Retirement on grounds of ill health: cross sectional survey in six organisations in United Kingdom

Constructing better health and wellbeing? Understanding structural constraints on promoting health and wellbeing in the UK construction industry

Purpose

The construction industry has high rates of work-related ill health. Whilst there have been more recent calls for a “health like safety” narrative within the industry, health has still predominantly been viewed via health risks rather than a more holistic conceptualisation of health and well-being. The workplace is viewed as a fruitful site for health promotion work, yet we know little about the possibilities and promise of health promotion within the construction industry. The paper aims to discuss these issues.

Design/methodology/approach

This paper explores the views of stakeholders with health-related roles and responsibilities within the UK construction industry. From the 21 semi-structured qualitative interviews, thematic analysis was conducted and two key themes emerged: the construction industry as anti-health promoting and understanding industry-specific health issues.

Findings

The construction industry faces significant constraint in attempting to promote better health and well-being due to its makeup, yet the health and well-being issues of the industry notably stress, and early retirement are major issues for both the industry and individuals.

Practical implications

The authors argue that only through understanding the structural constraints of the industry in this way can the possibilities and potentials for undertaking health promotion work be fully embedded within the industry in order to help create meaningful change for both employees and the industry as a whole.

Originality/value

This paper offers insight into the challenges that exist within construction for promoting positive employee health and well-being and takes an in-depth approach to exploring why health promotion may not be occurring within the industry.

Variations in the risk of disability pension in Norway 1970 - 99

Aims: A study was undertaken to investigate whether cohort or period effects could explain the varying and generally increasing incidence of disability pension in Norway between 1970 and 1999. Methods: The study used data from a complete national register of new disability cases in Norway, including all cases of disability pension in the 16 - 60 age group categorized according to age and gender for each year from 1970 to 1999. The population at risk was defined for each year from census data and number of individuals already receiving disability pension. Data were organized in five-year age groups, five-year time periods and corresponding overlapping nine-year birth cohorts. Age- and gender-specific rates were displayed graphically for periods and cohorts. Separate Poisson regression models were fitted for age periods and age cohorts. Finally a combined age, period, and cohort model was applied. Results: The overall incidence was 7.4/1,000 non-disabled persons per year for women and 6.0/1,000 for men. For women 52.1% of the cases were in the 51 - 60 age group, whereas the corresponding figure for men was 57.6%. Statistical analysis showed an increasing trend for both genders, more pronounced for women than men. All time periods deviated significantly from the trend, either upwards or downwards. Age-cohort models showed less variation, but recent cohorts had higher than expected rates, especially for men. Conclusions: Further studies should investigate why Norwegian women were more affected by the period effects than men. An increasing incidence of disability pension among recent cohorts is a major challenge for the Norwegian welfare system.

Ageing, musculoskeletal health and work

Changing demographics mean that many patients with soft tissue rheumatism, osteoarthritis, inflammatory arthritis, large joint prostheses and age-related co-morbidities are seeking to work beyond the traditional retirement age. In this chapter, we review the evidence on musculoskeletal health and work at older ages. We conclude that musculoskeletal problems are common in older workers and have a substantial impact on their work capacity. Factors that influence their job retention are described, together with approaches that may extend working life. Many gaps in evidence were found, notably on the health risks and benefits of continued work in affected patients and on which interventions work best. The roles of physicians and managers are also considered.

Mortality in relation to disability pension: findings from a 12-year prospective population-based cohort study in Sweden

AIMS

Knowledge is limited regarding the association between disability pension (DP) and mortality. The aim of this study was to examine the relative risk (RR) of mortality associated with DP among women and men of different ages over a 12-year period, for DP in general, and for full-time DP, part-time DP, and DP for labour-market reasons, respectively.

METHODS

A prospective cohort study was performed covering the total population of the Swedish county of Ostergötland aged 16-64 years in December 1984 (n = 245,704) followed up from 1985 to 1996. The RR of mortality was analysed in relation to DP, age, and gender using a Cox proportional hazards model.

RESULTS

The RR of mortality was higher for DP recipients than for individuals without DP, and this was true for both women (RR 2.79, 95% confidence interval (CI) 2.63 to 2.96) and men (RR 2.97, CI 2.83 to 3.11), and for all age groups. The RR of mortality was highest among the youngest DP recipients. The RR of mortality was especially high the first year of DP and remained elevated over the whole follow-up period. The RR of mortality among part-time DP recipients was lower than among full-time DP recipients and was significantly higher than seen for non-DP recipients. Individuals granted DP for labour-market reasons exhibited much lower RR of mortality than all other DP recipients.

CONCLUSIONS

Further research is needed to investigate which factors explain the very high RR of mortality among disability pensioners.

Return to work after ill-health retirement in Scottish NHS staff and teachers

BACKGROUND

Most major public and private sector pension schemes have provision for ill-health retirement (IHR) for those who become too ill to continue to work before their normal retirement age.

AIM

To compare the causes, process and outcomes of IHR in teachers and National Health Service (NHS) staff in Scotland.

METHODS

A total of 537 teachers and 863 NHS staff who retired due to ill-health between April 1998 and March 2000 were mailed an IHR questionnaire by the Scottish Public Pensions Agency.

RESULTS

The response rate for teachers was 53% and for NHS staff 49%. The most common cause of IHR was musculoskeletal disorders for NHS staff and mental disorders for teachers. Teachers retired at a younger average age than NHS staff. Ninety-two per cent of NHS staff but only 11% of teachers attended occupational health services (OHS) prior to IHR. Eighteen per cent of NHS staff and 9% of teachers were offered part-time work by their current employer in response to their ill-health. Fifteen per cent of NHS staff and 5% of teachers were offered alternative work prior to retirement. Seventeen per cent of NHS staff and 36% of teachers subsequently found employment. Multiple logistic regression analyses showed the following variables as independent predictors of subsequent employment: occupational group, age group, sex, managerial responsibility and cause of IHR.

CONCLUSIONS

Return to work after IHR suggests that some IHR could be avoided. Teachers had a higher rate of return to work and much less access to OHS.

Ill health retirement in Scottish teachers: process, outcomes and re-employment

OBJECTIVES

To assess the process, causes and outcomes of ill health retirement (IHR) in teachers in Scotland. Perceptions and experience of occupational health services (OHS), access to rehabilitation and redeployment, current health, post retirement experience and predictors of re-employment were identified.

METHODS

537 teachers who retired due to ill health between April 1998 and March 2000 were mailed our IHR questionnaire by the Scottish Public Pensions Agency.

RESULTS

The most common cause of IHR was mental disorders (37%), followed by diseases of the musculoskeletal system (18%). 11% of teachers attended an OHS prior to IHR. 9% of teachers were offered part-time work and 5% were offered alternative work. 63% of retired teachers stated their health had improved and 48% said they would like to work again. 36% of the surveyed teachers have found re-employment since their retirement. On unadjusted analyses, re-employment of teachers after IHR was significantly associated with sex, having dependants, job group, cause of IHR, health having improved and wanting to work again. Multiple logistic regression analyses showed three variables as independent predictors of re-employment: having dependants, job group and cause of IHR.

CONCLUSION

This is the first comprehensive study investigating teachers' experiences of IHR in Scotland. The findings highlight substantial lack of support for teachers in a number of areas which need to be addressed by managers and employers. Our study confirms the need for rehabilitation and teacher support services in order to try and retain experienced teachers in the profession.

Organisational downsizing as a predictor of disability pension: the 10-town prospective cohort study

OBJECTIVE

To examine whether downsizing, the reduction of personnel in organisations, is a predictor of increased risk of disability retirement among employees who kept their jobs.

DESIGN

Prospective cohort study. Based on reductions of personnel in participants' occupation and workplace, employees were grouped into exposure categories of no downsizing (less than 8% reduction), minor downsizing (reduction between 8% and 18%), and major downsizing (more than 18% reduction). They were followed up for a five year period after downsizing.

SETTING

Four towns in Finland.

PARTICIPANTS

19 273 municipal employees, aged 21-54 years.

MAIN OUTCOME MEASURES

All permanent full disability pensions granted because of medical reasons below 55 years of age between 1 January 1994 and 31 December 1998 from the national registers.

RESULTS

In all, 223 employees were granted a permanent disability pension. The overall rate for disability pensions per 1000 employees was 7.7 after no downsizing, 13.1 after minor downsizing, and 14.9 after major downsizing. Cox proportional hazard models adjusted for age, sex, occupational status, type of employment contract, and town showed 1.81 (95% confidence intervals 1.22 to 2.70) times higher risk of disability retirement after major downsizing than after no downsizing.

CONCLUSIONS

The immediate financial advantages of downsizing need to be considered in relation to increased occupational disability and the resulting extra costs to employers and society.

Swedish Council on Technology Assessment in Health Care (SBU). Chapter 5. Risk factors for sick leave - general studies

Extensive information is available from official statistics and descriptive studies on the association between different socio-demographic background factors and sickness absence. This information addresses age, gender, place of residence, and socio-economic status. However, few studies have thoroughly analysed these background factors, and rigorous scientific evidence on the causal relationship between these factors and sick leave is lacking. Regarding the family, we found no scientific evidence that marital status or children living at home were associated with sickness absence. However, we found limited scientific evidence for an effect of divorce. Regarding work-related factors, we found limited scientific evidence for an effect of physically stressful work, and moderate scientific evidence for low psychological control over the work situation. We found limited scientific evidence for a correlation in time between unemployment and sickness absence, but insufficient scientific evidence for the causes of the association. There was moderate scientific evidence that the amount of sickness absence is influenced by the design of the social insurance system, but insufficient evidence on the magnitude of change required to influence the level of sickness absence. Essentially the same results apply to disability pension, although the number of studies is small. However, we found moderate scientific evidence for the effects of socio-economic status, which could be explained partly by childhood experiences.

The mental health of early retirees-- national interview survey in Britain

BACKGROUND

There is intense political interest in retaining older workers in the workforce, to fund lengthening retirements. While health is important in early exit from work, the health of early retirees has been little studied.

OBJECTIVE

The aim of this study was to compare the health status of economically active 50- to 64-year-olds with economically inactive former workers (termed early retirees).

METHODS

A total of 1,875 respondents to the 2000 Psychiatric Morbidity Survey of Great Britain were included in the analysis. Current common mental (neurotic) disorder presence was based on the revised Clinical Interview Schedule (CIS-R).

RESULTS

Results In all, 71.2% of men and 66.4% of women early retirees reported having a long-standing illness. Of early retired men, 22.2% have a common mental disorder compared to 8.2% of those still in work (p value of difference<0.001). In contrast, the respective figures for women were 18.2% and 16.9%. In fully adjusted regression models for men, early retirees were more likely to have generalised anxiety disorders (OR 3.1: 95% CI: 1.2-7.8) and depressive disorders (OR 4.3: 95% CI: 1.7-11.0).

CONCLUSION

There is a substantial burden of specific mental health disorders in early retiree men. Understanding the mechanisms of this excess of mental disorders in early retiree men may be a prerequisite to increasing the numbers seeking or staying in work up to age 65.

Disability in society-medical and non-medical determinants for disability pension in a Norwegian total county population study

The objective of this study was to describe sociomedical determinants and developments for the medically based disability pension in Norway by linking individual based data from a county health survey to data on disability from the National Insurance Administration. Two cross-sectional total population health surveys with an approximate 10-year interval were conducted in Nord-Trøndelag county, HUNT I (1984-86) and HUNT II (1995-97), which allows for analyses of changes over time, supplied with official incidence data on disability pension. The large-scale variations and overall increasing incidence rates of disability pension in Norway during the last 20 years also applied to the county of Nord-Trøndelag. The prevalence of disability pension generally increased in the population from the mid-1980s to the mid-1990s. A striking finding was a consistent pattern of increasing prevalence of disability pension with decreasing socio-economic status and education. A geographic pattern for disability pension prevalence on a municipality level suggested that structural and cultural factors were important in determining the level of disability in society. Medical determinants alone cannot explain either the dramatic variations or the overall increased incidence rates of disability pension in the last two decades in Norway. The results demonstrate the importance of social, non-medical and contextual determinants for disability pension, how these determinants result in important prevalence differences by socio-economic status, and their impact on the level of disability in society.

Sickness absence and early retirement on health grounds in the construction industry in Ireland

OBJECTIVE

To establish a detailed pattern of the nature and extent of illnesses and injuries among construction workers in Ireland which cause temporary absence from work, and to identify diseases and disabilities which lead to premature retirement from the industry on health grounds.

METHODS

The population base for the study consisted of construction workers who were members of the Construction Federation operatives pension and sick pay scheme. Records of sickness absence since 1981, stored on computer disks, and records of early retirement on health grounds since 1972, stored on microfiche film, were examined. Pertinent data were extracted and transferred to a database; after cleaning and the exclusion of unvalidated data, records of 28 792 absences and 3098 records of early retirement were available for analysis. Data were analysed with Access 97 and Epi Info.

RESULTS

Over the period of the study the mean annual absences were 7.8/100 workers. Three quarters of absences were among younger workers; however, the rate of absence increased with age, as did the mean duration of absence. Injury was the most frequent reason for absence, followed by infectious disease, then musculoskeletal disorders. The mean annual rate of early retirement on health grounds was 5.3/1000 workers. The median age at retirement was 58 years. Cardiovascular disease and musculoskeletal disorders each accounted for nearly one third of the conditions leading to permanent disability on the grounds of which early retirement was granted. During the period of the study, over 677 000 working days were lost due to sickness absence, and over 24 000 potential years of working lives were lost due to early retirement on health grounds.

CONCLUSIONS

The study has shown patterns of sickness absence and early retirement on health grounds in the Irish construction industry which will contribute to the further development of health promotion strategies for construction workers.