research brief series : 5 - duke–nus medical school...research brief series 5 3the transition to...

Research Brief Series 5 19

Research BriefSeries : 5

To Work or Not to Work -Retirement and

Health Among Older Singaporeans


To Work or Not to Work - Retirement and Health Among Older SingaporeansGrand H.L. Cheng and Angelique Chan

Key Findings:

• Oversixyears(fromyear2009to2015),40%ofthestudied

olderemployeesbecameretireeswhereas60%remained

intheworkforce.

• Comparedwiththoseremaining intheworkforce, retired

olderadults felt lonelier,hadmoredepressedmoodand

exhibitedpoorercognitivefunction.

• Inaddition,retireesreportedhavingmorechronicdiseases,

limitationsinactivitiesofdailyliving(ADL)andinstrumental

activitiesofdailyliving(IADL).

• Overall, retirees reported a significant deterioration in

healthovertime.

CAREResearchAreas:HealthyAgeing

RetirementAgeinginPlace

CaregivingIntergenerational

SolidarityNeurocognitive/ SensoryDisorders

CAREresearchbriefs presentpolicy-oriented summariesofpublished

peerrevieweddocuments orabodyofpublished

workandwork inprogress.

GeneralEditorNormalaManap

©CAREAugust2018

2 Research Brief Series 5

Introduction

Theworld’spopulationisageingatanunprecedentedrate.InAsia,Singaporeisoneof

thefastestageingsocieties(Figure1).InorderforSingaporeanstoagesuccessfully,we

needtounderstandtheeffectsofvarious lifecoursetransitionsonthepopulation.This

informationcanbeusedtoguidepolicy-makingthatfacilitatessuccessfuladaptationsto

ageinginarapidlychangingsocio-economicenvironment.

Populationageinghasnumeroussocialandeconomicconsequences.Oneof themajor

consequences is thechange in theproportionof time individualsspend inworkand in

retirement.WhiletheproportionofolderSingaporeans,aged60andaboveinthelabour

force is rising (e.g. from5.5%in2006to12%in2015 [1]), theywillalsospenda larger

proportionof their time in retirement as their overall lifespan increases.At the current

minimumretirementageof62andtheaveragelifeexpectancyof84yearsold,anolder

Singaporeancouldexpect tospend22years in retirement.Assuch, researchon issues

associatedwithretirement,includingitsimpactonhealthandwell-being,isimperativefor

proactivenationalplanning.

Figure 1: Percentageofpopulationaged60+inAsia

Source: TheUnitedNationsDepartmentofEconomicandSocialAffairs(2010)[2]

Figure 1: Percentage of population aged 60+ in Asia

0

5

10

15

20

25

30

35

40

45

ChinaJapanMalaysiaR. of KoreaSingapore


Thetransitiontoretirementcanbeastressfullifeeventandmayleadtonegativehealth

consequences [3].Oneof themain reasons for this is thedisruptionofone’ssocial ties

upon retirement. Engagement in social relationships is a fundamental human need [4]

and itsdeprivation isdetrimental toone’swell-being [5].A largebodyof researchhas

documentedpoorsocialrelationshipsasariskfactorforcomorbidity[6;7].Socialisolation

isalsoassociatedwithhigherprevalenceof limitations inactivitiesofdaily living (ADL)

[8].Workplaces offer various opportunities for individuals to socialise and interactwith

colleagues,businesspartnersandcustomers.Afterretirement,individualsaremorelikely

to have fewer social ties and experience loneliness, and hence develop poor health

conditions.Whetheranolderpersoncancopewiththechallengesthatcanariseasaresult

ofretirementisdependentontheindividual’spersonalresilience.Itisalsocontingenton

contextualfactorssuchasculture,policiesandthehealthcaresystem[9].

Inthisbrief,utilisinglongitudinaldatafromanationallyrepresentativesample(n=4990)

ofolderSingaporeans(≥60years),weaddresstheimpactofretirementversusremaining

intheworkforceontheirwell-being.Thisstudyextendspriorlocalresearch[10]inthree

aspects.First,ourdataspansa relatively longperiodof time (sixyears),whichprovides

strong evidence for temporally causal relationships. Second, we include a wide range

of health variables. Third, we study the significance of change in employment status.

Specifically, we focus onworking older adults at baseline, who either remained in the

workforceorbecameretireessixyearslater,andlookathowtheirhealthconditionsvary

asaresultofachangeintheiremploymentstatus.

OuranalysisshowedthatretirementhasanimpactonthehealthofolderSingaporeans.

Thefindingsindicatethatretireesdevelopedpoorerpsychological,physicalandfunctional

healthovertimecomparedwithindividualswhoremainedintheworkforce,thussuggesting

thattherearemajorbenefitstocontinuedemploymentinoldage.


Method

Data for the study isdrawn from thePanelonHealthandAgeingamongSingaporean

Elderly(PHASE)-alongitudinal,nationalsurveytrackingthephysical,socialandmental

conditionsofcommunity-dwellingolderadultsinSingaporeovertime.AtPHASEWave1

(2009),asingle-stagestratified(byage,genderandethnicity)randomsamplingmethod

was adopted to recruit participants (≥ 60 years), and4990 survey interviews (including

proxy interviews)were conducted.AtPHASEWave2 (2011), 3103 follow-up interviews

wereconducted.Atotalof1764follow-upinterviewswereconductedforPHASEWave3

in2015,sixyearsafterWave1.

Forourpurposes,weutilisePHASEWave1andWave3datacomprisingatotalof1417

olderadultswhoprovideddirectresponses(i.e.,notthroughproxies).Amongthem,347

olderadultswereemployeesatWave1andtheyservedasthecurrentstudysample.At

Wave3,209 (60.2%) individuals from the sample remained in theworkforcewhilst138

(39.8%)of thembecame retirees.Overall,workingolder adults and retirees atWave3

hadsimilarbaselinedemographiccharacteristics.Onaverage,bothgroupswereover65

yearsold(65.2vs.67.6).Inbothgroups,themajoritywasmale(65.1%vs.60.1%),Chinese

(71.3%vs.73.9%),hadreceivedprimaryorsecondaryeducation(76.0%vs.71.7%),lived

in≥4roompublicorprivatehousing(66.0%vs.63.8%),married(78.0%vs.79.0%)and

livedwithsomeone(94.3%vs.96.4%).

Weconductedwithin-subjectsANOVAandsimpleeffectanalysistoexaminetheimpact

of retirement versus remaining in the workforce on health on the 347 sampled older

Singaporeans.Atotalofsevenhealth-relatedoutcomevariableswereassessednamely:

Psychological Health

i) Loneliness (score range = 0 to 12) [11].

ii) Depressive symptoms (score range = 0 to 22) [12].

iii) Cognitive function (score range = 0 to 10) [13].


Physical Health

iv) The number of 10 chronic diseases such as heart attack, cerebrovascular disease

and high blood pressure.

Functional Health

v) Number of limitations in the six activities of daily living (ADL) (e.g., taking a bath,

dressing up).

vi) Number of limitations in the seven instrumental activities of daily living (IADL)

(e.g., preparing own meals, taking public transport to leave home).

Overall Health

vii) Overall self-rated health (score range = 1 to 5).

Higher scores indicate higher levels of a particular construct.

Seven baseline demographic characteristics, namely age, gender, ethnicity, education

level, housing type [as a proxy of household income, in addition to education level],

maritalstatusandlivingarrangementwereincludedascovariatesforstatisticaladjustment

intheanalysis.

Asaruleofthumb,p-values<.05and<.10indicatesignificantandmarginallysignificant

findingsrespectively.


Impact of Retirement versus Remaining in the Workforce on Health-related Outcomes

Loneliness

AsillustratedinFigure2,retireesreportedincreasedlonelinessovertime(p<.001).Older

adults remaining in theworkforcealsoreported increased lonelinessover timebut toa

smallerextent(marginallysignificantatp=.060).AtWave3,higher levels of loneliness

were observed among retirees(p=.030).

Figure 2: Impactofretirementversusremainingintheworkforceonloneliness

Source: PanelonHealthandAgeingamongSingaporeanElderly(Waves1&3;n=347)Note: All individuals were employees at Wave 1. Means after adjustment with covariates are shown.

Figure 2: Impact of retirement versus remaining in the workforce on loneliness

1.431.93

1.26

2.76

1

1.5

2

2.5

3

3.5

4

4.5

5

Wave 1 Wave 3

Loneliness

still working at Wave 3 not working (retired) at Wave 3


Depressive symptoms

Figure 3 illustrates the findings on depressive symptoms. There was a reduction in

depressive symptoms among older Singaporeans who remained in the workforce

(marginally significant at p = .056) over the study period. A difference in depressive

symptoms between the two groups was observed atWave 1 (marginally significant at

p=.086).AstrongerdifferencewasobservedatWave3(p=.008).AtbothWave1and

Wave3,retirees reported more severe depressive symptoms.

Figure 3: Impactofretirementversusremainingintheworkforceondepressive symptoms


Figure 3: Impact of retirement versus remaining in the workforce on depressive symptoms

2.692.25

3.23.01

1

1.5

2

2.5

3

3.5

4

4.5

5

Wave 1 Wave 3

Depressive symptoms


Depressive symptoms

Figure 3 illustrates the findings on depressive symptoms. There was a reduction in depressive symptoms among older Singaporeans who remained in the workforce (marginally significant at p = .056) over the study period. A difference in depressive symptoms between the two groups was observed at Wave 1 (marginally significant at p = .086). A stronger difference was observed at Wave 3 (p = .008). At both Wave 1 and Wave 3, retirees reported more severe depressive symptoms.

Figure 3: Impact of retirement versus remaining in the workforce on depressive symptoms

Source: Panel on Health and Ageing among Singaporean Elderly (Waves 1 & 3;n=347)

Note: All individuals were employees at Wave 1. Means after adjustment with covariates are shown.

2.692.25

3.23.01

1

1.5

2

2.5

3

3.5

4

4.5

5

Wave 1 Wave 3

Depressive symptoms



Figure 4: Impact of retirement versus remaining in the workforce on cognitive function

8.51

8.558.62

8.36

88.28.48.68.8

99.29.49.69.810

Wave 1 Wave 3

Cognitive function


Cognitive function

Overthesix-yearstudyperiod,retireesexhibitedasignificantcognitivedecline(p=.003)

(Figure4).AtWave3,retirees seemed to have poorer cognitive functionthanthosewho

werestillworking(marginallysignificantatp=.063).

Figure 4: Impactofretirementversusremainingintheworkforceoncognitive function



Figure 5: Impactof retirementversus remaining in theworkforceonchronic diseases


Chronic diseases

Bothgroupsreportedmorechronicdiseasesovertime(p<.001)(Figure5).However,the

increaseinchronicdiseaseswashigheramongretireescomparedtoworkingolderadults

(marginallysignificantatp=.066).

Limitations in activities of daily living (ADL) and limitations in instrumental activities of daily living (IADL)

TheimpactsofretirementversusremainingintheworkforceonADLandIADLlimitations

weresimilar(Figures6&7).RetireesdevelopedmoreADLandIADLlimitationsovertime

(p<.001).AtWave3,retireesreportedmoreADLandIADLlimitationsthantheirworking

counterparts(p=.006;p<.001).

Figure 5: Impact of retirement versus remaining in the workforce on chronic diseases

Chronic diseases

Figure 4: Impact of retirement versus remaining in the workforce on cognitive function

8.51

8.558.62

8.36

88.28.48.68.8

99.29.49.69.810

Wave 1 Wave 3

Cognitive function


2

1.8

1.6

1.4

1.2

1

0.8

0.6

0.4

0.2

0

0.89

0.8

1.42

1.21


Figure 6: Impact of retirement versus remaining in the workforce on the number of ADL limitations

Figure 7: Impact of retirement versus remaining in the workforce on the number of IADL limitations

0 0.01

0.01

0.2

00.10.20.30.40.50.60.70.80.9

1

Wave 1 Wave 3

ADL limitations


0.01 0.02

0.01

0.31

00.10.20.30.40.50.60.70.80.9

1

Wave 1 Wave 3

IADL limitations


Figure 6: Impactofretirementversusremainingintheworkforceonthenumber ofADLlimitations

Figure 7: Impactofretirementversusremainingintheworkforceonthenumber ofIADLlimitations





0 0.01

0.01

0.2

00.10.20.30.40.50.60.70.80.9

1

Wave 1 Wave 3

ADL limitations


0.01 0.02

0.01

0.31

00.10.20.30.40.50.60.70.80.9

1

Wave 1 Wave 3

IADL limitations




0 0.01

0.01

0.2

00.10.20.30.40.50.60.70.80.9

1

Wave 1 Wave 3

ADL limitations


0.01 0.02

0.01

0.31

00.10.20.30.40.50.60.70.80.9

1

Wave 1 Wave 3

IADL limitations








0 0.01

0.01

0.2

00.10.20.30.40.50.60.70.80.9

1

Wave 1 Wave 3

ADL limitations


0.01 0.02

0.01

0.31

00.10.20.30.40.50.60.70.80.9

1

Wave 1 Wave 3

IADL limitations



Overall self-rated health

Finally, retirees perceived a significant reduction in their overall health over six years

(p<.001)(Figure8).AtWave3,retireesalsoperceivedpooreroverallhealththantheir

workingcounterparts(p<.001).

Figure 8: Impactofretirementversusremainingintheworkforceonself-rated health


Figure 8: Impact of retirement versus remaining in the workforce on self-rated health

3.45 3.42

3.36 3.07

1

1.5

2

2.5

3

3.5

4

4.5

5

Wave 1 Wave 3

Self-rated health


Overall self-rated health

Finally, retirees perceived a significant reduction in their overall health over six years (p < .001) (Figure 8). At Wave 3, retirees also perceived poorer overall health than their working counterparts (p < .001).

Figure 8: Impact of retirement versus remaining in the workforce on self-rated health



3.45 3.42

3.36 3.07

1

1.5

2

2.5

3

3.5

4

4.5

5

Wave 1 Wave 3

Self-rated health



Discussion

UtilisinglongitudinaldatafromasampleofolderSingaporeans,welookathowretirees

differfromworkingolderadultsintermsofsevenhealthoutcomes,includingloneliness,

depressive symptoms, cognitive function, chronic diseases, ADL limitations, IADL

limitationsandself-ratedhealth.Consistentwiththeexistingretirementliterature[3],our

datashowedthatafterretirement,olderadultsfeltlonelier,hadmoredepressedmoods

and exhibited poorer cognitive function. In addition, retirees developedmore chronic

diseases, ADL limitations and IADL limitations. Overall, they perceived a significant

deteriorationinhealthovertime.Incomparison,duringthesameperiod,olderadultswho

remainedintheworkforceshowedlessextensivedeteriorationintheirhealth,regardless

ofage,gender,ethnicity,education, income(housingtypeasproxy),maritalstatusand

livingarrangement.

A possible explanation for this can bemadewith reference to the literature on social

connectionsandwell-being[14;15].Engagementinsocialrelationshipsisafundamental

humanneedwithitsdeprivationassociatedwithaslewofilleffects,includingpoorhealth

andwell-being[4].Specifically,poorsocialrelationshipshavebeendeemedasriskfactors

for comorbidity [6;7],while social isolationhasbeen found tobeassociatedwithmore

limitationsofactivitiesofdailyliving(ADL)andinstrumentalactivitiesofdailyliving(IADL)

[8]. It is plausible that the opportunities provided by work places for interactions and

socialisationswithcolleagues,businesspartners,customersandotherscontributetothe

healthandwell-beingofolderadults. Incomparison,retireeswhogenerallyhavefewer

socialtiesandfeellonelierdeveloppoorhealthconditions.


Policy and practice recommendations

Our data, together with the literature reviewed, suggest that older adults’ health and

well-beingdeclineuponretirement,possiblyasaresultoffewersocialtiesandcontacts.

Various measures can be undertaken both prior to retirement and after retirement to

mediate this decline. One strategy is to work on developing the individual’s personal

resourcesindealingwiththechangesthatretirementbringsabout.Trainingandcoaching

sessionsaimedatdevelopingtheindividual’slevelsofpersonalmastery[16],psychological

resilience[17]andcognitiveflexibility[18]canenableretireestocopebetterwithsocial

disconnectionsandmaintaintheirwell-being.

Beyond developing such personal resources, abundant opportunities can be created

to nurture the development of non-work related interests and preoccupations among

older adults, ideally prior to their retirement. Pursuing new interests and partaking in

newengagementswillexposeolderadultstonewsocialcirclesandnetworks,whichcan

bufferthelossoftheirwork-basedties.Initiativestostrengthensocialnetworksthrough

greatersocialparticipationsuchasvolunteeringorcommunity involvementcanalsobe

further enhanced. These can be organised through various existing platforms such as

thegrassrootsagencies,oranyothersocialorreligiousservices.Themorelocalisedthe

platformsandactivities,thehigherthepossibilityofattractingretirees’participation.With

over 80% of Singapore’s population living in public housing, these local activities can

be organised at the block or even floor level to facilitate participation. The Singapore

government’sNationalSeniorVolunteerismMovementthattargetstorecruitanadditional

50,000oldervolunteersisdefinitelyastepintherightdirection[19].

Finally,withtherapidageingofSingapore’spopulation, it iscriticaltohaveathorough

understandingof the issues associatedwithwork and retirement to facilitateproactive

planning.ResearchinWesterncountrieshavedemonstratedthathumanresourcepractices

inorganisations(e.g.,flexibleworkschedules,fairtreatmentregardlessofage)mayreduce

older workers’ retirement intentions [20]. These studies also pointed out that less age

discriminationintheworkplaceisassociatedwithalowerdesiretoretire[21].However,

suchrelevantlocaldataislacking.Effortstounderstandthetransitionsbetweenworkand

retirementneed tobe intensified if Singapore is toharness thepotentialsof herolder

population.OnesucheffortisthelongitudinaldatacollectionworkthatCAREhasrecently

embarkedoninrelationtowork,retirementandhealth.Otherkeyareasofresearchmust

include an understanding of the ageing worker to develop insights into factors which

impact on their job performance such as age discrimination. Local knowledge on the

organisational strategies necessary for a changing demographic landscape must also

enhancedifwearetoencourageolderworkerstoremainintheworkforce.


References

1. Toh,Y.C. (2017,January10).Olderworkerscanworkuntilage67fromJuly.The

StraitTimes.

2. The United Nations Department of Economic and Social Affairs. (2010). World

population prospects: The 2010 revision. Retrieved April 24, 2017, from

http://esa.un.org/unpd/wpp/index.htm

3. Wang,M.(Ed.).(2012).The Oxford handbook of retirement.NewYork,NY:Oxford

UniversityPress.

4. Baumeister,R.F.,&Leary,M.R.(1995).Theneedtobelong:Desireforinterpersonal

attachments as a fundamental human motivation. Psychological Bulletin, 117(3),

497-529.

5. House,J.S.,Landis,K.R.,&Umberson,D.(1988).Socialrelationshipsandhealth.

Science, 241(4865),540-545.

6. Cornwell,E.Y.,&Waite,L.J.(2009).Socialdisconnectedness,perceivedisolation,

andhealthamongolderadults.Journal of Health and Social Behavior, 50(1),31-48.

7. Coyle, C. E., & Dugan, E. (2012). Social isolation, loneliness and health among

olderadults.Journal of Aging and Health, 24(8),1346-1363.

8. Zunzunegui, M. V., Rodriguez-Laso, A., Otero, A., Pluijm, S. M. F., Nikula, S.,

Blumstein, T., Jylhä, M., Minicuci, N., & Deeg, D. J. H. (2005). Disability and

social ties: Comparative findings of the CLESA study. European Journal of

Ageing, 2(1),40-47.

9. Wang,M.,Henkens,K.,&vanSolinge,H.(2011).Retirementadjustment:Areview

oftheoreticalandempiricaladvancements.American Psychologist, 66(3),204-213.

10. Schwingel,A.,Niti,M.M.,Tang,C.,&Ng,T.P.(2009).Continuedworkemployment

and volunteerism and mental well-being of older adults: Singapore longitudinal

ageingstudies.Age and Ageing, 38(5),531-537.

11. Hughes,M.E.,Waite,L.J.,Hawkley,L.C.,&Cacioppo,J.T.(2004).Ashortscalefor

measuringlonelinessinlargesurveys.Research on Aging, 26(6),655-672.


12. Kohout, F. J., Berkman, L. F., Evans, D. A., & Cornoni-Huntley, J. (1993). Two

shorter forms of the CES-D depression symptoms index. Journal of Aging and

Health, 5(2),179-193.

13. Pfeiffer,E.(1975).AShortPortableMentalStatusQuestionnairefortheassessment

of organic brain deficit in elderly patients. Journal of the American Geriatrics

Society, 23(10),433-441.

14. Cacioppo,J.T.,&Hawkley,L.C.(2003).Socialisolationandhealth,withanemphasis

onunderlyingmechanisms.Perspectives in Biology and Medicine, 46(3),S39-S52.

15. Cacioppo, J. T., Hawkley, L. C., Crawford, L. E., Ernst, J. M., Burleson, M. H.,

Kowalewski, R. B., Malarkey, W. B., Van Cauter, E., & Berntson, G. G. (2002).

Loneliness and health: Potential mechanisms. Psychosomatic Medicine, 64(3),

407-417.

16. Pearlin,L.I.,&Schooler,C.(1978).Thestructureofcoping.Journal of Health and

Social Behavior, 19(1),2-21.

17. Smith,B.W.,Dalen,J.,Wiggins,K.,Tooley,E.,Christopher,P.,&Bernard,J.(2008).

Thebriefresiliencescale:Assessingtheabilitytobounceback.International Journal

of Behavioral Medicine, 15(3),194-200.

18. Martin,M.M., & Rubin, R. B. (1995). A newmeasure of cognitive flexibility.

Psychological Reports, 76(2),623-626.

19. SingaporeMinistryofHealth.(2016).“IfeelyounginmySingapore!”Actionplanfor

successfulageing.RetrievedAugust15,2016,from

https://www.moh.gov.sg/content/moh_web/successfulageing.html

20. Kooij,D. T.A.M., Jansen, P.G.W.,Dikkers, J. S. E.,&De Lange,A.H. (2010).

TheinfluenceofageontheassociationsbetweenHRpracticesandbothaffective

commitment and job satisfaction: A meta-analysis. Journal of Organizational

Behavior, 31(8),1111-1136.

21. Schermuly,C.C.,Deller,J.,&Busch,V.(2014).Aresearchnoteonagediscrimination

and the desire to retire: the mediating effect of psychological empowerment.

Research on Aging, 36(3),382-393.


Publisher

TheCentre forAgeingResearch andEducation (CARE) is an academic research centrebasedinDuke-NUSMedicalSchool.ItaimstoharnessthepotentialsofpopulationageingbothinSingaporeandtheregionthroughitsinterdisciplinaryexpertiseandcollaborationsacross medical, social, psychological, economics and environmental perspectives.Recognisingtheneedforaconsolidatedandlongtermapproachtowardslongevity,CAREspearheadseducationalprogrammestobuildcompetenciesinageingamongresearchers,policyandprogrammeprofessionals.CAREalsoactivelyengageswithgovernmentandindustrypartnerstomeettheneedsofpopulationageing.

CARE’svisionisanageingpopulationthatishealthy,sociallyincludedandenjoysahighqualityoflife.

CARE’smissionisto:

• Provideanenvironmentthatenablesinterdisciplinaryresearchandeducation onageing

• Implement and evaluate best practices to improve health and function of olderadults

• Informpolicyandpracticeagendaonageing


Centre for Ageing Research and Education (CARE)Duke-NUS Medical School

8CollegeRoad,Singapore169857www.duke-nus.edu.sg/care

Tel:66011131

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