Do life-course trajectories of working conditions impact on successful aging?

They say you should not ‘live to work, but work to live’. But what if work actually reduced your chances of having a good life when you are older. To investigate this issue we looked at whether the type of work people in Sweden had done over their working lives impacted on whether they were healthy and active in later life.

What is successful ageing?

Most research on ageing focuses on negative outcomes in older age, such as ill health or poor function. Whilst this is important it does tend to portray later life as one dominated by illness and disability. We wanted to take a different approach and look at what contributes to positive outcomes. Another issue with existing research is that it generally focuses on one outcome, such as poor self-rated health or chronic illness. But in reality, health and well-being are more complex than that and conditions rarely appear in isolation. Hence, we used a multidimensional model of ‘successful aging’, as proposed by Rowe and Kahn, as the focus of our study. The idea behind this model is that ‘successful ageing’ is what may be possible if people are able to reserve capacities and maintain healthy lifestyles throughout the life course. To age successfully, according to Rowe and Kahn, is to have 1) high cognitive and physical function, 2) avoid disease and disability, and to have 3) a high engagement with life, via leisure and social activities.

We looked at people’s working conditions throughout their life, from the age of 18 onwards. Where previous studies have looked at the impact of work on health in later life they have tended to focus on occupational social class, rather than working conditions, and have generally taken a rather static view of occupation by relying on a single measure, e.g. ’lifetime occupation’ or ’most recent occupation’. A unique aspect of our study is that we were able to map each respondent’s entire occupational history. This provides a much more fine-grained understanding of how lifetime working conditions might affect health in late-late life. By using a job exposure matrix, which is a description of the working condition of each type of occupation, we were able to see whether people’s jobs were intellectually stimulating, hazardous, physically demanding, and/or stressful. From this we created trajectories of working conditions across the life course, for example, someone’s first few jobs might have been physically demanding but as they aged they had less physically demanding jobs.

What did we find?

We found that high levels of intellectually stimulating work in the beginning of one’s career followed by increasingly intellectually stimulating work throughout working life were associated with higher levels of successful ageing. In contrast, people began their working lives in stressful jobs, or doing hazardous work, or with a very physically demanding workload, such as unsuitable working postures and heavy lifting, and who experienced an increase in those conditions were least likely to age successfully.

A double-win for society

Many governments are raising retirement ages to reduce economic pressures associated with population ageing. However, there are concerns that working to older ages may come at the cost of ill-health in later life, especially for workers who are exposed to poor working conditions. As retirement ages increase, the influence of work on future health could become even more important. Understanding which working conditions contribute to successful ageing is central to the design of public health policies that aim to reduce health risks over the life course. Promoting a healthy workplace, by supporting intellectually stimulating work and reducing physically demanding and hazardous work and stressful jobs, may contribute to successful ageing after retirement. Interventions early in one’s employment career could have positive, long-term effects. Taken together with existing evidence, our findings underscore the need to promote a healthy workplace to age well. This requires policy makers, employers and practitioners to not only target isolated working conditions, or isolated health outcomes in later life, but rather to take a holistic approach. Investing in healthy workplaces by implementing interventions to improve the health of workers would not only reduce societal costs during working age and promote a sustainable working life, it may also lower the cost of health and social care by improving the health of future generations of older people. Investment in healthy workplaces is a double-win for society.

Guest blog by Dr Charlotta Nilsen, Aging Research Center (ARC), Karolinska Institutet/Stockholm University, Stockholm, Sweden

Nilsen C, Darin-Mattsson A, Hyde M, Wastesson JW. Life-course trajectories of working conditions and successful ageing. Scandinavian Journal of Public Health. May 2021.

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