Introduction
The transition from the adult age to older ages results in several inevitable life-course events. Among them, retirement from income-generating activities and reduced social participation pose a significant risk of cognitive loss in old age [
1,
2]. Cognitive performance has long been studied to determine the threshold age of retirement, predominantly in the developed nations [
3‐
5]. In a developing nation like India, greying of the population has an economic implication in terms of ascertaining the appropriate age for retirement [
6‐
8]. The population of 60 years and above is projected to increase to 19% (2050) from 8% (2015). The increase in the population of the elderly (80 and above) is also high in India [
9]. A substantial rise in aging has led to an increase in the incidence of physical limitations, cerebral pathologies, and alterations in socio-economic conditions like economic dependency, widowhood, and social isolation. There has also been an increase in the health burden due to mental morbidity and brain inactivity [
10]. As an indicator of healthy aging, cognitive health in later life helps to understand the quality of life of the elderly [
11].
Cognitive aging is explained by different stress pathways that consider intellectual engagement [
2,
3,
12]. Retiring from employment-related activities adds worries in regard to financial security, health care, and health expenditure. The nature of cognitive decline after retirement varies with occupation, duration since retirement, and participation in alternative activities in later life as found by several longitudinal studies [
2,
13‐
15]. Older persons with a higher cognition often continue to work until late in life. Early retirees tend to be individuals with a poor educational background and those who were engaged in low skill jobs [
14]. However, in India, due to the absence of a strong social pension system or support from the family, individuals in older ages continue working out of compulsion [
9]. Cognitive loss as a result of strenuous and involuntary work participation has been shown in a large number of studies, mainly in the advanced economies. The low- and middle-income countries too have started to face challenges arising from the growth of the longer living elderly.
Financial and social insecurity among the elderly heightens during the post-retirement phase due to an inadequate or dysfunctional social security system. Forced participation in employment in old age can be potent enough to alter the process of healthy aging among the fast-growing elderly population [
16,
17]. Low-grade occupation is associated with poor educational attainment, which leads to a higher cognitive decline during old age [
5]. Besides retirement from financial activities, reduced participation in social activities increases the risk of cognitive impairment in later life [
2,
18,
19].
The theory of retirement and cognitive decline is supplemented by the idea of involvement in various social and leisure activities. Presence of a ‘we’ feeling, availability of social support, and social involvement influences cognitive health of the elderly. Group engagement is more important than individual engagement during old age to maintain cognitive wellbeing. At the extreme ages, group participation saves 10 years of cognitive outcomes if an individual remains active and involved [
20]. In India, a number of older individuals are left alone in the family without adequate financial and social support. Increase in physical limitations, altered family structure, and low financial strength have been identified as stimulating agents for an increase in the feeling of insecurity among the elderly [
19]. Effective social involvement and interaction are known to safeguard against the development of depressive symptoms. Low psychological resources negatively influence physical functions and cognitive wellbeing [
21]. A better cognitive outcome can decrease the chances of degenerative diseases like dementia, depression, Alzheimer’s diseases, and other mental disorders in later years of life [
7,
22]. Chronic and multi-morbid conditions are gradually increasing across the older ages, increasing the likelihood of functional limitations and disability [
23,
24]. Among the elderly in India and low-middle income countries, a persistent increase in functional limitations has been observed as a result of multiple chronic morbidities [
25]. It is well known that functional limitations through various ways aggravate psychological distress, which can further influence cognitive performance [
26].
Cognitive performance is not the same across gender [
11]. Gender shows a differential pattern in how work participation and social connectedness determine the cognitive behavior of individuals. In India, women have a lower participation in income-generating activities due to social norms and/or lower educational attainment. Physical inability restricts social participation and worsens the overall health conditions. Decline in functional health and the resultant comorbid conditions affect social engagement and increase mental stress significantly [
27]. However, women benefit from close contact with others or from social participation. Through their participation in hobbies or volunteer groups, they preserve cognitive functions [
28] that are otherwise at stake in the older ages.
In India, studies regarding cognitive functions among individuals are mostly limited to morbid conditions, education, and financial distress [
11]. Even though a large number of elderly suffer from events like withdrawal from public interactions due to work restrictions/retirement, social isolation, discrimination, or social/financial neglect [
9], the transitory impact of work and social participation across the age groups in later life is scarcely evaluated. Retirement affects the physical and mental health of the elderly; thus, restricting their participation in social activities. The importance and extent of social participation has rarely been understood in the Indian context, which is grappling with a rapid increase in the greying of population. The gender association of labor participation reveals a substantially higher male work participation and better pay for males than females, which is reflected in the differential financial security, decision making, and health outcomes in later life. Aging outcomes are being affected as the female elderly is living a longer life with poor health outcomes and support. The differential male and female patterns of social connectedness can demarcate the pathways of cognitive decline in older ages. The complex interactions of income-generating activities and social participation have been necessary to understand the implication of cognitive aging. Work and social participation restrictions together have the potential to significantly aggravate cognitive decline. In that context, there is a policy relevance to modify the labor norms, opportunities, and social development such that there is an inclusive development in India. This study focusses on the patterns of cognitive decline among the elderly through proximate and dynamic factors, those are, retirement and social connectedness. This is essential so as to understand the cognitive aging of the elderly as it is associated with health care and social support.
Discussions
Changes in the life-course activities are stressors of cognitive outcome in later years of life. The rising number of older individuals in India necessitates measurement of one of the under-studied health outcomes, that is, cognition. The study used cross-sectional data to investigate the effect of major participation restrictions on cognitive outcomes of the elderly. Our study made a few important findings, which provide a comprehensive understanding of the impact of changes in the life-course events on cognitive health of the elderly. Elderly who had ‘never worked’ before had the worst mean value for cognitive health compared with the others after adjusting for the selected demographic and socio-economic factors. After controlling the socio-demographic and health factors, it was found that reduction in work and social participation significantly decreased cognitive performance. The pattern of decline was distinctive for the type of social participation practiced by individuals across different levels of labor participation. The theory of disuse perspective explains this nature of activity pattern and cognitive decline of the elderly [
18]. The findings are consistent with the studies on retirement that evoke the theory of ‘use it or lose it’. It proves that retirement significantly declines the cognitive health in old age.
Retirement from a highly complicated job negatively affects cognitive abilities in old age. A sudden discontinuation from an intellectually-challenging job makes the deterioration in cognition very pronounced. A long involvement in an occupation, mainly in the informal sectors, stimulates mental abilities up to a certain time. Employment in low-grade jobs and poor educational performance often have a degrading effect on financial security in old age. Lack of pension and social security in the informal labor market compels the elderly to continue to work beyond the statutory age of retirement. Individuals having low levels of education and those belonging to poorer wealth quintiles experience a stressful impact on cognition in old age [
31]. In the upcoming decades, more years are expected to be added to the life expectancy of the 60 years and older population. There is a pressing need to address the issue of retirement in regard to the pension system and health expenditure for the elderly population in India [
32]. Physical infirmities during old age reduce the working capacity. At the same time, the need to engage in work to overcome financial distress leads to dissatisfaction and depression. The notion of better cognitive functions due to an association with labor market was not supported by our study since financial distress is a reason for continuing work [
2].
The effect of retirement on the decline in cognitive outcomes is relatively lower for the age group of 60–69 years. This is substantiated by the theory of
relieved effect on mental functioning. Retirement from an occupation that is monotonous and repetitive in nature takes away mental worries. Retirement also provides a fair opportunity to engage in long-pending activities having social and cultural value, usually known as the
honeymoon effect [
33]. Other research suggests that retirement and involvement in voluntary activities, meeting with relatives, and participation in other social activities results in cognitive preservation [
5]. The initial increase in cognitive outcome in the age group of 60–69 is a good reason to perform socially meaningful activities [
14]. The Indian society acknowledges the elderly for their experience in life and their contribution to social activities [
22]. For those in the post-retirement phase of life or those who continue to work in older ages, social participation preserves cognitive functions. The interaction between work and social participation shows a positive and significant coefficient with cognition for the selected type in model 4 of multivariate regression. Retirement accompanied with ‘more’ social participation is beneficial for the maintenance of cognitive health in the later years of life as exhibited by Fig.
1. By contrast, ‘more’ social participation by those ‘presently working’ affects their health as they suffer from age-related functional restrictions. Other studies support our findings in that more frequent social participation restricts the cognitive decline regardless of an individual’s level of cognition or physical activity [
34]. Therefore, strong social support for the elderly is required to preserve wellbeing in the later stages of life.
Our study didn’t find any gendered pattern for work and social interaction through interactions in the multivariate analysis. This opens the scope for further research to understand the particular patterns for cognitive decline. Exclusion from income-generating activities along with reduced social participation can lead to a long-term deprivation. Such exclusion has a strong impact on mental health, and it also escalates the prevalence of chronic diseases and functional limitations. The evidence of a lower mean score for cognitive scores for depression calls for more social ties to deal with chronic health conditions among the elderly [
22].
The present study is a first effort to look into how work status and social participation affect an individual’s mental health. The cross-sectional nature of the data limited the understanding of the long-term effect on cognitive health at different working conditions, as age progresses. We were also limited to include social security measurement to control the effect on cognitive health in old age. However, all of the possible risk factors were taken into consideration.
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