the context of retirement (why the decision to retire was made and the experiences before and after retirement) can trigger new or increased alcohol-use disorders among older adults.

Drug abuse

Drug abuse among retirees and older people has focused largely on prescription drug use, by far the most common category of drug abuse among this group. Abuse of prescription drugs among older adults does not typically involve the use of these substances to ‘get high’ and the users do not usually obtain them illegally. Instead, unsafe combinations or amounts of medications may be obtained by seeking prescriptions from multiple doctors, by obtaining medications from family members or peers, or by stockpiling medications over time. It is important to note, however, that substance abuse issues among the elderly represent a growing public health concern.

Gambling

The growth of casinos and slot machines catering to seniors suggests there is a problem. To cater to this population, some casinos even supply wheelchairs and oxygen tanks! In fact, gambling, like alcohol consumption, exists along a continuum of involvement from not gambling at all, to social gambling, to problematic gambling. Although more men than women gamble, women’s progression to problematic gambling appears to be quicker than men’s, with women likely to face financial difficulties sooner than men as they do not have the financial buffer that men have.

There is now considerable evidence of gender differences in gambling choices. Men tend to gamble on games of ‘skill’ – card games such as poker, racing and other sports - and are characterised as ‘action’ gamblers. Women, however, are likely to be ‘escape’ gamblers, preferring activities such as bingo, lotteries or slot machines, and often gambling to reduce boredom, escape responsibility or relieve loneliness rather than for financial gain, pleasure or excitement. It seems that in the past two decades gambling has increasingly become a mainstream pastime for women, largely because of the expansion of electronic gaming machines. Possible motivations for gambling include social isolation, the need to escape from everyday stress and psychological co-morbidity. In the case of the last, depression and anxiety disorders are key factors that coexist with problematic gambling.

Maintaining good health in retirement

Physical activity, a balanced diet and sustaining a healthy weight are key factors in maintaining and enhancing good health together with being a non-smoker and other forms of addictions. Retirement provides the opportunity to engage in physical activity that may have been limited by the demands of full-time work, and the positive link between retirement health and physical activity has been well documented.

It is feasible to expect changes in weight to be associated with retirement. On one hand, healthier habits in retirement such as increased physical activity and better diet are likely to lead to weight loss. On the other hand, weight gain may result from the body changes as one ages, from being less physically active, from having less structured meal times or from using food as a means of dealing with post-retirement losses such as work identity, social interactions at work or the sense of accomplishment resulting from working.

For most age groups, men were more likely than women to participate in regular physical activity (walking, swimming or playing sport) on a weekly basis. Interestingly, women reported lower subjective well-being than men. 

Of course, weight gain may not only be caused by less physical activity but by changing eating habits. Healthy eating habits increased more among retired women than those continuously employed whereas among men healthy food habits were not associated with retirement. Possibly this gender difference can be explained by many retired women having more time and choosing to shop for and prepare healthy options; most men when they retire continue to eat the food that is provided for them.

As we age, the role of nutrition becomes even more important. There are many health benefits of a healthy diet and proper nutrition apart from weight loss. These include resistance to illness and disease, higher energy levels and increased mental sharpness. The good diet allows your body to function better. Eating a healthy mix of grains, fruits, vegetables, dairy and protein gives your body all of the nutrients it needs; you feel more awake, and you have more energy to spare. Eating fruits and vegetables are also believed to reduce your risk for certain cardiovascular diseases, stroke, type-2 diabetes and cancer.

So, with a healthy diet, your body physically functions better and there are mental health benefits as well. A healthy diet can also boost mood and lower stress levels as well as protect you to some extent from diseases.

Plan for a healthy retirement

Ageing itself is undeniably a health hazard. There are some fundamental lifestyle choices that will boost the chances of a healthy retirement, both physically and mentally. It is important that pre-retirement plans include thinking about a healthy retirement lifestyle. 

Stay active and involved. Whether it is organised sports or activities, or taking long walks on your own, it is important to keep moving. Make sure you have regular medical checks, especially for age-related diseases, as well as dental and hearing checks given the importance of the last for communication.

Maintain a healthy diet - follow dietary recommendations about daily intake; exercise every day to build strength, flexibility, cardiovascular health and balance.

Retirement can increase the time invested in repairs, gardening, and other household activities. These require physical effort and can, therefore, be expected to enhance health by providing physical activity over and above the increase in sports and exercise.

Exercise your brain too; crosswords, puzzles and learning new things are some of the activities that help you to maintain your level of cognitive functioning. But take time to relax as well. Try meditation or yoga, maintain good sleep habits - 7 to 9 hours every night is optimal. Try to avoid daily naps. Importantly, maintain social connections. Try to banish loneliness. Your relationships with people can help you live longer. Nurture your friendships and family ties. If you are away from friends and family, think about making social connections in other ways such as through volunteering - it is a great way to meet people and get the health benefits of relationships too.

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