Gill Mein

Is retirement good or bad for mental and physical health functioning? Whitehall II longitudinal study of civil servants

Background: To determine whether retirement at age 60 is associated with improvement or deterioration in mental and physical health, when analysed by occupational grade and gender. Methods: Longitudinal study of civil servants aged 54 to 59 years at baseline, comparing changes in SF-36 health functioning in retired (n=392) and working (n=618) participants at follow up. Data were collected from self completed questionnaires. Results: Mental health functioning deteriorated among those who continued to work, but improved among the retired. However, improvements in mental health were restricted to those in higher employment grades. Physical functioning declined in both working and retired civil servants. Conclusion: The study found that retirement at age 60 had no effects on physical health functioning and, if anything, was associated with an improvement in mental health, particularly among high socioeconomic status groups.

Pathways to early retirement: structure and agency in decision-making among British civil servants

The context of this paper is the changing nature of later life in the United Kingdom. It examines some of the broader issues of early retirement. While there has been considerable debate about the restructuring of employment during the latter part of the 20th century which led to a shake-out of older workers from the labour force, less attention has been given to those who take voluntary early retirement. Given the importance of early retirement to the economy and to social policy, it is important to find out how individuals make retirement decisions. The paper examines the results of a semi-structured interview study of the decisions made by a purposively drawn sample of British civil servants who are participants in the Whitehall II study. The sample included participants who chose early retirement and those who did not. From the interview data, ideal types of possible routes into retirement have been constructed. Illustrating these ideal types, individual life histories are drawn upon to show how responses to the issues surrounding retirement feature in peoples lives. It is argued that decisions about early retirement are not made in a vacuum, neither are they free from pressures or inducements. Some are to do with organisational restructuring, some are about financial offers, and some are influenced by the opportunities for leisure and self-fulfilment that early retirement offers. The paper concludes by arguing that early retirement needs to be studied as a process involving the interplay between structure and agency.

The effects of pre-retirement factors and retirement route on circumstances in retirement: findings from the Whitehall II study

Retirement has traditionally been seen as the beginning of old age. It has been depicted as mandatory expulsion from the workforce and seen to mark the transition to a period of ill health and poverty. Such ideas and associations are however being challenged in the developed world by socio-demographic changes in retirement and old age. People in the United Kingdom as elsewhere are living longer and healthier lives, and many older people have access to non-state incomes that afford them a reasonable standard of living in retirement. There is however still concern that inequalities persist into old age. Data from two waves of the British Whitehall II study have been used to assess the relative effects of occupational grade, psychological and general health during working life, and retirement patterns or pathways on activities, attitudes to health and income in retirement. The results show that the majority of the sample reported good health, financial security and overall satisfaction with life, but with observable inequalities. Regression analyses demonstrate that pre-retirement circumstances generally had a greater effect on later life than the retirement route or pathway. Retirement no longer represents a drastic break between working and post-work life but rather, the results suggest, there are continuities between the two periods. It is concluded that the main causes of inequalities in retirement are work-based rather than in retirement itself.

Paradigms of retirement: the importance of health and ageing in the whitehall ii study

This paper evaluates four well established sociological theories of ageing using qualitative data from the British Whitehall II study. We attempt to apply the theories to contemporary retirement and through each theory examine the issue of health in retirement. The effect of lowered income in retirement is discussed in relation to Townsends theory of structured dependency. Change in participants health following retirement is examined in respect of the theory of disengagement by Cumming and Henry, adjustment to retirement in relation to Lasletts theory of the third age. Parsons role theory is used to examine how social interactions and relationships change for people who have recently retired. We discuss the need for a multifaceted theory of ageing which can accommodate the continually changing experience and age of retirement. We analysed interviews conducted with 25 male and female civil servants aged between 55 and 63 years, from different grades who had been retired for less than 2 years.

A mixed exercise training programme is feasible and safe and may improve quality of life and muscle strength in multiple myeloma survivors

BackgroundExercise programmes are beneficial for cancer patients however evidence is limited in patients with multiple myeloma (MM), a cancer that is characterised by osteolytic bone disease, giving rise to high levels of bone morbidity including fractures and bone pain.MethodsWe conducted a single arm phase 2 study of an exercise programme (EP) as rehabilitation for treated MM patients, to evaluate feasibility, effects on QOL and physiological parameters. Patients were given individualised programmes, comprising stretching, aerobic and resistance exercises, carried out under supervision for 3 months then at home for a further 3 months.ResultsStudy uptake was high, 60 of 75 (80%) patients approached consented to the study. Screen failures (11, due to fracture risk and disease relapse) and patient withdrawals (12) resulted in a final 37 patients enrolling on the programme. These 37 patients demonstrated high attendance rates in the supervised classes (87%), and high levels of adherence in home exercising (73%). Patients reported better QOL following the EP, with improvement in FACT-G and Fatigue scores over time from baseline (p<0.01 for both, one-way repeated measures ANOVA) to 6 months. Upper and lower limb strength also improved on the EP, from baseline to 6 months (p<0.01 for both). There were no adverse reactions.ConclusionsAn EP in MM patients is feasible and safe, with high attendance and adherence. Benefits in QOL, fatigue and muscle strength await confirmation in randomized studies, prompting urgent evaluation of the benefits of EP in the rehabilitation of MM patients.

Altruism and participation in longitudinal health research? Insights from the Whitehall II study

Research that follows people over a period of time (longitudinal or panel studies) is important in understanding the ageing process and changes over time in the lives of older people. Older people may choose to leave studies due to frailty, or illness and this may diminish the value of the study. However, people also drop out of studies for other reasons and understanding the motivation behind participation or drop out may prevent further loss of valuable longitudinal information and assist the continuation of longitudinal studies. This paper examines qualitative data from interviews and focus groups in 2003/2008 with participants of the Whitehall II Study (based at UCL), and investigates reasons participants give for participating in longitudinal health studies, and recommendations they give for encouraging continued participation as they grow older. A total of 28 participants and 14 staff were interviewed, and 17 participants took part in focus groups. Our findings are discussed in the light of the debate between of altruism and reciprocity. Rather than being wholly motivated by altruism, as research staff had assumed, participants were motivated by the benefits they perceived, particularly the information and care received during the medical examinations and the sense of loyalty and membership associated with being part of the study. Our findings support the view that far from being primarily motivated by altruism, research participation in studies such as this may also involve a degree of implicit and explicit reciprocity. However, participants disliked the obligation to complete the study questionnaires--which may have influenced the expectation of payment or reciprocation, as participation was not wholly pleasing. To try and maintain participation in longitudinal health studies this project recommended gathering information from exit interviews as a way of preventing further withdrawals and closer involvement of participants through a user panel.

The retention of older people in longitudinal studies: a review of the literature

Research that follows people over a period of time (longitudinal or panel studies) is increasingly recognised as of great importance in helping us to understand the ageing process and changes over time in the lives of older people. If people drop out of studies ‐ which older people are more likely to do ‐ the value of the study diminishes. This research draws on evidence from ongoing and previous longitudinal studies of people aged 55 and over to examine what factors encourage the retention of participants and what causes them to drop out. The research is synthesising existing evidence, drawing together the experiences of researchers involved in longitudinal studies, and collecting some new evidence about the views of survey participants. This article reports on the first part of the research by drawing together evidence from other studies. These show that there are some factors that are related to attrition whereas for others the evidence is mixed. Methods employed by these studies to reduce attrition and retain participants are examined. It must be noted that apart from the consistent finding that attrition is associated with age, education, socio‐economic status and cognitive impairment, not all studies examined the same variables; some only being explored by one study. This makes it difficult to draw any further conclusions and indicates that attrition needs to be addressed in a uniform manner by more studies. This article identifies some implications for policy‐makers and practitioners.

Predictors of two forms of attrition in a longitudinal health study involving ageing participants: an analysis based on the Whitehall II study.

BackgroundLongitudinal studies are crucial providers of information about the needs of an ageing population, but their external validity is affected if partipants drop out. Previous research has identified older age, impaired cognitive function, lower educational level, living alone, fewer social activities, and lower socio-economic status as predictors of attrition.MethodsThis project examined attrition in participants of the Whitehall II study aged between 51–71 years, using data from questionnaires participants have completed biennially since 1985 when the study began. We examine the possibility of two distinct forms of attrition – non-response and formally requesting to withdraw – and whether they have different predictors. Potential predictors were age, gender, marital status, occupational grade, retirement, home ownership, presence of longstanding illness, SF-36 quality of life scores, social participation and educational level comparing participants and those who had withdrawn from the study.ResultsThe two forms of attrition share many predictors and are associated but remain distinct. Being older, male, having a lower job grade, not being a home owner, not having a long standing illness, having higher levels of education, and not having retired, were all associated with a greater probability of non-response; being married was associated with higher probability in women and lower in men. Being older, male, having a lower job grade, not being a home owner, having lower SF-36 scores, taking part in fewer social activities, and not having a long standing illness, were all associated with greater probability of withdrawal.ConclusionsThe results suggest a strong gender effect on both routes not previously considered in analyses of attrition. Investigators of longitudinal studies should take measures to retain older participants and lower level socio-economic participants, who are more likely to cease participating. Recognition should be given to the tendency for people with health problems to be more diligent participants in studies with a medical screening aspect, and for those with lower socio-economic status (including home ownership), quality of life and social participation, to be more likely to request withdrawal. Without taking these features into account, bias and loss of power could affect statistical analyses.

Exploring the experience of fatigue in people with Charcot–Marie–Tooth disease

This qualitative study explored the phenomenon of fatigue for people with Charcot-Marie-Tooth disease, while acknowledging the triggers, impact and strategies people have developed to manage this symptom in daily life. A phenomenological approach was used to explore the experience of fatigue. Participants were recruited from a support group. Twenty-five people participated in three focus groups. Group interviews were tape recorded and independently transcribed. Transcripts were coded and emerging themes were highlighted. Four areas were explored and themes identified within them. Fatigue descriptions: energy depletion, overwhelming nature, variations in fatigue and fatigue as an abnormal experience; triggers of fatigue: activity, stress and mental concentration; impact of fatigue on: physical abilities, mood, guilt and frustration, isolation and concerns about how they were perceived by others; strategies to manage fatigue: coping with symptoms; planning ahead; deception; and reducing symptoms. This study revealed that fatigue is an overwhelming experience for people with Charcot-Marie-Tooth disease that impacts on many areas of their lives. People may require significant adjustment that could be facilitated by fatigue management approaches. In addition, exercise may have potential to reduce the symptoms of fatigue in some people.

The Impact of Early Retirement on Perceptions of Life at Work and at Home: Qualitative Analyses of British Civil Servants Participating in the Whitehall II Retirement Study:

This study examined pathways to retirement and the role of circumstances at work and at home (including the introduction of financially-enhanced early retirement schemes) on retirement-related decision-making. In-depth qualitative interviews were conducted within 2 years of retirement with 59 British civil servants participating in the Whitehall II Study. Focusing on the experiences of 33 interviewees who spontaneously discussed “early retirement” we identified three pathways to retirement (non-applicants, successful applicants, and unsuccessful applicants for early retirement) each influenced by a range of complementary positive and negative factors at work and at home. The early retirement schemes influenced the balance between these factors in three ways: by encouraging participants to reflect on (and reconsider) existing retirement plans; by offering financial incentives to retire early; and because they were part of the ongoing process of restructuring and downsizing within the Civil Service which was accompanied by a perceived deterioration in conditions at work.