The Effect of Retirement on Physical Health
DAVID J. EKERDT, PHD, LYNN BADEN, MPH,
RAYMOND BossE-, PHD, AND ELAINE DIBBS, RN, MA
Abstract: This prospective study compared pre- to post-retire-
ment changes in physical health among male retirees with changes
among age peers who continued to work. The 229 retirees and 409
workers aged 55-73 at follow-up were all participants in the Veter-
ans Administration Normative Aging Study. Physical health at
baseline and follow-up (three to four years apart) was rated on a
four-point scale according to the findings of medical examinations.
Although physical health declined generally over time, regres-
sion analyses showed no significant difference between eventual
retirees and continuing workers on health change, after controlling
The notion that retirement harms health is a durable
one, which has persisted for several related reasons. First,
anecdotal evidence commonly attributes the illnesses and
deaths of retirees to the act of having retired. Such anec-
dotes come from popular, as well as clinical, observation.' 2
Second, people attribute such effects to retirement because
it is a single, large, vivid, and usually recent life event. As
such, it simplifies the interpretation of subsequent changes
in physical or emotional well-being.3 Third, negative views
of retirement are consistent with a Western cultural ideology
that celebrates work and identifies it as the locus of self-
esteem, identity, and personal fulfillment.4 Finally, the re-
cently prominent "stressful life events" paradigm has re-
newed the expectation that retirement, because it is disrup-
tive, increases personal vulnerability to illness.5 6
Against these rationales for health decline, the opposite
notion-that retiring can benefit health-has received far
less emphasis. Nonetheless, it is reasonable to argue that
removal from a noxious work environment or reduction of
work role demands could have a protective effect on health.7
Previous empirical findings have consistently indicated
that the health of most people is not adversely affected by
withdrawal from work. This body of evidence, however, is
typically viewed with considerable reserve due to method-
ological limitations.5.8-I0 The foremost cited limitation is that
findings are largely based on self-reports. of health and
illness. Evidence from self-reports, whatever its usefulness
in other contexts," is felt to be less conclusive for this issue
because responses are biased toward optimism with advanc-
ing age and thus toward stability over time; measures are
often ambiguous as to whether medical or functional aspects
of health are being evaluated; and the subjective framework
for the self-evaluation of health may change upon retire-
ment, confounding any interpretation of change or stability.9
Evidence from recent mortality studies, however, has also
failed to confirm the adverse impact of retirement on
From the Normative Aging Study, Veterans Administration Outpatient
Clinic, Boston, and Hellenic College, Brookline, Massachusetts. Address
reprint requests to Dr. David J. Ekerdt, Normative Aging Study, VA
Outpatient Clinic, 17 Court Street, Boston, MA 02108. This paper, submitted
to the Journal September 17, 1982, was revised and accepted for publication
January 26, 1983.
AJPH July 1983, Vol. 73, No. 7
for age and excluding men who retired due to illness or disability.
Among retirees alone, pre- to post-retirement health change was
also not significantly associated with several circumstances which
purportedly make the retirement transition more stressful, such as
mandatory retirement or retirement to a reduced standard of living.
The results of this study of physical health, which corroborate those
of other studies based on self-reported health measures and mortal-
ity data, support the conclusion that the event of retirement does not
influence the risk of health deterioration. (Am J Public Health 1983;
73:779-783.)
health. 12-15 The single positive finding here was a report of
increased risk of coronary mortality among retirees com-
pared to nonretirees,'6 about which the authors have none-
theless urged a cautious interpretation. '7 Finally, the only
previous study to have used physicians' health ratings
actually reported that health improvement rather than de-
cline was the more likely outcome of retirement.'8
In the present study, independent ratings of physical
health based on medical examinations were used to compare
pre- to post-retirement change among male retirees with
change among age peers who continued to work. Indepen-
dent ratings of physical health are appropriate outcome
measures for the investigation of this topic because, on the
one hand, they transcend the ambiguities and shifting criteria
that may underlie self-reports; on the other hand, ratings are
more differentiated than such gross indicators as mortality or
disease incidence. The specific rating scale used here has
already been applied to the study of health change in adult
men'9 and is particularly suited to this investigation because
it can rely on the same medical criteria for the evaluation of
impairment in workers and retirees alike. It also incorpo-
rates a prognostic dimension-discounting acute, temporary
illnesses in favor of health outlook over the longer term-
thereby limiting health change to shifts of a more substantive
kind. Another feature of this study was the ability to identify
and control for illness or disability as reasons for retirement,
a circumstance that often confounds the interpretation of
health change surrounding withdrawal from work.
Methods
Study Population
Groups of retirees and workers included in this study
are among the participants in the Veterans Administration
Normative Aging Study. Located in Boston, the study began
in 1963 as a prospective study of over 2,000 community-
dwelling men born between 1884 and 1945. Participants were
screened from a pool of several thousand volunteers accord-
ing to laboratory, clinical, radiographic, and electrocardio-
graphic criteria in order to exclude individuals with chronic
medical conditions.20'2' Because of original selection for
good health as well as geographic stability, distributions of
educational attainment, occupational level and occupational
stability are fairly similar at all age levels. Although occupa-
779
EKERDT, ET AL.
tionally heterogenous and evenly divided between white-
collar and blue-collar jobs, the participants tend to be of
slightly higher social class levels than the general population
from which they were drawn. A low attrition rate among
Normative Aging Study participants (less than I per cent
annually) has conserved the sample over time, thus aiding
the accurate description of within-individual change. More-
over, the loss of participants has not altered the original
composition of the population on such characteristics as
education, socioeconomic status, blood pressure, and the
frequency of somatic complaints.22
Participants return for regular medical examinations
every five years up to the age of 52, and every three years
thereafter. The group of retirees was constituted on the basis
of their age and date of retirement, as well as available data
from Normative Aging Study medical examinations. Based
on questionnaire responses, individuals were defined as
retired if they claimed to have retired, and if they were
receiving public or private pension income, and if any part-
time paid employment did not exceed 30 hours per week.
Retirees were included in the present study if: 1) they retired
between 1972 and March 1981; 2) they were between the
ages of 55 and 70 at retirement; 3) they completed a medical
examination after retiring; and 4) the time interval between
the post-retirement exam (T2) and their immediate pre-
retirement exam (T,) was at least 3 but less then 5.5 years. A
fifth condition for inclusion was that neither of the pair of
examinations could have occurred within 60 days before or
after retirement-this in order to ensure that each examina-
tion not be an unfair representation of pre- or post-retire-
ment status. Out of a possible group of 343 participants who
retired over the 1972-1981 interval between the ages of 55
and 70, 229 were included in the present study. At T2 these
men ranged in age from 55-73 with a mean age of 63.5, and a
mean time interval between medical examinations of 3.3
years. Of this group, 37 per cent had T, examinations within
one year of retirement, 39 per cent within two years, and the
remaining 24 per cent within three and one-half years.
Of the 114 excluded retirees: 20 had had a pre- or post-
retirement examination that was too proximate to their date
of retirement; 49 had not as yet reported for a post-retire-
ment examination before the censoring point of this study
(December 1981); and 45 either had pre- or post-retirement
examinations that were too far removed from their date of
retirement (>5 years) or else failed to report for a scheduled
post-retirement examination (three were deceased). Com-
pared to the included group of 229 retirees, this last group of
45 men, all of whom missed or had off-schedule examina-
tions, were twice as likely (26 per cent vs 13 per cent) to have
retired due to illness or disability, but did not significantly
differ in educational attainment, occupational prestige (Dun-
can Socioeconomic Index),23 or age at retirement. Of this
same group of 45 excluded retirees, 32 had T, examinations
that fell within five years prior to retirement. The distribu-
tion of physical health ratings (described below) in this group
of 32 did not significantly differ from the baseline T, ratings
in the included group of 229.
The group of workers included all non-retired Norma-
tive Aging Study participants as of March 1981 for whom the
time interval between their most recent pair of medical
examinations was also at least 3 but less than 5.5 years. In
addition, workers were included only if their age at T2 was
between 55 and 73, the age range found among retirees.
These criteria yielded a group of 409 workers, with a mean
age of 59.0 at T2, and a mean time interval between examina-
tions of 3.5 years.
780
Health Ratings
Physical health was rated from the record of the T, and
T2 medical examinations, which included medical history,
physical examination by an internist, ECG, chest x-ray, and
standard blood and urine tests. Using a scale developed by
Vaillant'924 and originally applied by an internist, a regis-
tered nurse on the staff of the Normative Aging Study (E.D.)
rated physical health for each examination along a four-point
scale, where 1 denoted irreversible illness with serious
disability, 2 denoted serious chronic illness without disabil-
ity, 3 denoted minor chronic problems, and 4 denoted
excellent health (no irreversible pathology). The present use
of this scale departs from the original by reversing the order
of the categories and omitting the use of an extreme scale
category for decedents. As in the original, the rating catego-
ries were characterized by the following prominent medical
conditions: 1) myocardial infarction, cardiac pacemaker,
coronary bypass, disabling arthritis; 2) treated hypertension,
diabetes, angina or proven coronary artery disease, chronic
obstructive pulmonary disease on medications, rheumatoid
arthritis, peripheral vascular disease; 3) early hypertension
(no medication), obesity, early chronic obstructive pulmo-
nary disease, chronic bronchitis, benign prostatic hypertro-
phy, glaucoma, cataracts, gout, osteoarthritis, herniated
disc, partial deafness; 4) essentially normal health with some
acute illnesses which were resolved, such as ulcer, pneumo-
nia, colds, bursitis, single episode renal stone.
The rater was blind to the employment status of individ-
uals and to the identity of their examinations as T, or T2. The
pair of T, and T2 examinations were rated independently of
each other and in random sequence. Intra-rater reproducibil-
ity was high, based on a repeated rating after one month of
160 randomly selected examinations with the rater blind to
the repetition (92 per cent agreement, unweighted kappa =
.86).25 Inter-rater reproducibility was also high, based on an
independent repeated rating of 50 randomly selected exami-
nations by a second rater, a geriatric nurse practitioner (90
per cent agreement, unweighted kappa =
.81).
Frequency distributions for the T, and T2 ratings are
shown in the margins of Table 1. The cross-classification of
physical health ratings in the body of the Table illustrates the
broad movement of health change over time. Because the
scale emphasizes chronic over acute conditions, temporary
fluctuations in physical health tend to be discounted. This is
demonstrated in Table where, after a three- or four-year
follow-up, substantially more cases fall below the diagonal
than above, indicating declining health consistent with aging.
The cross-sectional correlation of health ratings with age (at
T2) was -.13.
Other Measures
Periodic Normative Aging Study questionnaires on
work and retirement supplied information on the following
circumstances of retirement: age at retirement, whether
illness or disability was the primary reason for retirement,
whether retirement occurred due to compulsory age rules,
whether retirement occurred unexpectedly, and an evalua-
tion of subject's standard of living in retirement along a five-
point scale ranging from "well below" to "well above"
one's pre-retirement standard of living. Also available were
measures of educational attainment, marital status, and
prestige of the former occupation (Duncan Socioeconomic
Index).23
Data Analyses
Multiple regression techniques were used to compare
AJPH July 1983, Vol. 73, No. 7
 EFFECT OF RETIREMENT ON HEALTH

TABLE 1-Cross-classification of Physical Health Ratings at T1 and T2 for the Entire Study Population

Physical health at T2 (n) Total

Physical health at T, (n) 1 2 3 4 N %

1. Irreversible illness with serious disability 09 1 0 10 1.6

2. Serious chronic illness without disability 2 72 8 0 82 12.9
3. Minor chronic problems 7 56 281 5 349 54.7
4. Excellent health 1 20 64 112 197 30.9
Total N 19 148 354 117 638
Total Per Cent 3.0 23.2 55.5 18.3 100

workers and retirees for changes in physical health. In
particular, T2 physical health ratings were regressed on T,
physical health ratings, two covariates (between-examina-
tion time interval and age) and a binary variable representing
retirement status. Each individual's health rating was trans-
formed to a normal score, Z', which followed a normal
distribution with mean 0 and variance 1.0 so as to satisfy
better the assumption of the regression model. Specifically,
if we denote the inverse of a standard normal distribution by
D-' and the rank of the health score of an individual by i,
then an individual's normal score is defined as: Z' = D-'1 (i/
(n+ 1)), where n is the sample size (in the event of ties, i was
the average rank of all individuals with a given health rating).
Because the distributions of the health ratings change
with time, the Z' scores were recalculated for each time
period. Similarly, when cases were excluded from particular
analyses, new Z' scores were calculated specific to the
population under study.
Regression models were also used to investigate wheth-
er health changes among retirees differed by certain circum-
stances which might make the passage from work to retire-
ment more difficult.
Results
Table 2 shows percentage distributions of physical
health ratings at T1 and T2 for continuing workers and for
retirees (all of whom were working at T1). These ratings are
also shown for retirees divided into two groups depending on
whether they retired due to illness or disability. Disability
retirees (N = 29) were excluded from selected analyses
which follow because health change for this group was the
occasion for, rather than a possible outcome of, having
retired. Compared to other retirees, disability retirees were
characterized by younger mean retirement ages (58.9 vs
62.3; t = 4.46, p < .001) and lower occupational prestige by
Duncan SEI (46.0 vs 56.1; t = 2.39, p = .018).
Differences between workers and retirees on change in
physical health were assessed using normalized ratings in
multiple regression models (Table 3). The statistic of interest
in these models is the regression coefficient (b) for the binary
"retirement status" variable (a negative coefficient indicates
an association in the direction of health decline over time).
Among the full sample of workers and retirees, retirement
status was not a significant predictor of physical health
change (p = .727; 95 per cent CI = -.021 .119) after
controlling for time interval between examinations and for
age. When the regression model excluded men who retired
due to illness or disability, the sign of the coefficient for
retirement status was reversed, but still not statistically
significant (p = .485; 95 per cent CI = .044 .124).
Further regression models (not shown in Table 3) in-
cluded indicators of social class (educational attainment,
Duncan SEI) as covariates, but again there were no signifi-
cant effects of retirement status on health change. Likewise,
there was no substantial difference between workers and
retirees on physical health change when separate regressions
were run within three age strata (55-59, 60-64, 65-73 at T2).
All of these results indicate a comparable experience of
physical health change among continuing workers and even-
tual retirees.
Retirement takes place under a variety of circumstances
that can make withdrawal from work a difficult and stressful
experience. Among nondisability retirees only, we investi-
gated whether health decline was more likely among men
whof-retired early, left under compulsory age rules, retired
unexpectedly, had a reduced post-retirement standard of
living, retired from higher status occupations, or were with-
out spouses in retirement. These variables were entered on

TABLE 2-Per Cent Distributions of T1 and T2 Health Ratings by Work-Retirement Status

Physical health at T, Physical health at T2

N 1 2 3 4 1 2 3 4

All Workers 409 1.5 14.4 51.8 32.3 2.7 23.5 53.8 20.0
All Retirees 229 1.8 10.0 59.8 28.4 3.5 22.7 58.5 15.3
Nondisability 200 2.0 8.5 59.5 30.0 3.0 19.5 60.5 17.0
Disability 29 0.0 20.7 62.1 17.2 6.9 44.8 44.8 3.5
1 = Irreversible illness with serious disability.
2 = Serious chronic illness without disability.
3 = Minor chronic problems.
4 = Excellent health.

AJPH July 1983, Vol. 73, No. 7 781

EKERDT, ET AL.

TABLE 3-Regression of T2 Physical Health* on Control Variables and Retirement Status

Disability Retirees Excluded

Full Sample (N = 638) (N = 609)

Independent Variables b SE p b SE p

T, physical health* .680 .031 <.001 .699 .031 <.001

Time between medical exams (days) -.001 .001 .692 -.001 .001 .446
Age at T2 -.011 .007 .132 -.014 .007 .044
Retirement status at T2 (1 = retired, 0 =
working) -.021 .061 .727 .044 .063 .485
Intercept .705 .949
Multiple R2 .448 .476

'Normalized scores.

the last step of separate regression analyses (Table 4) to four years among eventual retirees compared to worker
examine their effect on physical health change controlling for peers. The criteria for these health ratings, however, were
time between medical examinations and age. Findings not specified and the overall incidence of health improve-
showed that retirement at later, rather than earlier, ages was ment-49 per cent in persons originally in "fair" to "very
associated with declining health, which is but a reflection of poor" health-seemed inordinately high given the age of the
chronological age at T2 for which age at retirement is a sample.
virtual proxy (r = .97). None of the other circumstances of As measured in the present study, levels of physical
retirement was significantly associated with health change. health were assigned by the overall severity and prognostic
That the "compulsory retirement" variable should fail to burden of disease. This approach, however, does not ex-
predict health decline is particularly notable because com- haust the possible health changes that may attend retire-
pulsory retirement has been alleged to be a stressor which ment. It does not, for example, encompass the functional
increases the risk of health deterioration.26'27 ability to perform daily activities, which may vary widely
Length of time retired was also considered as a predic- within similar levels of medical impairment. Whether indi-
tor of health outcome. This follows from speculation about viduals can "carry" their illnesses better as a consequence
possible phases of retirement,8s,0 which may include a period of retirement remains to be investigated.
of emotional letdown that leaves retirees vulnerable to In the analyses for this study we excluded men who
health reversals. The 200 nondisability retirees were grouped retired due to illness or disability because their self-selection
into six 6-month time intervals according to length of time to retirement would have confounded the interpretation of
retired at T2, and groups were compared for pre- to post- retirement's impact on health. Although current design
retirement physical health change, again covarying for time considerations warrant their exclusion, disability retirees
between medical examinations and age. There was no signif- may nevertheless be the very individuals who experience
icant main effect of length of time retired on health change (F further health deterioration due to the strain of unwanted or
= 1.60, p = .161) and thus no group-specific decline in untimely retirement.9 Whether retirement complicates the
physical health from pre-retirement baselines. existing vulnerabilities of these specific individuals requires
more research. On the other hand, the possible health
Discussion benefits of retirement, which could flow from reduced role
The findings from this prospective study indicated that
the experience of physical health changes over three to four
years among men who were employed and then retired did TABLE 4-Separate Regressions of Retirees' T2 Physical Health* on
not significantly differ from health changes among age peers Selected Variables, Controlling for T, Physical Health,* Time
between Medical Exams, and Age at T2 (Disability retirees
who remained at work. Nor was health decline predicted by excluded, N = 200)
certain circumstances which purportedly make the retire-
ment transition more difficult such as compulsory retire- Regression
ment, unexpected retirement, or retirement from higher Model Variable on Last Step b SE p
prestige occupations. The present findings, which were
based on independent ratings of physical health from medi- 1. Age at retirement" -.050 .012 <.001
cal examinations, corroborate previous reports on this popu- (Mean = 62.3, SD = 3.9)
2. Retired at compulsory age .059 .125 .636
lation based on self-reports and on somatic complaints as (1 = yes, 21%; 0 = no)
measures of health.28'29 Taken together with other evidence 3. Retired unexpectedly -.037 .106 .728
in the literature from subjective health measures and mortal- (1 = yes, 25%; 0 = no)
ity studies, the results support the conclusion that the event 4. Comparative standard of living .039 .066 .558
(Mean = 2.86, SD = 0.7)
of retirement does not put individuals at risk of health 5. Duncan SEI (former occupation) -.002 .002 .402
deterioration. (Mean = 56.1, SD = 21.5)
Neither was retirement predictive of health improve- 6. Marital status at T2 .101 .150 .499
ment, as had been reported by Thompson and Streibt8 in the (1 = currently married, 89%;
0 = other)
single previous study of objectively rated physical health.
Their results, using physicians' ratings along a five-point 'Normalized scores.
scale, showed disproportionate health improvement over **Age was not a control variable in this model.

782 AJPH July 1983, Vol. 73, No. 7

 EFFECT OF RETIREMENT ON HEALTH

demands and a more relaxed life-style, are also likely to be
best observed in the group of disability retirees. To have a
therapeutic effect, retired life may need only to stabilize
rather than improve one's physical well-being. Controlled
evaluation studies of retirement's protective effect on health
could provide health professionals with sound empirical
support for any life-style changes they may recommend to
men of retireable age.
The notion that retirement harms health is supported by
powerful rationales-listed at the outset of this article-but
by little empirical evidence. Nevertheless, the hypothesis of
adverse impact was used as an argument on behalf of the
recent upward revision of mandatory retirement ages.27
Retirement also continues to be prominently featured as a
"stressful event" of later life, which purportedly puts older
people at risk of illness.'230 Although loss of income,
isolation, frustration, and disesteem can attend retirement,
the strain of these is less than commonly supposed8.3' 32 and,
so far as the evidence goes, not readily manifested in
physical health decline. In all, there are a number of consid-
erations which can guide personal decisions about the choice
or timing of retirement, but the fear of failing health should
not be one of them.
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ACKNOWLEDGMENTS
The authors are grateful to George E. Vaillant for explaining procedures
used to rate physical health. This research was supported in part by the
Medical Research Service of the Veterans Administration and by a grant from
the National Institute on Aging (AG02287).

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AJPH July 1983, Vol. 73, No. 7 783