Work, Health and Well-being: an interdisciplinary approach to

Work, Health and Well-being: an interdisciplinary approach to managing health in the workplace The Work, health and well-being network has been funded for a 10-month period to build new multi-disciplinary teams as part of the Lifelong Health and Wellbeing Project (LLHW). This is a major cross-council initiative supporting multi-disciplinary research addressing factors across the life course that influence healthy ageing and wellbeing in later life. The objectives of the LLHW initiative are to: Target factors over the life course that may be major determinants of health and wellbeing in later life. Identify and develop effective interventions that lead to improved health and quality of life in later life. Inform policy and practice including the development of services and technologies to support independent living. Increase capacity and capability in ageing-relevant research Aims of the network To develop an interdisciplinary network focusing upon health transitions

in employment. The project will have a particular focus on the management of two of the main reasons for work loss (stress and musculoskeletal conditions) occurring during the middle and later phases of working life. The aim of the proposed network is to examine the influence of particular health conditions on work transitions at particular points of the life course. The network will focus on the two most common health reasons for work loss in the United Kingdom: (1) mental health problems relating to stress in the workplace; and (2) musculoskeletal disorders. This proposal brings together a range of disciplinary backgrounds to examine the influence of specific health conditions affecting work transitions in middle and later life. Network website pcmrc/WHW_Network/index.htm Symposium- Work, Health and Well-being: Older Workers Chris Phillipson and Ross Wilkie Health and social issues in extending working life David Lain Measuring Ill-health and older workers: a comparison of the US and the UK Joanne Ross Does an understanding of

occupational identity help to explain vocational rehabilitation for older workers? Sarah Vickerstaff Understanding the impact of health and health pessimism on the extending work life agenda Health and Social Issues in Extending Working Life Chris Phillipson and Ross Wilkie Debates on older workers 50s/60s: Labour force retention 70s/80s: Labour market exit 90s/early 2000s: Extending work Late 2000s: Extension - Exclusion Employment/Population Ratios and Activity: men and Women 55 - 64 UK Men UK Women USA Men USA Women

1990 1994 1997 2004 2007 Labour participation rate 68.1 64.0 63.6 67.9 68.9 Employment /population ratios 62.4

56.6 58.6 65.4 66.1 Labour participation rate 38.7 40.7 40.3 48.3 50.1 Employment /population ratios 36.7 38.5

38.7 47.3 49.0 Labour participation rate 67.8 65.5 67.6 68.7 69.6 Employment /population ratios 65.2 62.6 65.5

66.0 67.6 Labour participation rate 45.2 48.9 50.9 56.3 58.3 Employment /population ratios 44.0 47.0 49.5 54.3

56.6 Source: OECD Employment Outlook: 1998 and 2008 Factors behind increase in employment Policies less important than: Demand-side factors: economic growth Supply-side factors: impact of shift from DB to DC pensions on retirement behaviour Closure of early exit pathways: tightening of eligibility criteria for unemployment/disability benefits Bridging employment: expansion of selfemployment among older workers Is extending working life possible? Policy drivers Raising of pension ages (Pension Regulator, Turner: retirement at 70?) Age discrimination and equality at work (Employment Equality Age Regulations, 2006) Promotion of health and well-being in the workplace (Black, 2008, Working for a Healthier Tomorrow) Economic and social value of older workers (Building a Society for All Ages, DWP, 2009) Is extending working life possible?

Policy Barriers - rise in unemployment with older workers targeted for redundancy; - uncertainty about extended work agenda (Vickerstaff et al., 2008); - relationship to other events in the life course (Schmid, 2002). Is extending life possible? What do we know of the key barriers in respect of health and workplace issues? Data sets: British Household Panel Survey English Longitudinal Survey of Ageing Labour Force Survey Is extending working life possible? Key barriers Impact of transitions through work Impact of health issues in the workplace Impact of detachment from work IMPACT OF TRANSITIONS Work status of cohorts of men:

Stable transitions 45-49 (52-56) 50-54 (57-61) 55-59 (62-66) 60-64 (67-71) Full-time throughout 57.4 33.5 18.0 3.1 Part-time throughout 0.0

0.7 0.8 0.9 Unemployed 0.0 0.4 0.9 0.0 3.8 8.0 19.7 39.5 61.2

42.6 39.4 43.5 Transition Type Stable throughout Inactive throughout Source: British Household Panel Survey, Waves A-H (base = 1,132) (own calculations) Occupational status of cohorts of men: Bridging transitions 45-49 50-54 55-59 60-64 (52-56)

(57-61) (62-66) (67-71) Full-time + part-time 4.3 11.9 5.3 2.5 Full-time + part-time + unemployed 2.0 2.9 2.3 0.0

Full-time + part-time + inactive 1.5 5.0 7.2 4.7 Full-time part-time + unemployed + 0.9 1.1 1.0 2.0 8.7 20.9 15.8

9.2 Transition Type Bridging inactive Source: British Household Panel Survey, Waves A-H (base = 1,132) (own calculations) Occupational status of cohorts of men: unemployment transitions 45-49 50-54 55-59 60-64 (52-56) (57-61) (62-66)

(67-71) 11.3 6.3 0.5 0.0 Full-time + inactive 8.2 16.1 28.8 23.7 Unemployed + inactive 4.8 5.2

6.4 12.1 Full-time + unemployed + 4.8 8.3 5.8 2.7 1.0 0.6 2.3 8.7 30.1 36.5

43.8 47.2 Transition Type Unemployed/inactive Full-time + unemployed inactive Other Source: British Household Panel Survey, Waves A-H (base = 1,132) (own calculations) IMPACT OF HEALTH FACTORS Main reason for early retirement Men Offered reasonable financial terms to retire early Own ill health Made redundant etc To enjoy life while still young and fit enough Fed up with job and wanted a change Ill health of a relative/friend To spend more time with partner/family To retire at the same time as husband/wife /partner

Do not know Total Base: all respondents Age 50-55 55-59 Cell percentages Total 60-64 22 49 5 19 3 - 31 24 15 11 8 5 2

31 24 15 13 8 4 1 30 27 14 13 7 4 1 3 100 4 100 1 3 100

* 3 100 32 104 209 345 Source: English Longitudinal Study of Ageing (ELSA), Wave 1 2002 (own calculations) Main reason for early retirement Women Own ill health Offered reasonable financial terms to retire early To spend more time with partner/family Made redundant Fed up with job and wanted a change To enjoy life while still young and fit enough Ill health of a relative/friend To retire at the same time as husband/

wife/partner Could not find another job Do not know Total Base: all respondents Age 50-55 Cell percentages Total 55-59 27 35 33 9 5 9 14 14 5

16 15 9 7 4 6 14 12 9 9 7 6 9 9 100 26 3 1 4 100 84 4

1 56 100 110 Source: English Longitudinal Study of Ageing (ELSA), Wave 1 2002 (own calculations) Percentage of individuals aged 50 to 65 in paid work in 2002-03 who stay in paid work or move out of paid work between 2002-03 and 2004-05, job type and selfreported health status in 2002-03 (men only) Manual Workers Fair/poor Good Non-Manual Workers V.good Fair/poor Good /Excellent V.good/ Excellent

% % % % % % Working, working 68.8 86.9 87.2 80.5 84.8 88.3

Working, not working 31.2 13.1 12.8 19.5 15.2 11.7 Source: English Longitudinal Study of Ageing, Wave 2 (Emmerson & Tetlow, 2004) Health problems (for those who report a problem) by gender (cell%) Health problem lasting more than a year: Yes No Base If yes, nature of problem Problem with arms, hand Problems with legs or feet

Problems with back or neck Heart, blood pressure, circulation Other Base Note: Approximately a quarter of men and women received benefits. Male (50-64) Women (50-59) Source: Labourforce Survey (Cappellari et al, 2005) Male Female 45 55 41 59 9,745 7,468 21

29 29 30 58 29 32 35 20 57 4,743 3,241 Expected chances of returning to paid employment for economically inactive individuals below SPA Sample Size Fraction reporting zero chance of working in future Cell percentages Average percentage

chance of returning to work Men, 50-59 All inactive Inactive and retired 409 141 65 75 15 9 Men, 60-64 All inactive Inactive and retired 404 240 83 84

6 5 Women, 50-54 All inactive Inactive and retired 270 29 64 - 15 - Women, 55-59 All inactive Inactive and retired 440 122 74 74

9 8 Note: Men below 60 are asked the chances of their being in paid employment at or after age 60; those between ages 60 and 64 are asked the same question with reference to age 65 . Women below age 55 are asked the chances of their being in paid employment at or after age 55; those between ages 55 and 59 are asked the same question with reference to age 60. Source: English Longitudinal Study of Ageing (ELSA) (Banks and Casanova, 2003) Reported desired changes to working situation among those reporting that they have health problems that limit their ability to work in their current job Fewer hours/job sharing 11.1 Working from home sometimes 5.8 Flexible hours 3.1 Less mentally demanding/stressful

15 Special equipment/workplace adaption 7.8 Less physically demanding 25.9 Any change 42.9 0 5 10 15 20 25

30 35 40 45 50 Percentage Source: English Longitudinal Study for Ageing, Wave 3 (Emmerson & Tetlow, 2004) Proportion of men and women who had the opportunity to work past retirement age by previous occupational category % 80 70 60 50 40 30

20 10 0 Source: English Longitudinal Study of Ageing (ELSA), Wave 1 2002 (own calculations) Proportion of employees who have attended a formal educational or training course during the past 12 months Source: English Longitudinal Study of Ageing (ELSA), Wave 1, 2002 Key messages on barriers Health status especially major health changes most important factor pushing people out of work. Earlier the retirement the more it is driven by health. Men and women in lower social class social groups more likely to cite health factors. Working class groups more limited opportunities of working up to 65. Once out of work unlikely to return. Problems in current policies Raising pension age reinforces health inequalities. Under-pensioned groups forced to remain in labour market despite health problems (especially

manual workers, ethnic minorities). Triple jeopardy of poor health, lack of work training, inadequate pension provision. Failure to tackle poor working conditions and oppressive management styles both of which may be predictors of early retirement. Policy Options New emphasis on tackling health inequalities in the workplace (but note problems of SMEs). Workplace as setting for improving health and well-being (but globalization increasing pressures on workers). Focus upon occupational health in middle-life (though services being cut in many places). Specialist support for migrant workers (given complex work histories). Support for those balancing caring and working roles. Different needs short and long-term unemployed. Focus on key groups such as line managers whose attitudes towards older workers may be crucial. WORK, HEALTH AND WELL-BEING: RESEARCH NETWORK Some research questions: What is the role of line managers as gatekeepers facilitating

return to work? What variations can be identified in terms of the impact of their in respect of mental health and musculoskeletal issues? What role is played by different work environments in assisting return to work/retention etc? What forms of collaboration can be identified between health organisations and employers? What is the role of self-care? How can its effectiveness be enhanced within the workplace? Acknowledgements Rowntree Foundation and Department of Work and Pensions for funding for data analysis of sections of the paper. Dr. Jim Ogg (Young Foundation, UK) for work on the British Household Panel Survey and English Longitudinal Survey on Ageing. References Banks, J. and Tetlow, G. Extending Working Lives. In Living in the 21st Century. In: The 2006 English Longitudinal Study of Ageing (Wave 3). Institute for Fiscal Studies, 2008. Cappellari, L. et al. Labour market transitions among the over-50s. Department for Work and Pensions, 2005. Emmerson, C. and Tetlow, G. Labour Market Transitions.

In: The 2004 English Longitudinal Study of Ageing. Institute for Fiscal Studies, 2006. Loretto, ed The Future for older workers. Policy Press, 2007 Phillipson, C. Transitions from work to retirement. Policy Press, 2002 Selected references Phillipson, C and Smith, A. Extending Working life: a review of the research literature. Department for Work and Pensions, 2005. Phillipson, C. Extending Working Life: problems and prospects for social and public policy. In Bauld, L. et al. Social Policy Review Policy Press, 2006 Smeaton, D. and Vegaris, S. (2009) Older people inside and outside the labour market. Research Report No. 22. EHRC Schmid, G.Towards a theory of transitional labour markets. In Schmid, G and Gazier (eds) The dynamics of full employment. Edward Elgar, 2002. Vickerstaff, S. et al. Encouraging labour market activity among 60-64 year olds. Department of Work and Employment, 2008. Measuring Ill-health and older workers: a comparison of the US and the UK David Lain University of Brighton, UK [email protected]

Health and employment past 65 in the US and England Previous research indicates health is an important influence on employment past age 65. However, hard to measure / compare. More needs to be known about how the influence of health on employment is mediated through other known influences, such as education and wealth. Using English Longitudinal Study of Ageing 2002 and US Health and Retirement Study 2002, I will examine: 1. How can we compare health using these surveys? 2. How does health interact with wealth and education to influence employment past 65? 3. How does this vary between the countries? 70

Diagnoses reported by over 65s 60 50 40 England USA 30 20 10 0 High Blood Diabetes Pressure Cancer Lung Disease

Heart Problems A Stroke Psyche problems Arthritis None Difficulties reported by over 65s 60 50 40 England 30 USA

20 10 0 g in k al W er v se al s ck o bl ng ti ti S

G r fo et 2 g ti n s hr up m fro lim C b se

a ir a ch r ve f al lig o St s ht o rs ai t fs

o cr / g g in h uc in lif el y e t ul kn / c i g iff in D

p o ry ar c t/ 10 s lb g in k c Pi e R up / ng i

h ac in co te x e g in d n m ar s g in h s Pu

up g li n l pu o ts ec j b on N e Employment by number of health difficulties 30.0 25.0 % employed 20.0

England USA 15.0 10.0 5.0 0.0 0 1 2 3 4 5 Number of health difficulties 6

7 Employment Ratio: low : medium/high education Employment ratio (low: medium/high edu) 1.0 0.9 0.8 0.7 0.6 England USA 0.5 0.4 0.3 0.2 0.1 0.0 0 1 2

3 Number of health difficulties 4 Employment Ratio: Bottom 2 wealth quintiles : Top 3 quintiles 1 Employment ratio (bottom : top) 0.9 0.8 0.7 0.6 England USA 0.5 0.4 0.3 0.2 0.1

0 0 1 2 3 Number of health difficulties 4 Employment past 65 by wealth quintile, 2002 1st quintile 2nd quintile 3rd quintile 4th quintile 5th quintile Total Base England 11.5 8.5 6.1

5.2 2.7 6.8 5508 USA 21.7 17.7 18.9 17.4 12.6 17.7 10392 % Ratio 1.9 2.1 3.1 3.3 4.7 2.6 Source: Analysis of the English Longitudinal Study of Ageing and Health and Retirement Study Influence of wealth on employment past age 65:

Odds ratios from logistic regression analysis Q1 Q2 Q3 Q4 Q5 Model 1 (wealth + age) Model 2 (wealth + age + health + edu) England 1.00 0.72* 0.50*** 0.50*** 0.27*** England 1.00 0.86 0.66* 0.73

0.45*** USA 1.00 0.76** 0.81** 0.75*** 0.54*** Note:*** = p<0.001, ** = p<0.01, * = p<0.05. USA 1.00 0.85 1.00 1.02 0.82* Conclusions Comparative research can help us understand what is specific to the English situation. In both countries: Employment declines as health worsens (but employment higher at all health levels in US). In both countries: Education increases the likelihood of working for people with health difficulties. In England: Low levels of wealth reduce likelihood of

working (except for the very healthy poor); Institutional explanation: means-tested benefits. Adopted difficulties measure of health; need to consider the social construction of health measures. Does an understanding of occupational identity help to explain vocational rehabilitation outcomes for older workers? Dr Joanne Ross NHS Eastern and Coastal Kent Vocational rehabilitation a process whereby those disadvantaged by illness or disability can be enabled to access, return to, or remain in, employment, or other useful occupation. (British Society of Rehabilitation Medicine 2003 p1) Current perspectives in vocational rehabilitation Lifespan perspective Younger worker: accessing employment

Older worker: returning to and remaining in employment A condition-focused perspective A medical model approach seeks to understand: the disease process the nature and aetiology the impairment or disability the anticipated course management of the condition. A functional perspective A functional approach seeks to understand: the functional implications of a medical diagnosis physiological physical psychological status

the functional capacity of the worker (Ross J 2007) A bio-psychosocial perspective The bio-psychosocial model seeks to understand: the nature of the disability or condition psychological factors social contextual factors eg. family influences, environmental barriers (Waddell G, Burton KA, Kendall N 2008) An occupational perspective An occupational approach seeks to understand: the person the environment the occupation and the interface between them Person Occupation Environment

The person-environment-occupation model (adapted from Law et al 1996) What is an Occupation? Human occupation: Groups of activities and tasks of everyday life, named, organized and given value and meanings by individuals and a culture. Occupation is everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure) and contributing to the social and economic fabric of their communities (productivity). (Townsend 2002 p34) Occupation, or the ordinary and extraordinary things that people do every day, is central to the way we all live our lives what we are, who we become and how we achieve our dreams and aspirations. (Watson 2004 p3) An occupational perspective in vocational rehabilitation occupational identity the nature of

the condition the illness / injury experience Person Occupation (Work) Environment (Workplace) The participation in work framework: the person-centred stage (Ross 2008) The occupational identity . if someones got childcare issues, Ive had quite a number of those, childcare is not anything to do with the disability, but someones circumstances might of actually changed and you have to take that into consideration. in terms of an active return to work, facilitating that return to work, you have to look at all the various components and what will actually work with someone. I emphasise sort out the social life and the recreational life first, which will give us guidance as to how you are going to function in the workplace.

Occupational identity.. is underpinned by the value and meanings which an individual attaches to their daily occupations is made up of the unique blend of activities which make up the daily life of an individual includes the roles and routines which a person performs on a day-today basis the balance of occupational roles and activities contributes to an individuals health and overall sense of well-being extends beyond, the persons work life (worker identity) is shaped by family roles and social supports changes across the lifespan is influenced by the nature of a health condition and the persons illness/injury experience. Im actually a member of a Buddhist group...... and a lot of our meetings are always in the evening anyway, so I was missing out a lot of that and that to me was quite important , so what actually happened was that (the OT) said she thought that would be beneficial as well, if we could change my shifts somehow... occupational identity worker identity

worker identity the value attached to work the person-work match Defining the work activity Person as a worker Work (occupation) feeling fear Workplace (environment) The participation in work framework: the worker identity stage Worker identity is one element of a persons occupational identity Is the persons perceptions of themself as a worker or potential worker

Includes paid and unpaid work roles (volunteer, carer) includes the values and meanings which the person attaches to work the value attached to work is not static, it changes over time and across the lifespan may be altered by a significant life event. .hes a married man, his wife has had to go out and workhe was the house husband. Their roles had changed and the patterns that theyd developed, and he has a very close relationship with his wife she was very much reinforcing that he couldnt work His wife has quit work to look after him so now neither he or his wife work. Key implications for the older worker Following the onset of a health condition or disability: a person chooses to resume those occupations which are most highly valued occupational identity influences the persons decision about a return to employment worker identity may be altered a fear of returning to work is common the longer the person is away from work, the less value they may

attach to it paid work occupations may be replaced with unpaid occupations. References British Society of Rehabilitation Medicine (2003). Vocational Rehabilitation The Way Forward. London, BSRM. Law M et al (1996). The Person-Environment-Occupation Model: A Transactive Approach to Occupational Performance. Canadian Journal of Occupational Therapy vol 63,1 p 9-23. Ross J (2007). Occupational Therapy and Vocational Rehabilitation. West Sussex. Wiley and Sons. Ross J (2008). The participation in work framework: an occupation-focused perspective of rehabilitation for work. Conference proceedings. Paper presented at the 8th European Congress of the Council of Occupational Therapists for the European Countries (COTEC), Hamburg, Germany. May 2008. Townsend E (ed) (2002). Enabling Occupation; An occupational therapy perspective. Ottawa. Canadian Association of Occupational Therapists. Watson R & Swartz L (Eds) (2004). Transformation through Occupation. London.

Whurr Publishers. Understanding the impact of health and health pessimism on the extending work life agenda Sarah Vickerstaff On the threshold of a new era? In an era of workforce ageing and increasing life expectancy working longer may be presented as an unavoidable obligation. The Governments urge to extend our working lives is summed up in the title of the recent OECD review of policies: Live Longer Work Longer. Reasons for economic inactivity: by sex and age, 2008 Table 4.20 Reasons for economic inactivity: by sex and age, 20081 United Kingdom Men Long-term sick or disabled Looking after family or home Student Retired

Other All men (=100%) (millions) 2 Women Long-term sick or disabled Looking after family or home Student Retired Other All women (=100%) (millions) 2 Percentages All aged 5059/64 1659/64 1624 2534 3549 5

1 82 0 10 40 9 27 0 17 62 16 4 1 12 49 6 33 9 34 6 33 13

11 1.2 0.3 0.5 1.3 3.3 3 23 66 0 8 8 72 10 0 8 24 61

4 8 41 27 1 14 14 19 45 22 3 9 1.3 0.9 1.4 1.1 4.7 1 Data are at Q2 and are not seasonally adjusted. See Appendix, Part 4: Labour Force Survey.

2 Includes discouraged workers and those who are temporarily sick. Source: Labour Force Survey, Office for National Statistics Source: Social Trends, No 39, 2009 Edition, ONS. Governments agenda Target 80% employment rate Work as the best form of welfare Reduce numbers on Incapacity Benefit (now Employment Support Allowance) by 1 million and keep people with health conditions in work Extending working life: encourage people to delay retirement and work for longer New Deal for Carers Health and work 7% of the working age population are receiving incapacity benefits due to ill-health or disability 3% of the working age population are off work due to sickness at any one time May 2008 GB total for IB 2.6m claimants: 1.5m men and 1.1m women Target of 1m reduction in IB claimants by 2016 Doctors assessment of the nature of the claimants health problems and medical basis of the incapacity claim

Women (%) Men (%) Mental behavioural 41 41 Musculoskeletal 22 20 Nervous system 7 6 Injury, poisoning 4

5 Respiratory 3 2 Circulation 2 5 All other 20 20 Source: DWP Figures quoted by Beatty, Fothergill, Powell, Houston and Increasing trend of mental/behavioural ill health and disability* Women

Men 2000 2007 2000 2007 Mental/ behavioural 35.4 43.2 34.8 45.1 Musculoskeletal 22.4

18.4 19.1 14.5 * Data covers IB and SDA claimants aged 16-59 Source: Figures quoted by Beatty, Fothergill, Powell, Houston and Sissons (2009),Women on Incapacity Benefits; A Statistical Overview Qualitative research: Commissioned by DWP Interviews with couples and individuals (96 people 49 women;47 men - in total) Based in three areas: Edinburgh, Nottingham and Thanet Sample selected on the basis of age, income, labour market status, health and domestic circumstances Profile of the sample Self-reported Household Income Income band Edinburgh

Nottingham Thanet Under 10,000 0 1 15 10,000-20,000 8 13 9 21,000-30,000 13 6

3 31,000-40,000 5 6 0 Over 41,000 2 5 1 Unassigned 5 1 3

Complexity of the illness experience and its impact on working and work transitions - the condition itself the nature of the work environment the nature of the work GP, NHS responses the need or motivation to work the role of family and friends the individuals resilience Managing work and health Colin who is currently 60 had worked for the Police but retired in 1995 going on to work for British Gas for five years. In his forties he had had two heart attacks and a heart bypass at 50. His health continued to be a worry. He had also remarried in his forties and at the time of interview had three children under the age of 16. Two years ago he realised that he needed to scale down his work because of his health, although he wanted to continue working. He went back to working for the Police on the civilian side and had negotiated a job-share arrangement: Obviously because of previous medical problems, Ive got to be careful what I do, so, as I say, Im on a job-share, so Im OK with that because it means that because its a shift-system that I work, it means theres long periods when Im off. Well, normally I would work until

65. But obviously with a second marriage and young children Ive got to keep my options open and also the new age act thats come in, it opens doors for me that would have been closed previously. Source: Vickerstaff et al ((2008) Encouraging Labour Market Activity Among 60-64 Year Olds, Research Report no. 531 DWP. Colins illness experience Heart problems ongoing Flexible work Benign work available environment Illness experience Strong push to work from family Financial

motivation Forced to give up work Carol worked for over 10 years in a independently run centre for disadvantaged children, having been a respite foster carer previously. She was a day-care leader for pre-school children. The work was increasingly stressful: I mean an example would be that, you know, I went to one particular funeral where Id buried a mum, her baby of just over a year and her little girl of 3 years and Id been cuddling those 2 children a few hours before this fire and had got quite a good relationship going with this mum and she finally was able to open up. Carol had to go back to work straight after this event and soon after went on sick leave with headaches and anxiety and never returned to work. Source: Vickerstaff et al ((2008) Encouraging Labour Market Activity Among 60-64 Year Olds, Research Report no. 531 DWP. Carols illness experience Mental health Poor Stressful work

management Illness experience Children had GP rather left home, passive could cope on benefits The prospect of ill health I would like to carry on doing something for as long as I could, you know soI always want to remain active, doing something, for as long as physically possible I suppose so I dont know [when he might retire completely]. I find that difficult to answer directly, butit depends on my health. (ES36Male) Health might have an influence on that obviously [how long he might carry on working]. But things change dont they? I mean thats the thing and I mightWhatever Im saying now

things might happen.(NS72Male) Health pessimism: No-one was getting any younger So from our point of view, we just want to enjoy it [retirement] while weve both got health to do it. Because theres so many people work right to the end of their retirement, you know, whether theyre 60 or 65, and never get a good retirement, you know, for health reasons, and, well, we feel were fortunate we can do it now and enjoy it. (EC50F) Actuarial statistics versus the experience of families, friends and colleagues People that work downs a pit, you work under ground and you retire at 60. Thats standard. If you work on the surface you retire at 65. We had a deputy retire at the pit on the Friday and he died on the Sunday. (TC14Male) But I can always remember when we had this round of redundancies, they also let people retire early and there was one particular chap, I had known him all my working life. He was a welder, working on the shop floor, but hed got a passion for golf and he was quite good, and he retired two years early say he was 63 and on his 65th birthday he was playing golf, well he had a heart attack and died, and, you know, thats always stuck with me for some reason. (NC63 Male)

Cultural view that people should not leave it too late to enjoy retirement: And the one thing, just maybe to get a little bit out of it [retirement] because Ive lost a load of friends who have died quite young, who have died not long after their retirement age and I thought maybe it is time to get some social time to yourself.(ES45Female) We want to retire together because neither of our parents had any retirement together so I mean my mum died at 48 and my father died at 65 and his mum died at 60. His dad did live until he was nearly 80 but on his own, you know, and so we while weve got good health, touch wood, we want to enjoy it so (NS75Female) Responses to state pension deferral opportunities: carpe diem Because you never know whats round the corner. (EC33Female) But my argument is if youre retired and youre older, live for the moment! .... No, because you might just, you just might not be there. Just enjoy it, use it.(EC35Female) I will retire at 65 and get whats coming, if I can make it to 65. (TC14Male) I think its a cop-out for the government honestly. Its a way of them keeping the money, hoping you curl your toes

and they keep the money! (NS69Female) Conclusions Impact of health issues on continuing or ceasing work complex, multifaceted, need a bio psychosocial model Very important impact of role models; family friends, colleagues more persuasive than the facts Health subjectivities, health pessimism a significant factor in how older workers think about the future and retirement in particular

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