Because populations live longer, policies in Western countries are increasingly aimed at prolonging working lives in order
to keep the social security system affordable. For example, in The Netherlands, financially attractive early retirement options
have been discontinued and access to other exit routes, such as work disability, have been restricted. Furthermore, the official
retirement age is being increased in The Netherlands, just as in many other countries (1, 2). The Dutch Minister of Social Affairs and Employment asked the Health Council of the Netherlands for advice from a health
perspective on prolonging working lives (3).
In general, the likelihood of health problems increases with age. This applies not only to illness, but also to poor self-perceived
health, physical limitations, and decreased cognitive functioning (4, 5). In addition, older people are more likely to have multiple health problems at the same time. However, there is great diversity
within this group when it comes to health (6).
Many factors play a role in prolonging working lives, for example the ability, motivation and opportunity to work (7–9). However, considering the Minister’s question, the main focus of the advisory report is on the ‘ability’ to work, ie, the
role of health. Poor health decreases the employability of workers (10–13). For part of the 55–65-year-old workers who exit paid employment before the statutory retirement age (SRA), health plays
an important role (14). It mainly concerns people who exit paid employment via work disability, but may also involve people who exit the labor
force via unemployment or retirement before their SRA.
The aims of the full advisory report were to (i) describe the health of the ageing population, (ii) describe how prolonging
working life influences health, (iii) describe determinants – besides health – for prolonging working lives, and (iv) review
the literature on interventions aimed at retaining or improving employability of older workers. This opinion paper summarizes
the main findings and recommendations of the full advisory report (available in Dutch) that was submitted to the Dutch Minister
of Social Affairs and Employment on 26 June 2018.
The committee and its methodology
In 2016, the Health Council appointed a committee of ten scientists to address the Minister’s questions. The committee members
represented multiple disciplines, eg, occupational epidemiology, economics, sociology, human resource management, and occupational
medicine. All committee members completed a declaration regarding conflict of interest, which was published on the website
of the Health Council (www.gezondheidsraad.nl).
Because the extension of the statutory retirement age has only recently been implemented in The Netherlands and other countries,
there is virtually no research on extending working lives (ie, working in a paid job beyond the age of 65 years, the statutory
retirement age in the recent past). For that reason, four indicators of decreased employability were used as proxies in this
paper: (i) increased need for recovery, (ii) decreased work ability, (iii) increased sickness absence, and (iv) exit from
paid employment.
Different data sources and methods were used to answer the questions, ranging from descriptive data and key publications selected
by the committee to systematic literature searches in PubMed. To formulate conclusions, the committee also used expert interpretation
of the research findings.
Main findings and recommendations
Based on descriptive data, the committee concluded that currently in The Netherlands, people aged 45–75 years appeared not
to be much healthier than people in the same age range two decades ago. Life expectancy at age 65 years has increased, mainly
attributable to gained life years between 75 and 84 years of age for men and after 85 years of age for women (15, 16). Healthy life expectancy at age 65 years has also increased. However, this increase was mainly attributable to age-groups
>75 years. Despite the positive developments in predicted life expectancy at age 65 years, healthy life expectancy at age
65 years, and health at older ages (17, 18), the committee expected that these future gains will mainly be attributable to people >75 years of age and will not be pertinent
to the age range for which retirement age will be raised. However, low-educated older people generally have more health problems
and a lower life expectancy and healthy life expectancy than those with a higher educational level (19, 20).
And how does this influence work?
The committee evaluated population attributable fractions (PAF) to estimate the relative importance of health in exit from
paid employment. Based on these PAF, it was estimated that poor health played an important role in 16–27% of Dutch people
aged 55–65 years who stopped working due to unemployment (14, 21, 22). Workers who become unemployed at an older age also have a much smaller chance of finding a new job, especially when they
have health problems (9).
Prolonging working life in relation to health
Health not only has an effect on whether or not a person is able to prolong working life, but prolonging working life can
also have an effect on a person’s health (23–25). Working was found to be good for mental health during working age (23). Around the age of retirement, however, it appeared to be more beneficial for mental health to stop working, according to
prospective cohort studies (24, 25). Findings from natural experiments showed a possible decline in cognitive functioning after retirement, suggesting that
retirement may not be beneficial for cognitive health (26, 27). However, this has to be confirmed, since work characteristics, timing of retirement (early or ‘on time’), and education
level seemed to influence this association.
Determinants of prolonging working life – other than health
According to the committee, financial stimulants seem to play a crucial role in prolonging working lives (28–30). Individual factors, such as a healthy lifestyle and the motivation to work (31, 32), and organizational factors, such as decent working conditions, supportive personnel policies, and sufficient autonomy at
work, were also found to play an important role (31, 33). These factors can offer entrees for supportive interventions. Findings suggested that individual and organizational factors
that play a role in employability are quite similar for workers with and without chronic diseases (34). However, autonomy at work seems more important for workers with chronic diseases than for those without chronic diseases
(34). In addition, it has been found that low-educated people are often exposed to less favorable working conditions (35).
Interventions aimed at employability of older workers
The committee performed a literature search in PubMed for systematic reviews of randomized controlled trials (RCT) that evaluated
interventions to retain or improve the employability of older workers. The included RCT had to meet the following inclusion
criteria: (i) describe the effects on at least one of the four outcomes of interest (ie, need for recovery, work ability,
sickness absence, or exit from paid work), (ii) describe interventions for the general working population or a working population
with mild health problems or with an increased risk of health problems, and (iii) be published in English in a peer-reviewed
scientific journal. Studies were excluded if: (i) the intervention was aimed at a population already on sickness absence or
not working for other reasons, (ii) the intervention was conducted in a population with a specific disease, (iii) the intervention
was conducted in a student population, (iv) only a per-protocol analysis was available, (v) the methodology was unclear, (vi)
only the protocol/design of the RCT was described, (vii) the intervention was a pharmacotherapeutic intervention, or (viii)
the intervention took place in a clinical setting.
The search for systematic reviews was supplemented with a systematic search for RCT in PubMed published between 2012 [publication
date of the oldest included review (31)] and December 2017 (see table 1). For this search, the same inclusion and exclusion criteria applied as described above. RCT carried out in workers aged
≥40 years (“older workers”) were included.
Table 1
The following search strategy was used for aim 4:
Outcome
(“need for recovery”[All Fields] OR workability[All Fields] OR “work ability”[All Fields] OR “work functioning”[All Fields]
OR “sick leave”[MeSH Terms] OR (sick[All Fields] AND leave[All Fields]) OR “sick leave”[All Fields] OR absenteeism[MeSH Terms]
OR absenteeism[All Fields] OR “sickness absence”[All Fields] OR “work participation”[All Fields] OR “work disability”[All
Fields] OR “unemployment”[All Fields] OR “early retirement”[All Fields] OR “disability pension”[All Fields] OR “disability
benefit”[All Fields]) NOT “return to work”
Study design
“randomized controlled trial”[pt] OR “controlled clinical trial”[pt] OR randomized[tiab] OR
placebo[tiab] OR “clinical trials as topic”[MeSH:noexp] OR randomly[tiab] OR trial[ti] OR evaluation studies[publication type]
OR “intervention studies”[MeSH Terms] OR intervention studies[All Fields]
|
The committee identified seven systematic reviews: three on interventions specifically in older workers (31, 36, 37) and four umbrella reviews (ie, review of reviews) (38–41). There was a large variation in study populations, outcome measures, and research designs within and between the synthesized
studies. Three studies within these reviews met the predefined criteria for inclusion and were supplemented with five more
recent RCT from the additional systematic literature search. Thus, in total eight RCT were identified on seven supportive
interventions aimed at older workers (42–49).
The seven supportive interventions represented a wide range of measures: career development workshops, worksite health promotion
(such as yoga, fitness, availability of free fruits), preventive consultations with an occupational physician, web-based health
risk assessment, mental coaching by phone, regular exercise, and Tai Chi. Overall the interventions appeared to have small,
positive effects on one or more of the four indicators of employability (ie, increased need for recovery, decreased work ability,
increased sickness absence, and exit from paid employment of older workers). However, it has not yet been identified which
interventions are most effective for which people at what point of their careers or in what working situations.
Policy recommendations
The Health Council advised the government to focus on interventions to support workers in prolonging their working life. Thus
far, the positive effects of such interventions have been relatively small, but more effective interventions can be developed,
combined with improved implementation of these interventions. Increasing autonomy at work is a promising starting point as
well as human resource policies aiming at sustainable employability early in people’s careers.
Although problems with employability are not solely observed among low-educated older workers, this group of workers requires
special attention when it comes to prolonging working lives. This is because low-educated older workers have more health problems,
a lower life (and healthy life) expectancy, and they are often exposed to less favorable working conditions, while they start
working at a younger age.
The Health Council also recommended exploring whether flexible pension schemes are a better option compared to today’s pension
scheme when considering the large diversity in health. This diversity exists within the group of older workers in general
and between low- and high-educated people in particular. A specific topic to explore would be whether flexible pension schemes
could prevent a health-related exit from work via unemployment.
Furthermore, the Health Council advised to monitor the health of the working population in relation to a longer working life
as it is still largely unknown what the health effects are of prolonging working life. It was also recommended to monitor
the role of socioeconomic health differences in this perspective. Existing differences in health could be enlarged if people
with sufficient personal financial means can afford to exit paid employment when health deteriorates, while people without
these means cannot.
Concluding remarks
In conclusion, from a health perspective, prolonging working lives may be difficult for a substantial minority of workers
because the likelihood of health problems increases with age. Moreover, there is a large diversity in health at older age.
The Health Council advised to focus on interventions to support workers in prolonging their working lives and to explore whether
flexible pension schemes could prevent health-related exit from work via unemployment.
Acknowledgements
The authors gratefully thank Aleid Ringelberg for her suggestions during the advisory process with respect to current policy.
Conflict of interest & Funding
UB, AB, DJHD, GAG, CJIMH, IJK, AdL, ML, WvR, AJvdB received compensation for meeting attendance and travelling expenses from
the Health Council of The Netherlands.
The Board of the Health Council consciously weighed the interests and decided that UB, AB, DJHD, GAG, CJIMH, IJK, AdL, ML,
WvR could participate in the committee without restrictions. AJvdB could participate with the restriction that he would withdraw
from the discussion if a subject touches on his consultancy work (did not occur during the course of the project).
The authors declare no conflicts of interest.
References
OECD. (2014). Ageing and employment policies:Netherlands. 2014:working better with age. OECD Publishing. https://doi.org/10.1787/9789264208155-en.
OECD. Pensions at a glance. 2017:OECD and G20 indicators. (2017). Paris: OECD Publishing. https://doi.org/10.1787/pension_glance-2017-en.
The Health Council of the Netherlands. (2018). Health and working longer [in Dutch:Gezondheid en langer doorwerken]. The Hague. Report No: 2018/14.
Broese van, Groenou M, Deeg, DJ, de Boer, A, & de Boer, A (Ed.). (2006). Report on the Elderly [in Dutch: Rapportage ouderen. The Hague: Social and Cultural Planning Office of the Netherlands; 2006. Changes in the life course, pp. 167-93.
Vriend, S, Heyma, A, van der Noordt, M, & Deeg, DJ. (2016). Continuing to work longer with an occupational disability [in Dutch:Langer doorwerken met arbeidsbeperking - prognose van
de arbeidsparticipatie van ouderen tot 2030 in relatie tot gezondheidsontwikkelingen]. Amsterdam: SEO Amsterdam Economics. Report no: 2016-89.
van Solinge, H, & Henkens, K. (2007, Sep). Involuntary retirement:the role of restrictive circumstances, timing, and social
embeddedness. J Gerontol B Psychol Sci Soc Sci, 62(5), S295-303, https://doi.org/10.1093/geronb/62.5.S295.
Oude, Mulders J, van, Dalen HP, Henkens, K, & Schippers, J. (2014). How likely are employers to rehire older workers after
mandatory retirement?A vignette study among managers. Economist (Leiden), 162(4), 415-31, https://doi.org/10.1007/s10645-014-9234-8.
Schuring, M, Robroek, SJ, Otten, FW, Arts, CH, & Burdorf, A. (2013, Mar). The effect of ill health and socioeconomic status
on labor force exit and re-employment:a prospective study with ten years follow-up in the Netherlands. Scand J Work Environ Health, 39(2), 134-43, PubMed https://doi.org/10.5271/sjweh.3321.
Leijten, FR, van den Heuvel, SG, Ybema, JF, van der Beek, AJ, Robroek, SJ, & Burdorf, A. (2014, Sep). The influence of chronic
health problems on work ability and productivity at work:a longitudinal study among older employees. Scand J Work Environ Health, 40(5), 473-82, PubMed https://doi.org/10.5271/sjweh.3444.
Stansfeld, SA, Fuhrer, R, & Head, J. (2011, Jun). Impact of common mental disorders on sickness absence in an occupational
cohort study. Occup Environ Med, 68(6), 408-13, PubMed https://doi.org/10.1136/oem.2010.056994.
Magee, CA, Caputi, P, & Lee, JK. (2016, Jan). Distinct longitudinal patterns of absenteeism and their antecedents in full-time
Australian employees. J Occup Health Psychol, 21(1), 24-36, PubMed https://doi.org/10.1037/a0039138.
van Rijn, RM, Robroek, SJ, Brouwer, S, & Burdorf, A. (2014, Apr). Influence of poor health on exit from paid employment:a
systematic review. Occup Environ Med, 71(4), 295-301, PubMed https://doi.org/10.1136/oemed-2013-101591.
van den Berg, T, Schuring, M, Avendano, M, Mackenbach, J, & Burdorf, A. (2010, Dec). The impact of ill health on exit from
paid employment in Europe among older workers. Occup Environ Med, 67(12), 845-52, PubMed https://doi.org/10.1136/oem.2009.051730.
Deeg, DJ, van der Noordt, M, Hoogendijk, E, Comijs, HC, & Huisman, M. (2018). Employability after age 65?Trends over 23 years
in life expectency in good and in poor physical and cognitive health of 65-74-year-olds in the Netherlands. Report No.:Netspar Design Paper 96.
National Institute for Public Health and the Environment [internet]. (2018). Bilthoven, in Dutch, Volksgezondheid Toekomst Verkenning, [cited 2018 May]. Available from: https://www.vtv2018.nl/gezondheid
.
Galenkamp, H, Braam, AW, Huisman, M, & Deeg, DJ. (2013, Jun). Seventeen-year time trend in poor self-rated health in older
adults:changing contributions of chronic diseases and disability. Eur J Public Health, 23(3), 511-7, https://doi.org/10.1093/eurpub/cks031.
Boot, CR, Deeg, DJ, Abma, T, Rijs, KJ, van der Pas, S, van Tilburg, TG, et al. (2014, Sep). Predictors of having paid work
in older workers with and without chronic disease:a 3-year prospective cohort study. J Occup Rehabil, 24(3), 563-72.
Leijten, FR, de Wind, A, van den Heuvel, SG, Ybema, JF, van der Beek, AJ, Robroek, SJ, et al. (2015, Nov). The influence
of chronic health problems and work-related factors on loss of paid employment among older workers. J Epidemiol Community Health, 69(11), 1058-65, https://doi.org/10.1136/jech-2015-205719.
van der Noordt, M, IJzelenberg, H, Droomers, M, & Proper, KI. (2014, Oct). Health effects of employment:a systematic review
of prospective studies. Occup Environ Med, 71(10), 730-6, https://doi.org/10.1136/oemed-2013-101891.
van der Heide, I, van, Rijn RM, Robroek, SJ, Burdorf, A, & Proper, KI. (2013, Dec). Is retirement good for your health?A
systematic review of longitudinal studies. BMC Public Health, 13, 1180, https://doi.org/10.1186/1471-2458-13-1180.
Schaap, R, de Wind, A, Coenen, P, Proper, K, & Boot, C. (2018, Feb). The effects of exit from work on health across different
socioeconomic groups:A systematic literature review. Soc Sci Med, 198, 36-45, https://doi.org/10.1016/j.socscimed.2017.12.015.
Celidoni, M, Dal Bianco, C, & Weber, G. (2017, Dec). Retirement and cognitive decline. A longitudinal analysis using SHARE
data. J Health Econ, 56, 113-25, https://doi.org/10.1016/j.jhealeco.2017.09.003.
Bonsang, E, Adam, S, & Perelman, S. (2012, May). Does retirement affect cognitive functioning? J Health Econ, 31(3), 490-501, https://doi.org/10.1016/j.jhealeco.2012.03.005.
Gruber, J, & Wise, D. (1998). Social security and retirement:an international comparison. Am Econ Rev, 88(2), 158-63.
Bratberg, E, Holmås, TH, & Thøgersen, Ø. (2004). Assessing the effects of an early retirement program. J Popul Econ, 17(3), 387-408, https://doi.org/10.1007/s00148-003-0165-y.
Brouwer, S, de Lange, A, van der Mei, S, Wessels, M, Koolhaas, W, Bültmann, U, et al. (2012). Sustainable employability of older workers:state of knowledge [in Dutch:Duurzame inzetbaarheid van oudere werknemers:stand
van zaken:overzicht van determinanten, interventies en meetinstrumenten vanuit verschillende perspectieven]. Groningen: University Medical Center Groningen.
Robroek, SJ, Reeuwijk, KG, Hillier, FC, Bambra, CL, van Rijn, RM, & Burdorf, A. (2013, May). The contribution of overweight,
obesity, and lack of physical activity to exit from paid employment:a meta-analysis. Scand J Work Environ Health, 39(3), 233-40, https://doi.org/10.5271/sjweh.3354.
Pak, K, Kooij, DT, De Lange, AH, & Van Veldhoven, MJ. (2018). Human Resource Management and the ability, motivation and opportunity
to continue working:A review of quantitative studies. Hum Resour Manage R, https://doi.org/10.1016/j.hrmr.2018.07.002.
Sewdas, R, van der Beek, AJ, de Wind, A, van der Zwaan, LGL, & Boot, CRL. (2017). Determinants of working until retirement
compared to a transition to early retirement among older workers with and without chronic diseases:results from a Dutch prospective
cohort study. Scand J Public Health, https://doi.org/10.1177/1403494817735223.
Robroek, SJ, Rongen, A, Arts, CH, Otten, FW, Burdorf, A, & Schuring, M. (2015, Aug). Educational inequalities in exit from
paid employment among Dutch workers:the influence of health, lifestyle and work. PLoS One, 10(8), e0134867, https://doi.org/10.1371/journal.pone.0134867.
Cloostermans, L, Bekkers, MB, Uiters, E, & Proper, KI. (2015, Jul). The effectiveness of interventions for ageing workers
on (early) retirement, work ability and productivity:a systematic review. Int Arch Occup Environ Health, 88(5), 521-32, https://doi.org/10.1007/s00420-014-0969-y.
Poscia, A, Moscato, U, La Milia, DI, Milovanovic, S, Stojanovic, J, Borghini, A, et al. (2016, Sep). Workplace health promotion
for older workers:a systematic literature review. BMC Health Serv Res, 16(Suppl 5), 329, https://doi.org/10.1186/s12913-016-1518-z.
Wagner, SL, White, MI, Schultz, IZ, Williams-Whitt, K, Koehn, C, Dionne, CE, et al. (2015, Oct). Social support and supervisory
quality interventions in the workplace:a stakeholder-centered best-evidence synthesis of systematic reviews on work outcomes.
Int J Occup Environ Med, 6(4), 189-204, https://doi.org/10.15171/ijoem.2015.608.
Williams-Whitt, K, White, MI, Wagner, SL, Schultz, IZ, Koehn, C, Dionne, CE, et al. (2015, Apr). Job demand and control interventions:a
stakeholder-centered best-evidence synthesis of systematic reviews on workplace disability. Int J Occup Environ Med, 6(2), 61-78, https://doi.org/10.15171/ijoem.2015.553.
Wagner, SL, Koehn, C, White, MI, Harder, HG, Schultz, IZ, Williams-Whitt, K, et al. (2016, Jan). Mental health interventions
in the workplace and work outcomes:a best-evidence synthesis of systematic reviews. Int J Occup Environ Med, 7(1), 1-14, https://doi.org/10.15171/ijoem.2016.607.
White, MI, Dionne, CE, Wärje, O, Koehoorn, M, Wagner, SL, Schultz, IZ, et al. (2016, Apr). Physical activity and exercise
interventions in the workplace impacting work outcomes:a stakeholder-centered best evidence synthesis of systematic reviews.
Int J Occup Environ Med, 7(2), 61-74, PubMed https://doi.org/10.15171/ijoem.2016.739.
Toppinen-Tanner, S, Böckerman, P, Mutanen, P, Martimo, KP, & Vuori, J. (2016, Dec). Preventing sickness absence with career
management intervention:a randomized controlled field trial. J Occup Environ Med, 58(12), 1202-6, https://doi.org/10.1097/JOM.0000000000000887.
Strijk, JE, Proper, KI, van der Beek, AJ, & van Mechelen, W. (2012, Nov). A worksite vitality intervention to improve older
workers'lifestyle and vitality-related outcomes:results of a randomised controlled trial. J Epidemiol Community Health, 66(11), 1071-8, https://doi.org/10.1136/jech-2011-200626.
Strijk, JE, Proper, KI, van Mechelen, W, & van der Beek, AJ. (2013, Jan). Effectiveness of a worksite lifestyle intervention
on vitality, work engagement, productivity, and sick leave:results of a randomized controlled trial. Scand J Work Environ Health, 39(1), 66-75, https://doi.org/10.5271/sjweh.3311.
de Boer, AG, van Beek, JC, Durinck, J, Verbeek, JH, & van Dijk, FJ. (2004, Nov). An occupational health intervention programme
for workers at risk for early retirement;a randomised controlled trial. Occup Environ Med, 61(11), 924-9, https://doi.org/10.1136/oem.2003.009746.
Adler, DA, Lerner, D, Visco, ZL, Greenhill, A, Chang, H, Cymerman, E, et al. (2015, Jul-Aug). Improving work outcomes of
dysthymia (persistent depressive disorder) in an employed population. Gen Hosp Psychiatry, 37(4), 352-9, https://doi.org/10.1016/j.genhosppsych.2015.04.001.
Rutanen, R, Nygård, CH, Moilanen, J, Mikkola, T, Raitanen, J, Tomas, E, et al. (2014). Effect of physical exercise on work
ability and daily strain in symptomatic menopausal women:a randomized controlled trial. Work, 47(2), 281-6.
Palumbo, MV, Wu, G, Shaner-McRae, H, Rambur, B, & McIntosh, B. (2012, Feb). Tai Chi for older nurses:a workplace wellness
pilot study. Appl Nurs Res, 25(1), 54-9, https://doi.org/10.1016/j.apnr.2010.01.002.
Kouwenhoven-Pasmooij, TA, Robroek, SJ, Kraaijenhagen, RA, Helmhout, PH, Nieboer, D, Burdorf, A, et al. (2018, Jun). Effectiveness
of the blended-care lifestyle intervention 'PerfectFit':a cluster randomised trial in employees at risk for cardiovascular
diseases. BMC Public Health, 18(1), 766, https://doi.org/10.1186/s12889-018-5633-0.
