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A public health approach to health and retirement

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w w w . e l s e v i e r . p t / r p s p

Review

article

A

public

health

approach

to

health

and

retirement:

What

do

we

know

about

their

relationship?

Mafalda

Sousa

Uva

a,b,∗

,

António

Manuel

Fonseca

c

,

Baltazar

Nunes

a

,

Carlos

Matias

Dias

a,b

aDepartmentofEpidemiology,NationalHealthInstituteDr.RicardoJorge,Portugal bNationalSchoolofPublicHealth,NewUniversityofLisbon,Portugal

cFacultyofEducationandPsychology,CatholicUniversityofPorto,Portugal

a

r

t

i

c

l

e

i

n

f

o

Keywords: Retirement Chronicdiseases Self-perceivedhealth Publichealth Portugal

a

b

s

t

r

a

c

t

Theexitfromactivelifeandtheingressintoalifestageinwhichlabouractivitiesand relationsdonotexist,orcouldbeofadifferentnature,isafeatureofretirement.

Severalstudieshaveinvestigatedtheeffectsofchangesinhealthuponretirement.Several othershaveinvestigatedtheeffectsofretirementonhealth.Ifretirementisresponsiblefor affectinghealth,thentheimplementationofpublichealthpolicies,aimedatimprovingolder individual’shealth,shouldtakethismatterintoaccount.Similarly,theimplementationof politicalchangesinretirementagesuchasthosethatwearewitnessinginPortugalshould becarefullyplanned.

Theaimofthisworkistodescribeanddiscusstheinternationalandnationalstudies conductedtoimprovetheunderstandingoftherelationshipbetweenhealthandretirement, especiallybetweenchronicdiseases(andself-perceivedhealth)andretirement,andalsoto highlighttheimportanceofstudyingthissubjectfromapublichealth pointofviewin Portugal.

Regardingtheeffectsofhealthonretirement,self-perceivedhealthseemstohavea rel-evanteffectonretirement,aswellaschronicdiseases,althoughthereislessagreementin thelattercase.Findingsontheimpactofretirementinhealtharenotconsensualanditis thoughtthatthenatureoftheanalysis(cross-sectionalorlongitudinal),thetimingandthe reasonforretirement,thecircumstancesofanindividualbeforeandafterretirementand thehealthmeasureunderresearchcouldbeprimarilyresponsibleforthelackofconsistency amongstudies.

ConcerningthePortuguesepopulation,thefewstudiesfoundabouthealthand retire-mentarefocusedindifferenthealthstatusindicators,makingitdifficulttoreachageneral

Correspondingauthor.

E-mailaddresses:mafalda.uva@insa.minsaude.pt(M.SousaUva),afonseca@porto.ucp.pt(A.ManuelFonseca),

baltazar.nunes@insa.minsaude.pt(B.Nunes),carlos.dias@insa.minsaude.pt(C.MatiasDias).

http://dx.doi.org/10.1016/j.rpsp.2015.07.005

0870-9025/©2015TheAuthors.PublishedbyElsevierEspaña,S.L.U.onbehalfofEscolaNacionaldeSaúdePública.Thisisanopenaccess articleundertheCC-BY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).

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conclusion.Thustheneedremainsfortheestablishmentofmoremethodologicallyvalid researchstudiesinPortugal,mainlyepidemiologicstudiesinvolvingthequantificationof associationandimpactmeasures.

©2015TheAuthors.PublishedbyElsevierEspaña,S.L.U.onbehalfofEscolaNacionalde SaúdePública.ThisisanopenaccessarticleundertheCC-BY-NC-NDlicense (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Saúde

e

reforma:

o

que

conhecemos

da

sua

relac¸ão

numa

perspectiva

de

saúde

pública?

Palavras-chave: Reforma Doenc¸asCrónicas SaúdePercebida SaúdePública Portugal

r

e

s

u

m

o

Asaídadavidaativaeaentradanumafasedavidaemasrelac¸õeseatividadeslaboraisnão existemousãodenaturezadiferenteconstituemumacaracterísticadareforma.

Algunsestudostêminvestigadoosefeitosdasalterac¸õesdoestadodesaúdenareforma. Outrostêminvestigadoosefeitosdareformanoestadodesaúde.Seareformafor respon-sávelporafetaroestadodesaúde,entãoaimplementac¸ãodepolíticaspúblicassaudáveis, paramelhoriadasaúdedosadultosidosos,deveriamtê-loemconsiderac¸ão.Damesma forma,aimplementac¸ãodealterac¸õesnaidadedareforma,taiscomoaquelasquetêm vindoaverificar-seemPortugal,tambémodeverãoponderar.

Constituem objetivos deste trabalho descrever e discutir os estudos que têm sido desenvolvidos para melhoriado conhecimento da relac¸ão entre a saúdee a reforma, nomeadamente,entreasdoenc¸ascrónicas(esaúdepercebida)eareforma,assimcomo sublinharaimportânciadainvestigac¸ãodestetemaemPortugalnumaperspetivadeSaúde Pública.

Noqueconcerne aosefeitosdasaúdenareforma, asaúdepercebidaeas doenc¸as crónicasparecemterumimportantepapelparaareforma,apesardehavermenos con-cordânciarelativamenteàsúltimas.Poroutrolado,asconclusõessobreosefeitosdareforma nasaúdenãosãoconsensuais,factoquetemsidoatribuídoàsdiferenc¸asnanaturezade análise(transversaloulongitudinal),domomentodereforma,dosmotivosdereforma,e doindicadordeestadodesaúdesobinvestigac¸ãoemdiferentesestudos.

Relativamenteàpopulac¸ãoPortuguesa,ospoucosestudospreconizadosfocam difer-entesindicadoresdesaúde,tornandodifícilatingirumaconclusãocomum.Permanece, naverdade,anecessidadededesenvolvimentodeestudossobreestamatériaem Portu-galmetodologicamentemaisválidos,principalmentecomaquantificac¸ãodemedidasde associac¸ãoedeimpacte.

©2015TheAuthors.PublicadoporElsevierEspaña,S.L.U.emnomedaEscolaNacional deSaúdePública.EsteéumartigoOpenAccesssobalicençadeCC-BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Introduction

Thedemographicchangesobservedduringthelastdecades andtheprojectionsforthefuturepointtoanunprecedented transition in the demographic structure in the history of humanity.1 Population ageing has been made possible by advancesinmedicineandhealthcareinthelastcenturies,and thisreality hasimportantimplications forwhichcountries willhavetoadjust,particularlyinwhichpoliciesand legis-lationtobeadopted.Theextentofthechallengelinkedwith populationageinghasbeengreatlydebatableandmore posi-tiveoutlookshavebeenproposed.2–4

Itisestimatedthattheproportionofpeopleover65years ofagewilltriplebetween1950and2050inEurope.5 Accord-ing toStatistics Portugal,the number ofageist inPortugal (peopleover65yearsold)in2050willbe2.95 millions,one millionmorethanin2006(1.82 millions).6Inthis scenario,

thePortuguesepopulationageingprocesswillbeaggravated, asexpressedbytheageingindexthattodayisof129.4elders forevery100childrenunder14years7andisexpectedtobe 238forevery100childrenunder14yearsby2046.6

Inthelastcenturywehavealsowitnessedan epidemiolog-icaltransition,inwhichchronicdiseasesbecametheleading causeofdeathanddisabilityworldwide,withahigher preva-lenceinoldage.8Itsprevalencehasincreasedgloballyacross almostallregionsandsocio-economicbackgrounds.In2008 themorbidity,mortalityanddisabilityattributabletomajor chronicdiseasesaccountedfor68%ofalldeathsand43%of theglobalburdenofdisease,whileby2020estimatespointto 73%ofalldeathsand60% oftheglobalburdenofdisease.9 InPortugal,datafromtheNationalHealthSurvey2005/2006, showaprevalenceofthesediseasesin49.9%ofmenand58.5% ofwomen.10 Themortalityattributedtothem in2008was approximately45.4%inmenand43.4%inwomen.8Globally, currentevidencehasshownthatthemajorchronicdiseases

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arecerebro-cardiovasculardiseases,cancer,chronic respira-torydiseasesanddiabetes.9

Theexitfromactivelifeandtheingressintoanewlifestage inwhichlabouractivitiesandrelationsarereducedorbecome inexistent,isafeatureofretirement.11Retirementmightbe oneofthemostimportanteventsinpeople’slives.12Itcould embodyasimpleexit from workinglife;a changethrough whichadifferentroleisassignedtotheperson,withdifferent rulesandrights;or,and,atransitionfrommiddleagetoold age.Infact,whileforsomepeopleretirementcouldmeanthe longawaitedendfromademandingjobperformed through-outalifetime,forothersitmayrepresenttheopposite,aloss ofthemeaningoflife,especiallywhenitrevolvesaroundthe professionaldimension.13

Althoughinrecentyears,inPortugal,therehasbeen an increaseinlifeexpectancy,theaverageretirementageseems not have been undergoing considerable changes.In Social Securitypensioners(privatesectorworkers)retirementage decreasedfrom 63.7to62.5yearsbetween2002and2012,14 whereas inCaixa Geral deAposentac¸ões (CGA) pensioners (publicsector workers) retirementage increased from 58.2 yearsto60.1years.15

InPortugal,the legalretirementage forworkers,inthe publicand private sectors, is66 years old withat least15 yearsofcontributionstoSocialSecurityortoCGA.16,17Early retirement, can be provided to workers over 55 years old and withatleast30 years ofcontributions toCGA(except forthe new public sectorworkers after the 1st of January 2006,whichthereafterbegantoberegisteredinthegeneral SocialSecurityscheme). RegardingSocial Securityworkers, the government decreed a freeze of early retirementuntil 2014.18

Retirementisaneventinvolvingchangesinmany differ-entaspectsoflife,inwhicheachpersonislookingforthebest adaptation,requiringaneffortofre-organizationofthe indi-viduallivingstandards.19 Theavailabilityoftime,thesocial networking,thesocialposition,themonthlyincomeandthe physicaland mental activity may be different after retire-mentandanychangesintheselifeaspectsarelikelytoaffect retiree’shealth.20

Severalstudieshaveinvestigatedtheeffectsofchangesin healthuponretirement.20–23Severalothershaveinvestigated theeffectsofretirementonhealthstatusindicators.24–27 If retirementcouldactuallyberesponsibleforaffectinghealth, thentheimplementationofpublichealthpolicies,aimedat improvingolderindividual’shealth,shouldcertainlytakethis matterintoconsideration.Similarly,the implementationof politicalchangesinretirementagesuchasthatweare cur-rentlywitnessinginPortugal,aswell asinother European countries,shouldreflectthisaspect.

Theaim ofthis work isto briefly describe and discuss theinternationalandnationalstudiesdevelopedtoimprove the understanding of the relationship betweenhealth and retirement,especiallybetween chronicdiseases (aswell as self-perceived health)and retirement, and tohighlight the importanceofstudyingthesubjectfromapublichealth per-spectiveinPortugal.Agreaterfocusisgiventotheeffectsof retirementonhealth,duetotheincreasingrelevanceofthis issueinourcountrywiththerecentchanges inretirement age.

Forthatpurpose,thefirstpartoftheworkdescribesthe methodology explaininghowtheliteraturereviewwas per-formed. The second part of the work describes the main internationalstudiesontheeffectsofhealthstatusindicators (chronic diseases and self-perceived health)on retirement, followed byadescription ofthe maininternational studies on the effectsofretirementon thesehealth status indica-tors. Thefourthpart ofthe workdescribesthefew studies aboutthisissuepublishedinPortugal.Thelackofagreement ontherelationshipbetweenhealthandretirement,andthe relevance ofincreasingthis knowledgeinPortugal,is then discussed.

Methodology

The literature review to find international studies on the effectsofretirementonself-perceivedhealthand/orchronic diseaseswasconductedduringSeptember2013.The frame-workofitwasdividedintothefollowingstages:(1)identifying the research question; (2) identifying relevant studies; (3) selectionofstudiesbasedonpre-establishedinclusion crite-ria;(4)datacollection;and(5)summarizingandreportingthe results.

Weincludedinternationalstudiespublishedbetween1992 and 2013 on the effects of retirement on self-perceived healthand/orchronicdiseases.Thereviewcovered publica-tions notincluded in the report “Europeans ofRetirement age: chronic diseases and economic activity” from the RIVM,32 inorder toupdateand widen thescope of knowl-edge, although some studies may appearin both reviews. Additionally,weconfirmedandsupplementedextra informa-tion (study design,samplesize, study populationand data source).

TheinformationsourceusedwasPubMed,maintainedby the USNationalLibraryofMedicine.Wesearchedfor stud-iesinEnglishonly,combiningsearchtermswiththeBoolean operatorAND.Thetermsusedwere‘retirement’AND‘health’ ANDeachoneofthechronicdiseases(cardiovasculardiseases, diabetes, chronic respiratory diseases, cancer, and depres-sion).

Concerningthestudiesontherelationshipbetweenhealth andretirementinPortugal,weconductedaliteraturesearch alsoinSeptember2013,usingtheonlinedatabasesPubmed, B-onandGoogle,tofindstudiescarriedoutbetween1992and 2013.Thekeywordsusedtoidentifyrelevantstudieswere: ‘retirement’AND‘health’AND‘Portugal’(keywordswereused inbothPortugueseandEnglishlanguages).

In both the two literaturereviewsperformed, no inclu-sioncriteriawereestablishedintermsofstudydesign,type ofpublication,orageofthestudypopulation.Thequalityof thestudieswasnotusedasaninclusioncriterion,sincewe wantedtodescribethescope(quantity,focus,andnature)of theresearch.

Dataonthefollowingvariableswerecollectedandentered intoastandardtable:author(s),publicationyear,studydesign, sample size, study population, data source and the main results. Theinformationwas entered into the tableas the studieswere selectedandthedataweresubsequently ana-lyzed.

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Effects

of

health

on

retirement

Generally,themajorityofstudiesontheeffectofchangesin healthstatusonretirementhaveshownthatthehealthstatus mayinfluenceretirement.19

Somefindingsabouthealtheffectsonretirementarethe following:(i)workerswithpoorhealth,sufferingfromchronic healthconditions, retireearlierthan healthy workers28;(ii) menwithhealthproblemsretireoneortwoyearsearlierthan menwithouthealthproblems20;(iii)itislesslikelythat indi-vidualswithworsehealthcontinuetoworkcomparedtothose with good health, and changes inlife expectations during retirementaremuchmoreinfluencedbychangesinhealth thanbyeconomicfactors21;(iv)psychiatricdisordersincrease significantlytheoccurrenceof(early)retirementinbothmen andwomen29;(v)retireeswhoreportedtohavesufferedfrom thrombosis,depression,osteoarthritisorcancer,weretwice aslikelytoretireearlierduetoill-healththanthosewithout thesehealthproblems;thisassociationwasevenstrongerfor theselfperceivedhealth.30

AreviewofOortwijnandcolleagues,includingtheanalysis ofsixEuropeanlongitudinalstudies reportingthe relation-ship between poor perceived health and early retirement, concluded that a worker with poor perceived health was morelikelytoretireearlythanaworkerwithgoodperceived health.31

Nevertheless,asystematicreviewofVanRijnetal., includ-ing29longitudinalstudiesontherelationshipbetweenhealth andretirement,concludedthatself-perceivedpoorhealthisa riskfactorforearlyretirement(RR1.33;CI95%1.14–1.54),but chronicdiseasesarenot.23

In Table 1 we present a summary of the studies pub-lishedbetween1992and2012thatfoundaneffectofdifferent chronic health states and self-perceived health on retire-ment.Table 1 was adapted from the report “Europeans of Retirementage:chronic diseasesand economicactivity”of theDutchNationalInstituteforPublicHealthandthe Envi-ronment(RIVM),32 requested bythe EuropeanCommission, which highlights the current importance of this issue. It describesaliteraturesearchdevelopedbytheRIVMusingthe online databases Medline, PsycoINFO, SocialSciSearch and SciSearch,between1992and2012.

Effects

of

retirement

on

health

Thestudyofthepotentialeffectsofretirementonhealthhas beengainingimportanceinrecentyearsduetotheincreasein populationageingandtheassociatedincreaseinhealthcare spending.

Thetrendsinpopulationageingandthefinancial difficul-tiesfacedbySocialSecuritysystem,haveledtopolicychanges, suchastheincreaseoftheretirementage.However,theeffects ofretirementonhealthissomethingthathasnotbeentaken intoaccountwhensuchpolicieswereimplemented.25

AlongitudinalstudyofMeinetal.compared392retirees with618employeestodetermineifretirementatage60years wasassociatedwithchangesinmentalandphysicalhealth. Theyshowedthatmentalhealthdeterioratedinindividuals

whocontinuetoworkbeyond60yearsofage,whereasphysical healthdeterioratedinbothworkersandretirees.33

SolokangasandJoukamaaobservedsomeimprovementin mentalhealthafterretirement,butnocleareffectof retire-mentonphysicalhealth.34

SzinovaczandDaveyfoundthatsymptomsofdepressionin womenincreaseafterretirement,especiallyifretirementwas feltasabruptorforced.24Thiseffectwasgreaterinwomen marriedtomenwhohadfunctionallimitations.24

Alongitudinalstudyof6257municipalemployeesin Fin-land showed an increase of musculoskeletal diseases and cardiovasculardiseasesinmalepensioners.35

OstbergandSamuelsson,ontheotherhand,describedthe positiveeffectsofretirementonhealth,usingbloodpressure measurement, presenceofmusculoskeletaldisease, psychi-atricsymptomsandnumberofvisitstothedoctor.36

Overall, some studies have also found positive effects of retirement on health,25,37 while others found a lack of association,38andstillothershavefoundnegativeeffects.26,39 In Table 2 we present a summary of the international studies, published between 1992 and 2013, which aimed to investigate the effects ofretirementon different health states(chronicdiseasesandself-perceivedhealth).Thesearch provided uswith16 different studies.Onestudy foundno effects ofretirement oncancer,whileanotherstudy found no effectsofretirementonchronic respiratorydiseases.In whatconcernscerebro-cardiovasculardiseases,threestudies werefound,twoofwhichdescribedretirementasariskfactor, andthethirdfoundanabsenceofassociation.Ninestudies focusedonthe impactofretirementon mentalhealthand twoonantidepressantuse (Table2).From thosenine stud-ies,fourdescribedanegativeeffectofretirementonmental health;threedescribedapositiveeffect;andonedescribedan absenceofassociation(Table2).Onestudyfoundapositive effectofretirementontheantidepressantuseandotherfound alackofassociation(Table2).Regarding diabetes,bothtwo studiesabouttheimpactofretirementondiabetesreported theabsenceofasignificantassociation(Table2).Finally, con-cerningtheself-perceivedhealth,inthesevenstudiespresent inTable2,fivedescribedpositiveeffectsofretirement,one foundnegativeeffects,andanotheronefoundnoeffectsof retirementonself-perceivedhealth.

Studies

on

health

and

retirement

in

Portugal

Concerningthe studiesonthe relationshipbetweenhealth andretirementinPortugal,thesearchprovideduswith5 stud-ies, developedbetween 1992and 2013,on the relationship between health and retirement in the Portuguese popula-tion,whichwillbebrieflydescribedbelowtocomplementthe reviewsmentionedearlier.

FonsecaandPaúlconductedacomparativecross-sectional studybetween50retiredpersonsand50non-retiredpersons (25menand25women),livingathomeinthenorthand cen-treofPortugal,tostudytheretirementtransitionimpacton perceived health. Theretired participantswere individuals recentlyretired(lessthanoneyear)andthenon-retired par-ticipantswerefull-timeemployedindividuals.Theinstrument usedforevaluationwasaversionofthe“Self-ReportedHealth

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Table1–Summaryofstudiesthatfoundeffectsofchronicdiseasesandself-perceivedhealthonretirement.

Studies Healthstateaffectingretirement

RodgersLM.Afiveyearstudycomparingearlyretirementsonmedicalgroundsin ambulancepersonnelwiththoseinothergroupsofhealthservicestaff.PartII: Causesofretirements.OccupMed(Lond).1998;48:119–32.

Mentaldisorder(includingdepression)

WeberA,WeltleD,LedererP.Illhealthandearlyretirementamongschool principalsinBavaria.IntArchOccupEnvironHealth.2005;78:325–31. KarpansaloM,KauhanenJ,LakkaTA,ManninenP,KaplanGA,SalonenJT.

Depressionandearlyretirement:Prospectivepopulationbasedstudyinmiddle agedmen.JEpidemiolCommunityHealth.2005;59:70–4.

MaguireM,O’ConnellT.Ill-healthretirementofschoolteachersintheRepublicof Ireland.OccupMed(Lond).2007;57:191–3.

KarpansaloM,ManninenP,KauhanenJ,LakkaTA,SalonenJT.Perceivedhealthasa predictorofearlyretirement.ScandJWorkEnvironHealth.2004;30:287–92.

Poorperceivedhealth VandenBergT,SchuringM,AvendanoM,MackenbachJ,BurdorfA.Theimpactofill

healthonexitfrompaidemploymentinEuropeamongolderworkers.Occup EnvironMed.2010;67:845–52.

VandenBergT,SchuringM,AvendanoM,MackenbachJ,BurdorfA.Theimpactofill healthonexitfrompaidemploymentinEuropeamongolderworkers.Occup EnvironMed.2010;67:845–52.

Havingatleastonechroniccondition(heart disease,stroke,diabetes,lungdisease, asthma,arthritisorrheumatismand osteoporosis)

MaguireM,O’ConnellT.Ill-healthretirementofschoolteachersintheRepublicof Ireland.OccupMed(Lond).2007;57:191–3.

Circulatorydiseases BurkeFJ,MainJR,FreemanR.Thepracticeofdentistry:Anassessmentofreasons

forprematureretirement.BrDentJ.1997;182:250–4.

Cardiovasculardiseases MaguireM,O’ConnellT.Ill-healthretirementofschoolteachersintheRepublicof

Ireland.OccupMed(Lond).2007;57:191–3.

Cancer CarlsenK,OksbjergDaltonS,FrederiksenK,DiderichsenF,JohansenC.Cancerand

theriskfortakingearlyretirementpension:ADanishcohortstudy.ScandJPublic Health.2008;36:117–25.

AdaptedfromtheRIVMreport“EuropeansofRetirementage:chronicdiseasesandeconomicactivity”.32

Questionnaire”from“TheEuropeanSurveyonAging Proto-col”(ESAP).Resultsshowednosignificantdifferencesbetween retiredandnon-retiredconcerningself-reportedhealth.40

SequeirareportedthedecisionsmadebyCGAmedical pan-elswithrespecttocardiovasculardiseases(excludingthose thatmayhavecausedstroke)intheperiod2002–2008. Car-diovascular diseases were considered the justification for the early retirement of 4.5–7.5% of employees during the periodunderinvestigation.Therewasaconsiderable differ-encebetweengenders,withmenaccountingfor7–12%ofthe totalandwomen2.8–.9%.41

Verbisckstudiedtherelationshipbetweenthe transition toretirementandsubjectiveself-reportedhealth,perceived social support and spiritual well-being. The sample con-sisted of 150 subjects, divided into three groups of equal size (workers, recent retirees, and retirees forlonger than five years). The selected instruments were a scale mea-suring subjectivehealth, the Social SupportQuestionnaire, shortversion(SSQ6–Portugueseversion),andtheSpiritual Well-beingQuestionnaire(SWBQ–Portugueseversion).The resultsshowed no significant differences betweenthe two groupsofretirees.However,thereweredifferencesintermsof self-reportedhealth,socialsupport,andspiritualwell-being betweenworkersand retirees,always infavourofthe first group.42

Clímaco,Pita-Barrosand Lourenc¸o, usingdata from the national health survey 2005/2006, estimated a continuous healthindexthroughanorderedprobitmodelforretireesand workersaged50to80yearsoldtocomparetheirhealth.They

concludedthatretirementappearsnottobeahealthstatus determinant.43

Loureiro, Fonseca and Veríssimo developed a study to describe theevolutionofindividual’sbehaviourand health status duringretirement. Thiswasa quantitativestudy,in whichaquestionnairewasadministered to432individuals whohadbeenretiredforlessthanfiveyears.Thesamplewas selectedusingthenetworkmethod.Afterretirement respon-dents improved their health behaviours, but their health statusdidnotimprove(BodyMassIndexincreasedin94.8% ofcasesandtheprevalenceofchronicdiseaseincreasedin 3.7%,particularlypsychiatricillnesses).44

Discussion

All ofthe studies mentioned here onthe effects ofhealth statusonretirementaddress importantaspectsofthe rela-tionshipbetweenhealthandretirement.Asamatteroffact, itseemsclearthatapoorself-perceivedhealthstateleadsto earlyretirement.31,45,46Themajorityofstudiesdescribedhere alsoindicatethat chronicdiseasescouldberesponsiblefor affectingretirement,althoughthesystematicreviewofVan Rijnetal.concludedthatchronicdiseasesarenotriskfactors forearlyretirement.23

Itshouldbepointedout,regardingtheeffectsofhealthon retirement,thatthereisgenerallyalackofagreement, particu-larlyconcerningtheeffectsofhealthstatusontheretirement decision.47 The decision to retire may be influenced by a

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Table2–Summaryofstudieswhichaimedtoinvestigatetheeffectsofretirementonhealth.

Healthoutcomeandreferences Relationship Studydesign Samplesize StudyPopulation Data Cancer

BehnckeS.Doesretirement triggerillhealth?HealthEcon. 2012;21:282–300.

− Cohort 1439 Peoplebornbefore

1952wholivein England

EnglishLongitudinal StudyofAgeing (ELSA) Chronicbronchitisorasthma

WesterlundH,VahteraJ,Ferrie JE,Singh-ManouxA,PenttiJ, MelchiorM,etal.Effectof retirementonmajorchronic conditionsandfatigue:French GAZELoccupationalcohort study.BMJ.2010;341:c6149.

0 Cohort 14104 Employeesin1989of

theFrenchnational gasandelectricity company:Electricité deFrance-Gazde France(EDF-GDF)

LargeFrench occupationalcohort (theGAZELstudy)

Cerebro-Cardiovasculardisease: WesterlundH,VahteraJ,Ferrie JE,Singh-ManouxA,PenttiJ, MelchiorM,etal.Effectof retirementonmajorchronic conditionsandfatigue:French GAZELoccupationalcohort study.BMJ.2010;341:c6149.

0 Cohort 14104 Employeesin1989of

theFrenchnational gasandelectricity company:Electricité deFrance-Gazde France(EDF-GDF)

LargeFrench occupationalcohort (theGAZELstudy),

BehnckeS.Doesretirement triggerillhealth?HealthEcon. 2012;21:282–300.

− Cohort 1439 Peoplebornbefore

1952wholivein England EnglishLongitudinal StudyofAgeing (ELSA) MoonJR,GlymourMM,

SubramanianSV,Avenda ˜noM, KawachiI.Transitionto retirementandriskof cardiovasculardisease: ProspectiveanalysisoftheUS healthandretirementstudy.Soc SciMed.2012;75:526–30.

− Cohort 5422 Americanswith50

ormoreyears, workingfulltimein 1998 USHealthand RetirementStudy (HSR) Mentalhealth/depression: MeinG,PMartikainen,H Hemingway,SStansfeld,M Marmot.Isretirementgoodor badformentalandphysical healthfunctioning?WhitehallII longitudinalstudyofcivil servants.JEpidemiolCommun H.2003;57:46–49. +a Cross-sectional study 1010 Civilservants workingin20

Londonbasedcivil

servicedepartments

WhitehallII

longitudinalstudyof

civilservants

BuxtonJW,SingletonN,Melzer

D.Thementalhealthofearly

retireesNationalinterview

surveyinBritain.SocPsychiatry

PsychiatrEpidemiol. 2005;40:99–105. −b Cross-sectional study 1875 Adultseconomically activeaged50-to 64-year-oldslivingin privatehouseholds inGreatBritain 2000Psychiatric MorbiditySurvey

ButterworthP,GillaSC,Rodgers

B,AnsteyKJ,VillamilE,MelzerD.

Retirementandmentalhealth:

AnalysisoftheAustralian

nationalsurveyofmentalhealth

andwell-being.SocSciMed.

2006;62:1179–1191. −b Cross-sectional study 4189 AdultAustralian residentsaged45–74

yearsandwholived

inprivatedwellings

NationalSurveyof

MentalHealthand

Well-beingfrom

AustralianBureauof

Statistics(ABS)

Mojon-AzziS,Sousa-PozaA,

WidmerR.Theeffectof

retirementonhealth:Apanel

analysisusingdatafromthe

SwissHouseholdPanel.Swiss

MedWkly.2007;137:581–5.

+ Cohort 696 Individualsaged55

to75yearsresidents inSwitzerland, workingin1999 Livingin SwitzerlandSurvey oftheSwiss HouseholdPanel (SHP)

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Table2–(Continued)

Healthoutcomeandreferences Relationship Studydesign Samplesize StudyPopulation Data FalbaTA,GalloWT,SindelarJL.

Workexpectations,realizations, anddepressioninolderworkers JMentHealthPolicyEcon.2009; 12:175–186.

−c Cohort 4241 Americanworkers

whowerelessthan

62yearsofagein

1992

Healthand

RetirementStudy

(HRS)

JokelaM,FerrieJE,GimenoD,

ChandolaT,ShipleyMJ,HeadJ,

etal.Frommidlifetoearlyold

age:Healthtrajectories

associatedwithretirement.

Epidemiology.2010;21:284–90.

+c Cohort 7584 Civilservants

workingin20

Londonbasedcivil

servicedepartments aged39–64yearsat baseline WhitehallII longitudinalstudyof civilservants

WesterlundH,VahteraJ,Ferrie

JE,Singh-ManouxA,PenttiJ,

MelchiorM,etal.Effectof

retirementonmajorchronic

conditionsandfatigue:French

GAZELoccupationalcohort

study.BMJ.2010;341:c6149.

+ Cohort 14104 Employeesin1989of

theFrenchnational

gasandelectricity

company:Electricité

deFrance-Gazde

France(EDF-GDF)

LargeFrench

occupationalcohort

(theGAZELstudy)

BehnckeS.Doesretirement

triggerillhealth?HealthEcon.

2012;21:282–300.

0 Cohort 1439 Peoplebornbefore

1952wholivein

England

EnglishLongitudinal

StudyofAgeing

(ELSA)

CalvoE,SarkisianN,Tamborini,

CR.Causaleffectsofretirement

timingonsubjectivephysical

andemotionalhealth.JGerontol

BPsycholSciSocSci.

2013;68:73–84.

−d Cohort 6624 OlderAmericans

andtheirspouses

bornbetween1931

and1941

Paneldatafromthe

Healthand

RetirementStudy

Antidepressantuse:

OksanenT,VahteraJ,

WesterlundH,PenttiJ,SjostenN,

VirtanenM,etal.Isretirement

beneficialformentalhealth?:

Antidepressantusebeforeand

afterretirement.Epidemiology.

2011;22:553–9.

+ Cohort 13559 Finnish

public-sector

employeeswhohave

beenemployedin10

municipalitiesor6

hospitalreferral

districtsforatleast

sixmonthsinany

yearfrom1991to

2005.

FinnishPublicSector

Studycohort

LeinonenT,LahelmaE,

MartikainenP.Trajectoriesof

antidepressantmedication

beforeandafterretirement:The

contributionof

socio-demographicfactors.EurJ

Epidemiol.2013.Published

OnlineFirst:DOI

10.1007/s10654-013-9792–0.

0 Cohort 19877 Employees

registeredin

administrative

registerdatafrom

Filand-national

registerdatafrom

theFinnishCentre

forPensions

(earnings-related

pensions)andthe

SocialInsurance

Institutionof

Finland(national

pensions)

Administrative

registerdatafrom

varioussources

linkedtogetherby

StatisticsFinland

Perceivedhealth:

VanSolingeH.Healthchangein

retirementalongitudinalstudy

amongolderworkersinthe

Netherlands.ResAging.

2007;29:225–56.

0e Cohort 778 Olderemployees,

aged55yearsand

olderandtheir

partners,workingin

morethan50

operatingcompanies

oftwolargeDutch

multinational

companiesactivein

thefieldofretail,

tradeandindustry

Dutchpanelstudy

onretirement

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Table2–(Continued)

Healthoutcomeandreferences Relationship Studydesign Samplesize StudyPopulation Data BehnckeS.Doesretirement

triggerillhealth?HealthEcon. 2012;21:282–300.

– Cohort 1439 Peoplebornbefore

1952wholivein England EnglishLongitudinal StudyofAgeing (ELSA) ÖstbergH,SamuelssonSM. Occupationalretirementin womenduetoage:Health aspects.ScandJSocMed. 1994;22:90–6.

+ Cohort 116 FemaleMunicipal

employees(age 62–64yearsold)in Malmö,Sweden MalmöMunicipal EmployeesPanel Mojon-AzziS,Sousa-PozaA, WidmerR.Theeffectof retirementonhealth:Apanel analysisusingdatafromthe SwissHouseholdPanel.Swiss MedWkly.2007;137:581–5.

+ Cohort 696 Individualsaged55

to75yearsresidents inSwitzerland, workingin1999 Livingin SwitzerlandSurvey oftheSwiss HouseholdPanel (SHP)

BonsangE,KleinT.Retirement andsubjectivewell-being. InstitutefortheStudyofLabor discussionpaperNo.5536,2011. Availablefrom:

http://ftp.iza.org/dp5536.pdf.

+ Cohort 4018 Menlivingin

West-Germanywho

arebetween50and

70yearsold German Socio-Economic Panel(GSOEP) WesterlundH,KivimakiM, Singh-ManouxA,MelchiorM,

FerrieJE,PenttiJ,etal.Self-rated

healthbeforeandafter

retirementinFrance(GAZEL):A

cohortstudy.Lancet.

2009;374:1889–96.

+ Cohort 14104 Employeesin1989of

theFrenchnational

gasandelectricity

company:Electricité

deFrance-Gazde

France(EDF-GDF)

LargeFrench

occupationalcohort

(theGAZELstudy),

1989–2007

RijsKJ,CozijnsenR,DeegDJH.

Theeffectofretirementandage

atretirementonself-perceived

healthafterthreeyears

follow-upinDutch

55–64-year-olds.AgingSoc.

2012;32:281–306.

+ Cohort 506 Employeeswholive

inAmsterdamwith 55–64-year-old LongitudinalAging StudyAmsterdam (LASA) Diabetes:

WesterlundH,VahteraJ,Ferrie

JE,Singh-ManouxA,PenttiJ,

MelchiorM,etal.Effectof

retirementonmajorchronic

conditionsandfatigue:French

GAZELoccupationalcohort

study.BMJ.2010;341:c6149.

0 Cohort 14104 Employeesin1989of

theFrenchnational

gasandelectricity

company:Electricité

deFrance-Gazde

France(EDF-GDF)

LargeFrench

occupationalcohort

(theGAZELstudy),

1989–2007

BehnckeS.Doesretirement

triggerillhealth?HealthEcon.

2012;21:282–300.

0 Cohort 1439 Peoplebornbefore

1952wholivein

England

EnglishLongitudinal

StudyofAgeing

(ELSA)

AdaptedfromtheRIVMreport“EuropeansofRetirementage:chronicdiseasesandeconomicactivity”,32confirmedandupdatedhereinabrief

literaturereview.

“+”referstoapositiveeffectofretirementonhealth;“−”referstoanegativeeffectofretirementonhealth;“0”referstonoeffectofretirement

onhealth.

a Merelyretirementat60years.

b Merelyearlyretiredmen.

c Merelyearlyretirementperceivedasnotexpected.

dMerelyearlyretirement.

e Merelyinvoluntaryretirement.

varietyoffactors,notonlythehealthofindividualsbutalso theavailabilityofahealthinsurance,eligibilityforSocial Secu-rity,financialresourcesandtheinterdependenceofcouples.19 Itisinfactacomplexissuestudiedmainlybyresearcherson theareasofEconomy,PsychologyandSociology.

Forinstance,theimpactofhealthstatusversuseconomic factorsontheretirementdecisionhaslongbeendebated.48–50

Bazzoli found that economicvariables playa more impor-tantrolethanhealthinretirementdecisions,49yetDwyerand Mitchellfoundtheopposite.20

Regarding the effects of retirement on health status, it is commonly assumed that there is a lack of consen-sus between different studies.25–27 However, if we focus merely on the effects of retirement on chronic diseases,

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themajorityofdisagreeing studiesconcerndepressionand cerebro-cardiovasculardiseases.Howeverthenumberof stud-iesonthismatter(effectsofretirementonchronicdiseases) issosmallthatitisdifficulttodiscusswhetherthereisa con-sensusornot.Infact,wefoundonlyonestudy(seeTable2) whichinvestigatestheeffectofretirementontheprobability ofhavingcancer.

One reason for the lack of agreement on the relations between health and retirement studies may be that most of these studies refer to research conducted in different countries,whichmayhavedifferentlawsregardingworkand retirement,differentlabourmarkets,differentwaysof per-ceiving disease, and also different economic incentives to retirement.

Severalstudiesarecrosssectionalindesignandmakea comparisonbetweenthegroupsofretireesandworkers, ignor-ingtheheterogeneityamongindividualsbelongingtothese groups.Others,althoughhavingacohortdesign,arebased onsmallsampleslackingstatisticalpowertodetectthe expo-sureeffectsorarebasedonnon-representativesampleswhich cannotbegeneralizedtothegeneralpopulation.

Retirementisnotanisolatedeventinpeoples’lives,but alsoachoice,ofteninfluencedbyeventsandcircumstances thatprecedeit,whichcanincludenotonlythehealthstatus, butalsothedeathorhealthstateofacloserelative,thework relationships,thefitnessforwork,economicreasons,partner retirement,aswellasotherpossibleassociatedfactorsrarely takentogetherintoaccountinsuchstudies.

Almostallstudiesignorethecomplexityoftheretirement transition,notcommonlyincludingmatterssuchasthe retire-menttiming,previous health,qualityofthejob,aswell as theperformanceofphysicalactivityafterretirement,orthe engagementinanactivitysuchasvolunteering.51

Regarding the retirementtiming, Calvoet al. concluded thatworkerswhobegantheirretirementtransitionbefore cul-tural(in Portugal 65 yearsold) and institutionaltimetables experiencedtheworsthealthoutcomes.Continued employ-ment after traditionally expected retirement age, however, did not seem to offer health benefits. Retiring too early couldbeproblematicbutnodisadvantageswereseeninlate retirement.27

Recentstudiesattemptedtofindabetterwaytoanalyze theeffectsofretirementonhealth.Their strategyistouse themethodofinstrumentalvariablestoallowmoreconsistent estimationofthoseeffects.Aninstrumentalvariableisa vari-ablethatdoesnotitselfbelongintheexplanatoryequation oftheeffectsofretirementonhealth,butiscorrelatedwith theexposurevariable.52 Thisisavariable thatonlyaffects theretirementdecision,but doesnotaffectthehealth out-come.AccordingtoBehnckestudieswhichuseinstrumental variablestendtofindpositiveeffectsofretirementonhealth, whilethestudies thatattempttocontrolforpotential con-founderstendtofindnegativeeffects.26

Examplesofstudiesthat use instrumentalvariables are Charles andNeumaninwhich individualsare given finan-cialincentivestoretireataparticularageviacollaboration withtheU.S.SocialSecurity.53,54Thesestudiesshowedthat retirementhadpositiveeffectsonthesubjectivemeasuresof health,butdidnothaveanyeffectsontheobjectivemeasures ofhealth.

An example of a study that controlled forconfounding variables isDave et al. in the United States, in which the sample was stratified between individuals with and with-out serioushealthproblemsduringtheperiodimmediately beforeretirement.19 Theargument usedwasthatforthese individualsthereasonforretirementcouldbeexogenousto theirhealth,incontrasttothosewhohad previously expe-riencedhealthproblems.Theconclusionsofthisstudywere thatretirementincreaseddepressionin6–9%,occurrenceof diseasein5–6%,anddifficultiesassociatedwithmobilityand dailyactivitiesin5–16%.19

Wemayalsoassumethatthelackofconsensusamong dif-ferentstudiesmaybeduetoaconsiderablediversityoffactors involvedintherelationshipbetweenretirementandhealth.In thatsense,onepossibleexplanation,andperhapsoneofthe mostplausible,isthatdifferentresearchstrategiesresultin differentestimatesoftheeffect.Foraninstance,studieson theeffectsofretirementondepressionusediversecase def-initions,suchasvariousdepressionmeasurementscales,or self-assesseddepression,whichmayberesponsiblefor mea-suringdifferenteffectsofretirementondepression.Thisuse ofdifferentmeasurementinstruments andcasedefinitions could certainlydifficultthe comparisonbetweenstudiesin thiscontext.

Regarding the studies in the Portuguese population describedhere,40–44itshouldbeemphasizedthatallofthem gave positivecontributions for the knowledgeon the rela-tionshipbetweenhealthandretirementinPortugal.However, it is difficult to reach a general conclusion, since each of those studiesfocusedondifferent healthstatusindicators, namelyself-perceivedhealth,ahealthindex(withsubjective andobjectivehealthmeasures),chronicdiseasesandhealth behaviours.40–44

Theneedremainsfortheestablishmentofmore method-ologicallyvalidresearchstudies,mainlyepidemiologicstudies involvingthequantificationofassociationandimpact meas-ures,andperformedwithlargeandrepresentativesamples ofthe Portuguesepopulation. Actually,acohort study that could allow observing health status indicators before and after retirement in each sampled individual should be carried out. Portugal started to participate in the Survey of Health Ageing and Retirement in Europe (SHARE) in 2011 (4th wave). The analysis of SHARE data could con-stitute a good wayto better understand this issue in our country.55

Nowadays,itisincreasinglyimportanttostudythe conse-quencesofchangesintheretirementageonthePortuguese workers health, in order to establish conscientious politi-caldecisions.Primarily,itisincreasinglyimportanttoknow whichconsequencesitmighthaveonchronicdiseaseswhich represent the major contribution for the global burden of disease and which are more frequent in elderly individu-als.

Thequestionremainsonwhatwouldresultingreater ben-efits forourcountry withthe retirementage raise: onone hand,thepossibleresultingaggravationofworkers’health, leading to increasinghealth care expenditure; and on the otherhand,theneedtoincreaselabourforceinorderto man-agetheageingofthepopulationandguaranteetheeconomic sustainabilityofourpensionssystem.

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Conclusions

Thecurrentconclusionofthisliteraturereviewisthat self-perceivedhealthandchronicdiseasesbothhaveimportant effectsonretirement,althoughthereislessagreementabout thelatterhealthstatusindicators.

Thereareasmallnumberofstudiesontheimpactof retire-mentonself-perceivedhealthandchronicdiseases.Findings on this subject are conflicting and it is thought that the natureofthe analysis (cross-sectionalor longitudinal),the timingandthereasonforretirement, thecircumstancesof anindividualbeforeandafterretirementandthehealth mea-sureunderinvestigationcouldberesponsibleforthelackof agreement.

ConcerningthePortuguesepopulation,therewereonlyfive studiesfoundabouthealthandretirement,whichfocusedon differenthealthstatusindicators,makingitdifficulttoreach ageneralconclusion.Theneedremainsfortheestablishment ofmoremethodologicallyvalidresearchstudiesinPortugal, mainlyepidemiologicstudiesinvolvingthequantificationof associationandimpactmeasures.

Anunderstandingoftherelationshipbetweenchronic dis-easesandretirementinPortugalmaybeimportantforthree mainreasons:first,tosupportinterventionsdesignedto pre-ventorreducetheburdenofdisease;second,tohelpassess thecost-effectivenessofsuchprogrammes;andthird,inthe contextofourcurrentpopulationageing,asincreasinglymore individualswillreachtheretirementage.

r

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n

c

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s

1. HamblinKA.ActiveageingintheEuropeanUnion:Policy convergenceanddivergence.London:PalgraveMacmillan; 2013[internet]availablefrom:http://books.google.pt/

2. SandersonWC,ScherbovS.Remeasuringaging.Science. 2010;329:1288–97.

3. HerrmannM.Populationagingandeconomicdevelopment: Anxietiesandpolicyresponses.JPopulAging.2012;5:23–46.

4. EmeryT.Intergenerationalconflict:EvidencefromEurope.J PopulAging.2012;5:7–22.

5. WorldHealthOrganization.Activeageing:Apolicy framework.Geneva:WorldHealthOrganization;2002 [internet]availablefrom:http://whqlibdoc.who. int/hq/2002/whonmhnph02.8.pdf

6. InstitutoNacionaldeEstatística.Census2011:resultados definitivos.Lisboa:InstitutoNacionaldeEstatística;2012 [internet]Availablefrom:http://tinyurl.com/o9gwqy5

7. Pordata.Pensionistas.Lisboa:Fundac¸ãoFranciscoManueldos Santos;2013[internet]availablefrom:http://www.pordata.pt/ Municipios/Indice+de+envelhecimento-458

8. WorldHealthOrganization.Noncomunicablediseases countryprofiles2011;2012[Internet]availablefrom:http:// whqlibdoc.who.int/publications/2011/9789241502283eng.pdf

9. WorldHealthOrganization.TheWHOGlobalstatusreporton noncommunicablediseases2010.Geneva:WorldHealth Organization;2011[internet]availablefrom:http://whqlibdoc. who.int/publications/2011/9789240686458eng.pdf

10.Portugal.MinistériodaSaúde.InstitutoNacionaldeSaúdeDr. RicardoJorge.ObservatórioNacionaldeSaúde.Quarto InquéritoNacionaldeSaúde:relatóriofinal.Lisboa:INSA; 2007.

11.Forman-HoffmanV,RichardsonK,YankeyJ,HillisS,Wallace R,WolinskyF,etal.Retirementandweightchangesamong menandwomeninthehealthandretirementstudy.J GerontolBPsycholSciSocSci.2008;63:146–53.

12.FonsecaAM.Reformaereformados.Coimbra:Almedina; 2011.

13.AtchleyR.Socialforcesandageing:Anintroductiontosocial gerontology.9thed.Belmont,CA:Wadswoth;2000.

14.Pordata.CaixaGeraldeAposentac¸ões:médiadeidadesdos aposentados/reformadosàdatadaaposentac¸ão.Lisboa: Fundac¸ãoFranciscoManueldosSantos;2013[internet] availablefrom:http://www.pordata.pt/Portugal/Caixa+ Geral+de+Aposentacoes+media+de+idades+dos+ aposentados+reformados+a+data+da+aposentacao-1085

15.Pordata.Médiadeidadesdosnovospensionistasdevelhicee invalidezdaSeguranc¸aSocial:totaleporsexo.Lisboa: Fundac¸ãoFranciscoManueldosSantos;2013[internet] availablefrom:http://www.pordata.pt/Portugal/Media+de+ idades+dos+novos+pensionistas+de+velhice+e+invalidez+da+ Seguranca+Social+total+e+por+sexo-1121

16.DecretodeLein.◦167-E/2013.D.R.253.1.asérie(2013-12-31). Procedeàalterac¸ãodoDecreto-Lein.◦464/80,de13de outubro,queestabeleceascondic¸õesdeacessoede atribuic¸ãodapensãosocial.

17.Lein.◦11/2014.D.R.46.1.asérie.(2014-03-06).Estabelece mecanismosdeconvergênciadoregimedeprotec¸ãosocialda func¸ãopúblicacomoregimegeraldaseguranc¸asocial. 18.DecretodeLein.◦85-A/2012.D.R.69.1.asérie.(2012-04-05).

Procedeàsuspensãodoregimedeflexibilizac¸ãodaidadede pensãoporvelhiceporantecipac¸ão.

19.DaveD,RashadI,SpasojevicJ.Theeffectsofretirementon physicalandmentalhealthoutcomes.NationalBureauof EconomicResearch;2007(WorkingPapers;12123).

20.DwyerDS,MitchellOS.Healthproblemsasdeterminantsof retirement:Areself-ratedmeasuresendogenous?JHealth Econ.1999;18:173–93.

21.McGarryK.Healthandretirement:Dochangesinhealth affectretirementexpectations?JHumResour.2004;39:624–48.

22.RiceN,RobertsJ,JonesAM.Sickofworkortoosicktowork?: Evidenceonhealthshocksandearlyretirementfromthe BHPS.Health,EconometricsandDataGroup;2006(Working Paper;06/13).

23.VanRijnRM,RobroekSJW,BrouwerS,BurdorfA.Influenceof poorhealthonexitfrompaidemployment:Asystematic review.OccupEnvironMed.2013;71.

24.SzinovaczM,DaveyA.Honeymoonsandjointlunches:Effects ofretirementandspouse’semploymentondepressive symptoms.JGerontolBPsycholSciSocSci.2004;59: 233–45.

25.SeitsamoJ.Retirementtransitionandwell-being:A16-year longitudinalstudy.Helsinki:FinnishInstituteofOccupational Health;2007[internet]availablefrom:

https://helda.helsinki.fi/bitstream/handle/10138/23535/ retireme.pdf?sequence=2

26.BehnckeS.Doesretirementtriggerillhealth?HealthEcon. 2012;21:282–300.

27.CalvoE,SarkisianN,TamboriniCR.Causaleffectsof retirementtimingonsubjectivephysicalandemotional health.JGerontolBPsycholSciSocSci.2013;68:73–84.

28.BelgraveLL,HaugMR,Gomez-BellengeFX.Genderandrace differencesineffectsofhealthandpensiononretirement before65.ComprGerontol.1987;1:109–17.

29.EttnerSL,FrankRG,KesslerRC.Theimpactofpsychiatric disordersonlabormarketoutcomes.IndLaborRelatRev. 1997;51:64–81.

30.PitSW,ShresthaR,SchofieldD,PasseyM.Healthproblems andretirementduetoill-healthamongAustralianretirees aged45–64years.HealthPolicy.2010;94:175–81.

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31.OortwijnW,NelissenE,AdaminiS,vandenHeuvelS, GeuskensG,BurdorfL.Socialdeterminantsstateoftheart reviews:Healthofpeopleofworkingage:Fullreport. Luxembourg:EuropeanCommissionDirectorateGeneralfor HealthandConsumers;2011.

32.DutchNationalInstituteforPublicHealthandthe

Environment.Europeansofretirementage:Chronicdiseases andeconomicactivity.Bilthoven:DutchNationalInstitutefor PublicHealthandtheEnvironment;2012[internet]available from:http://ec.europa.eu/health/major chronic

diseases/docs/rivmreportretirementen.pdf

33.MeinG,MartikainenP,HemingwayH,StansfeldS,MarmotM. Isretirementgoodorbadformentalandphysicalhealth functioning?:WhitehallIIlongitudinalstudyofcivilservants. JEpidemiolCommunityHealth.2003;57:46–9.

34.SalokangasRK,JoukamaaM.Physicalandmentalhealth changesinretirementage.PsychotherPsychosom. 1991;55:100–7.

35.TuomiK,JarvinenE,EskelinenL,IlmarinenJ,KlockarsM. Effectofretirementonhealthandworkabilityamong municipalemployees.ScandJWorkEnvironHealth. 1991;17:75–81.

36.OstbergH,SamuelssonS.Occupationalretirementinwomen duetoage.ScandJSocMedSuppl.1994;2:90–6.

37.CoeNB,ZamarroG.RetirementeffectsonhealthinEurope.J HealthEcon.2011;30:77–86.

38.WesterlundH,VahteraJ,FerrieJE,Singh-ManouxA,PenttiJ, MelchiorM,etal.Effectofretirementonmajorchronic conditionsandfatigue:FrenchGAZELoccupationalcohort study.BMJ.2010;341:c6149.

39.OverlandS,GlozierN,MaelandJG,AaroLE,MykletunA. Healthstatusbefore,duringandafterdisabilitypension award:TheHordalandHealthStudy(HUSK).OccupEnviron Med.2008;65:769–73.

40.FonsecaAM,PaúlC.Saúdepercebidae“passagemàreforma”. PsiSaúdeDoenc¸as.2004;5:17–29.

41.SequeiraCMM.Aposentac¸õespordoenc¸acardíacaem Portugal(2002–2008).RevPortCardiol.2009;28:561–5.

42.VerbisckMGV.Asaúdesubjectivadepessoasnatransic¸ão paraareforma:contributosdosuportesocialpercebidoedo bem-estarespiritual.Faro:FaculdadedeCiênciasHumanase SociaisdaUniversidadedoAlgarve;2010:Dissertac¸ãode MestradoemPsicologiaClínicaedaSaúde.

43.ClimacoI,Pita-BarrosP,Lourenc¸oO.Healthyenoughtowork longer?Coimbra:CenterforStudiesandResearchinHealth, UniversityofCoimbra;2011(WorkingPapers)[internet] availablefrom:http://www.uc.pt/org/ceisuc/Documentos/ DocTrab/wp201105ClimacoBarrosLourenco2011.pdf

44.LoureiroH,FonsecaA,VeríssimoM.Evoluc¸ãodos comportamentosedoestadodesaúdenapassagemà reforma.RevRefer.2012;8:47–56.

45.KarpansaloM,ManninenP,KauhanenJ,LakkaTA,Salonen. Perceivedhealthasapredictorofearlyretirement.ScandJ WorkEnvironHealth.2004;30:287–92.

46.VandenBergT,SchuringM,AvendanoM,MackenbachJ, BurdorfA.Theimpactofillhealthonexitfrompaid employmentinEuropeamongolderworkers.OccupEnviron Med.2010;67:845–52.

47.GalamaT,KapteynaA,FonsecaR,Pierre-CarlM.Ahealth productionmodelwithendogenousretirement.HealthEcon. 2013;22:883–902.

48.AndersonKH,BurkhauserRV.Theretirement-healthnexus:A newmeasureofanoldpuzzle.JHumResour.1985;20:315–30.

49.BazzoliGJ.Theearlyretirementdecision:Newempirical evidenceontheinfluenceofhealth.JHumResour. 1985;20:214–34.

50.RiceN,RobertsR,JonesAM.Sickofworkortoosicktowork?: Evidenceonhealthshocksandearlyretirementfromthe BHPS.York:Health,EconometricsandDataGroup(HEDG), DepartmentofEconomics,UniversityofYork;2006(HEDG WorkingPapers;06/13).

51.MoonJR,GlymourMM,SubramanianSV,Avenda ˜noM, KawachiI.Transitiontoretirementandriskofcardiovascular disease:ProspectiveanalysisoftheUShealthandretirement study.SocSciMed.2012;75:526–30.

52.GreenlandS.AnIntroductiontoinstrumentalvariablesfor epidemiologists.IntJEpidemiol.2000;29:722–9.

53.CharlesKK.Isretirementdepressing?:Laborforceinactivity andpsychologicalwell-beinginlaterlife.ResLaborEcon. 2004;23:269–99.

54.NeumanK.Quityourjobandgethealthier?:Theeffectof retirementonhealth.JLaborRes.2008;29:177–201.

55.MunichCenterfortheEconomicsofAging(MEA).Surveyof Health,AgingandRetirementinEurope;2012[Internet] availablefrom:http://www.share-project.org/

Imagem

Table 1 – Summary of studies that found effects of chronic diseases and self-perceived health on retirement.
Table 2 – Summary of studies which aimed to investigate the effects of retirement on health.

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