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Background: Governments of Western countries need people to work to older ages, however the COVID-19 pandemic impacted the workforce by pushing older adults to retire. Socio-demographic factors that influence the decision to retire in the pre-pandemic period were, poor or good health, finances, marital status, and gender. The aim of this study was to explore aspects that contributed to the decision to retire among middle-aged and older people in England who retired during the COVID-19 pandemic., Methods: In September 2022 semi-structured interviews were conducted with a sample of participants from the Health and Employment After Fifty (HEAF) study who retired since March 2020. Consenting participants were purposively selected to achieve a wide spread of characteristics deemed important in the retirement process. Telephone interviews were conducted, audio-recorded, transcribed and then thematically analysed., Results: 24 interviews were conducted (10 men and 14 women, mean age 65 years). Six themes were identified: four of them were non-COVID-19 aspects while two can be interpreted as impact of COVID-19 on the workforce. Work-related factors were of major importance. A sense of appreciation and attachment in relation to their employer, and conversely high work demands and stress, as well as changes in work responsibilities and work practices since lockdown and/or perception of personal safety in the workplace during the pandemic influenced their retirement decision, as did physical and mental health issues. Another theme suggested that some participants felt they had reached the 'right' age and needed to spend more time with family. Having the financial capacity to retire was widely mentioned but was never the main factor., Conclusions: The decision to retire during the pandemic was multi-factorial although changes to work during lockdown were of great importance. Post-pandemic, our findings suggest that there are modifiable aspects of work, including appreciation and fair pay and work conditions, that employers and policy makers could encourage to retain their older workers., (© 2024. The Author(s).)

The COVID-19 pandemic resulted in a dramatic reduction of routine healthcare availability in many European countries. Among a cohort of English middle-aged adults, we explored pre-pandemic and pandemic factors associated with not seeking healthcare during lockdown, and their effect on subsequent self-reported health measures. Longitudinal data from the Health and Employment After Fifty (HEAF) cohort were used. Pre-pandemic data came from the 5th annual follow-up (2019), when participants were aged 56-71 years, and pandemic data were collected by e-survey in February 2021 and November 2021. Response rates of the two e-surveys were 53% and 79%, respectively. Pre-pandemic predictors of not seeking healthcare were: female gender, higher BMI, higher comorbidity, poorer self-rated health and depression; non-care seekers were also more likely to report that family or friends were affected by COVID-19 and to have been advised to shield. Not seeking healthcare during lockdown was associated with a higher risk of reporting worsening of physical, but not mental, health during the later phase of the pandemic. In this cohort, those with generally poorer health were disproportionately more likely to not seek healthcare during lockdown, which may potentially exacerbate pre-existing inequalities and lead to longer-term health consequences.

Background: The COVID-19 pandemic markedly disrupted people's lives. It caused higher mortality and morbidity amongst individuals from poorer socio-economic position (SEP). It is well-recognised that job loss has a negative impact on health. We hypothesised that health effects of the pandemic on middle-aged people might be different depending on SEP and changes in employment., Methods: Data are from the Health and Employment After Fifty (HEAF), a cohort recruited 2013-2014 when aged 50-64 through 24 English general practices. At baseline and annually since, participants completed a questionnaire reporting about demographics, employment, health, lifestyle, and finances. In 2021 we sent an e-survey to all contactable HEAF participants, asking about effects of the first lockdown (March-July 2020). Outcomes were participants' perception of worsening of mental, physical health, and self-rated health (SRH) since lockdown. Associations between SEP, COVID-19 related employment changes and health were explored with Poisson regression with robust standard error, with adjustment for age, sex, and pre-pandemic SRH., Results: In total, 2,469 (53%) returned a usable questionnaire, amongst whom 2,344 provided complete information for these analyses (44% men, mean age 65.7 years). Worsening of mental, physical or SRH since lockdown was reported by 21%, 27% and 17% respectively. Mutually adjusted models showed that reporting struggling financially pre-pandemic (versus living comfortably) was associated with an increased risk of deterioration in: mental (RR = 2.0, 95%CI 1.7-2.5), physical health (RR = 2.0, 95%CI 1.6-2.3), and SRH (RR = 1.6, 95%CI 1.2-2.1). Participants working from home during lockdown and those who lost their job (as opposed to those with unchanged employment) were at increased risk of reporting deterioration in mental health and SRH., Conclusion: In a cohort of older workers, working from home, job loss and poorer pre-pandemic SEP were all associated with worsening of mental health and SRH since lockdown., (© 2022. The Author(s).)

Background: Occupational exposures may play a key role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk. We used a job-exposure matrix linked to the UK Biobank to measure occupational characteristics and estimate associations with a positive SARS-CoV-2 test., Methods: People reporting job titles at their baseline interview in England who were < 65 years of age in 2020 were included. Healthcare workers were excluded because of differential access to testing. Jobs were linked to the US Occupational Information Network (O*NET) job exposure matrix. O*NET-based scores were examined for occupational physical proximity, exposure to diseases/infection, working outdoors exposed to weather, and working outdoors under cover (score range = 1-5). Jobs were classified as remote work using two algorithms. SARS-CoV-2 test results were evaluated between August 5th-November 10th, 2020, when the UK was released from lockdown. Cox regression was used to calculate adjusted hazard ratios (aHRs), accounting for age, sex, race, education, neighborhood deprivation, assessment center, household size, and income., Results: We included 115,451 people with job titles, of whom 1746 tested positive for SARS-CoV-2. A one-point increase in physical proximity score was associated with 1.14 times higher risk of SARS-CoV-2 (95%CI = 1.05-1.24). A one-point increase in the exposure to diseases/infections score was associated with 1.09 times higher risk of SARS-CoV-2 (95%CI = 1.02-1.16). People reporting jobs that could not be done remotely had higher risk of SARS-CoV-2 regardless of the classification algorithm used (aHRs = 1.17 and 1.20). Outdoors work showed an association with SARS-CoV-2 (exposed to weather aHR = 1.06, 95%CI = 1.01-1.11; under cover aHR = 1.08, 95%CI = 1.00-1.17), but these associations were not significant after accounting for whether work could be done remotely., Conclusion: People in occupations that were not amenable to remote work, required closer physical proximity, and required more general exposure to diseases/infection had higher risk of a positive SARS-CoV-2 test. These findings provide additional evidence that coronavirus disease 2019 (COVID-19) is an occupational disease, even outside of the healthcare setting, and indicate that strategies for mitigating transmission in in-person work settings will remain important., (© 2022. The Author(s).)

Background: Physical activity, nutrition and other lifestyle factors play important roles in maintaining musculoskeletal health. The coronavirus disease (COVID-19) originated in late 2019, spread globally to be declared a pandemic by the World Health Organisation in March 2020, and led to widespread behaviour change. The aim of this study was to use two existing cohorts, the Hertfordshire Cohort Study (HCS) and Health and Employment After Fifty Study (HEAF), to understand how wave one of the COVID-19 pandemic impacted lifestyle factors associated with musculoskeletal health in the UK., Methods: 125 eligible participants, 65 males and 60 females (drawn from the HCS study, median (IQR) age 84.3 (82.4-86.6) years, all Caucasian, and community dwelling) were contacted by telephone and asked to complete a questionnaire administered by a trained researcher. Data collection occurred over the period July 2020 to February 2021. 2469 participants, 1086 men and 1383 women (drawn from the HEAF study, median age 65.7 (62.0-69.3) years, mostly Caucasian and community dwelling) completed an online questionnaire in March 2021., Results: In HCS, 47% respondents reported being less physically active than before the pandemic (and only 5% more so), 27% said they consumed less alcohol compared to pre-pandemic times (and only 3% more so), and 18% reported eating less than before, although quality of diet was generally unchanged over this timeframe surveyed. In HEAF, 44% participants said they were less active than before the pandemic, while 17% reported being more active. The majority of participants reported no changes in alcohol consumption and diet; however, 19% said they drank more than before (32% of which was above recommended levels), 16% said their diet was less healthy, and 19% reported eating more than before., Conclusion: We have reported the experience of the first wave of the COVID-19 pandemic among participants of two Caucasian community dwelling UK cohorts, highlighting the impact of the pandemic on lifestyle factors associated with musculoskeletal health. Changed physical activity levels were reported in a high proportion of respondents in both studies; an investigation of reversibility of these changes is required., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Bevilacqua, D’Angelo, Linaker, Paul, Bloom, Zhang, Laskou, Cooper, Ward, Walker-Bone and Dennison.)

Objectives: To understand what we can learn from the impact of the COVID-19 pandemic and lockdown about what enables work participation for people with inflammatory arthritis and chronic pain conditions., Design: Qualitative interviews embedded within an observational questionnaire study of individuals with musculoskeletal (MSK) conditions., Setting: UK primary care (general practices), and secondary care-based rheumatology services., Participants: Individuals with axial spondyloarthritis, psoriatic arthritis and MSK pain from three established cohorts completed an online/paper-based questionnaire (July-December 2020). A subset of respondents were selected for semistructured interviews., Primary and Secondary Outcome Measures: The survey quantified the effects of lockdown on work circumstances. Qualitative interviews explored the impacts of these changes and the advantages and disadvantages of changes in work circumstances., Results: 491 people (52% female, median age 49 years) who were employed at the time of lockdown responded to the questionnaire. The qualitative analysis included 157 free-text comments on work from the questionnaire and data collected within 18 interviews.Participants reported impacts on mental and physical health, and significant financial anxieties. The impact of work changes varied depending on individual and home circumstances. Some felt forced to ignore advice to shield and continue working. The flexibility offered by home working and changes in commuting enabled greater physical activity for some, while others missed the exercise normally undertaken as part of their commute. Others reported a constant need to be 'present' online, which heightened anxiety and worsened MSK symptoms., Conclusion: Lockdown showed that flexible working arrangements, which consider the positive and negative aspects of commuting, posture, movement, and work environment matter for work participation, and can have wider benefits in terms of health and well-being for those with long-term MSK conditions. Incorporating these into new models of work will help make the workplace more equitable and inclusive for people with long-term MSK conditions., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: In response to the COVID-19 pandemic, populations were advised to remain at home to control viral spread. Government-mandated restrictions on free movement affected individuals' engagement with physical activity, with reported increases leading to biopsychosocial health benefits and conversely increased sedentary behaviour leading to poorer health. Good foot health is key to enabling physical activity and maximal participation in activities of occupation and daily living., Methods: A population-based cross-sectional study was performed, using a web-based platform. Quantitative and qualitative data were captured through responses to closed and open survey questions. Anybody with a foot health condition was eligible to participate in the online survey. Links were sent through professional networks, support groups and charities, using a snowball strategy to maximise participation., Results: Two hundred fifty-five respondents completed the survey. Most (n = 193, 75.69%) reported an ongoing foot pain or problem that had been present for 4 weeks or longer, whilst 49 respondents (19.22%) noted a new pain or problem. Pain was the most frequently reported symptom (n = 139, 54.51%), whilst change in appearance of the foot was also commonly reported (n = 122, 47.84%), often alongside the observable presence of swelling. Musculoskeletal foot symptoms were frequently reported (n = 123, 48%), and were significantly associated with reported reduced physical activity (X 2  = 6.61, p = 0.010). Following qualitative analysis five themes and 11 subthemes emerged, informed by 49 independent codes. A central theme of lockdown disrupting support networks, both formal (healthcare providers) and informal (friends or family members) emerged. The 5 sub-themes were: 1. foot pain is a constant companion, 2. self-care, 3. 'cope or crumble' scenarios, 4. future intent to access healthcare and 5. reduced ability to undertake physical activity., Conclusions: Pain was the most frequently reported foot problem during COVID-19 lockdown restriction. Lockdown restrictions disrupted support networks integral to maintaining foot health. Poor foot health impacted people's ability to remain physically active. Complaints previously considered relatively 'minor' such as support for skin and nail care, were found to be exacerbated by restricted support networks, leading to greater negative impact.