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Maturitas 78 (2014) 8–10

Contents lists available at ScienceDirect

Maturitas

jou rn al hom ep age: www.elsev ier .com/ locate /matur i tas

eview

ealth benefits of encore careers for baby boomers

nya Topiwala, Shivani Patel, Klaus P. Ebmeier ∗

epartment of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK

r t i c l e i n f o

rticle history:eceived 6 February 2014

a b s t r a c t

Baby boomers now represent an aging population group at risk of the diseases of older age. Their relativelyhigh education, amongst other attributes, means that they can make a significant contribution to the work

ccepted 10 February 2014

eywords:etirementensionementiaepression

force beyond the statutory retirement age. On an individual level, potential health benefits may motivatethem to pursue encore careers. We review some of the evidence supporting such a trend.

© 2014 Elsevier Ireland Ltd. All rights reserved.

ontents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82. Health benefits of occupation on psychiatric morbidity and mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

2.1. Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82.2. Cognitive impairment and dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

3. Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Competing interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Provenance and peer review. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

. Introduction

The great population bulge of the 50–68 year olds (thebaby boomers”), has caused some anxiety to policy makers, ashe pension-paying younger generations are getting smaller andmaller, and already need to be supplemented in many West-rn countries by younger overseas immigrants and their children.K projections estimate that baby boomers will live on averagenother 15.8–20.9 years [1]. They will thus represent a substan-

4.6–9.3% in >75 year olds) [4] and dementia (5.9–7.0% of >65 yearolds) [5]. While pension ages are being increased to catch up grad-ually with the projected budget deficits, the question arises, if thismay not confer benefits on this generation, rather than just repre-senting an economic sacrifice to be made. Certainly, baby boomersare well placed to work on a paid or voluntary basis into older age.US statistics show that as a group they are better educated (28.8%have at least a bachelor’s degree), are more likely to be employed(74.1%) and wealthier (only 8.9% in poverty) than are any other agestrata of the population [2].

ial section of the population (26% in the US) [2]. Yet in the UK,

edian retirement age is 64.6 for men, and 62.3 years for women,espectively [3]. Public health focus has been on the risk of illnessesommon after retirement, such as depression (point prevalence of

∗ Corresponding author. Tel.: +44 1865 226469; fax: +44 1865 793101.E-mail address: klaus.ebmeier@psych.ox.ac.uk (K.P. Ebmeier).

ttp://dx.doi.org/10.1016/j.maturitas.2014.02.005378-5122/© 2014 Elsevier Ireland Ltd. All rights reserved.

2. Health benefits of occupation on psychiatric morbidityand mortality

2.1. Depression

Prolonged unemployment accounts for a proportion of depres-sion across adult age groups [6–8]. Unemployed, but also part-time

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nd retired workers are more likely to be depressed than thosen full-time work [6]. In many cases it may be difficult to estab-ish whether unemployment led to depression or vice versa, butome studies have claimed that unemployment is causally relatedo depression [9,10]. Loss of regular income has been identified as

critical factor contributing toward depressive symptoms. Men atetirement age, who were working for pay, were less likely to beepressed than men who were not being paid for their work [11].imilarly, the low-income unemployed suffer most with depres-ion, further supporting the idea that loss of financial security is

critical factor [12]. Regularity of work has also been identifieds important in reducing reported depressive symptoms. Full-timeorkers, compared with ‘non-standard’ or temporary workers,

eported fewer depressive symptoms, even after adjusting for edu-ation, occupational class and income [13]. This suggests that inddition to providing a livelihood, paid employment gives workers

sense of purpose and self-worth that is removed with retire-ent. Social isolation (particularly the size of the social network

nd subjective social support) has been identified as important inredicting depression in the elderly retired population [14]. Thoseho engage in fewer social activities have a significantly higher

ncidence of depression [15]. Social support appears relevant tohronicity of major depressive illness more than its severity [16]. Asoing to work is the main form of social interaction for many, retire-ent may thus predispose older individuals toward depression,hich would be mitigated by an encore career.

.2. Cognitive impairment and dementia

A number of studies have demonstrated a link between high life-ime occupational attainment (i.e. non-manual/white collar) and aeduced incidence of all cause [17], vascular [18], and Parkinson’sisease dementia [19]. Duration of employment may determinehe strength of such associations [18]. Additionally, one study hasinted at a negative impact of retirement upon cognitive function20].

No study has to date examined the association between laterife careers and dementia risk. However, it seems reasonable toxtrapolate from studies of mental activity and social interaction,hich would be components of the majority of encore careers. Aeta-analysis in 2004 concluded that social and mental activities

ave a beneficial effect on cognition and a protective effect againstementia [21].

Longitudinal studies associate cognitively stimulating leisurectivities (one can argue for a similarity with mental work) with

decreased risk of dementia [22], Alzheimer’s disease [23], vas-ular dementia [24], as well as with a later age of dementia onset25]. Similarly, the majority of studies have shown reduced cogni-ive decline with increasing leisure activity [26]. Such activities areiverse and include computer use [22], odd jobs and knitting [27].

The majority (10/12) of longitudinal studies have shown thatncreased social interaction is associated with reduced dementiancidence [28] or later onset [25]. Similarly, 17 of 18 studies haveemonstrated a significant correlation between increased socialctivity and reduced cognitive decline [29].

Of course, one must make causal interpretations in such studiesith care. The vast majority of participants were >65 years at base-

ine, hence decreased mental or social activity may be the result ofre-existing subtle cognitive impairments.

. Mortality

There is a substantial evidence base suggesting that unemploy-ent in middle age increases mortality. In one prospective study of

0–59 year olds, those unemployed in the five years after screening

tas 78 (2014) 8–10 9

had approximately double the risk of dying (from cardiovasculardisease or cancer) compared with those continuously employed,even after adjustment for multiple confounders [30]. However, therelationship between employment and mortality is likely to becomplicated, and one cannot necessarily extrapolate that encorecareers would decrease mortality. Temporary (rather than per-manent) employment may actually increase mortality [31] – therelationship between total working hours and mortality may actu-ally be u-shaped [32].

Correspondingly, several studies have found mortality is higheramongst those retiring early (<65 years) [33], although this asso-ciation may be confounded by those retiring early on grounds ofill health. Following adjustment for this, early retirees spent fewerdays in hospital in the preceding two years and had no change inmortality [34].

One can make a compelling argument that encore careers maydecrease suicides in baby boomers. Unemployment [35], retire-ment [36], and a restricted social network [37] are all risk factors forelderly suicide. A meta-analysis found that having a hobby or activeparticipation in an organization decreased the risk of suicide in >65year olds (although this was not significant following adjustmentfor life events, psychosocial variables and mental health) [38].

4. Conclusions

Baby boomers now represent an aging population and are atrisk from debilitating diseases of older age. Their relatively higheducation, amongst other attributes, means that they could makea significant contribution to the work force beyond the statutoryretirement age. On an individual level, potential health benefitsmay motivate them to pursue encore careers. Mental and socialactivities seem to decrease the risk of dementia; employment,income and social contact decrease the risk of depression; and mor-tality (particularly from suicide) is decreased by employment andsocial contact. Depression, dementia or lethal morbidity may ofcourse result in early retirement rather than vice versa. However,physical and mental activity seems to improve mood and cognitiveperformance supporting the argument that employment confers abeneficial impact on health [39,40].

Contributors

All authors were involved in the first draft (part) and full revisionof the manuscript.

Competing interest

Anya Topiwala and Shivani Patel both declared no competinginterest and Klaus P. Ebmeier reports consultation fees receivedfrom Lily in relation to Amyvid TM.

Funding

Anya Topiwala – UK Medical Research Council (G1001354) –Clinical Lecturer.

Shivani Patel – North East Thames Foundation School.Klaus P. Ebmeier – UK Medical Research Council (G1001354),

the Gordon Edward Small’s Charitable Trust (SC008962), and theHDH Wills 1965 Charitable Trust.

Provenance and peer review

Commissioned and externally peer reviewed.

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