Faculty of Health, Social Care and Education

The context of this paper is the changing nature of later life in the United Kingdom. It examines some of the broader issues of early retirement. While there has been considerable debate about the restructuring of employment during the latter part of the 20th century which led to a shake-out of older workers from the labour force, less attention has been given to those who take voluntary early retirement. Given the importance of early retirement to the economy and to social policy, it is important to find out how individuals make retirement decisions. The paper examines the results of a semi-structured interview study of the decisions made by a purposively drawn sample of British civil servants who are participants in the Whitehall II study. The sample included participants who chose early retirement and those who did not. From the interview data, ideal types of possible routes into retirement have been constructed. Illustrating these ideal types, individual life histories are drawn upon to show how responses to the issues surrounding retirement feature in people's lives. It is argued that decisions about early retirement are not made in a vacuum, neither are they free from pressures or inducements. Some are to do with organisational restructuring, some are about financial offers, and some are influenced by the opportunities for leisure and self-fulfilment that early retirement offers. The paper concludes by arguing that early retirement needs to be studied as a process involving the interplay between structure and agency.

Retirement has traditionally been seen as the beginning of old age. It has been depicted as mandatory expulsion from the workforce and seen to mark the transition to a period of ill health and poverty. Such ideas and associations are however being challenged in the developed world by socio-demographic changes in retirement and old age. People in the United Kingdom as elsewhere are living longer and healthier lives, and many older people have access to non-state incomes that afford them a reasonable standard of living in retirement. There is however still concern that inequalities persist into old age. Data from two waves of the British Whitehall II study have been used to assess the relative effects of occupational grade, psychological and general health during working life, and retirement patterns or pathways on activities, attitudes to health and income in retirement. The results show that the majority of the sample reported good health, financial security and overall satisfaction with life, but with observable inequalities. Regression analyses demonstrate that pre-retirement circumstances generally had a greater effect on later life than the retirement route or pathway. Retirement no longer represents a drastic break between working and post-work life but rather, the results suggest, there are continuities between the two periods. It is concluded that the main causes of inequalities in retirement are work-based rather than in retirement itself.

The context of this paper is the changing nature of later life in the United Kingdom. It examines some of the broader issues of early retirement. While there has been considerable debate about the restructuring of employment during the latter part of the 20th century which led to a shake-out of older workers from the labour force, less attention has been given to those who take voluntary early retirement. Given the importance of early retirement to the economy and to social policy, it is important to find out how individuals make retirement decisions. The paper examines the results of a semi-structured interview study of the decisions made by a purposively drawn sample of British civil servants who are participants in the Whitehall II study. The sample included participants who chose early retirement and those who did not. From the interview data, ideal types of possible routes into retirement have been constructed. Illustrating these ideal types, individual life histories are drawn...

Background: it is uncertain how recent changes in labour force dynamics may have in¯uenced the increasing numbers of people taking early retirement in industrialized countries. The Whitehall II study provides an opportunity to examine the predictors of early retirement in one of the largest employers in the United Kingdom. Methods: we examined the factors predicting early retirement in a 7-year follow-up period from 1988 to 1995 using longitudinal data on 2532 male and female London-based civil servants aged between 50 and 59.5 years. Baseline data on employment grade and duration of time working for the Civil Service were obtained from self-completed questionnaires. The primary factors examined included health, work characteristics, questions about job demands and job satisfaction and ®nancial insecurity, wealth and material problems. Time until early retirement was analysed using Cox proportional hazards model. Results: of the 2532 civil servants, 26.7% retired early during the follow-up period. We found that men and women in the higher-paid employment grades, those that had suffered from ill health and those that were less satis®ed with their jobs were more likely to retire early, whereas material problems tended to keep people working. Conclusions: our results show that self-perceived health, employment grade and job satisfaction are all independent predictors of early retirement. Qualitative analyses may further advance our understanding of the retirement process.

Retirement has traditionally been seen as the beginning of old age. It has been depicted as mandatory expulsion from the workforce and seen to mark the transition to a period of ill health and poverty. Such ideas and associations are however being challenged in the developed world by socio-demographic changes in retirement and old age. People in the United Kingdom as elsewhere are living longer and healthier lives, and many older people have access to non-state incomes that afford them a reasonable standard of living in retirement. There is however still concern that inequalities persist into old age. Data from two waves of the British Whitehall II study have been used to assess the relative effects of occupational grade, psychological and general health during working life, and retirement patterns or pathways on activities, attitudes to health and income in retirement. The results show that the majority of the sample reported good health, financial security and overall satisfaction...

Background Exercise programmes are beneficial for cancer patients however evidence is limited in patients with multiple myeloma (MM), a cancer that is characterised by osteolytic bone disease, giving rise to high levels of bone morbidity including fractures and bone pain. Methods We conducted a single arm phase 2 study of an exercise programme (EP) as rehabilitation for treated MM patients, to evaluate feasibility, effects on QOL and physiological parameters. Patients were given individualised programmes, comprising stretching, aerobic and resistance exercises, carried out under supervision for 3 months then at home for a further 3 months. Results Study uptake was high, 60 of 75 (80%) patients approached consented to the study. Screen failures (11, due to fracture risk and disease relapse) and patient withdrawals (12) resulted in a final 37 patients enrolling on the programme. These 37 patients demonstrated high attendance rates in the supervised classes (87%), and high levels of ad...

Background: Longitudinal studies are crucial providers of information about the needs of an ageing population, but their external validity is affected if partipants drop out. Previous research has identified older age, impaired cognitive function, lower educational level, living alone, fewer social activities, and lower socioeconomic status as predictors of attrition. Methods: This project examined attrition in participants of the Whitehall II study aged between 51-71 years, using data from questionnaires participants have completed biennially since 1985 when the study began. We examine the possibility of two distinct forms of attritionnon-response and formally requesting to withdrawand whether they have different predictors. Potential predictors were age, gender, marital status, occupational grade, retirement, home ownership, presence of longstanding illness, SF-36 quality of life scores, social participation and educational level comparing participants and those who had withdrawn from the study. Results: The two forms of attrition share many predictors and are associated but remain distinct. Being older, male, having a lower job grade, not being a home owner, not having a long standing illness, having higher levels of education, and not having retired, were all associated with a greater probability of non-response; being married was associated with higher probability in women and lower in men. Being older, male, having a lower job grade, not being a home owner, having lower SF-36 scores, taking part in fewer social activities, and not having a long standing illness, were all associated with greater probability of withdrawal. Conclusions: The results suggest a strong gender effect on both routes not previously considered in analyses of attrition. Investigators of longitudinal studies should take measures to retain older participants and lower level socioeconomic participants, who are more likely to cease participating. Recognition should be given to the tendency for people with health problems to be more diligent participants in studies with a medical screening aspect, and for those with lower socioeconomic status (including home ownership), quality of life and social participation, to be more likely to request withdrawal. Without taking these features into account, bias and loss of power could affect statistical analyses.

82% (27% CR/VGPR). In relapsed patients, RR was 67%, 67%, and 50% in R1, R2, and R3+, respectively. The median cumulative dose of bortezomib was 21.3mg/m 2 ; RR was 81% in patients receiving 21.3mg/m 2 and 48% in those receiving < 21.3 mg/m 2. With a median follow-up of 9.3 months (range, 1.1-48.8 months), median time to treatment failure (TTF) was 6.4 months (PRP, 15.6; R1, 7.2; R2, 6.8; R3 , 3.45). High cumulative dose (21.3 mg/m 2) correlated with increased TTF (9 months vs. 3.4 months). Toxicity was scored by NCI criteria. Grade 3 painful neuropathy affected 13% (no grade 4) and sensory neuropathy 1% (grade 3; no grade 4). Pre-existing neuropathy increased the risk of sensory neuropathy, whereas higher cumulative doses predicted painful neuropathy. Fifty-two percent developed grade 3/4 thrombocytopaenia, 31% developed grade 3/4 neutropenia but only 11% had infections requiring I.V. antibiotics. Grade 3 diarrhea affected 6 patients (no grade 4) with no cases of grade 3 constipation. Four patients developed acute renal failure, necessitating dialysis; 2 following grade 3 diarrhea. They both subsequently died. Forty-six percent of patients received dose reductions, mainly for neuropathy. Our experience confirms the tolerability and good responses possible with bortezomib, especially in primary refractory patients. Prompt dose reduction reduces the incidence of painful neuropathy. Severe diarrhea is uncommon but avoidance of dehydration is essential to prevent prerenal renal failure.

Background: To explore the relationship between work, retirement and physical activity. Methods: Crosssectional analyses of data from self-completed questionnaires by 6224 civil servants aged 45-69 years participating in phase 5 of the Whitehall II longitudinal study. Results: There appeared to be a doseresponse relationship between hours worked and the prevalence of physical activity, with a lower prevalence of recommended physical activity amongst participants working full time ($ 30 h/week), higher prevalence rates amongst those working part time (, 30 h/week), and the highest rates amongst participants who were not working at all. Physical activity rates did not increase greatly amongst study participants who had retired from the Civil Service but had gone on to do further full-time work, however, the higher physical activity rates of participants working part time, or not at all, were further enhanced amongst those who had also retired. Conclusions: These findings suggest that full-time work is associated with lower rates of recommended physical activity levels in this cohort of middle-aged whitecollar office workers. Lower grade occupations are also less likely to meet the recommended physical activity levels. While retirement is associated with higher rates of recommended physical activity levels, this benefit is evident amongst those who work part time, or not at all, during their retirement, for whom the benefits of retirement and lower working hours on rates of physical activity appear additive. The frequency of different types of physical activity is associated with different occupational grades, with more sport and gardening being done by the higher occupational grades.

Background: To determine whether retirement at age 60 is associated with improvement or deterioration in mental and physical health, when analysed by occupational grade and gender. Methods: Longitudinal study of civil servants aged 54 to 59 years at baseline, comparing changes in SF-36 health functioning in retired (n=392) and working (n=618) participants at follow up. Data were collected from self completed questionnaires. Results: Mental health functioning deteriorated among those who continued to work, but improved among the retired. However, improvements in mental health were restricted to those in higher employment grades. Physical functioning declined in both working and retired civil servants. Conclusion: The study found that retirement at age 60 had no effects on physical health functioning and, if anything, was associated with an improvement in mental health, particularly among high socioeconomic status groups.

The increase in drop-out rates, especially among older people, in longitudinal studies is a matter for concern if the results are to be valid. The research reported here contains a number of pieces of evidence that might help address the problem. These include a literature review, a survey of some longitudinal studies, secondary (quantitative and qualitative) analysis of the data from a longitudinal study of civil servants (the Whitehall II study), and new data from focus groups and telephone interviews with participants from this current study. The findings relate to reasons why older people continue to take part in such studies, why they drop out and what might encourage them to continue participating. The main reasons for drop out relate to being older, having cognitive impairment and poor functioning, living alone, being a woman and being less educated. There were also a range of practical reasons including the study being too time-consuming and problems with transport.

Research that follows people over a period of time (longitudinal or panel studies) is important in understanding the ageing process and changes over time in the lives of older people. Older people may choose to leave studies due to frailty, or illness and this may diminish the value of the study. However, people also drop out of studies for other reasons and understanding the motivation behind participation or drop out may prevent further loss of valuable longitudinal information and assist the continuation of longitudinal studies. This paper examines qualitative data from interviews and focus groups in 2003/2008 with participants of the Whitehall II Study (based at UCL), and investigates reasons participants give for participating in longitudinal health studies, and recommendations they give for encouraging continued participation as they grow older. A total of 28 participants and 14 staff were interviewed, and 17 participants took part in focus groups. Our findings are discussed in the light of the debate between of altruism and reciprocity. Rather than being wholly motivated by altruism, as research staff had assumed, participants were motivated by the benefits they perceived, particularly the information and care received during the medical examinations and the sense of loyalty and membership associated with being part of the study. Our findings support the view that far from being primarily motivated by altruism, research participation in studies such as this may also involve a degree of implicit and explicit reciprocity. However, participants disliked the obligation to complete the study questionnaires e which may have influenced the expectation of payment or reciprocation, as participation was not wholly pleasing. To try and maintain participation in longitudinal health studies this project recommended gathering information from exit interviews as a way of preventing further withdrawals and closer involvement of participants through a user panel.

ÐThis paper evaluates four well established sociological theories of ageing using qualitative data from the British Whitehall II study. We attempt to apply the theories to contemporary retirement and through each theory examine the issue of health in retirement. The eect of lowered income in retirement is discussed in relation to Townsend's theory of structured dependency. Change in participant's health following retirement is examined in respect of the theory of disengagement by Cumming and Henry, adjustment to retirement in relation to Laslett's theory of the third age. Parson's role theory is used to examine how social interactions and relationships change for people who have recently retired. We discuss the need for a multifaceted theory of ageing which can accommodate the continually changing experience and age of retirement. We analysed interviews conducted with 25 male and female civil servants aged between 55 and 63 years, from dierent grades who had been retired for less than 2 years.

Exercise is increasingly recognized as a core component of palliative rehabilitation. The group exercise model is often adopted as a means of reaching more patients with limited resource. Despite the growth of quantitative research examining this area of practice, few qualitative studies have looked at the patient experience of participating in group exercise in a palliative setting, and most exclude patients with a non-cancer diagnosis. The aim of this study was to explore patients&#39; experiences of participating in group exercise classes in a hospice setting. In this qualitative, phenomenological study, nine patients participating in a group exercise programme at a South London hospice completed semi-structured interviews. Participants were purposively sampled by gender, age, ethnicity and diagnosis; to include diagnoses across cancer, respiratory and neurological conditions. Transcripts were interpreted using thematic analysis. All patients reported positive experiences of part...

Background: To explore associations between pets, and specifically dog ownership and sleep, health, exercise and neighbourhood. Methods: Cross sectional examination of 6575 participants of the Whitehall II study aged between 59 and 79 years. We used self-assessed measurement scales of the Short Form (SF36), General Health Questionnaire (GHQ), Control, Autonomy, Self-realisation and Pleasure (CASP), Centre for Epidemiologic Studies Depression Scale (CES-D), sleep, exercise, and perceptions of local neighbourhood. In addition the Mini Mental State Examination which is administered to test global cognitive status (MMSE). Results: We found 2/7 people owned a pet and of those 64% were "very" attached to their pet. Mild exercise in metabolic equivalents (MET-hours) was significantly higher in pet owners than non-owners (median 27.8 (IQR 18.1 to 41.8) vs 25.7 (IQR 16.8 to 38.7), p = 0.0001), and in dog owners than other pets (median 32.3 (IQR 20.8 to 46.1) vs 25.6 (IQR 16.8 to 38.5), p < 0.0001). Moderate exercise was also significantly higher in pet owners than non pet owners (median 11.8 (IQR 4.2 to 21.9) vs 9.8 (IQR 2.8 to 19.5), p < 0.0001), and dog owners than owners of other pets (median 12.3 (IQR 4.2 to 22.2) vs 10.1 (3.1 to 20.0), p = 0.0002) but there were no significant differences with vigorous exercise. We found that pet owners were significantly more positive about their neighbourhood than non-owners on 8/9 questions, while dog owners were (significantly) even more positive than owners of other pets on 8/9 questions. Associations with sleep were mixed, although dog owners had less trouble falling asleep than non-dog owners, with borderline statistical significance. Conclusion: Dog owners feel more positive about their neighbourhood, do more exercise, and fall asleep more easily than non-dog owners. These results suggest that dog owners could be more likely to exercise by walking their dogs and therefore may be more familiar and positive about the area in which they walk their dog.