Palmer - ESRC - ES/L002663/1 Health risks and benefits of extended working life (the HEAF study)

The need to keep Britain's ageing population economically active has prompted government policies aimed at extending working lives. However, working beyond the traditional retirement age may not be feasible for those with major health problems of ageing and, depending on occupational and personal circumstances (e.g. savings, retirement intentions, domestic responsibilities, whether work is arduous, rewarding), might be either good or bad for health. Non-medical circumstances, including the design of work and workplace policies, may also hinder or harm prospects of job retention. Better information on these questions has many potential uses - e.g. to optimise government and employer policies; to identify interventions that may help older workers with health problems to remain in work; to alert doctors to medical problems associated with poor vocation outcomes; and to inform fitness for work decisions; to improve the design of work for older people; evidence on health, ageing, and risk of occupational injury can be used to ensure older workers are placed in safe work and that, where possible, their employment opportunities are not restricted without good justification. We are being funded by the charity Arthritis Research UK to recruit and follow 6,000 men and women aged 50-64 years from some 18 general practices in England. The practices contribute to the Clinical Practice Research Datalink (CPRD), a research database maintained by the government's Medicines and Healthcare Products Regulatory Agency (MHRA). The CPRD contains a log of every medical consultation episode associated with significant events, illnesses, or medical activity (diagnosis, referral, prescription, death etc) among the patients of participating general practices. These data are pseudo-anonymised (only identifiable by an ID code) and collected by MHRA from 250 practices in England and Wales, from which we will sample practices. CPRD linkage offers compelling scientific and logistic advantages. In particular, because we will access the entire GP medical records of participants in selected areas of inquiry, we can pursue our study questions using a hugely detailed database in which many health events and their timings are objectively corroborated. This will enable us to explore the effect of health on work, and vice versa, at a level of detail that is not feasible in periodic interviewer-administered or postal surveys. Moreover, the data will be captured at very low cost relative to alternative means of acquiring the same information. ARUK has provided funding only to investigate the impact of common musculoskeletal disorders (MSDs) of ageing on work retention and the effect of deferring retirement on musculoskeletal health. This leaves us short, particularly in respect of research assistant time to develop the cohort and computing and statistical time to analyse the many non-MSD problems that the dataset offers. We hope through this bid to maximise the value of the cohort, and the efforts of participants, by extending our analysis to a much broader range of health conditions and their impact on work participation. Funding will be used to purchase more research assistant, data programmer and statistical time, but many of the other costs (eg mailing, clerical, payment to practices) are already met and many of the practical hurdles (eg ethics and governance permissions, access rights to CPRD data) have already been resolved. The MHRA's research director is a collaborator in this application. Patients from participating general practices who agree to be studied will complete questionnaires about their work and home circumstances, initially over a 3-year follow-up. With their written permission, we will access their health data via the CPRD and link this to their questionnaire data. The inter-relation of changes in employment (with reasons) and changes in health (eg major new illnesses, new treatments, mortality) will be examined statistically.