Maria Fleischmann

Can favourable psychosocial working conditions in midlife moderate the risk of work exit for chronically ill workers? A 20-year follow-up of the Whitehall II study

Objectives To investigate if favourable psychosocial working conditions can reduce the risk of work exit and specifically for workers with chronic disease. Methods Men and women (32%) aged 35–55, working and having no chronic disease at baseline of the Whitehall II study of London-based civil servants were selected (n=9040). We observed participants’ exit from work through retirement, health-related exit and unemployment, new diagnosis of chronic disease (ie, coronary heart disease, diabetes, stroke and cancer) and their psychosocial working conditions in midlife. Using cause-specific Cox models, we examined the association of chronic disease and favourable psychosocial working conditions and their interaction, with the three types of work exit. We adjusted for gender, occupational grade, educational level, remaining in civil service, spouse’s employment status and mental health. Results Chronic disease significantly increased the risk of any type of work exit (HR 1.27) and specifically the risk of health-related exit (HR 2.42). High skill discretion in midlife reduced the risk of any type of work exit (HR 0.90), retirement (HR 0.91) and health-related exit (HR 0.68). High work social support in midlife decreased the risk of health-related exit (HR 0.79) and unemployment (HR 0.71). Favourable psychosocial working conditions in midlife did not attenuate the association between chronic disease and work exit significantly. Conclusions The chronically ill have increased risks of work exit, especially through health-related exit routes. Chronic disease is an obstacle to extended working lives. Favourable working conditions directly relate to reduced risks of work exit.

Are societies with a high value on the Active Ageing Index more age-integrated?

Combining round four data from the European Social Survey (ESS) with indicators of Active Ageing, Dykstra and Fleischmann examine conditions conducive to age integration. It uses both a behavioural and an attitudinal measure of age integration: the prevalence of cross-age friendships and low levels of ageism. The analyses focus on both “young” (ages 18–30) and “old” (ages 70–90). Interestingly, high levels of independence, health and security in late life, and greater capacity to actively age rather than high levels of working, volunteering, caring and political engagement among the old create the greatest opportunities for meaningful cross-age interactions. Contrary to public belief, “productive ageing” will, in and of itself, not lead to greater age integration.

Occupational and educational inequalities in exit from employment at older ages: evidence from seven prospective cohorts

Objectives Past studies have identified socioeconomic inequalities in the timing and route of labour market exit at older ages. However, few studies have compared these trends cross-nationally and existing evidence focuses on specific institutional outcomes (such as disability pension and sickness absence) in Nordic countries. We examined differences by education level and occupational grade in the risks of work exit and health-related work exit. Methods Prospective longitudinal data were drawn from seven studies (n=99 164). Participants were in paid work at least once around age 50. Labour market exit was derived based on reductions in working hours, changes in self-reported employment status or from administrative records. Health-related exit was ascertained by receipt of health-related benefit or pension or from the reported reason for stopping work. Cox regression models were estimated for each study, adjusted for baseline self-rated health and birth cohort. Results There were 50 003 work exits during follow-up, of which an average of 14% (range 2–32%) were health related. Low level education and low occupational grade were associated with increased risks of health-related exit in most studies. Low level education and occupational grade were also associated with an increased risk of any exit from work, although with less consistency across studies. Conclusions Workers with low socioeconomic position have an increased risk of health-related exit from employment. Policies that extend working life may disadvantage such workers disproportionally, especially where institutional support for those exiting due to poor health is minimal.

Recurrent back pain during working life and exit from paid employment : a 28-year follow-up of the Whitehall II Study

Objectives To examine the impact of recurrent, as compared with single, reports of back pain on exit from paid employment over decades of follow-up. Methods The study sample was from the British Whitehall II Study cohort (n=8665, 69% men, aged 35–55 at baseline), who had provided information about their reports of back pain between 1985 and 1994. Data about exit from paid employment (health-related and non-health related exit, unemployment and other exit) were collected between 1995 and 2013. Repeated measures logistic regression models were fitted to examine the associations, and adjust for covariates. Results Recurrent pain was reported by 18% of participants, while 26% reported pain on an occasion and 56% did not report pain. Report of back pain on an occasion was not associated with health-related job exit, whereas recurrent pain was associated with such an exit (OR 1.51; 95% CI 1.15 to 1.99), when compared with those who did not report pain. These associations were somewhat stronger among middle-grade and lower-grade employees, while these associations were not seen among higher-grade employees. Differences in associations by age and psychosocial working conditions were small. Conclusions These results highlight the need for early detection of recurrent back pain to prevent exit out of paid employment for health reasons. As the risk varies by occupational grade, this emphasises the importance of identification of high-risk groups and finding ways to address their modifiable risk factors.

Changes in autonomy, job demands and working hours after diagnosis of chronic disease: a comparison of employed and self-employed older persons using the English Longitudinal Study of Ageing (ELSA)

Background Modifications in working conditions can accommodate changing needs of chronically ill persons. The self-employed may have more possibilities than employees to modify their working conditions. We investigate how working conditions change following diagnosis of chronic disease for employed and self-employed older persons. Methods We used waves 2–7 from the English Longitudinal Study of Ageing (ELSA). We included 1389 participants aged 50–60 years who reported no chronic disease at baseline. Using fixed-effects linear regression analysis, we investigated how autonomy, physical and psychosocial job demands and working hours changed following diagnosis of chronic disease. Results For employees, on diagnosis of chronic disease autonomy marginally decreased (−0.10, 95% CI −0.20 to 0.00) and physical job demands significantly increased (0.13, 95% CI 0.01 to 0.25), whereas for the self-employed autonomy did not significantly change and physical job demands decreased on diagnosis of chronic disease (−0.36, 95% CI −0.64 to –0.07), compared with prediagnosis levels. Psychosocial job demands did not change on diagnosis of chronic disease for employees or the self-employed. Working hours did not change for employees, but dropped for self-employed (although non-significantly) by about 2.8 hours on diagnosis of chronic disease (−2.78, 95% CI −6.03 to 0.48). Conclusion Improvements in working conditions after diagnosis of chronic disease were restricted to the self-employed. This could suggest that workplace adjustments are necessary after diagnosis of chronic disease, but that the self-employed are more likely to realise these. Policy seeking to extend working life should consider work(place) adjustments for chronically ill workers as a means to prevent early exit from work.

The relationship between workplace psychosocial environment and retirement intentions and actual retirement: a systematic review

Psychosocial work characteristics are potential determinants of retirement intentions and actual retirement. A systematic review was conducted of the influence of psychosocial work characteristics on retirement intentions and actual retirement among the general population. This did not include people who were known to be ill or receiving disability pension. Relevant papers were identified by a search of PubMed, PsycINFO and Web of Science databases to December 2016. We included longitudinal and cross-sectional papers that assessed psychosocial work characteristics in relation to retirement intentions or actual retirement. Papers were filtered by title and abstract before data extraction was performed on full texts using a predetermined extraction sheet. Forty-six papers contained relevant evidence. High job satisfaction and high job control were associated with later retirement intentions and actual retirement. No consistent evidence was found for an association of job demands with retirement intentions or actual retirement. We conclude that to extend working lives policies should increase the job control available to older employees.

Under pressure: an international comparison of job security, social security, and extra effort

Purpose: Previous research leads to contrasting hypotheses about the relationship between extra effort of employees and the level of job security. According to agency theory, job security leads to lower levels of extra effort and social exchange theory argues that extra effort requires job security. The purpose of this paper is to formulate a set of hypotheses based on these theories. Besides considering them as mutually exclusive, they are integrated into a single theoretical framework that argues that both theories can apply, depending on the conditions and social context (in terms of the social security system). Design/methodology/approach: Data from the International Social Survey Program (2005) including 22 countries from around the globe are analyzed using multilevel analysis. Findings: The study provides evidence that social security moderates the relationship between job security and extra effort. Originality/value: This study differs from previous research as it focuses on two sides of insecurity in the workplace and because it analyzes a large data set to include institutional factors.

Prenatal famine exposure and mental health in later midlife

ABSTRACT Objectives: Maternal malnutrition during pregnancy may have long-lasting effects on offsprings mental health. We investigate the effect of prenatal exposure to the Dutch famine (mid November 1944 to late April 1945) on mental health in later mid-life. Methods: Data are from the Netherlands Kinship Panel Study (n = 642). We use difference-in-difference analyses to compare mental health in later midlife (measured with the MHI-5 index) across three cohorts (‘pre-famine cohort’, ‘famine cohort’, ‘post-famine cohort’) and across two regions (famine affected cities vs. rest of the country). Results: In the affected cities, we find poorer mental health for the famine cohort than for the pre-famine and post-famine cohorts. In the non-affected rest of the country, no significant mental health differences between birth cohorts were found. The mental health differences between birth cohorts differ significantly between the affected cities and the rest of the Netherlands. Conclusion: Our analyses link prenatal famine exposure to poorer mental health in later midlife. This suggests that in utero malnutrition has a long-lasting detrimental effect on mental health.

Older workers and employer-provided training in the Netherlands: a vignette study

ABSTRACT Older workers throughout Europe are increasingly expected to participate longer in the labour market. While training appears to increase workers’ employability, prior research indicates that employers are less prone to provide training with increasing age of the workers. In this study, we aim to provide a better understanding of what affects employers’ considerations. We conduct a vignette experiment among Dutch employers to investigate how the government and workers themselves can exert influence on employers’ willingness to provide training. Our analyses show that employers’ provision of training declines with workers’ age, and additionally reveal two mitigating mechanisms. First, government reimbursements appear to work as a buffer: when reimbursements are offered, the decline in employers’ willingness to offer training is less pronounced throughout workers’ careers. Second, workers’ interest in training has a delaying effect: when workers are interested in training, employers’ willingness to provide training remains rather stable until workers are aged about 55, and decreases only afterwards. This contrasts the constant decline with age when workers had no interest in training. Our findings emphasise that employers’ considerations cannot be understood without taking the context into account, because governments and workers can affect employers’ decisions through cost reduction and social exchange relations, respectively. More research is needed to disentangle other possible underlying mechanisms.

From Early Exit to Postponing Pension: How the Dutch Polder Model Shapes Retirement

The Netherlands have been known for their early exit culture. In recent years the retirement age and the labour market participation of older workers have successfully been reversed. Several measures increased workers’ need to stay in the labor market longer to fulfill their pension requirements: Occupational pension funds changed from a pay-as-you-go to a capital-funded system and the Dutch government made early retirement fiscally less attractive. Workers’ participation is maintained through collective agreements that define the implementation of human resource practices and employability-enhancing practices in companies. Moreover, employers’ contributions in training and development funds emphasize their role for training and skilling. Thus, collaboration between social partners and the government, i.e. the so-called Dutch polder model, has arguably shaped retirement in the Netherlands.