Heterogeneity in the association between social support and mental distress in old-age retirees - a computational approach using longitudinal cohort data.

BACKGROUND: Mental distress among retirees and older people is a severe public health challenge, and information on new risk groups is needed. This study aims to identify subgroups of old-age retirees with varying associations between low social support and mental distress by applying model-based recursive partitioning (MOB). METHODS: We used the Helsinki Health Study follow-up survey data of old-age retired former municipal sector employees of the City of Helsinki, Finland. Phase 1 data were collected in 2000-2002, when all participants were employed, Phase 2 in 2007, Phase 3 in 2012, Phase 4 in 2017, and Phase 5 in 2022 (n = 4,466, 81% women). Social support and covariates were measured at each Phase 1-5 and the outcome, mental distress (Depression Anxiety Stress Scales [DASS-21]) was measured at a single occasion, during Phase 5. The three subscales and the common factor of general distress were analysed separately. An approach rooted in computational statistics was used to investigate risk factor heterogeneity in the association of low social support and mental distress. MOB combines decision trees with regression analysis to identify subgroups with the most significant heterogeneity among risk factors. RESULTS: Median (IQR) general distress score from DASS-21 was 5.7 (3.0, 9.0), while Social Support Questionnaire number-score (SSQN) was 1.5 (1.15, 2.05). The primary effect modifier for the association between social support and general distress was education (p < 0.001). Those with high education had a different association of low social support and general distress than those with low or medium education. Additionally, the subgroup with low and medium education had a significant effect modification for age (p = 0.01). For the association between low social support and depressive symptoms, the moderating effect of education was dependent on gender, as men with medium-high education had the weakest association, while for women with medium-high education the association was strongest. CONCLUSIONS: Our results suggest that stratification by sociodemographic variables is justifiable when investigating risk factors of mental distress in old-age retirees. The incongruent association of low social support and depressive symptoms in men with medium-high education compared to women with medium-high education is a promising target for confirmatory research.

Exploring determinants of flourishing: a comprehensive network analysis of retirees in Taiwan.

BACKGROUND: Human flourishing is an emerging concept, extending beyond the conventional boundaries of subjective well-being and evolving into a comprehensive capture of the diverse dimensions of human life within complex societal structures. Therefore, moving away from traditional approaches centered on the single latent construct, this study aims to explore the multiple aspects of human flourishing and the intricate interplay of their contributing factors. METHODS: Data were collected from the Health and Living Environments Survey of Taiwanese Retirees during 2023 (valid sample n = 1,111). Human flourishing was measured using the Secure Flourish Index developed by Harvard University, which includes 12 indicators: (1) life satisfaction, (2) happiness, (3) mental health, (4) physical health, (5) meaning in life, (6) sense of purpose, (7) promoting good, (8) delaying gratification, (9) content relationships, (10) satisfying relationships, (11) financial stability, and (12) material stability. A mixed graphical network analysis was employed to analyze the related determinants, divided into four groups: (a) sociodemographic factors, (b) physical functions and health status, (c) social and family engagement, and (d) community environmental characteristics as nodes. RESULTS: We analyzed 31 variables and identified 133 nonzero edges out of 465 potential connections in the comprehensive network. Results showed that happiness and promoting good were the two most critical indicators influencing retirees' overall flourishing. Different flourishing indicators were also associated with various influential factors. For instance, personal characteristics, especially gender and education, emerged as central factors. Family caregiving negatively affected happiness and financial stability, whereas social engagement was positively associated with life satisfaction and meaning in life. Employment status had mixed effects, negatively associated with life satisfaction but positively associated with mental health. Community environments, such as a sense of community and neighborhood safety, generally enhanced flourishing. However, the accessibility of neighborhood resources was paradoxically associated with material stability, pointing to the complexity of environmental factors in human flourishing. CONCLUSION: This study provides a comprehensive network analysis that reveals intricate connections between personal, behavioral, and environmental factors, offering profound insights for targeted interventions to foster human flourishing.

Lifetime exposure to unemployment and prior working conditions are associated with retiree's health: A retrospective study in a large population-based French cohort.

It is unclear whether unemployment exposure, as well as working conditions, can have sustained effects on the health of retirees who are no longer exposed. The aim of the present study is to investigate this issue in 29,281 French retirees from the CONSTANCES cohort in whom the prevalence of suboptimal self-rated health, disability for routine tasks, cardiovascular diseases and cancers is assessed according to lifetime exposure to unemployment and prior working conditions. The analyses are performed retrospectively using multivariable logistic regression models with adjustment for potential confounders such as sex, birth year, parental histories of cardiovascular disease and cancer, social position, retirement age and duration. High lifetime exposure to unemployment is associated with an increased prevalence of suboptimal self-rated health (adjusted odds ratio (95% CI), 1.39 (1.23-1.57)), disability for routine tasks (1.41 (1.26-1.57)) and several cardiovascular diseases including stroke (1.66 (1.19-2.31)), myocardial infarction (1.65 (1.18-2.31)) and peripheral arterial disease (2.38 (1.46-3.90)). Bad prior working conditions are associated with an increased prevalence of disability for routine tasks (1.17 (1.04-1.33)) and cancers (1.27 (1.04-1.54)), notably prostate cancer (1.60 (1.01-2.64)). These findings suggest that unemployment and working conditions have long-term health effects that may cumulate over lifetime, emphasizing that risk evaluation and preventive strategies in retirees, as in workers, should take into account the life-course of individuals in addition to traditional risk factors.

[Les retraités au Canada : portrait comparatif selon le statut d'immigrant].

La retraite au Canada a fait l'objet de plusieurs recherches, mais peu d'études ont comparé le passage de la vie active à la retraite des natifs et des immigrants ainsi que leurs caractéristiques une fois à la retraite, une lacune importante compte tenu de l'augmentation de la part des immigrants parmi les futures cohortes canadiennes de retraités. Cette étude descriptive vise à pallier cette lacune à l'aide des données de l'Enquête sociale générale de 2016. Les résultats montrent, entre autres, que les femmes et les hommes natifs ont plus de chances de prendre leur retraite que les immigrants, quel que soit le groupe d'âge étudié, et que l'âge moyen à la retraite des femmes et hommes immigrants est de deux ans supérieur à celui des natifs. Cette étude suggère que le statut d'immigrant implique une transition vers la retraite différente de celle vécue par les natifs ; différence qui devrait être considérée dans la structure du système de revenus de retraite.

(Re)production of Inequalities in Retirement Practices and Meanings Assigned to the Term 'Retiree' in the Post-Communist Context.

In the institutionalized life course transition from work to retirement is the transition that culturally defines the beginning of later life. However, there is no universal way of experiencing retirement or understanding retirees' social roles. Especially in the context of the post-communist, liquid modern reality in Poland. The social role of the retiree, defined as a set of rules and expectations generated for individuals occupying particular positions in the social structure, is constructed at the intersection of what is culturally defined and individually negotiated. Therefore, the way in which individuals (re)define term "retiree" and "do retirement" reflects not only inequalities in individual resources and attitudes, but also in social structure in a given place and at a given time. In this contribution, I draw upon data from 68 qualitative interviews with retirees from Poland to analyze retirement practices and meanings assigned to the term "retiree." Applying practice theory, I explore the inequalities they (re)produce, mirror and reinforce at the same time. Results show that there are four broad types of retirement practices: caregiving, working, exploring and disengaging. During analysis of meanings assigned by participants to the term "retiree," two definitions emerged: one of a "new wave retiree" and the other of a "stagnant retiree." Results suggest that in the post-communist context, retirement practices and meanings assigned to the term "retiree" are in the ongoing process of (re)negotiation and are influenced on the one hand by the activation demands resulting from discourses of active and productive aging, and on the other by habitus and imaginaries of retirement formed in the bygone communist era. Retirement practices and definitions of the term "retiree" that emerged from the data reflect structural and individual inequalities, highlighting intersection of gender, age and socioeconomic status in the (re)production of inequalities in retirement transition in the post-communist context.

Multicomponent positive psychology intervention for health promotion of Brazilian retirees: a quasi-experimental study.

This study evaluated the effects and impact of a multicomponent positive psychology program for health promotion of retirees. A quasi-experimental longitudinal design was used, and the baseline and end of intervention evaluations were analyzed. The intervention consisted of six weekly group sessions for 2 h each. Eighty-eight retirees (females = 72) aged 49-86 (M = 65.66, SD = 7.53) from South Brazil took part in the study, 54 (females = 48) in the experimental group (M = 66.37 years old, SD = 7.42), and 34 (females = 24) waitlist controls (M = 64.53 years old, SD = 7.68). The instruments used were a sociodemographic questionnaire and the Brazilian version of the scales: Interpersonal Reactivity Index; 12-item General Health Questionnaire; Life Orientation Test-Revised;14-item Perceived Stress Scale; Resilience Scale; and Satisfaction with Life Scale. Mixed factorial ANOVA models revealed significant decrease in depression and anxiety symptoms and perceived stress levels, whereas improvement in life satisfaction and resilience was detected in the experimental group at the end of the program. No main effect was found for empathy and optimism. Interaction effects yielded significant difference between groups for measures of empathy, optimism, depression, and anxiety symptoms after the program. There was no significant interaction effect for the other outcome variables. The usefulness and applicability of this model of intervention to aid future health practices and policies are discussed. Contextual issues in the fields of health promotion and disease prevention in Brazil are also problematized.

Gender differences in the effect of social resources and social status on the retirement satisfaction and health of retirees.

This study explores the effect of positive and negative social support, social reciprocity, and subjective social status on the retirement satisfaction and health of retirees and gender differences therein. Using cross-sectional data from the 2010 and 2012 waves of the Health and Retirement Study (HRS), we found that social support seems to matter more for the retirement satisfaction and health of women, while social reciprocity matters more for the health of men and subjective social status for the retirement satisfaction of men. Implications for the development of social programs and policies over the life course are discussed.

Multicomponent positive psychology intervention for health promotion of Brazilian retirees: a quasi-experimental study

Abstract This study evaluated the effects and impact of a multicomponent positive psychology program for health promotion of retirees. A quasi-experimental longitudinal design was used, and the baseline and end of intervention evaluations were analyzed. The intervention consisted of six weekly group sessions for 2 h each. Eighty-eight retirees (females = 72) aged 49-86 ( M = 65.66, SD = 7.53) from South Brazil took part in the study, 54 (females = 48) in the experimental group ( M = 66.37 years old, SD = 7.42), and 34 (females = 24) waitlist controls ( M = 64.53 years old, SD = 7.68). The instruments used were a sociodemographic questionnaire and the Brazilian version of the scales: Interpersonal Reactivity Index; 12-item General Health Questionnaire; Life Orientation Test-Revised;14-item Perceived Stress Scale; Resilience Scale; and Satisfaction with Life Scale. Mixed factorial ANOVA models revealed significant decrease in depression and anxiety symptoms and perceived stress levels, whereas improvement in life satisfaction and resilience was detected in the experimental group at the end of the program. No main effect was found for empathy and optimism. Interaction effects yielded significant difference between groups for measures of empathy, optimism, depression, and anxiety symptoms after the program. There was no significant interaction effect for the other outcome variables. The usefulness and applicability of this model of intervention to aid future health practices and policies are discussed. Contextual issues in the fields of health promotion and disease prevention in Brazil are also problematized.

Pre-retirement job and the work-to-retirement occupational transition process in Australia: A review.

BACKGROUND: The transition from work to retirement is a complex process and unique experience with a relationship existing between work and retirement with implications for health in later life. This review explored the relationship between pre-retirement job and participation in the work-to-retirement transition process in Australia by exploring: (i) factors influencing retirement in relation to pre-retirement job; (ii) how jobs are classified; (iii) the effect of pre-retirement job (based on categories) on this occupational transition; and (iv) the potential role for occupational therapy in this occupational transition. METHOD: An integrative literature review was completed. PRISMA guidelines were used. Study designs were analysed for methodological quality using the National Health and Medical Research Council levels of evidence. Thematic analysis determined retirement factors which were used to compare differences between jobs. RESULTS: This review included 15 papers. There were two Level III-2, one Level III-3 and 13 Level IV studies. Factors influencing retirement related to the stages of work, preparation, transition and retired. White collar and blue collar was the most common job classification system. Although white collar and blue collar worker definitions utilised were inconsistent, differences between the two groups were still determined in all stages. CONCLUSION: Differences in the work-to-retirement transition process, based on pre-retirement job, are evident. Understanding differences by job groupings may assist occupational therapists to understand individualised needs during this occupational transition and subsequent tailoring of interventions (both individual and group based) to enable engagement in meaningful occupation in the work-to-retirement occupational transition to effect active healthy ageing.

[On the correlation of guarantees of the labor rights of the elderly in Russia and Europe.]

Many lawyers, referring to the topic of guarantees for ensuring the labor rights of elderly people who receive a pension, begin the analysis from the provisions of Art. 19 of the Russian Constitution on the prohibition of discrimination and art. 3 of the Labor Code of the Russian Federation on the prohibition of discrimination. ILO Convention № 111 on Discrimination in Employment and Occupation [8] also does not mention the age as a discriminatory motive. At the same time, among the listed elements of Article 19 of the Constitution of the Russian Federation, there is no direct indication of age. Therefore, the issue of employment and retention of the workplace for an elderly employee, the payments due to dismissal, including in connection with the liquidation of the organization or the reduction of staff, is related in one way or another to the understanding of the essence of the labor rights of such persons by the bodies that protect labor rights of workers and justice. Controversial aspects often have fundamentally different approaches to application, thus requiring careful and cautious treatment without generalizations and formalism. Based on the analysis of judicial practice, ILO recommendations, WHO reports and other materials, we will reveal common and distinctive features in ensuring the labor rights of elderly people and old age pensioners and the quality of life in Russia and European countries.

Health Of Americans Who Must Work Longer To Reach Social Security Retirement Age.

To receive full Social Security benefits, Americans born after 1937 must claim those benefits at an older age than earlier birth cohorts. Additionally, proposals to improve the fiscal position of Social Security typically include increasing the age at which workers can receive full benefits. Birth cohorts required to work longer are in worse health at ages 49-60, based on multiple measures of morbidity, than cohorts who could retire earlier.

Biopsychosocial and Retirement Factors Influencing Satisfaction With Life: New Perspectives.

Founded on expectation confirmation theory and a resource perspective, this research examines the impact of retiree resources, retirement planning, conditions of work exit, and confirmation of retirement expectations on satisfaction with life in retirement. The study of 543 retirees found significant effects of retiree resources (i.e., self-efficacy, health, and income), confirmation of retirement expectations, ageism, retirement planning, and conditions of exit on retirees' satisfaction with life. The study also showed that self-efficacy, activity participation, health, income, ageism, and retirement planning significantly impacted confirmation of retirement expectations, although conditions of exit did not significantly affect confirmation of retirement expectations.

A review of occupational therapy's contribution to and involvement in the work-to-retirement transition process: An Australian perspective.

BACKGROUND: Retirement from paid work is an occupational transition, which can have a profound impact on a person's life. This review explored occupational therapy's contribution to and involvement in the work-to-retirement transition process in Australia. METHODS: An integrative literature review was undertaken using seven article repository databases. PRISMA guidelines informed searches. Articles were included if participants were Australian; researchers' discussed retirement from an occupational perspective or the scope of practice of occupational therapists; and publication was from 1994 to June 2015 in a peer-reviewed journal. Articles were critically appraised and thematic analysis explored: (i) occupational perspective, (ii) occupational therapy scope of practice, (iii) theory and (iv) retirement definitions. RESULTS: Eight articles met the review criteria. Three occupational perspective themes were identified: retirement intention influences, retirement preparation and retirement roles and activities. No articles on the current scope of practice of occupational therapy were found. Three articles discussed potential occupational therapy approaches. Three themes on what retirement is were identified: complete cessation, gradual transition and intermittent worker. Four theory themes were identified: occupational therapy, ageing, identity and work. CONCLUSION: Occupational therapy has the potential to be involved in improving health and well-being for people in the work-to-retirement transition process. It is suggested that future research explore not only people's experiences but also the approaches of occupational therapy in assisting people through this occupational transition. The use of theory to guide Australian occupational therapy practice on retirement should also be explored. The use of consistent retirement definitions will assist in understanding research.

Health of grey nomads: On the move and under the health sector radar.

OBJECTIVE: Grey nomads - older people driving long distances recreationally and staying in caravans, tents or motor homes - are common on Australian highways. Although grey nomads report many benefits from their travels, there is anecdotal evidence that they impose a significant burden on rural/remote health services, including general practitioners, pharmacists and hospitals. There have been calls for better resourcing and service provision, but little reference to solid evidence on which to base this. This literature review is the first to integrate existing evidence for a health audience. SETTING: Australia. DESIGN: Narrative literature search and synthesis. RESULTS: There is very little published information about the health and health service utilisation of grey nomads, and almost none in the medical literature. One key exception, a survey at a caravan park in the Kimberley region, found that, like other older Australians, many grey nomads have chronic diseases, and they have high rates of medication use. However, other studies have found that they generally view themselves as relatively healthy. There is some evidence of inadequate preparation for travelling. Issues include lack of health summaries, inadequate medication supplies and suboptimal vaccination. Some experience emergencies, sometimes resulting in hospital admissions. Overall, they place a poorly documented burden on rural/remote services. CONCLUSION: There is a need for further research on the health of grey nomads, their use of self-care strategies, and their uptake of health services both on the road and at home, to inform the provision of health services and optimise their well-being and health care utilisation.

Hepatitis C Virus in the US Military Retiree Population: To Screen, or Not to Screen?

BACKGROUND: In 2012, the Centers for Disease Control (CDC) recommended hepatitis C virus (HCV) screening for those born between 1945 and 1965. Prior recommendations endorsed screening based on risk factors (RFs). Because United States (US) military retirees have had at least 20 years of access to free comprehensive health care, mandatory physical fitness tests, periodic health assessments and mandatory drug screening, we hypothesized that the prevalence of HCV amongst military retirees is lower than the national average. Thus the new CDC screening guidelines may not be applicable or cost effective in this particular population. METHODS: A quality improvement (QI) initiative implemented the new birth-cohort CDC screening guidelines for the internal medicine (IM) clinic of our hospital (QI group). An age-matched group from the same IM clinic, screened based on RFs for HCV infection, served as the comparator (RF group). The prevalence of the anti-HCV antibody and chronic infection was determined and compared with each other and with the national average. RESULTS: The prevalence of the HCV antibody was 2.1% and 2.3% in the QI and RF groups, respectively (odds ratio (OR): 1.08, 95% CI: 0.37 - 3.21, P = 1.000). The prevalence of chronic infection was 0.4% and 1.8% in the QI and RF groups, respectively (OR: 4.39, 95% CI: 0.80 - 24.13, P = 0.083). When our data were compared with the national average, there were no statistical differences in the prevalence of the HCV antibody; however, there was statistically more viral clearance, and subsequently less chronic infection, in the QI group versus the national average. CONCLUSIONS: The military retiree population did not have a lower prevalence of the HCV antibody than the American populace whether screened based on age or traditional RFs. Thus, the CDC guidelines are applicable in this population. One interesting finding of this study is the higher rate of viral clearance in military retirees when compared with the national average. It is therefore possible that military retirees may be more likely to have natural viral eradication than the civilian population.

The role of retiree health insurance in the early retirement of public sector employees.

Most government employees have access to retiree health coverage, which provides them with group health coverage even if they retire before Medicare eligibility. We study the impact of retiree health coverage on the labor supply of public sector workers between the ages of 55 and 64. We find that retiree health coverage raises the probability of stopping full time work by 4.3 percentage points (around 38 percent) over two years among public sector workers aged 55-59, and by 6.7 percentage points (around 26 percent) over two years among public sector workers aged 60-64. In the younger age group, retiree health insurance mostly seems to facilitate transitions to part-time work rather than full retirement. However, in the older age group, it increases the probability of stopping work entirely by 4.3 percentage points (around 22 percent).

How does retiree health insurance influence public sector employee saving?

Economic theory predicts that employer-provided retiree health insurance (RHI) benefits have a crowd-out effect on household wealth accumulation, not dissimilar to the effects reported elsewhere for employer pensions, Social Security, and Medicare. Nevertheless, we are unaware of any similar research on the impacts of retiree health insurance per se. Accordingly, the present paper utilizes a unique data file on respondents to the Health and Retirement Study, to explore how employer-provided retiree health insurance may influence net household wealth among public sector employees, where retiree healthcare benefits are still quite prevalent. Key findings include the following: Most full-time public sector employees anticipate having employer-provided health insurance coverage in retirement, unlike most private sector workers.Public sector employees covered by RHI had substantially less wealth than similar private sector employees without RHI. In our data, Federal workers had about $82,000 (18%) less net wealth than private sector employees lacking RHI; state/local workers with RHI accumulated about $69,000 (or 15%) less net wealth than their uninsured private sector counterparts.After controlling on socioeconomic status and differences in pension coverage, net household wealth for Federal employees was $116,000 less than workers without RHI and the result is statistically significant; the state/local difference was not.

The effects of retiree health insurance plan characteristics on retirees' choice and employers' costs.

To moderate the rate of growth of retiree health insurance costs, employers can modify plans and move retirees into less expensive plans. We examine policy modifications implemented by the North Carolina State Health Plan. We investigate whether incentives produce the desired plan elections and whether these changes, along with cost shifting, produce the expected reductions in cost growth. Using individual-level administrative data, along with aggregated data on expenditures for retirees, we estimate the effects of the introduction and subsequent repeal of a Comprehensive Wellness Initiative for non-Medicare eligible retirees, as well as increases in coinsurance and copayments and the introduction of a premium for all retirees. Over a third of non-Medicare retirees shifted into the least generous plan between June 2009 and December 2012. The level effects on annual costs and unfunded accrued liabilities were relatively modest, but growth rates were diminished. Increases in the retiree premiums reduced the state's projected costs.

Active and retired public employees' health insurance: potential data sources.

Employer-provided health insurance for public sector workers is a significant public policy issue. Underfunding and the growing costs of benefits may hinder the fiscal solvency of state and local governments. Findings from the private sector may not be applicable because many public sector workers are covered by union contracts or salary schedules and often benefit modifications require changes in legislation. Research has been limited by the difficulty in obtaining sufficiently large and representative data on public sector employees. This article highlights data sources researchers might utilize to investigate topics concerning health insurance for active and retired public sector employees.

The fiscal stress arising from state and local retiree health obligations.

A major factor weighing down the long-term finances of state and local governments is the obligation to fund retiree benefits. While state and local government pension obligations have been analyzed in great detail, much less attention has been paid to the costs of the other major retiree benefit provided by these governments: retiree health insurance. The first portion of the paper uses the information contained in the annual actuarial reports for public retiree health plans to reverse engineer the cash flows underlying the liabilities given in the report. Obtaining the cash flows allows us to construct liability estimates which are consistent across governments in terms of the discount rate, actuarial method and assumptions concerning medical cost inflation and mortality. We find that the total unfunded accrued liability of state and local governments for the provision of retiree health care exceeds $1 trillion, or about ⅓ of total state and local government revenue. Relative to pension obligations discounted at the same rate, we find that unfunded retiree health care liabilities are ½ the size of unfunded pension obligations. We also find that using assumptions concerning the growth in health care costs that are arguably more realistic than those employed by most states actually reduces the size of the liability in most cases. Pushing in the opposite direction, we find that using plausibly more realistic mortality assumptions increases the size of liability. The second portion of the paper places retiree health care obligations into context by examining the budget pressures associated with retiree health on a continuing, largely pay-as-you go basis. We find that much of the projected increase in retiree health obligations as a share of revenue is the result of health care cost growth. On average, states could put their retiree health obligations into long-run fiscal balance by contributing an additional ¾ percent of total revenue toward the benefit each year. There is, however, wide variation across the states, with the majority of states requiring little in the way of additional financing, but some states requiring a significantly larger increase.