A systematic review of published research articles on health promotion at retirement

Physical activity and psychological adjustment among retirees: a systematic review

BACKGROUND

Health-related behaviors may change after retirement and induce changes in the mental health. This systematic review aimed to investigate the nature of changes in physical activity and leisure activities, as well as the relationship between physical activity, leisure, and psychological adjustment among retirees.

METHODS

Search of papers was done in three electronic databases of PubMed, ISI Web of Science, and Scopus without constraints on time, geographical regions, or languages in February 2022. The papers that had examined the relationship between physical activity and adjustment among retirees using observational design (cross-sectional or longitudinal) were included in the present study. To evaluate the methodological quality of cross-sectional studies, Joanna Briggs Institute (JBI) Critical Appraisal Checklist, and for longitudinal studies, Newcastle-Ottawa Scale (NOS) were used.

RESULTS

The search results identified 1458 records. Twenty-six papers were included in this review based on the inclusion and exclusion criteria. The findings of most of these studies indicated a significant positive correlation between physical activity, leisure, and psychological adjustment in retirees. Retirees were mostly engaged in passive leisure activities such as reading, watching TV and movies, and less engaged in physical activities, sport, or physical exercise. General organized assessment of the total physical activity among retirees was not possible.

CONCLUSIONS

Based on the study findings, it can be stated that there is a positive correlation between physical activity, leisure, and the retirees' adjustment. Usage of the same and valid measurement method specific to old age and retirement period can be useful in more precise assessment of physical activity and its association with adjustment among retirees.

Interventions across the Retirement Transition for Improving Well-Being: A Scoping Review

(1) Background: The work-to-retirement transition involves a process of psychologically and behaviorally distancing oneself from the workforce that is often accompanied by other social changes, which can influence health and well-being. However, research on interventions targeting the work-to-retirement transition to improve health status is limited. Our objective was to summarize and describe interventions aiming to improve well-being across the retirement transition; (2) Methods: We conducted a scoping review following the methodological framework described by Arksey and O'Malley; the Joanna Briggs Institute guidelines as well as the PRISMA-ScR statements; we systematically searched articles and gray literature to identify interventions and policies that aimed to improve well-being across the retirement transition. (3) Results: 15 publications were included, which comprised both experimental designs (n = 10) and systematic reviews (n = 5). (4) Conclusions: More research on how to promote overall well-being during the work-to-retirement transition is needed. The results of this scoping review show that most reported interventions address one single lifestyle behavior, and that relevant social determinants of health have been barely considered in their design. Future investigations need to consider vulnerable groups and country-specific structural conditions. Adopting a patient and public involvement approach will contribute to developing interventions that address the significant needs of those in the transition to retirement.

Macro-level determinants of post-retirement health and health inequalities: A multilevel analysis of 18 European countries

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.

The effects of an empowering self-management model on self-efficacy and sense of coherence among retired elderly with chronic diseases: a randomized controlled trial

Background

Being elderly and retired are related phenomena that overlap in a time symmetry. The present study aimed to assess the effect of an empowering self-management model on the self-efficacy and sense of coherence (SOC) in retired elderly with chronic diseases.

Methods

A randomized controlled trial that included 60 elderly people was carried out in Bushehr (Iran) in 2016. The participants were randomly assigned to either a control group or an intervention group. Based on an empowering self-management model, the intervention group participated in a five-stage plan: 1) self-awareness of changes and understanding their personal level of performance and expectations; 2) optimal goal setting; 3) planning; 4) adjusting physical, psychological, and social structures; and 5) evaluation. Self-efficacy and SOC were measured using the questionnaires developed by Sherer and Antonovsky, respectively, before and after the intervention. The results of the observed differences between the groups were subsequently compared. Data were presented as mean±SD.

Results

The mean change of the self-efficacy score in the intervention and control groups was 9.48±5.32 and 1.68± 6.04, respectively, (t[56]=5.20, P<0.001). The mean change of the SOC score in the intervention and control groups was 24.17±12.05 and 0.10±13.42, respectively, (t[56]=7.18, P<0.001).

Conclusion

The applied empowering self-management model led to an improved self-efficacy and SOC among the retired elderly with chronic diseases. This model can be used to empower the elderly to achieve comprehensibility, manageability, and meaningfulness in their lives.

Structural developmental psychology and health promotion in the third age

In response to the ever-increasing longevity in Western societies, old age has been divided into two different periods, labelled the third and fourth age. Where the third age, with its onset at retirement, mostly involves positive aspects of growing old, the fourth age involves functional decline and increased morbidity. This article focuses on the entry to the third age and its potential for health promotion initiatives. Well-being is an important factor to emphasize in such health promotion, and this article views the lifestyle of third agers as essential for their well-being. The structural developmental theory of Robert Kegan delineates how a person's way of knowing develops throughout the life course. This theory is an untapped and salient perspective for health promotion initiatives in the third age. This article outlines Kegan's approach as a tool for developing psychologically spacious health promotion, and suggests future directions for research on the topic.

Physical Activity, Sedentary Behavior, and Retirement: The Multi-Ethnic Study of Atherosclerosis

INTRODUCTION

Physical activity and sedentary behavior are major risk factors for chronic disease. These behaviors may change at retirement, with implications for health in later life. The study objective was to describe longitudinal patterns of moderate to vigorous and domain-specific physical activity and TV watching by retirement status.

METHODS

Participants in the Multi-Ethnic Study of Atherosclerosis (n=6,814) were recruited from six U.S. communities and were aged 45-84 years at baseline. Retirement status and frequency and duration of domain-specific physical activity (recreational walking, transport walking, non-walking leisure activity, caregiving, household, occupational/volunteer) and TV watching were self-reported at four study exams (2000 to 2012). Fixed effect linear regression models were used to describe longitudinal patterns in physical activity and TV watching by retirement status overall and stratified by socioeconomic position. Analyses were conducted in 2017.

RESULTS

Of 4,091 Multi-Ethnic Study of Atherosclerosis participants not retired at baseline, 1,012 (25%) retired during a median of 9 years follow-up. Retirement was associated with a 10% decrease (95% CI= -15%, -5%) in moderate to vigorous physical activity and increases of 13% to 29% in recreational walking, household activity, and TV watching. Among people of low socioeconomic position, the magnitude of association was larger for moderate to vigorous physical activity. Among people of high socioeconomic position, the magnitude of association was larger for non-walking leisure and household activity.

CONCLUSIONS

The retirement transition was associated with changes in physical activity and TV watching. To inform intervention development, future research is needed on the determinants of behavior change after retirement, particularly among individuals of low socioeconomic position.

[Health promotion in primary care: study based on the Paulo Freire method]

The scope of this study is to analyze the implementation of health promotion actions in the working process of the Family Health Teams of a city in the state of Santa Catarina. It involves research adopting a qualitative approach linked to the methodological benchmark of Paulo Freire, consisting of three dialectic moments: thematic investigation; encoding and decoding; critical revelation. Fifteen Culture Circles were conducted, covering five district health units, with the participation of 70 professionals. Each meeting was scheduled to last two hours with an average attendance of thirteen participants of the Family Health teams. The research revealed that there are limitations to the implementation of health promotion as a key element of participatory action together with the community. It also highlighted the importance of interdisciplinarity and intersectorality between workers and the city, state and federal manager. The commitment to the principles of the Unified Health System (SUS) and health promotion also presents itself as a challenge to improve the quality of life of the population.

Interventions to promote or maintain physical activity during and after the transition to retirement: an evidence synthesis

Background

It has been argued that transition points in life, such as the approach towards and early years of retirement, present key opportunities for interventions to improve the health of the population. Interventions that may change or preserve activity levels around the time of retirement have the potential to provide benefits in terms of increased health and well-being for people in later life. Research has highlighted health inequalities in health statuses in the retired population and in response to interventions.

Objective

We aimed to conduct a systematic review and meta-synthesis of the types and effectiveness of interventions to increase physical activity among people around the time of retirement. We also aimed to identify factors that may underpin the effectiveness or acceptability of interventions, and how issues of health inequalities may be addressed.

Data sources

The following electronic databases were searched: (1) MEDLINE; (2) Applied Social Sciences Index and Abstracts; (3) The Cochrane Library (including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database); (4) Cumulative Index to Nursing and Allied Health Literature; (5) Science Citation Index; (6) Social Science Citation Index; (7) PsycINFO; (8) Evidence for Policy and Practice Information and Co-ordinating Centre; (9) SPORTDiscus; (10) Social Policy and Practice; (11) Health Management Information Consortium; and (12) Sociological Abstracts. We also searched for grey literature, checked reference lists of included papers and screened other reviews.

Review methods

A systematic review of quantitative and qualitative literature was carried out between February 2014 and April 2015. The searches aimed to identify, first, evidence of effectiveness of interventions for older adults at the point of transition to retirement and, second, data relating to perceptions of barriers and facilitators to intervention effectiveness. A meta-synthesis of the two types of evidence was also carried out to provide further interpretation of the review findings.

Results

A systematic search of the literature identified a large number of potentially relevant studies. Of these, 103 studies examining the effectiveness of interventions and 55 qualitative papers met the criteria for inclusion. A review of the effectiveness literature indicated a dearth of studies that investigate interventions that specifically examine the transition to retirement. More general studies in older adults indicated that a range of interventions might be effective for people around retirement age. The qualitative literature indicated the importance of considering the appeal and enjoyment, and social aspects, of interventions. Although there were a range of different measures in use, many were self-reported and few studies included an evaluation of sedentary time. A meta-synthesis across the data types indicated that elements reported as significant by participants did not always feature in the interventions.

Limitations

Owing to the lack of evidence relating to the retirement transition, we examined the literature relating to older adults. The applicability of these data to people around retirement age may need consideration.

Conclusions

Although the retirement transition is considered a significant point of life change, only a small volume of literature has reported interventions specifically in this period. The included literature suggests that interventions should take account of views and preferences of the target population and evaluate effectiveness by measuring meaningful outcomes and using a control group design.

Study registration

This study is registered as PROSPERO CRD42014007446.

Funding

The National Institute for Health Research Public Health Research programme.

Promoting and maintaining physical activity in the transition to retirement: a systematic review of interventions for adults around retirement age

It has been argued that transition points in life, such as the approach towards, and early years of retirement present key opportunities for interventions to improve the health of the population. Research has also highlighted inequalities in health status in the retired population and in response to interventions which should be addressed. We aimed to conduct a systematic review to synthesise international evidence on the types and effectiveness of interventions to increase physical activity among people around the time of retirement. A systematic review of literature was carried out between February 2014 and April 2015. Searches were not limited by language or location, but were restricted by date to studies published from 1990 onwards. Methods for identification of relevant studies included electronic database searching, reference list checking, and citation searching. Systematic search of the literature identified 104 papers which described study populations as being older adults. However, we found only one paper which specifically referred to their participants as being around the time of retirement. The intervention approaches for older adults encompassed: training of health care professionals; counselling and advice giving; group sessions; individual training sessions; in-home exercise programmes; in-home computer-delivered programmes; in-home telephone support; in-home diet and exercise programmes; and community-wide initiatives. The majority of papers reported some intervention effect, with evidence of positive outcomes for all types of programmes. A wide range of different measures were used to evaluate effectiveness, many were self-reported and few studies included evaluation of sedentary time. While the retirement transition is considered a significant point of life change, little research has been conducted to assess whether physical activity interventions at this time may be effective in promoting or maintaining activity, or reducing health inequalities. We were unable to find any evidence that the transition to retirement period was, or was not a significant point for intervention. Studies in older adults more generally indicated that a range of interventions might be effective for people around retirement age.

Possible Selves and Physical Activity in Retirees: The Mediating Role of Identity

Many retirees remain insufficiently physically active for health benefits. Self-perceptions can influence physical activity. Possible selves and identity are two self-perceptions that, when examined relative to physical activity, may help explain physical activity levels among retirees. Scholars claim that a focus on possible selves may impact identity, which, in the physical activity domain, is a known physical activity correlate. The aim of this study was to examine the relationship between these variables, and more specifically, to determine whether exercise identity mediates the relationship between physical activity possible selves and physical activity. We examined the proposed mediation relationship in 531 new retirees. Data were collected across three time points (1 month apart). We conducted mediation analyses with bootstrapping. Identity mediated the relationship between possible selves (content and processes) and behavior-all related to physical activity. These findings represent an important first step toward designing relevant physical activity interventions for retirees.

An intervention to support professional driver retirement transition: Results of a pilot study for older taxi drivers in Singapore

Introduction

Older taxi drivers in Singapore face mandatory retirement at 73 years of age, often marked by the simultaneous loss of the worker and driver roles. The Driver Retirement Program was developed as an intervention to support this transition.

Method

A pre- and post-experimental design was conducted with retired 73-year-old, male taxi drivers ( n = 15) to investigate the hypotheses: (i) the Driver Retirement Program would increase activity participation (e.g. time use) and wellbeing (e.g. mood) outcomes at immediate post-intervention and (ii) maintain these changes at 3 months’ follow-up. Non-parametric tests were used to compare changes between (i) pre- and post-intervention and (ii) 3 months follow-up to post-intervention. Participants’ feedback on the Driver Retirement Program was obtained using a semi-structured questionnaire.

Results

The Driver Retirement Program significantly improved mood, self-efficacy and satisfaction with individualised goals at post-intervention and maintained these changes at 3 months’ follow-up. A significant decrease in time spent alone was found at follow-up compared with post-intervention. Participants rated high satisfaction with the Driver Retirement Program but also recommended a shorter programme without compulsory group sessions.

Conclusion

The Driver Retirement Program was useful to support some aspects of work and driver retirement transition. Further work to enhance sensitivity to cultural and gender issues is indicated.

Association of behaviour change techniques with effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

There is a need for development of more effective interventions to achieve healthy eating, enhance healthy ageing, and to reduce the risk of age-related diseases. The aim of this study was to identify the behaviour change techniques (BCTs) used in complex dietary behaviour change interventions and to explore the association between BCTs utilised and intervention effectiveness.

METHODS

We undertook a secondary analysis of data from a previous systematic review with meta-analysis of the effectiveness of dietary interventions among people of retirement age. BCTs were identified using the reliable CALO-RE taxonomy in studies reporting fruit and vegetable (F and V) consumption as outcomes. The mean difference in F and V intake between active and control arms was compared between studies in which the BCTs were identified versus those not using the BCTs. Random-effects meta-regression models were used to assess the association of interventions BCTs with F and V intakes.

RESULTS

Twenty-eight of the 40 BCTs listed in the CALO-RE taxonomy were identified in the 22 papers reviewed. Studies using the techniques 'barrier identification/problem solving' (93 g, 95% confidence interval (CI) 48 to 137 greater F and V intake), 'plan social support/social change' (78 g, 95%CI 24 to 132 greater F and V intake), 'goal setting (outcome)' (55 g 95%CI 7 to 103 greater F and V intake), 'use of follow-up prompts' (66 g, 95%CI 10 to 123 greater F and V intake) and 'provide feedback on performance' (39 g, 95%CI -2 to 81 greater F and V intake) were associated with greater effects of interventions on F and V consumption compared with studies not using these BCTs. The number of BCTs per study ranged from 2 to 16 (median = 6). Meta-regression showed that one additional BCT led to 8.3 g (95%CI 0.006 to 16.6 g) increase in F and V intake.

CONCLUSIONS

Overall, this study has identified BCTs associated with effectiveness suggesting that these might be active ingredients of dietary interventions which will be effective in increasing F and V intake in older adults. For interventions targeting those in the peri-retirement age group, 'barrier identification/problem solving' and 'plan for social support/social change' may be particularly useful in increasing the effectiveness of dietary interventions.

Association of Mediterranean diet and other health behaviours with barriers to healthy eating and perceived health among British adults of retirement age

OBJECTIVES

Health behaviours including diet, smoking, alcohol consumption, and physical activity, predict health risks at the population level. We explored health behaviours, barriers to healthy eating and self-rated health among individuals of retirement age. Study design 82 men and 124 women participated in an observational, cross-sectional online survey. Main outcome measures A 14-item Mediterranean diet score (MDPS), perceived barriers to healthy eating (PBHE), self-reported smoking, physical activity habits, and current and prior perceived health status (PHS) were assessed. A health behaviours score (HBS) including smoking, physical activity, body mass index (BMI) and MDPS was created to evaluate associations with PHS. Two-step cluster analysis identified natural groups based on PBHE. Analysis of variance was used to evaluate between group comparisons.

RESULTS

PBHE number was associated with BMI (r=0.28, P<0.001), age (r=-0.19; P=0.006), and MDPS (r=-0.31; P<0.001). PHBE cluster analysis produced three clusters. Cluster-1 members (busy lifestyle) were significantly younger (57 years), more overweight (28kg/m(2)), scored lower on MDPS (4.7) and reported more PBHE (7). Cluster-3 members (no characteristic PBHE) were leaner (25kg/m(2)), reported the lowest number of PBHE (2), and scored higher on HBS (2.7) and MDPS (6.2). Those in PHS categories, bad/fair, good, and very good, reported mean HBS of 2.0, 2.4 and 3.0, respectively (P<0.001). Compared with the previous year, no significant associations between PHS and HBS were observed.

CONCLUSIONS

PBHE clusters were associated with BMI, MDPS and PHS and could be a useful tool to tailor interventions for those of peri-retirement age.

Working experiences of Iranian retired nurses: a content analysis study

Understanding the experiences of retired nurses can be useful in increasing self-confidence, motivation to work and work enthusiasm among nurses. The purpose of this study was to explore the work experiences of Iranian retired nurses. A qualitative design was conducted using a content analysis approach. Purposive sampling was used to choose the study participants. Semi-structured interviews were held to collect the perspectives of 20 retired nurses (10 female and 10 male). Two main themes emerged in the data analysis: 'work problems and unpleasant experiences in a sense' with subthemes 'exhausting work', 'insufficient salary', 'inappropriate relation' and 'unsuitable social position'; and 'job satisfaction and pleasant experiences in a sense' with subthemes 'divine satisfaction and religious belief', 'satisfaction of patients and their companions' and 'love of nursing profession and relaxation experience'. The findings indicate the challenges that nurses face after retirement. These experiences will help nurse managers to adopt appropriate measures to support nurses after retirement.

Wellness in older adults: a concept analysis

PURPOSE

The purpose of this analysis is to examine the concept of wellness within the context of older adulthood. Identifying characteristics of wellness will clarify and develop conceptual strengths and limitations, providing a step toward evaluating its relevance in older adults and increasing utility in geriatric nursing.

ORGANIZING FRAMEWORK

Rodger's evolutionary perspective.

METHODS

Computer and manual searches were conducted of articles in the English language from 1950 to 2010, addressing wellness across the life span or among older adult populations. An inductive analysis of articles produced descriptive themes.

FINDINGS

A historical time line traced the evolution of the wellness concept and its operationalization. Wellness has evolved from a little used concept to one commonly applied across many industries. Antecedents, attributes, and consequences of wellness are described. Concepts related to wellness are also identified.

CONCLUSIONS

This concept analysis adds clarity to wellness in older adults. The state of wellness development as a concept in geriatric nursing is moving from conceptualization to use and testing in nursing theory and interventions. Increased knowledge of wellness will enable geriatric nurses to discover the strengths of older adults thereby promoting their ongoing growth and development while simultaneously guiding care for their changing and diverse health.

The health of Australian baby boomers

The large baby boomer cohort is beginning to reach retirement age. This paper reviews recent Australian literature on baby boomers' health and health behaviours. Databases were searched for peer-reviewed literature and the Internet for online studies and reports. The boomers can expect an increased life span compared to those in later life now. Boomers' health behavioural risks include physical inactivity, low vegetable consumption, obesity and rising medical risk due to increasing prevalence of diabetes. Their health will impact on workforce participation and retirement timing. There is substantial scope for health improvement and consequent quality of life as boomers age. However, little is known about health decision-making, inequalities between social groups and health information sources. Future research can yield a better understanding of the health trajectories of baby boomers in order to plan for health and service needs for an ageing Australia.

The shaping of midlife women's views of health and health behaviors

The menopausal transition is a marker of aging for women and a time when health professionals urge women to prevent disease. In this research we adopted a constructivist, inductive approach in exploring how and why midlife women think about health in general, about being healthy, and about factors that influence engaging in healthy behaviors. The sample constituted 23 women who had participated in a women's wellness program intervention trial and subsequent interviews. The women described lives of healthy eating and exercise, yet, their perceptions of health and healthy behavior at midlife contradicted that history. Midlife was associated with risk and guilt at not doing enough to be healthy. Health professionals provided a very limited frame within which to judge what is healthy. Mostly this was left up to individual women. Those who were successful framed health as "being able to do what you want to do when you want to do it." In this article we present study findings of how meanings attached to health and being healthy were constructed through social expectations, family relationships, and life experiences.