Inequalities in associations between young adult caregiving and social relationships: Evidence from the UK Household Longitudinal Study.

INTRODUCTION: Young adult caregivers (aged 16-29 years) are an important but underrecognized group of informal caregivers. There is some evidence suggesting that young adult caregivers have fewer social relationships. However, this research has been largely cross-sectional in design or restricted to caregivers, providing no comparison with noncaregivers. Further, there is little evidence on whether and to what extent there are inequalities in associations between young adult caregiving and social relationships by gender, age, caregiving intensity, or household income. METHODS: Using five waves of data on 3-4000 young adults aged 16-29 from the UK Household Longitudinal Study, we investigated associations between becoming a young adult caregiver and subsequent social relationships (number of close friends and participation in organized social activities) in the short-term (1-2 years after caregiving initiation) and longer-term (4-5 years later). We also assessed differences by gender, age, household income, and caregiving intensity. RESULTS: Overall, those who became young adult caregivers, and particularly those providing 5+ h/week, reported fewer friends in the short- but not longer-term. No associations were observed between young adult caregiving and participation in organized social activities. Also, there was no evidence of differences by gender, age, income, or caregiving hours. CONCLUSIONS: Becoming a young adult caregiver is associated with a reduction in number of close friends, particularly in the short-term. Given the importance of practical and emotional support provided by friends, the early identification of young adult caregivers and greater population awareness of caring in young adulthood may help to mitigate the effects on social relationships.

Cognitive reserve over life course and 7-year trajectories of cognitive decline: results from China health and retirement longitudinal study.

BACKGROUND: Cognitive reserve (CR) could partly explain the individual heterogeneity in cognitive decline. No study measured CR from a life course perspective and investigated the association between CR and trajectories of cognitive decline in older Chinese adults. METHODS: Data of 6795 Chinese adults aged 60+ from China Health and Retirement Longitudinal Study were used. Global cognition score (0-32) was assessed in all four waves. A life-course CR score was constructed using markers of childhood circumstance, education, highest occupational class, and leisure activities in later life. Latent growth curve modelling (LGCM) was applied to assess the association between CR and trajectories of cognitive decline. RESULTS: For the life-course CR, factor loadings of markers in adulthood and later life were larger than that of markers in childhood. The life-course CR score (ranged between - 2.727 and 6.537, SD: 1.74) was higher in urban Chinese adults (0.75, SD: 1.90) than in rural Chinese adults (- 0.50, SD: 1.43). The unconditional LGCM results showed that urban older Chinese adults had better global cognition at baseline (intercept: 15.010, 95% CI: 14.783, 15.237) and a slower rate of cognitive decline per year (linear slope: -0.394, 95% CI: - 0.508, - 0.281) than their rural counterparts (intercept: 12.144, 95% CI: 11.960, 12.329; linear slope: -0.498, 95% CI: - 0.588, - 0.408). After controlling for all covariates, one-unit higher CR score was associated with 1.615 (95% CI: 1.521, 1.709) and 1.768 (95% CI: 1.659, 1.876) unit higher global cognition at baseline for urban and rural older Chinese adults, respectively. The slower rate of cognitive decline associated with higher CR was more evident in rural residents (slope: 0.083, 95% CI: 0.057, 0.108) than in their urban counterparts (0.054, 95% CI: 0.031, 0.077). CONCLUSIONS: CR was associated with better baseline cognition and slower cognitive decline in Chinese older adults. Although rural residents were disadvantaged in both CR and cognition, the protective effect of CR against cognitive decline was stronger for them than in those who live in urban area.

Effect of retirement on cognitive function: the Whitehall II cohort study.

According to the 'use it or lose it' hypothesis, a lack of mentally challenging activities might exacerbate the loss of cognitive function. On this basis, retirement has been suggested to increase the risk of cognitive decline, but evidence from studies with long follow-up is lacking. We tested this hypothesis in a cohort of 3433 civil servants who participated in the Whitehall II Study, including repeated measurements of cognitive functioning up to 14 years before and 14 years after retirement. Piecewise models, centred at the year of retirement, were used to compare trajectories of verbal memory, abstract reasoning, phonemic verbal fluency, and semantic verbal fluency before and after retirement. We found that all domains of cognition declined over time. Declines in verbal memory were 38% faster after retirement compared to before, after taking account of age-related decline. In analyses stratified by employment grade, higher employment grade was protective against verbal memory decline while people were still working, but this 'protective effect' was lost when individuals retired, resulting in a similar rate of decline post-retirement across employment grades. We did not find a significant impact of retirement on the other cognitive domains. In conclusion, these findings are consistent with the hypothesis that retirement accelerates the decline in verbal memory function. This study points to the benefits of cognitively stimulating activities associated with employment that could benefit older people's memory.

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.

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.

The Associations Between Retirement and Cardiovascular Disease Risk Factors in China: A 20-Year Prospective Study.

Despite China's being the largest and most rapidly aging country in the world, there have been no longitudinal studies investigating the relationship between retirement and cardiovascular disease risk factors in China. In this study, we assessed the associations between retirement and systolic blood pressure, diastolic blood pressure, waist circumference, body mass index, smoking status, and alcohol consumption over a 17-year period both before and after retirement among 1,084 people (41.3% women) who participated in the China Health and Nutrition Survey (1991-2011) at least once prior to the year in which they retired and at least once afterward. Piecewise models centered at the year of retirement were applied. Retirement was accompanied by a reduction in diastolic blood pressure, a slowdown in the increase of both systolic blood pressure and waist circumference, and a reduction in the probability of being a heavy alcohol drinker. The association between retirement and blood pressure was stronger for men and for urban dwellers. No significant associations with body mass index or smoking were found. This study suggests that retirement may be beneficial for blood pressure, waist circumference, and alcohol consumption in the Chinese context. Understanding the potential health influence of retirement is essential, given plans to raise the retirement age in China.

Mental and physical health changes around transitions into unpaid caregiving in the UK: a longitudinal, propensity score analysis.

BACKGROUND: The health of unpaid caregivers is poorer, on average, than in non-caregivers. There has been little focus on how health changes when becoming a caregiver and whether this varies by age, gender, and caregiving intensity. We aimed to investigate the mental and physical health changes involved with becoming a caregiver and whether these associations varied by gender, caregiving intensity, or age. METHODS: This study used data from the UK Household Longitudinal Study (2009-20) to examine mental and physical health changes around the transition to becoming a caregiver in adults aged 16 years and older. We included adults with information on care, complete covariates needed for matching, and at least one measure of health before or after becoming a caregiver (or matched non-caregiver). Health was measured via General Health Questionnaire-12 (GHQ-12, psychological distress) and 12-item Short Form Survey (SF-12, physical and mental functioning). We applied piecewise growth curve modelling with propensity score matching to model trajectories of mental and physical health for caregivers and matched non-caregivers. Analyses were stratified by age group, gender, and caregiving intensity. FINDINGS: Sample sizes varied from 3025 (GHQ-12 analyses in early adulthood) to 5785 (SF-12 analyses in early mid-adulthood). Psychological distress increased during transition to caregiving for all ages, particularly in those younger than 64 years, those providing care for 20 h or more per week, and for someone living within the household. Mental health functioning worsened during caregiving transition for those aged 30-64 years, those providing 20 h or more per week, and for those caring for someone within the household. Physical health functioning did not change but there was evidence of lower levels of functioning before caregiving. Changes in mental and physical health upon transition to caregiving did not differ by gender. INTERPRETATION: Our findings highlight the importance of early identification of and support for caregivers, including younger caregivers. This is important to break the cycle of caregiving and future care need. Health services staff, including general practitioners and hospital discharge teams, are well positioned for early identification of caregivers. We also encourage particular support for the mental health of caregivers and particularly those who become caregivers at a younger age. FUNDING: The UK Economic and Social Research Council.

Do Health and Well-Being Change Around the Transition to Informal Caring in Early Adulthood? A Longitudinal Comparison Between the United Kingdom and Germany.

PURPOSE: Providing care in early adulthood may have long-term consequences, given the importance of this life stage for life-course transitions. This study aimed to analyze how the transition into caring during young adulthood (17-29 years old) influenced health and life satisfaction in the United Kingdom and Germany. METHODS: Datasets were from 10 annual waves of the UK Household Longitudinal Study and the German Socioeconomic Panel between the years 2009-2018. We used propensity score matching to match young adult carers (YACs) to similar noncarers to address the endogeneity of unpaid care provision. Then we applied piecewise growth curves to observe changes in self-rated health (United Kingdom N = 2,851; Germany N = 454) and life satisfaction (United Kingdom N = 2,263; Germany N = 449) between YAC and noncarers before, during, and after the onset of care. We assessed carer status, weekly hours spent on care, and duration of care. RESULTS: In the United Kingdom, life satisfaction decreased and the probability of reporting poor health increased after becoming a YAC, particularly for those who reported caring for more weekly hours. However, no such differences were found between YAC and noncarers in Germany. DISCUSSION: The onset and intensity of caring responsibilities during early adulthood influenced health and life satisfaction in the United Kingdom but not in Germany. One possible interpretation for these differences may be attributed to the different welfare contexts in which YACs are providing informal care. Our results highlight the importance of identifying and supporting the needs of young adults who are providing informal care while making key life-course transitions.

The association between subjective cognitive decline and trajectories of objective cognitive decline: Do social relationships matter?

OBJECTIVES: We examine the association between subjective cognitive decline (SCD) and the trajectories of objective cognitive decline (OCD); and the extent to which this association is moderated by social relationships. METHODS: Data come from waves 10 (2010) through 14 (2018) of the Health and Retirement Study, a nationally representative panel survey of individuals aged 50 and above in the United States. OCD is measured using episodic memory, and overall cognition. SCD is assessed using a baseline measure of self-rated memory. Social relationships are measured by social network size and perceived positive and negative social support. Growth curve models estimate the longitudinal link between SCD and subsequent OCD trajectories and the interactions between SCD and social relationship variables on OCD. RESULTS: SCD is associated with subsequent OCD. A wider social network and lower perceived negative support are linked to slower decline in memory, and overall cognition. None of the social relationship variables, however, moderate the link between SCD and future OCD. CONCLUSION: Knowing that SCD is linked to subsequent OCD is useful because at SCD stage, deficits are more manageable relative to those at subsequent stages of OCD. Future work on SCD and OCD should consider additional dimensions of social relationships.

Bidirectional association between depressive symptoms and mild cognitive impairment over 20 years: Evidence from the Health and Retirement Study in the United States.

BACKGROUND: Research examining the association between depressive symptoms and mild cognitive impairment (MCI) has yielded conflicting results. This study aimed to examine the bidirectional association between depressive symptoms and MCI, and the extent to which this bidirectional association is moderated by gender and education. METHODS: Data come from the US Health and Retirement Study over a 20-year period (older adults aged ≥50 years). Competing-risks regression is employed to examine the association between baseline high-risk depressive symptoms and subsequent MCI (N = 9317), and baseline MCI and subsequent high-risk depressive symptoms (N = 9428). Interactions of baseline exposures with gender and education are tested. RESULTS: After full adjustment, baseline high-risk depressive symptoms were significantly associated with subsequent MCI (SHR = 1.20, 95%CI 1.08-1.34). Participants with baseline MCI are more likely to develop subsequent high-risk depressive symptoms than those without baseline MCI (SHR = 1.16, 95%CI 1.01-1.33). Although gender and education are risk factors for subsequent depression and MCI, neither moderates the bidirectional association. LIMITATIONS: Items used to construct the composite cognitive measure are limited; selection bias due to missing data; and residual confounding. CONCLUSIONS: Our study found a bidirectional association between depressive symptoms and MCI. High-risk depressive symptoms are related to a higher risk of subsequent MCI; and MCI predicts subsequent high-risk depression. Though neither gender nor education moderated the bidirectional association, public health interventions crafted to reduce the risk of depression and MCI should pivot attention to older women and those with less formal education.

Does providing informal care in young adulthood impact educational attainment and employment in the UK?

Most research on the effects of caring has focused on older spouses or working-age carers providing care for older people, but providing care in early adulthood may have longer-term consequences, given the importance of this life stage for educational and employment transitions. This study aims to investigate the impact of informal care in early adulthood on educational attainment and employment in the UK and to test whether these associations differ by gender or socio-economic circumstances. Data are from young adults (age 16-29 at first interview, n = 27,209) in the UK Household Longitudinal Study wave 1 (2009/11) to wave 10 (2018/2020). Carers are those who provide informal care either inside or outside the household. We also considered six additional aspects of caring, including weekly hours spent caring, number of people cared for, relationship to care recipient, place of care, age at which caring is first observed, and duration of care. Cox regression was used to analyse the association between caring and educational qualifications and employment transitions. We found that young adult carers were less likely to obtain a university degree and enter employment compared to young adults who did not provide care. In terms of care characteristics, weekly hours spent caring were negatively associated with the likelihood of obtaining a university degree qualification and being employed. Providing care after full-time education age negatively influenced employment entry, but having a university degree buffered the negative influence of providing care on entering employment. The influence on unemployment may be stronger for female carers than for male carers. Our results highlight the importance of supporting the needs of young adults who are providing informal care while making key life course transitions.

Young Adult Carers in the UK-New Evidence from the UK Household Longitudinal Study.

Despite growing interest in young adult carers, little is known about trends in prevalence of caregiving among young adults aged 16-29. Furthermore, few studies have so far investigated demographic, health, and socioeconomic inequalities in the duration of care among young carers as well as demographic differences in caregiving characteristics. Using data from 11 waves of the nationally representative UK Household Longitudinal Study (2009-2021), we first estimated the prevalence of caregiving among 16-29 years-old adults at each wave. Results show that about 9% of those aged 16-29 provided care, and that this prevalence remained stable throughout the 2010s. Then, selecting respondents who participated for three waves of more, we assessed demographic, socioeconomic, and health characteristics associated with duration of care using ordinal regression models. Almost 52% of carers cared at two or more waves. Compared to non-carers, those who cared had more disadvantaged socioeconomic backgrounds, were from ethnic minorities and reported poorer health, particularly if they cared at two or more waves. Finally, focusing on carers, we tested differences by sex, age, and urbanicity in care relationships, intensity, and duration. Overall, women and those aged 25-29 cared for longer hours, for more people, and for more years than men and younger carers respectively. Put together, these findings provide an up-to-date description of young carers in the 2010s in the UK.

Working beyond SPA and the trajectories of cognitive and mental health of UK pensioners: Do gender, choice, and occupational status matter?

We assessed the association between work status beyond state pension age (SPA) and the long-term trajectories of cognitive and mental health for men and women separately, and the extent to which this relationship is conditioned by their occupational status and whether the choice to retire or continue working is voluntary or involuntary. Data are pensioners (aged between SPA and SPA + 9) from the English Longitudinal Study of Ageing waves 4 (2008/09) through 9 (2018/19). The analytic sample includes 959 men and 1217 women when considering cognitive outcomes and 1131 men and 1434 women when evaluating depression. Findings based on growth curve models reveal that, compared to women who retired at SPA and without any particular reason, their peers who retired due to frailing health reported a more precipitous decline in memory over time (coefficient = -0.10). However, analysis stratified by occupation shows that this association between ill-health retirement and long-term memory decline was concentrated among older women of the highest occupational status. We also found that men who retired or worked past SPA voluntarily reported a better baseline verbal fluency and were less likely to report depression over time (coefficient for work = 0.80; coefficient for retired = 0.87). Women who worked past SPA voluntarily were less likely to report depression at baseline (OR = 0.53). Policies that extend work life should offer older people more personal control over decision surrounding retirement. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00644-4.

The mental and physical health of young carers: a systematic review.

The health of those who care for someone with a health condition or advanced age is poorer, on average, than non-carers. However, the health of young carers (<18 years of age) has been under-researched, especially in quantitative studies. This systematic review aimed to summarise studies assessing the mental and physical health of young carers. 1162 unique studies were screened and 14 associations between being a young carer and health were identified (two studies were treated as a single unit of analysis as they had information from the same sample). Most of the included studies were done in the UK, with the remaining studies done in the USA, Canada, Australia, and Austria. A cross-European study of 21 countries was also included. Five of the included studies investigated both mental and physical health outcomes, seven studies investigated only mental health outcomes, and one study investigated only physical health outcomes of being a young carer. All of the included studies, except one, were cross-sectional in design. Most studies found that young carers had poorer physical and mental health, on average, than their non-caregiving peers. However, the evidence is relatively weak and more quantitative research is needed, particularly research that is longitudinal in design and assesses physical health outcomes.

Gender differences in unpaid care work and psychological distress in the UK Covid-19 lockdown.

OBJECTIVE: To describe how men and women divided childcare and housework demands during the height of the first Covid-19 lockdown in the UK, and whether these divisions were associated with worsening mental health during the pandemic. BACKGROUND: School closures and homeworking during the Covid-19 crisis have resulted in an immediate increase in unpaid care work, which draws new attention to gender inequality in divisions of unpaid care work. METHODS: Data come from the wave 9 (2017-19) of Understanding Society and the following April (n = 15,426) and May (n = 14,150) waves of Understanding Society Covid-19 study. Psychological distress was measured using the General Health Questionnaire (GHQ) at both before and during the lockdown, and unpaid care work was measured during the lockdown. Linear regression models were used. RESULTS: Women spent much more time on unpaid care work than men during lockdown, and it was more likely to be the mother than the father who reduced working hours or changed employment schedules due to increased time on childcare. Women who spent long hours on housework and childcare were more likely to report increased levels of psychological distress. Working parents who adapted their work patterns increased more psychological distress than those who did not. This association was much stronger if he or she was the only member in the household who adapted their work patterns, or if she was a lone mother. Fathers increased more psychological distress if they reduced work hours but she did not, compared to neither reducing work hours. CONCLUSION: There are continued gender inequalities in divisions of unpaid care work. Juggling home working with homeschooling and childcare as well as extra housework is likely to lead to poor mental health for people with families, particularly for lone mothers.

The Long Shadow of Youth: Girls' Transition From Full-Time Education and Later-Life Subjective Well-Being in the English Longitudinal Study of Ageing.

OBJECTIVES: To investigate whether the timing and nature of women's transitions out of full-time (FT) education are related to later-life subjective well-being and the life-course experiences that might explain any associations seen. METHODS: Data are from women in Wave 3 of the English Longitudinal Study of Ageing who have participated in the life history interview and were aged 50+ at the interview (n = 3,889). Using multichannel sequence analysis, we identified 6 types of transition out of FT education (ages 14-26). Regression models were used to examine associations between transition types and life satisfaction, quality of life, and depressive symptoms at age 50+. RESULTS: Women who made early transitions to married parenthood and FT domestic labor had lower levels of well-being on all 3 later-life well-being outcomes (p < .01), compared to women who made later transitions to family life and remained employed. Women who remained single up to age 26 also had lower life satisfaction (p < .05) and quality of life (p < .01) in later life than their counterparts who married and had children. These associations were explained by the life-course socioeconomic and relationship pathways. Advantaged childhood socioeconomic circumstances and higher educational qualifications set "Later Marriage and Later employment" women apart onto advantaged trajectories and a better quality of life later (p < .01). DISCUSSION: The timing and nature of exits from FT education played a pivotal role in setting people onto life-course trajectories that influence well-being in later life for this older generation of women.

Do depressive symptoms link chronic diseases to cognition among older adults? Evidence from the Health and Retirement Study in the United States.

BACKGROUND: Few studies have assessed psychological pathways that connect the association between non-psychotropic chronic disease and cognition. We assessed the extent to which the association between the two was mediated by depressive symptoms in older adults. METHODS: Data came from waves 10-13 (2010-2016) of the Health and Retirement Study in the United States (7,651 men and 10,248 women). Multilevel path analysis, allowing for random intercepts and slopes, was employed to estimate the extent to which depressive symptoms mediated the total effect of a chronic disease on cognition. RESULTS: We found that the presence of stroke, high blood pressure, diabetes, heart problems, and comorbidity, in both men and women, and lung disease in women, was associated with lower levels of cognition. The total effects of chronic diseases on cognition were partially mediated through depressive symptoms. Depressive symptoms mediated approximately 19%-39% and 23%-54% of the total effects of chronic diseases on cognition in men and women, respectively. LIMITATIONS: We relied on self-reported diagnoses of diseases and depressive symptoms. Our use of a multilevel path analysis with random slopes precluded the inclusion of binary/categorical dependent variables, and the estimation of standardized beta values. CONCLUSIONS: To understand the cognitive challenges that chronically ill older adults face, practitioners and policymakers should consider not just the direct symptoms related to chronic diseases, but also the often overlooked psychological conditions faced by older adults.

Girls' transition to adulthood and their later life socioeconomic attainment: Findings from the English longitudinal study of ageing.

Transitions to adulthood represent a sensitive period for setting young people into particular life course trajectories, and the nature of these transitions have varied more for girls, historically, than for boys. We aim to investigate the long-term significance of different transitions out of full-time education for socioeconomic attainment in later life amongst postwar young women in England. Our data are from the English Longitudinal Study of Ageing for girls born during World War II and the post-war period (1939-1952, n = 1798). Using sequence analysis, we identified six types of transition out of full-time education between ages 14 and 26: Early-Work, Mid-Work, Late-Work, Early-Domestic, Late-Domestic, and Part-time Mixed. We used linear and multinomial regression models to examine associations between transition types and socioeconomic attainment outcomes from age 50, including individual income, household income and wealth, and occupational class. Our study found that later transitions into employment (Mid-Work and Late-Work) were associated with higher socioeconomic attainment after age 50 compared with women who made early transitions from education to employment (Early-Work); much of the advantage of making later transitions to employment was due to higher educational attainment. We also found that early transitions to domestic work (Early-Domestic) set young women onto trajectories of lower socioeconomic attainment than compared with those who made early transitions to employment, suggesting the nature of the transition from full-time education is as important as the timing, perhaps uniquely for women. A pathway of cumulative advantage/disadvantage is also evident in our study; results suggest a partial mediating role for educational attainment in associations between childhood social class and later life socioeconomic attainment.

The Impact of Retirement on Cardiovascular Disease and Its Risk Factors: A Systematic Review of Longitudinal Studies.

BACKGROUND AND OBJECTIVES: People are now spending longer in retirement than ever before and retirement has been found to influence health. This study systematically reviewed the impact of retirement on cardiovascular disease (CVD) and its risk factors (metabolic risk factors, blood biomarkers, physical activity, smoking, drinking, and diet). RESEARCH DESIGN AND METHODS: Longitudinal studies published in Medline, Embase, Social Science Citation Index, PsycINFO, and Social Policy and Practice were searched. No language restrictions were applied if there was an English abstract. Eighty-two longitudinal studies were included after critical appraisals. RESULTS: Studies in the United States often found no significant effect of retirement on CVD, while studies in European countries, except France, showed a detrimental effect of retirement on CVD. Results from the United States and several European countries consistently show that retirement increase adiposity measures among those retired from physically demanding jobs. For diabetes and hypertension, five out of nine studies suggest no effect of retirement. Retirement has been repeatedly linked to increasing leisure-time physical activity but may reduce work- and transport-related physical activity in turn. Most studies showed that retirement either decreased smoking or had no effect on smoking. The evidence did not show a clear conclusion on drinking. Only a few studies have assessed the impact on diet and blood biomarkers. DISCUSSION AND IMPLICATIONS: Effect of retirement varies according to the health outcomes studied and country of the study population. Policy concerning extending the retirement age needs to focus on ensuring they are suited to the individual.

Mental Health Before and After Retirement-Assessing the Relevance of Psychosocial Working Conditions: The Whitehall II Prospective Study of British Civil Servants.

OBJECTIVES: Retirement could be a stressor or a relief. We stratify according to previous psychosocial working conditions to identify short-term and long-term changes in mental health. METHOD: Using data from the Whitehall II study on British civil servants who retired during follow-up (n = 4,751), we observe mental health (General Health Questionnaire [GHQ] score) on average 8.2 times per participant, spanning up 37 years. We differentiate short-term (0-3 years) and long-term (4+ years) changes in mental health according to retirement and investigate whether trajectories differ by psychosocial job demands, work social support, decision authority, and skill discretion. RESULTS: Each year, mental health slightly improved before retirement (-0.070; 95% CI [-0.080, -0.059]; higher values on the GHQ score are indicative of worse mental health), and retirees experienced a steep short-term improvement in mental health after retirement (-0.253; 95% CI [-0.302, -0.205]), but no further significant long-term changes (0.017; 95% CI [-0.001, 0.035]). Changes in mental health were more explicit when retiring from poorer working conditions; this is higher psychosocial job demands, lower decision authority, or lower work social support. DISCUSSION: Retirement was generally beneficial for health. The association between retirement and mental health was dependent on the context individuals retire from.