Health and Employment After Fifty (HEAF)

Using information from the HEAF study dataset, we explored the impact of health on work for people who are working aged 50 and over

People in Britain are living for longer, and an increasing number of older people are working past the traditional retirement age. The Health and Employment After Fifty (HEAF) study was setup in 2013 to find out whether working to older ages is good or bad for health and how often health affects people’s ability to work in different types of job at older ages.

Background to this research

Beginning in 2013, HEAF researchers sent questionnaires to willing participants from 24 GP practices in England, with a targeted age of 50-64. Those who agreed to participate in the study returned this baseline questionnaire, and also gave their contact information and consent to be contacted for a successive annual follow-up questionnaire, as well as allowing researchers access to their health records.

In the first wave of responses, HEAF received over 8,000 returned questionnaires, and as of 2017/2018 there were still 6,100 participants willing to continue to receive an annual follow-up. The result of this process is that HEAF has built up a dataset following a large number of older workers as they move towards the latter stages of their working lives and into retirement.

Using this dataset, CMHW researchers have performed a number of analyses to try and answer some key questions about the effects of health and work for people aged 50 and over.

The impact of obesity on older workers

The main aim of this analysis was to interrogate the existing HEAF dataset in order to investigate what impacts obesity might have on the working lives of older people.

What did this research involve?

This work involved an analysis of existing HEAF data.

Overall there were 8134 initial responses to HEAF, and of these 7,901 people provided information on their height and weight. In order to further target the analysis, we excluded 88 people with a BMI of over kg/m2, 537 who hadn’t provided consent to data linkage and 587 who had only returned their first baseline questionnaire and hence who had not been followed up since. We also excluded people who hadn’t had a paid job as of their baseline, first- and second-year follow-up responses, leaving us with 4974 people’s data to analyse.

We analysed the data looking for connections between BMI and various work outcomes, including reported rates of sickness absence, people needing to cut down, avoid, or change the work they did, as well as reported actions they did at work as a result of a health problem in the follow-up period. We also conducted analyses separately for men and women in order to account for the fact that men and women were more likely to undertake different types of occupations.

What did we find?

Participant characteristics

At baseline, the prevalence of obesity (including severe obesity) was 23.8% in men and 24.0% in women. Both men and women with obesity were less likely to own their own homes, more likely to report that they were struggling financially, more likely to do no leisure-time physical activity, less likely to drink any weekly alcohol and more likely to report that they were struggling to cope with the physical demands of their work.

Men with obesity were more likely to be unmarried, and were more likely to be ex or current smokers.

Women with obesity were better educated and were more likely to be earning at least half of the household income, compared with those with normal weight.

Likewise, the prevalence of hypertension, diabetes, musculoskeletal disorders, and common mental health conditions was increased amongst both men and women with obesity and, additionall, women with obesity tended to be less satisfied with their job overall.

Cutting Down at Work and Prolonged Sickness Absence

Over the 2-year follow-up period 206 (10.4%) men and 276 (12.6%) women experienced at least one episode of long-term sickness absence and 176 (8.9%) men and 182 (8.3%) women needed to cut down, avoid, or change what they usually did at work because of a health problem. Women with severe obesity reported increased odds of having had to cut down, avoid, or change what they did at work because of a health problem, even after adjustment for confounding factors such as age or lifestyle factors, while no similar effect was found for men after adjustment.

When looking at odds of prolonged sicnkess absence, women again had greater odds of being affected, and again the effect was more pronounced than in was for men, who also displayed slightly increased odds, but which were attenuated by adjustment for health conditions.

Health-related job loss

A total of 101 (4.4%) men and 152 (6.3%) women experienced a health-related job loss over the two-year follow-up period. After adjustment we found an increased risk of job loss for women with severe obesity, however no such association existed for men in the cohort. This effect persisted after further adjustment for physical activity score at work, as well as musculoskeletal disorders and common mental health conditions, which could all have an effect on the final analysis.

Publications

You can read the full research paper from this study here:

The impact of fatigue in older workers

Fatigue is a commonly reported symptom and often co-exists with other comorbidities. Recent trends show an increase in economic inactivity, mostly because of ill health.

This analysis aimed to quantify the relationship between fatigue, work impairment and health-related job loss among older workers.

What did this research involve?

We analysed longitudinal data from the HEAF study, to explore whether fatigue was associated with reduced productivity and with job loss attributed to ill health. Furthermore, we explored whether people with a job loss attributed to ill health were more likely to report fatigue compared with participants who continued working.

What did we find?

Participants reporting fatigue were almost twice as likely to report lower work productivity and a future health-related job loss, compared with participants without fatigue. Supporting older workers with fatigue may contribute to extend working lives.

Publications

You can read the full research paper from this study here:

The health of older women in work

In recent years, women more commonly work beyond the age of 50, however research on occupational health among women is scarce.

This analysis aimed to describe the jobs that older women do and to identify risk factors for job loss among women over the age of 50.

What did this research involve?

We analysed longitudinal data on women participating in the HEAF study and in paid work at some point over the course of the study. We carried out an initial descriptive analysis. Then we used Cox proportional hazard models to explore risk factors associated with job exit. To better disentangle the potential effect of new legislation regarding entitlement to state pension, the analyses were conducted separately by age group.

What did we find?

Amongst all women, not managing comfortably financially and not coping with the mental demands of the job were associated with job exit. Risk factors for job exit differed in the age bands 50–54, 55–59 and over 60 years, reflecting socio-economic status, markers of health and work factors (under-appreciation, job dissatisfaction, temporary/permanent contracts, coping with work’s physical demands).

Publications

You can read the full research paper from this study here:

The impact of walking speed on health-related job loss

With demographic changes, there is increasing demand for individuals and governments to lengthen working lives. Jobs that are very physically demanding are likely to be more difficult to sustain at older ages. If workers at risk of mismatch of demand and capability could be identified early, there would be opportunities for intervention for health or lifestyle and/or re-training or redeployment.

This analysis aimed to investigate the relationship between self-reported walking speed and health-related job loss over 4 years of follow-up among older workers.

What did this research involve?

We analysed longitudinal data from the HEAF study to explore the association between self-reported walking speed and subsequent health-related job loss with survival analysis techniques.

What did we find?

Both women and men with self-reported slow walking speed were at fourfold increased risk of a health-related job loss, even after adjustment for confounding factors. This simple measure could be part of a strategy used to identify workers at high risk and intervene with improved working conditions, optimising health and/or considering opportunities for retraining or redeployment.

Publications

You can read the full research paper from this study here:

Study team

Chief investigator
Professor Karen Walker-Bone (Monash University)


Co-investigators
Professor Cyrus Cooper (University of Southampton)
Stefania D’Angelo (University of Southampton)
Georgia Ntani (University of Southampton)
Gabrielle Palermo (University of Southampton)
Holly Syddall (University of Southampton)
Gregorio Bevilacqua (University of Southampton)
Elena Zaballa (University of Southampton

Centre institutions

Research partners

Further information

For any queries related to this work, please contact kwb@mrc.soton.ac.uk