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Background: Continuous in-home monitoring of older adults can provide rich and sensitive data capturing subtle behavioral and cognitive changes. Our previous work has identified multiple metrics that describe meaningful trends in daily activities over time. The continuous, multidomain nature of this technology may also serve to inform caregivers of the need for higher levels of care to maintain the health and safety of at-risk older adults. Accordingly, care decisions can be based on objective, systematically assessed real-time data., Objective: This study deployed a suite of in-home monitoring technologies to detect changing levels of care needs in residents of independent living units in 7 retirement communities and to assess the efficacy of computer-based tools in informing decisions regarding care transitions., Methods: Continuous activity data were presented via an interactive, web-based tool to the staff identified in each facility who were involved in decisions regarding transitions in care among residents. Comparisons were planned between outcomes for residents whose data were shared and those whose data were not made available to the staff. Staff use of the data dashboard was monitored throughout the study, and exit interviews with the staff were conducted to explicate staff interaction with the data platform. Residents were sent weekly self-report questionnaires to document any health- or care-related changes., Results: During the study period, 30 of the 95 residents (32%) reported at least one incidence of new or increased provision of care; 6 residents made a permanent move to a higher level of care within their communities. Despite initial enthusiasm and an iterative process of refinement of measures and modes of data presentation based on staff input, actual inspection and therefore the use of resident data were well below expectation. In total, 11 of the 25 staff participants (44%) logged in to the activity dashboard throughout the study. Survey data and in-depth interviews provided insight into the mismatch between intended and actual use., Conclusions: Most continuous in-home monitoring technology acceptance models focus on perceived usefulness and ease of use and equate the intent to use technology with actual use. Our experience suggests otherwise. We found that multiple intervening variables exist between perceived usefulness, intent to use, and actual use. Ethical, institutional, and social factors are considered in their roles as determinants of use., (©Katherine Wild, Nicole Sharma, Nora Mattek, Jason Karlawish, Thomas Riley, Jeffrey Kaye. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.01.2021.)

Background: Unlike some other safety critical professions, there is no mandatory age of retirement for doctors, including surgeons. Medical regulators in Australia are implementing additional checks on doctors from the age of 70. We describe expert opinions on assuring performance and supporting career transitions among older surgeons., Methods: In this qualitative study, experts in four countries were purposively selected for their expertise in surgical governance. Experts responded to interviews (Australia, New Zealand and UK) or a survey (Canada). A tiered framework of interventions was developed by integrating findings with previous literature and responsive regulation theory., Results: 52 experts participated. Participants valued the contribution of senior surgeons, while acknowledging that age-related changes can affect performance. Participants perceived that identity, relationships and finances influence retirement decisions. Experts were divided on the need for age-specific testing, with some favouring whole-of-career approaches to assuring safe care. A lack of validated tools for assessing performance of older surgeons was highlighted. Participants identified three options for addressing performance concerns-remediate, restrict or retire-and emphasised the need for co-ordinated and timely responses., Conclusion: Experts perceive the need for a staged approach to assessing the performance of older surgeons and tailoring interventions. Most older surgeons are seen to make decisions around career transitions with self-awareness and concern for patient safety. Some older surgeons may benefit from additional guidance and support from employers and professional colleges. A few poorly performing older surgeons, who are recalcitrant or lack insight, require regulatory action to protect patient safety. Developing robust processes to assess performance, remediate deficits and adjust scopes of practice could help to support safe career transitions at any age., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Despite an increasing number of studies measuring the effect of retirement on individual well-being, research on spillover effects of one spouse's retirement on another spouse's well-being is limited. If such an effect exists but is not considered, it would result in an underestimation of the total retirement effect. This article examines the effect a man's retirement has on his wife's mental and physical health. Using data from the China Health and Retirement Longitudinal Survey (CHARLS), I exploit the large increase in the probability of retirement at the legal retirement age for urban male wage earners in China as a natural experiment. I implement a fuzzy regression discontinuity design to compare the health outcomes of women whose husbands recently retired with those whose husbands are close to retiring. Findings indicate that the retirement of her spouse improves a woman's physical and mental well-being, most likely by increasing the frequency of her social interactions and exercise., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Poor health after retirement may have an important economic and societal impact and may be affected by macro-level factors. Our aim was to examine whether macro-level factors are associated with health and educational differences in health in recent retirees. We used data covering 18 European countries from the Survey on Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA) on 8867 respondents who had been retired less than 5 years. We performed multi-level linear regression analyses to examine whether social expenditure in nine policy areas, minimum pension replacement rates, and unemployment replacement rates explained cross-country differences in post-retirement self-rated health (SRH) and educational inequalities in SRH. In both men and women, a higher total expenditure as well as higher expenditures on health, old age, housing, and 'other social policy areas' (non-categorical cash benefits to low-income households and other social services) were associated with better SRH. Cross-level interactions showed that in the presence of a higher old age expenditure, a higher unemployment expenditure, and a higher total expenditure, the absolute educational inequalities in post-retirement SRH were smaller than with lower expenditures in these areas, in both men and women. We found the same effect in women only for a higher expenditure on health as well as a higher minimum pension replacement rate. A higher expenditure on survivors pensions, a lower expenditure on family, and a higher unemployment replacement rate had this effect in men only. This study showed that social expenditure and replacement rates were associated with post-retirement health and health inequalities., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Cross-national comparisons of patterns of population aging have emerged as comparable national micro-data have become available. This study creates a metric using Rasch analysis and determines the health of American and Mexican older adult populations., Methods: Secondary data analysis using representative samples aged 50 and older from 2012 U.S. Health and Retirement Study (n = 20,554); 2012 Mexican Health and Aging Study (n = 14,448). We developed a function measurement scale using Rasch analysis of 22 daily tasks and physical function questions. We tested psychometrics of the scale including factor analysis, fit statistics, internal consistency, and item difficulty. We investigated differences in function using multiple linear regression controlling for demographics. Lastly, we conducted subgroup analyses for chronic conditions., Results: The created common metric demonstrated a unidimensional structure with good item fit, an acceptable precision (person reliability = 0.78), and an item difficulty hierarchy. The American adults appeared less functional than adults in Mexico (β = - 0.26, p < 0.0001) and across two chronic conditions (arthritis, β = - 0.36; lung problems, β = - 0.62; all p < 0.05). However, American adults with stroke were more functional than Mexican adults (β = 0.46, p = 0.047)., Conclusions: The Rasch model indicates that Mexican adults were more functional than Americans at the population level and across two chronic conditions (arthritis and lung problems). Future studies would need to elucidate other factors affecting the function differences between the two countries.

Objectives: This study aims to analyse the associations between general practitioner (GP) retirement, job satisfaction and attitudes towards a mandatory accreditation scheme. External interventions such as mandatory accreditation schemes may be perceived negatively by GPs, causing early retirement from practice. In Denmark, almost half of the GPs had negative attitudes prior to the implementation of a mandatory accreditation scheme, constituting a possible risk of early practice retirement., Setting: In January 2015 all 3,404 Danish GPs were invited to participate in a survey on attitudes towards a forthcoming mandatory accreditation programme., Participants: 1,906 GPs (56%) answered the questionnaire. In total, 391 (11%) retired from practice in the following period from 1 January 2015 to 31 January 2017. Of these, 193 GPs (49%) answered the questionnaire., Primary and Secondary Outcome Measures: The primary outcome was GP retirement. Labour union data on practice retirement were linked with data from the questionnaire survey on job satisfaction and attitudes prior to implementation of mandatory accreditation. Logistic regression analyses were used to determine the associations between practice retirement and job satisfaction and attitudes towards accreditation., Results: Practice retirement was associated with job dissatisfaction (OR: 2.5, 95% CI 1.6 to 3.7). Retirement was not associated with any of the other surveyed attitudinal variables. Retirement rate was relatively high in the accreditation start-up period., Conclusion: Practice retirement was associated with job dissatisfaction but not to a priori attitudes towards an upcoming mandatory accreditation programme. However, the retirement rate was relatively high in the start-up period of the accreditation programme. Future research should evaluate the effects of external interventions on preterm retirement from general practice., Trial Registration Number: NCT02762240., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Consistent patterns of gender differences in retirement planning behaviours have been shown but little is known about these behaviours among nurses., Aims: To analyse the antecedents of the behaviours to prepare for retirement in nurses older than 55 and to identify differences as a function of gender., Methods: A two-wave longitudinal study with Spanish nurses (n = 132)., Results: Statistically significant gender differences were revealed. Specifically, paths from financial knowledge to public protection and self-insurance as well as paths from goals clarity to public protection all differed by gender., Conclusions: Patterns of retirement planning differentiated by gender apparently continue to emerge., Implications for Nursing Management: The study adds evidence showing that female nurses continue to rely on public protection as a solid support for their retirement. Despite their greater awareness of the importance of health care and social relations, savings and finance are more neglected by female nurses. Intervention should be aimed at fostering financial literacy of the entire nursing population, but particularly, the access of women to this training. Secondly, given that the differences persist, advance planning of social actions to protect those who will be living alone and economically helpless in old age., (© 2018 John Wiley & Sons Ltd.)

Background: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known., Objective: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions., Methods: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested., Results: A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times., Conclusions: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions., (©Hyunju Shim, Jennifer Ailshire, Elizabeth Zelinski, Eileen Crimmins. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.05.2018.)

Problem: Medical school faculty are aging, but few academic health centers are adequately prepared with policies, programs, and resources (PPR) to assist late-career faculty. The authors sought to examine cultural barriers to successful retirement and create alignment between individual and institutional needs and tasks through PPR that embrace the contributions of senior faculty while enabling retirement transitions at the University of Massachusetts Medical School, 2013-2017., Approach: Faculty 50 or older were surveyed, programs at other institutions and from the literature (multiple fields) were reviewed, and senior faculty and leaders, including retired faculty, were engaged to develop and implement PPR. Cultural barriers were found to be significant, and a multipronged, multiyear strategy to address these barriers, which sequentially added PPR to support faculty, was put in place. A comprehensive framework of sequenced PPR was developed to address the needs and tasks of late-career transitions within three distinct phases: pre-retirement, retirement, and post-retirement., Outcomes: This sequential introduction approach has led to important outcomes for all three of the retirement phases, including reduction of cultural barriers, a policy that has been useful in assessing viability of proposed phased retirement plans, transparent and realistic discussions about financial issues, and consideration of roles that retired faculty can provide., Next Steps: The authors are tracking the issues mentioned in consultations and efficacy of succession planning, and will be resurveying faculty to further refine their work. This framework approach could serve as a template for other academic health centers to address late-career faculty development.

Aim: To explore the situation of older nurses approaching retirement with regard to their retirement planning, and the relationship of their retirement planning behaviour with the job environment and job satisfaction under their current employment arrangements and other work-related variables., Background: Nurse shortage has become a global phenomenon that can be alleviated by retaining older nurses in service. The Chinese government proposed the "Incremental Delay Retirement Age Policy." However, older nurses face delayed retirement but lack retirement plans., Method: A cross-sectional questionnaire survey was conducted among a convenience sample of older retiring nurses (n = 152; 84.92% response rate) recruited from every department of four large general hospitals in Changchun, Jilin Province from June to August 2016., Result: The majority of the respondents presented poor retirement planning (n = 122, 80.3%). The independent variables of information exchange with patients, teamwork and personal growth and development explained approximately 16.6% of the variance in retirement planning. Nurse-patient communication and personal growth and development can promote retirement planning, but teamwork is negatively related to retirement planning., Conclusion: Retirement planning by Chinese older nurses is related to certain work-related variables. However, many other work-related variables were not associated with retirement planning and require further research. Overall, Chinese older retiring nurses must improve their retirement planning practices., (© 2017 John Wiley & Sons Ltd.)

The Extending Working Lives (EWL) agenda seeks to sustain employment up to and beyond traditional retirement ages. This study examined the potential role of childhood factors in shaping labour force participation and exit among older adults, with a view to informing proactive interventions early in the life-course to enhance individuals' future capacity for extending their working lives. Childhood adversity and socioeconomic disadvantage have previously been linked to ill-health across the life-span and sickness benefit in early adulthood. This study builds upon previous research by examining associations between childhood adversity and self-reported labour force participation among older adults (aged 55). Data was from the National Child Development Study - a prospective cohort of all English, Scottish, & Welsh births in one week in 1958. There was evidence for associations between childhood adversity and increased risk of permanent sickness at 55 years - which were largely sustained after adjustment for educational disengagement and adulthood factors (mental/physical health, qualifications, socioeconomic disadvantage). Specifically, children who were abused or neglected were more likely to be permanently sick at 55 years. In addition, among males, those in care, those experiencing illness in the home, and those experiencing two or more childhood adversities were more likely to be permanently sick at 55 years. Childhood factors were also associated with part-time employment and retirement at 55 years. Severe childhood adversities may represent important distal predictors of labour force exit at 55 years, particularly via permanent sickness. Notably, some adversities show associations among males only, which may inform interventions designed to extend working lives., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Older women workers' decision making around retirement is increasingly important given the increasing involvement of older women in paid employment. This article explores influences on the retirement decision making of older women workers in Ireland. It is based on a case study of 57 interviews with women in the Irish civil service exploring work-life decision making. It finds that retirement choices vary according to initial socioeconomic resources and/or life-course trajectories and are particularly affected by gendered caring norms, employment policy, job tenure, and place in organizational hierarchies. Those women with interrupted careers and low pay have fewer choices around retirement timing.

Aims: To understand nurse administrators' intentions and considerations in recruiting inactive nurses and to examine predictors of intent to recruit., Background: Few studies have provided insight into employer intentions and considerations in recruiting inactive nurses., Methods: A census survey collected data from 392 nurse administrators via a mailing method., Results: Overall, 89.0% of nurse administrators were willing to recruit inactive nurses. Stepwise regression analysis revealed that the only predictor of nurse administrators' intention to recruit was nurse turnover rate at the hospital. Nurse administrators perceived the most important recruiting considerations were inactive nurses' cooperation with alternating shifts, health status and nursing licence. The most frequent reasons for not recruiting were an inactive nurse's lack of understanding of the medical environment and poor nursing competence., Conclusions: Most hospital nurse administrators were willing to recruit inactive nurses. Inactive nurses who wish to return to work should be qualified, willing to work both day and night shifts, and in good health., Implications for Nursing Management: Nurse administrators can reduce the nursing shortage by recruiting inactive nurses. Re-entry preparation programmes should be implemented that will provide inactive nurses with knowledge of the current medical environment and the skills required to improve their nursing competence., (© 2016 John Wiley & Sons Ltd.)

Objectives: The Royal Australasian College of Surgeons (RACS) has been innovative in developing core competencies, which provide a framework for assessing performance and a 'Code of Conduct', for the lifelong journey of all surgeons. The older surgeon may face significant challenges, having passed their peak, with a lower volume of cases, and potentially increased complications. They also face the challenges of retiring from active clinical practice with its logistical and psychological dilemmas. The RACS has, therefore, put in place several initiatives to deal with these dilemmas., Conclusions: The Senior Surgeons' Group, which conducts annual 'Building Towards Retirement' workshops, has been the driving force behind these initiatives. The group has a regular program in the RACS Annual Scientific Congress, including the multidisciplinary session 'The ageing specialist - challenges for regulators: hypothetical' which took place in 2014, and some of its members are part of a multidisciplinary team with an approach to adapting to ageing that encourages self-reflection and self-monitoring. It has also influenced the RACS Council to change the continuing professional development (CPD) regulations to include requirements for ageing surgeons regards health maintenance, peer reviews, and modified requirements to satisfy CPD completion. The RACS offers a variety of other opportunities for the ageing surgeon to remain active in college activities., (© The Royal Australian and New Zealand College of Psychiatrists 2016.)

Objectives: The aim is to present recommendations of the Australian and New Zealand College of Anaesthetists (ANZCA) with respect to practice implications for ageing specialists, together with brief discussion of effects of ageing on professional medical capabilities and recommendations on preparing to retire from medical practice., Conclusions: Practitioners should recognise that planning for retirement is part of good management of a medical career, and that the ageing process will inevitably compromise their ability to treat patients safely unless they retire at the appropriate time. Planning should include adequate financial preparation, and cultivation of interests and friends outside medicine. Practitioners should also realise that insight is likely to be compromised, so that they should seek colleagues who are trusted to advise them if/when they begin to lose competency. Lastly all practitioners should ensure that they consult a General Practitioner frequently, and that they have arranged all the proper legal instructions such as a Will, a Power of Attorney and an Advanced Health Directive.The ANZCA recommendations concerning ageing specialists have wide application to all medical specialties, not just for anaesthetists, and therefore all Medical Colleges should generate their own specific recommendations for ageing practitioners and the general effects of fatigue particularly for aged practitioners., (© The Royal Australian and New Zealand College of Psychiatrists 2015.)

Background: Retirement policies for surgeons differ worldwide. A range of normal human functional abilities decline as part of the ageing process. As life expectancy and their population increases, the performance ability of ageing surgeons is now a growing concern in relation to patient care. The aim was to explore the effects of ageing on surgeons' performance, and to identify current practical methods for transitioning surgeons out of practice at the appropriate time and age., Methods: A narrative review was performed in MEDLINE using the terms 'ageing' and 'surgeon'. Additional articles were hand-picked. Modified PRISMA guidelines informed the selection of articles for inclusion. Articles were included only if they explored age-related changes in brain biology and the effect of ageing on surgeons' performance., Results: The literature search yielded 1811 articles; of these, 36 articles were included in the final review. Wide variation in ability was observed across ageing individuals (both surgical and lay). Considerable variation in the effects of the surgeon's age on patient mortality and postoperative complications was noted. A lack of neuroimaging research exploring the ageing of surgeons' brains specifically, and lack of real markers available for measuring surgical performance, both hinder further investigation. Standard retirement policies in accordance with age-related surgical ability are lacking in most countries around the world., Conclusion: Competence should be assessed at an individual level, focusing on functional ability over chronological age; this should inform retirement policies for surgeons., (© 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.)

Context: Workforce shortages have been identified as a priority for US public health agencies. Voluntary turnover results in loss of expertise and institutional knowledge as well as high costs to recruit and train replacement workers., Objective: To analyze patterns and predictors of voluntary turnover among public health workers., Design: Descriptive analysis and linear probability regression models., Participants: Employees of state health agencies in the United States who participated in the Public Health Workforce Interests and Needs Survey (PH WINS)., Main Outcome Measures: Intended retirement and voluntary departure; pay satisfaction; job satisfaction., Results: Nearly 25% of workers reported plans to retire before 2020, and an additional 18% reported the intention to leave their current organization within 1 year. Four percent of staff are considering leaving their organization in the next year for a job at a different health department. There was significant heterogeneity by demographic, socioeconomic, and job characteristics. Areas such as administration/management, health education, health services, social services, and epidemiology may be particularly vulnerable to turnover. The strongest predictors of voluntary departure were pay and job satisfaction, which were associated with 9 (P < .001) and 24 (P < .001) percentage-point decreases, respectively, in the probability to report the intention to leave. Our findings suggest that if all workers were satisfied with their job and pay, intended departure would be 7.4%, or less than half the current 18% rate. Controlling for salary levels, higher levels of education and longer work experience were associated with lower pay satisfaction, except for physicians, who were 11 percentage points (P = .02) more likely to be satisfied with their pay than employees with doctoral degrees. Several workplace characteristics related to relationships with supervisors, workplace environment, and employee motivation/morale were significantly associated with job satisfaction., Conclusions: Our findings suggest that public health agencies may face significant pressure from worker retirement and voluntary departures in coming years. Although retirement can be addressed through recruitment efforts, addressing other voluntary departures will require focusing on improving pay and job satisfaction.

Background: There is a strong belief in the potential of increased physical activity to improve the health of populations. The objective of the present study was to estimate the association between low cardiorespiratory fitness in young adulthood and subsequent health impairment until middle age, measured by disability pension., Methods: The study utilised data on cardiorespiratory fitness and a number of covariates (social background, health behaviours and psychological characteristics) from the Swedish Conscription Cohort of 1969/1970 including 49,321 men born in 1949-1951, and data on disability pension from 1971 to 2008 (20-59 years of age) through record linkage with two national insurance databases. Cox proportional-hazards regressions yielded hazard ratios (HR) with 95% confidence intervals (CI)., Results: Having low-level or mid-level cardiorespiratory fitness in late adolescence was associated with an increased HR of disability pension across the follow-up (HR for low fitness: 1.85, CI 1.71 to 2.00; HR for mid-level fitness: 1.40, CI 1.31 to 1.50). The association was stronger with earlier disability pensions than with later disability pensions, which was also seen after multiple confounding adjustments. At the same time, these adjustments revealed considerable confounding of the association by individual differences in psychological characteristics in particular., Conclusions: Lower levels of cardiorespiratory fitness in young adulthood were found to be associated with an increased HR of disability pension throughout the follow-up until 59 years of age, even after adjustment for important confounding factors measured in late adolescence. Increased physical fitness may thus have a lowering effect on the risk of disability pension., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

In developed countries, economic and financial well-being is playing a crucial positive role in ageing and inclusion processes. Due to the complexity and pervasiveness of financial economy in the real life, more and more social as well as individual well-being are perceived as influenced by financial conditions. On the other hand, the demographic circumstances drive scholars as well as politicians to reflect on ageing dynamics. Bridging the two domains, the following research focuses on the role of the financial well-being as a mediating role of general well-being in elder people. The assumption is that elderly people have specific financial needs that sometimes are not covered by financial providers' offers. The motivation is mainly on the role of information asymmetries between elder consumers and financial institutions. On the dynamics of these asymmetries, the research will specifically investigate the role of financial literacy, as the ability of comprehension of elder people of their needs and of financial information. The applicative implication of this research work consists in finding the determinants of financial well-being for elders and the definition of their specific financial competencies, in order to 1) identify educational and regulatory guidelines for policy makers in charge of creating financial market transparency conditions, and to 2) support design of organizational mechanisms as well as financial product/services for this specific target of client. The following chapter presents preliminary explorative results of a survey delivered on 200 elder individuals (65-80 yrs.) leaving in Milan. Findings show that active elders consider the ability of managing personal wealth as one of the core determinant of well-being, although the economic and financial literacy is limited. Furthermore, the chapter proposes a research agenda for scholars interested in exploring the relationship between financial well-being and ageing.

Background: Disability retirement because of depression is increasingly common in Finland. The rise of such retirement coincided with the rise of unemployment in the second half of the 1990s. In this study we sought potential connections between these two epidemics. We assumed that depressiveness incurs a higher risk of disability retirement among the unemployed than among the employed population., Methods: Data were derived from HeSSup Study, which follows a large population sample. A total of 14,487 participants responded in 1998 and in 2003 in postal surveys about their employment status. Their depressiveness was measured in 1998 with Beck's depression inventory. Labour market status in 1998 was classified as employed, short-term unemployed and long-term unemployed. In 2003 the status was dichotomised into disability retired or not., Results: A total of 329 participants (2.3%) retired during the 5-year follow-up. The retirement percentage was 1.9 among the employed, 4.8 among short-term unemployed and 6.7 among long-term unemployed. The percentage for the employed ranged from 1.4 (no depressiveness) to 7.1 (severe depressiveness), for the short-term unemployed, the range was from 3.3 to 17.9% and for the long-term unemployed the range was from 2.6 to 14.2%. Retirement was more probable among unemployed participants than among employed (OR 2.24 [95% CI 1.50-3.36] for short-term and OR 2.82 [95% CI 1.93-4.13] for long-term unemployed), when employment status was adjusted by sociodemographic background and somatic comorbidity and interaction term employment status with depressiveness was taken into account. Moreover, the interaction of employment status and depressiveness with the probability of disability retirement was significant. Our final analysis also revealed that disability retirement was particularly common among the short-term unemployed with severe depressiveness. Among the long-term unemployed, in contrast, retirement was more common in the mildly depressed than in the severely depressed., Conclusions: Our results suggest that high level of unemployment may mean high level of premature exit from the work-force due to disability retirement. The epidemic of depression-related disability contributes significantly to this general trend. In future, it will be important to find ways to support depression patients to hold on to their jobs and to develop services, combined with health policy and employment policy, can interrupt the vortex of deteriorating mental well-being, prolonged unemployment and marginalisation from health care.

Objective: Recent studies of age-related effects on cognition and performance have raised concerns about the appropriate timing and regulatory surveillance of retirement for surgeons. Little is known about the practice patterns and retirement plans of aging neurosurgeons. Analyses of informed opinions on possible regulatory options are also lacking., Methods: During a consensus development workshop conducted at the 2007 Annual Meeting of the Congress of Neurological Surgeons, participants collected data regarding neurosurgeons' retirement plans, reviewed expert background information, and assessed opinions. Participants submitted data and discussion points throughout the session using digital handheld devices. These data were then statistically analyzed, with particular attention to shifts in opinion and emergence of consensus after the presentation of expert material and discussion., Results: Neurosurgeons strongly oppose government regulation of retirement using uniform retirement age regulations. The most favored policy option, initially, particularly among older neurosurgeons, was status quo. After consensus development, the most favored policy option was local regulation by hospital privileging bodies. Neurosurgeon age, but not perceived ability to reach financial retirement goals, significantly influenced opinions., Conclusion: Retirement age is an area of active government regulation in other professions. Neurosurgeons seem to favor a flexible system of regulation based on local and quality standards, rather than national age-based thresholds. The Congress of Neurological Surgeons Consensus Conference process offers a viable methodology for initiating discussion of important policy issues facing organized neurosurgery, engaging the informed input of practicing neurosurgeons, and formulating preliminary strategies for pursuit by stakeholder neurosurgical policy organizations.

Recent implementation of the International Civil Aviation Organization (ICAO) amendment 167 to Annex 1 allows pilots from ICAO contracting states to fly until 65 yr old. In response to the new ICAO standard, the Federal Aviation Administration (FAA) commissioned an Aviation Rulemaking Committee (ARC) to make recommendations on whether the FAA should retain or amend the Age-60 Rule. Unable to reach a consensus, the ARC formed two working groups and submitted two position papers with opposing views. After reviewing the ARC's report, the FAA has decided to move toward raising the mandatory retirement age for airline pilots from 60 to 65. In this article, we provide a brief review of the ICAO's amendment to the age limit and discuss the various implications of this new international standard.

Objectives: The objective of this study was to assess whether recurrent involuntary job loss among US workers nearing retirement resulted in increasingly less severe changes in depressive symptoms with successive job losses., Methods: With data drawn from the US Health and Retirement Survey (HRS), we used repeated measures longitudinal analysis to investigate the effect of recurrent job loss on follow-up depressive symptoms, measured up to 2 years following job loss. Study participants include 617 individuals, aged 51-61 years at the 1992 study baseline, who had at least one job loss between 1990 and 2000. Our primary outcome variable was a continuous measure of depressive symptoms, constructed from the 8-item Center for Epidemiologic Studies-Depression (CES-D) battery administered at every HRS wave. A second, dichotomous outcome, derived from the continuous measure, measured clinically relevant depressive symptoms. The exposure (recurrent job loss) was defined by binary dummy variables representing two and three/four job losses. All job losses were the result of either plant closing or layoff., Results: Our main finding indicates that, after relevant covariates are controlled, compared to one job loss, two job losses result in a modest increase in the level depressive symptoms (not significant) at two-year follow-up. Three or more job losses result, on average, in a decline in depressive symptoms to a level near pre-displacement assessment (not significant). Somewhat in contrast, two job losses were found to be associated with increased risk of clinically relevant depressive symptoms., Conclusions: The principal finding confirms our hypothesis that, among US workers nearing retirement, repeated exposure to job separation results in diminished effects on mental health. Adaptation to the job loss stressor may underlie the observed response, although other explanations, including macroeconomic developments, are possible.

Objectives: To identify the core best practice standards in ill-health retirement (IHR) procedures. To investigate whether changing medical criteria and introducing medical severance payments affect the rate and cost of IHR., Methods: The core standards for best practice in IHR procedures were distilled from the published literature. On 1st April 2000 the study pension scheme altered the IHR medical criteria to define permanent incapacity and introduced medical severance payments for employees with temporary incapacity. Rates and costs of IHR were measured before and after these changes., Results: Following the changes, the annual rate of IHR fell from 8.89 to 2.90 per 1000 members (P < 0.001), the median age at IHR rose from 50 to 55 years (P = 0.01) and pension scheme costs fell by 25 million pounds sterlings per year., Conclusions: Changing medical criteria and introducing medical severance payments may reduce the rate and costs of ill-health retirement. Target rates of four cases of IHR per 1000 active members per year, and 15% of total retirements, are proposed for schemes serving industries with average health risks.

Exercise during adolescence, especially during the pre-pubertal years, builds a skeleton with a high bone mineral density (BMD) and possibly a larger skeleton with a different skeletal architecture. This would lead to a stronger skeleton more resistant to trauma. These changes could be of biological significance for fracture reduction, if they were maintained into old age where fragility fractures exponentially rise. The Achilles heel of exercise is its cessation. Most BMD benefits achieved by exercise appear to be eroded with cessation of exercise. Reduced exercise intensity after a period of high activity, may maintain some residual BMD benefits into old age. A decreased fracture rate in the population could perhaps be achieved by promoting a physically active life style with lifelong high activity. But what happens if the activity in former athletes is reduced to the same level as in individuals who never exercised? The null hypothesis that exercise has no effect on fracture rates in old age cannot be rejected on the basis of any published, randomised, prospective data. Instead we have to rely on retrospective observational and case control studies, all hypothesis-generating, not hypothesis-testing. Existing data suggest that there could be a reduced fracture risk in former athletes. This notion may be correct, but consistently replicated sampling bias may produce the same observation and any biological explanation for this fracture reduction is unclear. Residual structural skeletal benefits, improved muscle strength, coordination and balance are all traits possibly maintained in former athletes after their active career. These traits may possibly reduce the number of fractures in later life.

Background: Early retiring is a major social problem in many western countries., Aim: To investigate whether good cardiorespiratory fitness prevents disability pensioning in Finnish middle-aged men., Methods: Subjects were a random population based sample of 1307 men who were 42-60 years old at baseline, had not retired before baseline or died during follow up, and had undergone a cycle ergometer test at baseline. Cardiorespiratory fitness was assessed at baseline with a maximal but symptom limited exercise test on an electrically braked cycle ergometer., Results: During a follow up of 11 years on average, 790 (60.4%) men were awarded a disability pension, only 254 (19.4%) men reached the old-age pension without previous early pension, and 263 (20.1%) men were still working at the end of follow up. After adjustment for age, body mass index, alcohol consumption, smoking, education, occupation, and baseline chronic diseases, an inverse association was observed between cardiorespiratory fitness and the risk of disability pension. Men with VO2max <25.98 ml/kg/min (lowest fifth) had a 3.28-fold (95% CI 1.70 to 6.32) and men with the duration of exercise test <9.54 minutes (lowest fifth) had a 4.66-fold (95% CI 2.43 to 8.92) risk of disability pension due to cardiovascular diseases compared with men in the highest fifths. Men with lowest fitness level also had an increased risk of disability pension due to musculoskeletal disorders, or all reasons combined., Conclusions: Physical fitness is inversely associated with the risk of disability pension and especially with the risk of disability due to cardiovascular diseases.

Early retirement produces a heavy economic burden in many western societies. There is a need to identify single risk factors for early retirement and to find methods for preventing it. To estimate the effect of heavy physical work on early retiring, a cohort of 1755 men aged 42 to 65 years from eastern Finland was followed up from 1984 to 2000. Self-estimated physical workload was assessed at baseline. The inclusive pension records were obtained from national pension institutions. Logistic regression modeling was used to estimate the effect of physical workload and single physical risk factors on the risk of disability pension and nonillness-based pension. Risks were estimated for both disease-specific and all disability pensions. The interaction of physical fitness and physical workload and the resulting effects on risk were also estimated. During the follow-up, 861 (49.1%) men retired on a disability pension and 331 men (18.9%) retired on a nonillness-based early pension. Only 273 (15.6%) men reached the age for getting the normal old-age pension without having had any other early pension After adjustment for age, body mass index, alcohol consumption, smoking, maximal oxygen uptake, education and corresponding illness at baseline, heavy physical work was found to be associated with an increased risk of being retired on a disability pension due to musculoskeletal disorders (odds ratio (OR) 2.21, 95% confidence interval 1.36 to 3.61) but not due to cardiovascular or mental diseases. The association was stronger if cardiorespiratory fitness was poor. Lifting, static muscular loading and uncomfortable work positions increased the risk of early retirement especially due to musculoskeletal disorders. Loading of the upper extremity alone or with the neck and shoulder region seems to be an independent risk factor for early retirement. We concluded that physical workload increases the risk of retirement on a disability pension especially due to musculoskeletal disorders. In heavy physical work, the risk is increased especially among men with musculoskeletal or cardiovascular disease and poor cardiorespiratory fitness.

About one person in eight remains employed past 65, the average age for retirement in the U.S. These persons tend to be highly reliable. They can adapt and learn new technology, but may require extra time to do so. Older workers have particular needs in the workplace due to physiological changes that accompany aging. They may require more lighting, and they may have decreased mobility, physical strength, and dexterity. These factors often have no impact on their ability to accomplish job duties. This chapter underscores the significant contributions that older workers often provide, and also addresses retirement planning.

Against a background of an aging population, rising social security costs, and foreseeable labor and skill shortages, there have been public policy changes affecting older workers in Germany. Labor-market related initiatives aim at an increase of labor force participation among this group. Enterprise-related, active age-management strategies aim at improving occupational conditions of aging workers. In this context, prolonging the working life must be seen as one option of "active aging." Another view of the current retirement discussion is the question of how the unused potential of Germany's younger, early-retired seniors can be exploited. Active aging has become a social duty nowadays, with the intention that older persons contribute to society to avoid generational conflicts. In the future, active aging will preserve the competitiveness of enterprises and of the entire economy, despite an aging labor force. But gerontological research points out that different options to carry out individual life plans of active aging are also required. This article reviews the changes in public policies towards older workers and includes the findings of a project that illustrates good practice to combat age barriers in the labor world.

New voluntary individual savings accounts have been proposed by some as a part of, or in addition to, Social Security. The success of these proposals would depend greatly on how many workers participate. This paper compares participation rates in three existing voluntary individual account-type plans--Individual Retirement Accounts (IRAs), 401(k)s, and the federal Thrift Savings Plan (TSP)--to clarify expectations about who might participate in a voluntary individual account system. It finds that participants in IRAs, 401(k)s, and the TSP tend to be disproportionately male, higher earners, older, full-time workers, and either white or nonblack minorities compared with the population at large. Differences in earnings explain much of the difference between participation rates of men and women, however, but less of the difference between participation rates of workers of different races. Whether participation in a new system of voluntary individual accounts would resemble participation in IRAs, 401(k)s, or the TSP would depend on a number of factors. For instance, the population covered by 401(k)s and the TSP is much smaller than that covered by Social Security. Average earnings are also higher among 401(k) and TSP participants than for workers covered by Social Security, which, based on these findings, suggests that participation rates could be lower in a universal system. Participation would also depend on many other factors, however, such as the extent of matching contributions or other financial incentives, the investment options available, and the amount of education provided to potential participants.

A feminist analysis of retirement is presented by questioning the applicability of traditional definitions and theories of retirement to retired women. The effects of marriage, caregiving and other family obligations on women's retirement are examined within the context of salient social, psychological and economic factors. An empowerment-oriented perspective that considers interactions and connections between family and work roles, public and private and personal and political levels are recommended to alleviate the high poverty rates among older women, to promote parity among men and women during retirement and to emancipate women from substantial involvement in unpaid work, specifically, caregiving and home labor.

This Issue Brief is designed to provide a basic understanding of the relationship of the Employee Retirement Income Security Act of 1974 (ERISA) to health plans. It is based, in part, on an Employee Benefit Research Institute-Education and Research Fund (EBRI-ERF) educational briefing held in March 1995. This report includes a section by Peter Schmidt of Arnold & Porter, a section about multiemployer plans written by Judy Mazo of The Segal Company; and a section about ERISA and state health reform written by Kala Ladenheim of the Intergovernmental Health Policy Project. Starting in the late 1980s, three trends converged to make ERISA a critical factor in state health reforms: increasingly comprehensive state health policy experimentation; changes in the makeup of the insurance market (including the rise in self-insurance and the growth of managed care); and increasingly expansive interpretations of ERISA by federal courts. The changing interpretations of ERISA's relationship to three categories of state health initiatives--insurance mandates, medical high risk pools, and uncompensated care pools--illustrate how these forces are playing out today. ERISA does have a very broad preemptive effect. Federal statutes do not need to say anything about preemption in order to preempt state law. For example, if there is a direct conflict, it would be quite clear under the Supremacy Clause [of the U.S. Constitution] that ERISA, or any federal statue, would preempt a directly conflicting state statute. States can indirectly regulate health care plans that provide benefits through insurance contracts by establishing the terms of the contract. And they also raise money by imposing premium taxes. But they cannot do the same with respect to self-funded plans. That is one of the factors that has caused a great rise in the number of self-funded plans. State regulation [of employee benefits] can create three kinds of problems: cost of taxes, fees, or other charges; cost of dealing with substantive, possibly inconsistent, benefit standards; and cost of identifying, understanding, and complying with the regulations themselves.

A sample survey of 769 ACOG Fellows who were age 60 or older in 1990 was undertaken to determine current patterns of retirement. Among 415 respondents, only 23% reported remaining in full-time practice of both obstetrics and gynecology, with an additional 16% in full-time practice of gynecology only. Full-time practice was reduced to part-time for 24% at the mean age of 63. Thirty-eight percent were fully retired at the mean age of 67.