Background
Life expectancy is increasing, and, as a result, individuals will live longer after retirement age than ever before, if retirement ages would remain unchanged. Life expectancy at the common current retirement age of 65 has increased substantially over the years; for example, in the United Kingdom it has increased from 16.2 (1993) to 19.0 (2007) years and in the Netherlands from 16.8 (1993) to 19.0 (2007). Furthermore, due to decreased birth rates, there are fewer adolescents to compensate for elderly's exit from the labour force, and as a consequence, the balance between employed and unemployed people will shift. Without intervention, it is thought that the ratio of employed to unemployed will increase from 3:1 in 2004 to 1:1 in 2050 in European Union countries, which could greatly impact the healthcare burden. Recent European policies have been developed to raise retirement ages in order to reduce the burden on welfare budgets. In this context there is considerable debate about the timing of retirement and its influence on health.
Based on Feldman's often-cited definition, the present study defines retirement as 'the exit from labour force, taken by individuals after middle age, and taken with the intention of reduced psychological commitment to work thereafter'. This definition does not explicitly incorporate the range of retirement forms which include voluntary retirement, involuntary retirement and regulatory retirement. Voluntary retirement can be understood as the relative preference for leisure versus continuing work and seems more likely to occur among those who have economic security after the transition, for instance in the form of savings or pension-like benefits. On the other hand, some workers are forced to retire because of corporate reorganisations or due to health reasons, for example. This type of retirement is often referred to as involuntary retirement and can be expected to cause more stress than voluntary retirement, as workers have less control over the situation. Retirement at a statutory retirement age is referred to as regulatory retirement, but sometimes also labelled as involuntary retirement. An important characteristic of regulatory retirement is that it is country specific, given that statutory retirement ages and socially accepted pension ages differ between countries. With all types of retirement, the national economic situation and the availability of pension-like social benefits can influence the meaning and consequences of retirement.
The assumption that retirement may affect physical and psychological well-being is based on the idea that retirement is a major life transition, which results in social-psychological transformation. According to the stressful-life-event approach, which forms the basis of much of the literature on the impact of retirement on health, the stress caused by major life events can have repercussions for an individual's physical and mental well-being. Factors such as desirability, the degree of control, intrinsic values, predictability and irreversibility can contribute to the stressfulness of a life event. These factors can be related to the characteristics of work and retirement; for example, when work is physically or mentally demanding retirement might be perceived as desirable, which may reduce the stressfulness of the transition. In other cases, however, retirement may be perceived as the loss of social contacts and intrinsic values, leading to more stress. Furthermore, involuntary retirement might be perceived as more stressful because of a perceived lack of control, as opposed to voluntary (early) retirement.
Studies have shown contradictory results with regards to the relationship between retirement and health. Early studies suggested that there were no detrimental effects on either physical or psychological health after retirement. However, later studies have suggested that retirement does contribute to deterioration in health resulting in an increased burden on the healthcare system. The study of Hult and colleagues showed, adjusting for selection based on health, retirement had no effect on mortality. Westerlund and colleagues showed that retirement had a positive effect on mental health and fatigue, but no effect on chronic conditions. Thus, evidence on the impact of retirement on one's physical as well as mental health is ambiguous. Furthermore, the evidence has not yet been systematically summarised.
The aim of this study is to provide a systematic literature review, which summarises the available evidence on the health effects of retirement and describes differences in health effects between types of retirement (voluntary, involuntary or regulatory) and types of work (blue-collar workers and white-collar workers). Blue-collar workers and white-collar workers differ from each other with respect to their physical and mental workload, which could influence the health effects of retirement. This review is relevant for researchers because it addresses challenges in research, but is also relevant for policy makers since it provides insight into the possible health consequences of retirement that may aggravate or alleviate pressures on the healthcare system.