Is working in later life good for your health? A systematic review of health outcomes resulting from extended working lives

There has been increasing policy focus on retaining older workers in the workforce [1]. The rationale cites the fact that whilst retirement age has been getting higher since the 1990s, it has not kept up with increasing life expectancy [2]. There are also concerns around the globe regarding addressing the increasing “old age dependency ratio” [3].

While the evidence is clear that generally work rather than involuntary unemployment is good for health (particularly mental health) [4], there may be an age when the benefits are outweighed by adverse impacts. The removal of a default retirement age in many countries potentially gives employees more choice regarding when to retire [3, 5, 6]. However, around a third of those working beyond state pension age report that they have remained in employment due to financial necessity [6]. There is the potential for policies which extend working lives, to adversely impact on health inequalities in older age, and act differentially in population sub-groups [7, 8].

Requiring older workers to remain in employment because of increasing life expectancy may lead to a perception of victimisation, as they perceive that they are paying for those who have already retired at a younger age than them [7]. It has been reported that there can be a sense of unfairness from extending working age amongst current workers, which can negatively affect production and job satisfaction [7]. While the agenda to drive extended working has principally focused on the economic needs and benefits, it is known that employees grapple with both “push” and “pull” factors in their decision-making about when to retire [9, 10]. The value of mental stimulation and a need for pension security in older age tend to pull employees to remain in work, while other commitments such as family, leisure activities and having financial security push workers towards retirement [7]. Authors have identified that actions by managers to support successful ageing in the workplace can determine intentions to stay [11].

While the case for extended working lives in terms of productivity and avoiding labour shortages [12] and maximising individual pension income has been established [9], the link between extended employment and health outcomes is less well understood. It is important to examine the health outcomes associated with increased retention of older workers (both positive and negative) to inform policy and guidance, and also so interventions can maximise any health benefits of employment, and mitigate any potential harms.

The overall aim of this review was to synthesise existing research evidence on health outcomes resulting from the extension of working lives, and to evaluate the effectiveness of interventions which have the aim of optimising healthy extended working.

The searches generated 772 records, of which 36 were retrieved as full papers. Of these, nine were found to meet the inclusion criteria. An additional four papers were identified from checking reference lists of included studies, and a further four were identified via citation searching. See Fig. 1 for a diagram illustrating the selection process as recommended by the PRISMA guidelines [18]. The list of papers excluded at full paper screening and extraction table are provided as an additional file.

We identified 16 studies of cohort or cross-sectional design which provide evidence regarding the effects of extended working life beyond typical or statutory retirement age. One additional study evaluated an intervention. Review of this literature indicates that while there is some inconsistency, the greater weight of evidence is of positive or neutral outcomes from extended working. This evidence is particularly in regard to overall health status and physical health for most workers. Some authors have argued that in higher income countries, there has been a perception that workers should be “protected” from adverse effects of longer working lives, which has led to discouragement of extending working and entrenched employers’ attitudes regarding their ageing workforce [12]. This review adds to evidence from previous reviews that there can be health benefits from working longer [12].

While positive effects are encouraging, the evidence of neutral effects on health could also be viewed as a beneficial outcome, as it is known that working longer improves personal finances in retirement. If employment can be continued with no adverse health effects, then this could be a gain for those with limited pensions. Further analysis of these headline findings however, indicates that the benefits reported are most likely to be for males, those reducing to part time working, and those employees who are in jobs which are not low quality or low reward.

Evidence regarding the effect on mental health was more mixed than overall self-rated health, but also indicated neutral or positive effects for most workers. Other authors however, have suggested that retirement has a beneficial effect on mental health [35]. If mental health can be enhanced by retiring, then this provides an argument against extending working. The small body of evidence on quality of life effects found in our review may be suggestive of an emphasis on health for employability, with a more limited focus on understanding of work as one contributor to overall quality of life [7].

Some authors argue that any positive health effects of extending working may solely be the result of those in better health continuing in employment, whereas those in poorer health retire. However, a study in this review which adjusted for health status still found a positive effect of extended working (although the effect was of a lower magnitude) [27]. Our review suggests that health differences may not be the only explanation for the positive effects of continuing employment for some groups.

Few sources distinguished between those who had retired voluntarily by choice, and those whose decision-making was constrained by economic, health, or personal situations. Choice however, is important as those who choose to remain in employment benefit to a greater degree than those working due to financial necessity [6]. The role of health, financial and other constraints on an individual’s choice whether to continue working or retire, further highlights that while extended working may be positive for some, there may be adverse effects for others.

Differing career pathways and employment patterns for men versus women are important to consider. Women are more likely to have been employed part time during their career [25], which may preclude being able to make a choice about labour market exit due to poor pension provision. Levels of poverty are known to be higher amongst part time workers [36]. Authors have argued that the caregiving responsibilities of women should be adequately recognised and supported in order to help extend working life [37].

Many studies did not provide details of the working pattern of employees, although it can be conjectured that a sizeable number of those “extended employment” groups were not working full time, given that one study reported that of those continuing employment 45% worked less than 20 h per week [27]. Much of the evidence may therefore be comparing working part time versus retiring, which adds to the complexity in interpretation of the findings.

Of concern to potential widening of inequalities, the opportunity to reduce to part time working is more available to some employees than others [25], although it is known to enable those with a disability to extend employment [38], and be of particular benefit to those in physically demanding jobs [39].

The evidence highlights that the type of employment is important when considering health outcomes, and the potential for widening gaps in health inequalities as a result of extended working lives. Authors have described disadvantaged workers as being “virtually invisible” in policies to increase state pension age, and have starkly portrayed the struggles of workers with low levels of health and education to continue in physically demanding jobs [40]. Preferences for earlier retirement are associated with low recognition and high job demands [41], and the nature of work and health are both of key importance in retirement decision-making [42].

Attitudes to extended working are known to be influenced by not only financial gain, but also having flexible employment conditions [43]. If working lives are to be extended for those who are able to choose, employers will need to overcome workers typical preference for earlier rather than delayed retirement [44]. It has been highlighted that participation of older adults in the workforce requires consideration of both the supply side (whether employees need, want and are healthy enough to work), and the demand side (whether employees enable extended working for example by training or offering other adaptations to continue working) [12]. There has been a call for creativity in developing approaches to continued work participation [45].

The type of employment and working conditions matter in relationships between health and work [39]. The absence of studies on interventions to enable healthy extended working lives is concerning. Policies extending employment need to be accompanied by changing workplace practices to address potentially adverse effects on some population sub-groups. It has been suggested that social benefits are required to compensate for the loss of earnings and subsequent effect on income and pension for those from poorer households [46]. A cumulative disadvantage from extending employment may result, with accumulating work exposures among less advantaged population groups potentially contributing to their trajectories of greater ill health [47]. Researchers point to the “genuine protective effects” of better jobs on musculoskeletal disorders, mental health and general health [48]. Evidence from this review adds to the calls for “new tools, training methods, and organisational practices” to promote successful ageing at work [49].

There is evidence from cohort and cross-sectional studies of benefit or a neutral effect on overall health status and physical health from extending working. These effects are for some workers, but not all. Evidence regarding the effect on mental health was more mixed and there is little evidence regarding the effect on quality of life. The benefits reported are most likely to be for males, those reducing to part time working, and those employees who are in jobs which are not low quality or low reward. There is a clear gap in regard to interventions which have the aim of enabling older workers to extend their healthy working life, with this of particular importance for workers in employment with greater risk of adverse outcomes. We were able to identify only a single evaluation of an initiative to enhance the health of workers of typical retirement age. There is the potential for widening health inequalities between those who can choose to reduce their working hours, and those who need to continue working full time for financial reasons.