He was a frustrating patient, a retired field worker with poorly controlled diabetes and hypertension. I'd warned, I'd pleaded, I'd explained, but nothing had worked. He ignored dietary advice, didn't exercise and failed to rigorously use his medication. We grew to dread his visits. Then one day he came to the office early for medication refills. His pot belly was almost gone, and his blood sugar levels and blood pressure were right on target. The reason? He'd decided to return to work.
It brought to mind another of my patients, an oil field worker, who had always had a vitality that belied his fiftysomething years. But then he was involuntarily laid off. The next time he came to the office, I was shocked. It was as if he'd aged a decade or two.
Americans are hard-wired to consider retirement age to be 65. Social Security, under a formula established in the 1930s when the average age at death was about 15 years earlier than it is today, reinforced that idea. And now that retirees can begin collecting Social Security and/or pensions before they turn 65, a growing number of people leave the workplace even earlier.
As a geriatrician, I've come to believe that working longer is generally a good thing. Most people just plain do better, both intellectually and physically, when they continue to work. I've observed many times that mature patients who quit working — whether they have been laid off or retired voluntarily — are likely to gain weight, become hypertensive and even develop depression.
These tendencies have been substantiated by research. One 2007 study, for example, found that "retirement was associated with a significantly higher odds for a decline in physical activity." The Whitehall II study, a longitudinal examination of British civil servants, found that continuing to work may reduce the risk of cognitive decline. And a recent study by the Rand Corp. and the University of Michigan found that "men and women in countries where people worked longer did better on a test of cognitive skill involving memory than those in countries where early retirement was the norm."
A study in Israel looked at wage earners in their 70s and concluded that "work correlated with better perceived health and greater independence for both women and men independent of preexisting economic difficulties, education, illness." And, perhaps most important, at a time when available medical resources are being stretched to the limit, an analysis of data from the Americans' Changing Lives Study saw "productive engagement (including volunteering) as an important ... pathway to health in late life."
Physicians deal with individuals, not just statistics, and the findings of these studies don't surprise me a bit. There are always, of course, exceptions, and not all people can continue to work late in life. But in general, my employed (and committed volunteer) senior patients seem more robust and happier than those who have opted for retirement. I can still see the joy on the face of one of them, an attractive 76-year-old widow, when she announced that she'd recently been hired as a receptionist. I have a 92-year-old patient who still takes immense pride in knitting sweaters for disadvantaged babies, and I have a 72-year-old patient who is always eager to share the scholastic accomplishments of the inner-city fourth-graders she volunteers with daily.
Studies have shown that people in their 30s and younger expect to see the retirement age raised by the time they're in their 60s, and they don't believe that Social Security will necessarily be there for them, at least in its current form. They are probably right. Social Security's current recipients grew up in a time when families had an average of four children. Those born after the '60s typically come from two-child families. This is not a good trend for the sustainability of Social Security, which depends on worker contributions.
From my end of the exam table, I'd say younger people shouldn't worry about having to work longer. Increasingly, it has become obvious that the old dictum "use it or lose it" definitely applies where humans are concerned.
Katherine Schlaerth, an associate professor emeritus at the USC School of Medicine, sees patients and teaches at several Southern California locations.