Health and morbidity among those in paid work after age 64: a systematic review

Abstract Background Despite the increase of labour market participation at older ages, very little is known about health and morbidity among those who remain in a paid work after age 64. The aim was to systematically review the scientific knowledge on health and morbidity among people aged above 64 years who are in paid work. Methods A systematic literature review of studies published in English in scientific journals in 2014-2020. We identified 18,972 unique publications, of which 66 were deemed relevant by at least two independent researchers. Quality judgements and data extraction were done by at least two independent researchers according to pre-specified templates. Results There was a great heterogeneity in the included studies regarding study design, included populations (both size and type), exposures, outcomes, covariates, measures, and analytical methods. Few were assessed as having high quality. Most studies (95%) were from OECD countries and results were about men to a greater extent than women. 42 of the 66 studies had results indicating that being in paid work after age 64 was associated with good health and less morbidity. Six studies presented at least one result showing the opposite; those in paid work had worse health than those not, while 21 studies presented at least one result showing that there were no health/morbidity differences between those in paid work and who were not. Only one study presented results regarding mortality. Many aspects had not been studied at all, or only in one or two studies. Conclusions Many studies had results indicating that those who were in paid work >64 had better health/less morbidity than those who were not, however, there was a great variety in the results. There are surprisingly few studies about health/morbidity among people in paid work after age 64, and those published are heterogeneous: it is thus not possible to draw conclusions regarding scientific evidence based on the currently existing studies. Key messages • Both study designs and results were very heterogenous in the 66 studies that presented results on health or morbidity among people in paid work after age 64. • More and better studies are needed as well as greater clarity regarding study designs, populations, measures, analytical methods and definitions of central concepts such as work, health and morbidity.


Background:
The number of employed people with certain mental or chronic illnesses is increasing.Given the fact that these are mainly diseases of the elderly and the fact that working life is increasing and populations are aging, we are already facing a public health problem that can increase without appropriate measures.Dementia mainly affects the elderly, but may occur in employed persons as well.This impairs their ability to work and is associated with costs.For the first time in Slovenia we performed a study to assess health absenteeism due to the diagnosis of dementia in the period from 2015 to 2018, to show its economic consequences and to plan the measures.

Methods:
The method of direct and indirect costs was used.We showed the indirect costs, which represent a loss, ie goods and services not produced on the market, namely, absenteeism due to dementia, and its economic impact.The costs of temporary absence from work were calculated on the basis of data obtained from the national health databases.The estimated cost of compensation for absence from work is based on the average gross salary.International Classification of Diseases-10 edition was used for the diagnoses of dementia; the Health Insurance Institute of Slovenia was the source of financial data.

Results:
Temporary absence from work due to the diagnosis of dementia in the period 2015-2018 in Slovenia amounted to around 0.6% of all calculated direct and indirect costs for this period, amounting to 11,037,275.00 EUR.The cost has been rising over the years.

Conclusions:
The results are underestimated, as rare cases of dementia are diagnosed before the age of 65 and due to data limitations.The employers should keep affected persons as long as possible active by adjusting the labour environment, working hours, providing an ergonomically designed workplace or by implementing preventive measures.These will reflect in positive financial effects on the economy, companies and the individuals.

Key messages:
It is fundamental to encourage employers of persons with dementia to keep them in the initial phase of dementia active for as long as possible by adopting proper measures.Awareness of dementia is extremely important, as rapid recognition of signs of dementia and subsequent diagnosis, allow early and appropriate treatment.

Background:
Despite the increase of labour market participation at older ages, very little is known about health and morbidity among those who remain in a paid work after age 64.The aim was to systematically review the scientific knowledge on health and morbidity among people aged above 64 years who are in paid work.

Methods:
A systematic literature review of studies published in English in scientific journals in 2014-2020.We identified 18,972 unique publications, of which 66 were deemed relevant by at least two independent researchers.Quality judgements and data extraction were done by at least two independent researchers according to pre-specified templates.

Results:
There was a great heterogeneity in the included studies regarding study design, included populations (both size and type), exposures, outcomes, covariates, measures, and analytical methods.The determination of staffing needs in healthcare is not just calculating the optimal number of professionals but is defining how the professional contingent accompanies the development of the healthcare organisation and of the population's care needs.This research investigates the existence of a gold standard for determining health personnel requirements.We perform a systematic literature review to explore several approaches worldwide, examining a wide range of contextual variables, useful for the definition of an omni-comprehensive approach.A total of 557 articles was initially detected, then reduced to 57 after excluding everything not related to healthcare context and staff planning models.Results do not reveal a recognized standard for determining staffing needs.Approaches to the definition of staffing standards are mainly ex-ante (31%), based on the characteristics of specific models and organisational needs, or ex-post (62%), based on production analysis and historical trends.Most of these refer to the medical and nursing category (68.4%), while the minority proposes a multi-professional approach (17.5%).This review highlights innovative approaches based on algorithms which, starting from historical data, are adjusted by moderating key variables such as contextual factors, healthcare organisation models and professional attributes.The review suggests: 1. Develop and share a unique tool for defining standards based on several variables that identify the characteristics of the context 2. Use up-to-date information flows and quality data 3. Consider a multi-professional approach 4. Adopt a long-term vision and continuous dialogue with the training process It is clear the need to develop a tool for the definition of personnel requirements in line with internal and external changes in the health system.Therefore, such models need to account for an adequate number of variables, useful to identify the characteristics of the overall context.

Key messages:
The development of staffing needs estimates must necessarily rely on a certain level of standardisation, but at the same time must take into account the variability characterising different contexts.
In order to respond to recent demographic and epidemiological trends, it is crucial to include in the model skill mix and task shifting strategies involving health professionals as a whole.
Abstract citation ID: ckac131.261Managers' prevention and self-confidence in supporting employees with common mental disorders

Background:
Despite managers' responsibility for work environment and employee health few studies have investigated managers' actions to prevent common mental disorders (CMD).Concerning prevention of CMD, qualitative studies report managers feeling unconfident.We investigated managers' selfconfidence in supporting employees with CMD and two managerial preventive actions (MPA): 'reviewing assignments and the work situation' (MPA-review) and 'taking initiative to talk about depression and anxiety at the workplace' (MPAtalk).We hypothesized that managers' self-confidence in supporting employees with CMD would be positively associated with both MPAs.
Methods: An on-line survey was sent in 2017 to 4737 managers, answer rate 71% (n = 3358), of which 2 899 were included in this study.Both independent and dependent variables were measured through single questions.Self-confidence in supporting employees with CMD was analyzed in relation to MPA-review and MPA-talk using binary logistic regression analysis adjusted for sex, education, managerial experience and training, lived experiences of CMD, work organizational context and general preventive actions in the organization towards CMD.

Results:
The proportion of managers with higher self-confidence in supporting employees with CMD was 48.9%, performing MPA-review and MPA-talk was 50% and 57% respectively.Adjusted for all co-variates, managers with higher selfconfidence in supporting employees with CMDs were more likely to do both MPA-review (OR 1.57; 95% CI, 1.31-1.87)and MPA-talk (OR 2.06; 95% CI, 1.71-2.25).

Conclusions:
The study hypotheses were confirmed.Managers with more self-confidence in supporting employees with CMD were more 15th European Public Health Conference 2022 and Welfare, Halmstad University, Halmstad, Sweden Contact: monica.bertilsson@socmed.gu.se Few were assessed as having high quality.Most studies (95%) were from OECD countries and results were about men to a greater extent than women.42 of the 66 studies had results indicating that being in paid work after age 64 was associated with good health and less morbidity.Six studies presented at least one result showing the opposite; those in paid work had worse health than those not, while 21 studies presented at least one result showing that there were no health/ morbidity differences between those in paid work and who were not.Only one study presented results regarding mortality.Many aspects had not been studied at all, or only in one or two studies.Conclusions:Many studies had results indicating that those who were in paid work >64 had better health/less morbidity than those who were not, however, there was a great variety in the results.There are surprisingly few studies about health/morbidity among people in paid work after age 64, and those published are heterogeneous: it is thus not possible to draw conclusions regarding scientific evidence based on the currently existing studies.