Sustainable Work Ability during Midlife and Old Age Functional Health and Mortality

Abstract

Background: Sustainable work ability is a multifaceted concept that <br/>involves the matching of the needs and abilities of the individual with the quality <br/>of work. Good work ability during a work career is one of the potential indicators <br/>of sustainable work ability and employment, as it requires a good balance <br/>between individual resources and work demands. We aimed to study the <br/>developmental pathways of work ability during midlife until retirement and its <br/>impact on functional health in terms of mobility limitations in old age using <br/>longitudinal data on employees in a large amount of blue- and white-collar <br/>occupations. Furthermore, we studied the difference in survival among people in <br/>different trajectory groups. Methods: Questionnaire data on work ability, working <br/>conditions, lifestyle, and physical functioning of middle-aged municipal <br/>employees (n = 2918) were linked with registers on retirement and all-cause <br/>mortality. Perceived work ability was measured as the current work ability <br/>compared with the lifetime best in a score of 0 to 10. The trajectory of work ability <br/>was analyzed by using growth mixture modeling in 16 years of follow-up data. <br/>Mobility limitations as an outcome was defined using nine items related to <br/>physical mobility tasks. Trajectory membership of work ability was used as a <br/>predictor of mobility limitation after 12 years using generalized linear models. <br/>Cumulative hazard curves for mortality by trajectory group were calculated. <br/>Results: Three distinct trajectories of work ability emerged. The majority of the <br/>participants (65%) had good work ability, which is here defined as sustainable <br/>work ability, 25% having L-shaped decreasing work ability and 10% having U-<br/>shaped decreasing work ability. Demographics, lifestyle factors, morbidity, and <br/>physical workload-adjusted models shows that L-shaped (Incidence rate ratio <br/>(IRR) 1.24, 95% confidence interval (CI) 1.18–1.30) and U-shaped (IRR 1.37, 95% CI <br/>1.28–1.47) work ability trajectory membership was strongly associated with a <br/>higher risk of mobility limitations in the next 12 years of follow-up. The <br/>cumulative hazard for all-cause mortality was highest among those in the U-<br/>shaped decreasing work ability trajectory group. Conclusions: Those with a <br/>sustainable work ability during midlife showed a lower risk of mobility <br/>limitations and better survival compared to those with decreasing work ability. <br/>These findings highlight the importance of sustainable work ability throughout <br/>the working career as well as the need for early identification of workers with <br/>diminishing work ability and need for workplace interventions to help to promote <br/>an extended working career as well as a healthy old age.