Retirement, health and wellbeing

You've worked hard for many years and now you are retired. All those stressors – 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's 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 10th 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.

We noted earlier the dramatic increase in life expectancy through the 20th century and, correspondingly, longer periods spent in retirement. The remarkable improvements in life expectancy over the past century were part of a shift in the leading causes of disease and death. There is now considerable literature naming advances in medicine as one 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.[i]

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 prevalence of dementia. This places considerable demands on the health care system, on long-term care, and on wellbeing of family members, especially the primary carer. 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.

What do we know about health and retirement? Is finally quitting the workplace good for you or not? Research indicates that mental health issues occur relatively infrequently post-retirement but physical health problems are relatively common, although often associated with ageing rather than retirement per se. So let's begin with a consideration of physical health. Is retirement associated with physical health improvements?

The 'no' case

A recent prospective study by the highly regarded Harvard School of Public Health investigated the association between transition to retirement and risk of stroke and heart attack. They followed participants aged 50 and over who were in the paid workforce and free of major cardiovascular disease up to 10 years until they retired. After adjusting for a wide range of factors (age, sex, socio-economic status, behaviour and co-morbidities), the researchers found that retirees were 40 per cent more likely to have had a heart attack or stroke than those who were still working at the same age. There were no differences between men and women in these outcomes.

Outcomes of a large UK study showed almost 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 had a higher risk than the overall sample of being diagnosed with cancer and a lower risk of developing cardiovascular diseases. Male retirees were more at risk than the overall sample for heart attack, stroke and psychiatric problems. However, the author notes that poorer health outcomes among retirees compared to those still working cannot be regarded solely as the result of retirement, even after adjusting for age. Poor health is often one of the reasons people retire, rather than a result of the process of retirement. Nevertheless, as we discuss later in the chapter, there may be some factors associated with retirement that lead to worsening health, for example an increase in social isolation or adoption of bad health habits.

The 'yes' case

Not all research shows detrimental effects of retirement. Consistent with a number of studies, one recent study, across 12 Western European countries, using rigorous methods, showed that retirement can lead to improvements in self-reported health, across educational levels and for men and women alike.[ii] Further, in the US Normative Aging Study of men, although men's physical health declined over three to four years, there were no differences between those who were still working and those who had retired.

Equally positive are the findings from recent German research.[iii] The study author concluded that 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 improves, even after allowing for age-related medical problems and for those retired early due to ill health. The author estimated that the number of doctor visits reduced by 25 per cent for retirees compared to non-retirees of the same age, an important finding for the economics of the German health system. It would be interesting to see this research replicated in other countries.

Nevertheless, as both the proportion of older people in communities and the length of life increase throughout the world, key questions arise. Will population ageing be accompanied by a longer period of good health, a sustained sense of wellbeing, and extended periods of social engagement and productivity? Or will it be associated with more illness, disability and dependency? These questions are important not only in terms of providing best practice preparation for retirement and subsequent health care but also because of policy moves in some countries to raise the age at which state pensions become available, with a view to inducing postponed retirement.

What influences retirement health?

I did not expect retirement to be this good. I feel that I am fortunate to be in good health, and able to enjoy life as it is.

I expected my health to be better, and to be more mobile than I am. This is restricting me in many ways. . . . I can no longer join some friends for brisk walks, hikes with backpacks etc.

What is behind these two contrasting experiences of health in retirement? As we saw earlier, there is equivocal evidence regarding the health consequences of retirement with some studies showing positive effects, others negative. Issues which may affect health outcomes in retirement include social connectedness/support, participation in physical exercise, post-retirement lifestyle (e.g., changes in 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. Researchers have shown that loneliness can be a bigger killer than obesity and should be considered a major public health issue. A review of 218 studies into the health effects of social isolation and loneliness[iv] found that lonely people have a 50 per cent higher chance of premature death, while obesity increases the chance of early death by 30 per cent. The team found that the risk of early death associated with loneliness, social isolation and living alone was equal to or greater than the premature death risk associated not only with obesity but with other major health conditions.

Another factor relates to lifestyle changes post-retirement. Some people improve their nutrition and exercise regimes; others do not. For example, in a large study of Australian women in 2016,[v] 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 for retired men.[vi]

A long-term study of British civil servants reinforces the need for care in concluding that retirement affects health, either positively or negatively. On-time retirement and voluntary early retirement were both related to better physical functioning and mental health when retirees were compared to those who remained in the workforce. The authors suggested that there might be a causal relationship between voluntary retirement and positive health outcomes. However we need here to consider the possibility of including selection bias. For example, those 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. Certainly, there is evidence from our study of Australian women that a significant minority retire voluntarily, but many do so for health reasons (15 per cent), because of work stress (19 per cent) or the ill health of family members (11 per cent). We need to tease out what is meant by 'voluntary' retirement.

A number of studies have used careful methodologies, including sophisticated sampling methods, and analyses that adjust for selection bias (e.g., pre-retirement work and health history, timing of retirement) to overcome these difficulties. In the analysis of data from seven waves of the US Health and Retirement Study[vii] these biases accounted for most of the observed differences in health between retirees and non-retirees over time. The authors concluded 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, a finding consistent with other studies.

Is early retirement a healthy idea? Some studies have similarly shown that early retirement has negative consequences for post-retirement physical and emotional health and cognitive functioning, although, in respect of the last, there is recent evidence that work that requires higher mental demands is protective against cognitive decline in retirement independent of education level and socio-economic status. At least one study has shown that people who retired at age 55 had almost twice the risk of death compared to people who retired at age 60. The link between early retirement and early death was greater for men than women; men who retired at 55 had an 80 per cent greater increase risk than women who retired at 55.

In the relatively narrow age range of older women in our study (mostly in their 60s), age was not related to health per se, but it was related to changes in health. Women's health was deteriorating 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. For example, those whose health got better on retirement were more likely to have retired younger than those whose health stayed the same, but then so were those whose health got worse post-retirement. 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. The most commonly researched marker of mental health in retirement is depression while another approach is to determine how individuals' adjust to retirement and how satisfied they are with this life transition.

Psychological wellbeing

I thought that I was ready to retire mentally – but found that it actually took me three years to adjust – I grieved for my job and that process took that long. There was no help or recognition about the grieving process. I had to work through that myself, and it was only after I came out the other end that I realized what had happened to me.

Psychological wellbeing refers to the extent to which an individual experiences life in a positive way and functions well psychologically and is often described in studies of retirees as 'adjustment', although few researchers have actually measured pre- and post-retirement psychological adjustment specifically. Most rely on life satisfaction or satisfaction with retirement as a surrogate for this.

The majority of retirees report little or no change in psychological wellbeing post-retirement. Our study 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.

An extensive review of the literature[viii] noted that research into the association between life satisfaction and retirement has produced inconsistent findings and is partly dependent on pre-retirement levels of life satisfaction.

What of depression in retirement? Depression is an important 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 less convincingly. For example, while an Institute of Economic Affairs report[ix] showed being retired increased risk of clinical depression by 40 per cent, not all studies have demonstrated such a strong effect and some, none at all. There is clearly more research needed here to tease out the effects of pre-retirement psychological health, retirement, social isolation, ageing and lifestyle factors on depression.

What predicts psychological adjustment after retirement?

Psychological wellbeing 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.[x] While many (most?) retirees have little or no difficulty in negotiating retirement, some appear not to have the resources to refashion their lives. For example, in our study, the word 'boring' recurred frequently as women complained about the 'emptiness' of their retirement lives.

It can be tedious, boring and even though I am a loner, more solitary than I would sometimes like. I don't fit much of the community programs and even some of the other activities that are around.

Lower levels of wellbeing 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.

It's hard to build structure into a life that suddenly becomes freefalling.

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 loss of self-esteem and sense of contributing to society.

I absolutely hate it. I find it financially challenging, lonely and boring. I feel as though I am brain dead, and I am being left further and further behind in learning new technologies and discovering new interests. . . . I find I am sinking into apathy and the less I do the less I want to do.

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, as we have seen in Chapter 3. 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.

Since 2010, a number of reviews addressing the determinants of adjustment to life during retirement have been published, reflecting the growing interest in this field. A recent thorough review of predictors of adjustment to retirement[xi] 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, timing of retirement and ethnicity. In all these cases, the majority of studies found no effect of the variable in question on retirement adjustment or, at best, results were inconsistent.

This carefully conducted and substantial systematic review of the literature on predictors of retirement adjustment is important but it may leave the reader confused about contributions of specific individual factors. For example, in half the studies reviewed, participants who had been retired longer presented better quality of life, wellbeing and satisfaction with retirement and with life. Time since retirement had no effect in six studies, and only two studies indicated time was a risk factor for retirement.

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

The consequences of poor psychological wellbeing can be associated with retirees engaging in maladaptive behaviours. These behaviours can further compromise physical as well psychological wellbeing with implications for retirees' ability to plan and manage their retirement. As we have seen, 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. Two of the most common behaviours are substance abuse (both alcohol and drugs) and problem gambling.

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 been four-fold increase.[xii] 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. Bamburger concludes 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. According to 2017 data from the US Office of Alcoholism and Substance Use Services, 17 per cent of people over 65 in the US have abused prescription drugs. Clearly the link between retirement and drug abuse and the reasons for this need to be a greater focus of attention by researchers.

Gambling

Is excessive gambling a problem for retirees? Certainly 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 problem 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.[xiii] 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. Suggested motivations for gambling include social isolation, the need to escape form everyday stress and psychological co-morbidity. In the case of the last, depression and anxiety disorders are key factors that coexist with problem gambling.

The literature we have reviewed indicates some consistent health and wellbeing consequences of retirement, but there are many factors whose impact is uncertain or contradictory. As we have seen, the challenge is to take into account the myriad of contextual factors associated with the transition to retirement and the experience of this life stage.

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 moderation in alcohol intake and being a non-smoker. 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, as already discussed.

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.

Where gender differences in weight change after retirement have been studied, the results are inconsistent. A prospective study of a large and stable French cohort included yearly and long-term measurements that enabled researchers to obtain accurate estimates of physical activity and changes in weight during the actual retirement transition. One analysis[xiv] showed that physical activity increased by 36 per cent among men and 61 per cent among women during the transition to retirement. Not surprisingly, weight gain was greater among physically inactive persons compared with those physically active. The observed increase in physical activity after retirement corroborates findings in many other studies, confirming the importance of post-retirement physical activity. In another study, there was no significant weight change among men, but women who had retired were more likely to gain weight than those who continued to work part-time, who were of normal weight upon retiring and those who retired from blue-collar occupations.

In contrast, results from another large-scale nationally representative cohort in the UK[xv] showed, 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 wellbeing than men. The authors speculate that this may be attributable to women's lower employment participation rates and lower income as well as their greater role as informal carers since these are all related to lower subjective wellbeing.

Of course, weight gain may not only be caused by less physical activity but by changing eating habits. One Finnish study found that 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. We could locate no research examining the specific links between good nutrition and retirement, but it is reasonable to assume the importance of a good diet among retirees. 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. 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 is also believed to reduce your risk for certain cardiovascular diseases, stroke, type 2 diabetes and cancer.

A recent English survey showed a multi-year trend towards increasing levels of obesity with a quarter of all adults obese now compared to around 15 per cent in 1993, with the increase slightly quicker for men than women. The 'obesity epidemic' has profound public health effects because obesity increases the likelihood of diseases such as heart disease, diabetes and some kinds of cancer. More than three in every 10 people aged 55 to 64 and just heading into retirement were classed as obese. As the authors note dryly, after these ages obesity prevalence declines, possibly because the least healthy die off.

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 disease.

Plan for a healthy retirement

How do we ensure good health in retirement? Sometimes retirement is a necessary outcome of poor health. Or the unexpected happens after we retire and we become ill in spite of all our efforts to remain healthy. Ageing itself is undeniably a health hazard. But as we have seen in this chapter, there are some fundamental lifestyle choices that will boost chances of a healthy retirement, both physically and mentally. It is important that pre-retirement plans include thinking about a healthy retirement lifestyle. Better still, start the process before retiring.

There is an abundance of self-help advice about how to maintain good health in retirement and it is remarkably consistent. Stay active and involved. Whether it's organised sports or activities, or taking long walks on your own, it's 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.

If you can't or don't want to engage in sports or exercise activities there are other options that may fit your lifestyle better. Retirement can increase 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's a great way to meet people and get the health benefits of relationships too.

- Emeritus Professor Doreen Rosenthal and Emeritus Professor Susan Moore are social researchers and retired academics who have jointly authored books on adolescence, sexuality, grandparenting and retirement. They take their own advice about retirement, aiming to stay mentally, physically and socially active.

This chapter is from 'The Psychology of Retirement', from the Routledge series 'The Psychology of Everything'. Read extracts from other books in the series.

[i] World Health Organisation. (2011). Global health and aging. Bethesda, MD: WHO.

[ii] Hessel, P. (2016). Does retirement (really) lead to worse health among European men and women across all educational levels? Social Science & Medicine, 151, 19–26.

[iii] Eibich, P. (2015). Understanding the effect of retirement on health: Mechanisms and heterogeneity. Journal of Health Economics, 43, 1–12.

[iv] Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), Article ID: e1000316.

[v] Zhu, R. (2016). Retirement and its consequences for women's health in Australia. Social Science & Medicine, 163, 117–125.

[vi] Helldán, A., Lallukka, T., Rahkonen, O., & Lahelma, E. (2012). Changes in healthy food habits after transition to old age retirement. European Journal of Public Health, 22, 582–586.

[vii] Dave, D., Rashad, I., & Spasojevic, J. (2008). The effects of retirement on physical and mental health outcomes. Southern Economic Journal, 75, 497–523.

[viii] Heybroek, L., Haynes, M., & Baxter, J. (2015). Life satisfaction and retirement in Australia: A longitudinal approach. Work, Aging and Retirement, 1, 166–180.

[ix] Sahlgren, G. H. (2013). Work longer, live. IEA Discussion Paper No. 46, Institute of Economic Affairs, UK.

[x] Barbosa, L. M., Monteiro, L., & Giardini Murta, S. (2016). Retirement adjustment predictors: A systematic review. Work, Aging and Retirement, 2, 262–280.

[xi] Ibid.

[xii] Bamburger, P. A. (2015). Winding down and boozing up: The complex link between retirement and alcohol misuse. Work, Aging and Retirement, 1, 92–111.

[xiii] Holdsworth, L., Hing, N., & Breen, H. (2012). Exploring women's problem gambling: A review of the literature. International Gambling Studies, 12, 199–213.

[xiv] Sjosten, N. M., Kivimaki, M., Singh-Manoux, A., & Vahtera, J. (2012). Change in physical activity and weight in relation to retirement: The French GAZEL Cohort Study. BMJ Open, 21.

[xv] Duberley, J., Carmichael, F., & Szmigin, I. (2014). Exploring women's retirement: Continuity, context and career transition. Gender, Work and Organization, 21, 71–90.