HT hat retirement constitutes one of life's crises with -*· implications for nursing practice has been recog- nized to a limited extent in nursing literature and to a lesser extent in nursing practice. The purpose of this paper is to consider the implications of retirement, a potentially transient phenomenon, on the need for retirement preparation programs and specifically, the nurse's responsibility in relation to retirement prepara- tion for self and client.
Statutory old age was created with passage of the Social Security Act in 1935 which established 65 as the mandatory retirement age for industrial workers. The youthful drafters of social security legislation intended to effect the removal of older workers engaged primarily in physical endeavors from the labor force at a time when the unemployment rate was 25 percent. People whose work involved predominantly mental activity were not included until later. The notion that people ought to retire by age 65 caught on without regard for differential aging, variation in effect of aging on skills or waste of talent when people are forced to drop work they do well. Conflicts with basic American ideals such as free enterprise, rugged individualism, or reward in accord with productivity were also ignored. Economic forces rather than sociological facts shaped mandatory retirement policy. It is interesting to note that those who serve in Congress, on the Supreme Court, or as President have never been subject to mandatory retirement.
Like discrimination against women and blacks, it took time for people to recognize and deal with age- related discrimination. Today the American people are requesting a return of the right to work without age discrimination. A national poll in 1974 showed that 86 percent of those surveyed agreed that no person who wants to work and is able should be forced to retire because of age. Seattle, Washington abolished manda- tory retirement for city employees whose retirement age was not mandated by state law (uniformed police and fire personnel) through executive order in 1977. Local courts in several states have ruled that forced retirement, when not based on a criterion that measures the individual's ability to work, is an arbitrary denial of human rights without due process which violates the equal protection clause of the Fourteenth Amendment. Employees have been relatively successful in convincing arbitrators that an employer's policy of mandatory retirement violates their right to work under collective bargaining agreements when no established uniform retirement plan exists or when a plan is established without union agreement or is administered unfairly. The Age Discrimination in Employment Act (ADEA) enacted in 1967 prohibits age discrimination in employment for persons between ages 40-65. Proposals before Congress and several state legislatures would remove the upper age barrier.
Except for a minority of workers forced to retire due to poor health, retirement was not a problem before it was legislated into existence in 1935. Today retirement is viewed by some as a crisis for both the individual and society which varies from the early to later years of the retirement phase of life and which affects all retirees. Alternatively, retirement is regarded not as a problem for retired individuals generally, but rather, for certain kinds of people in specific circumstances.* A variant of this notion of retirement as a limited problem is that retirement is a temporary problem which will be eliminated as economic factors permit policy reversal to end mandatory retirement.
Income and perceived state of health are the two most important factors in determining retirement adjust- ment. Other variables including age, sex, occupation, employment opportunities, self-concept, life style, retirement circumstances (voluntary or mandatory), role models, etc., have been inconsistently or slightly associated with adaptation in retirement.
Retirement Preparation Programs
Recognition of the negative potential of retirement for individual physical, social, emotional and economic well-being was in part responsible for development of retirement preparation programs. To the extent that these programs provided information, they were well accepted and resulted in demonstrable information gain for participants. Those programs which focused primarily on counseling to guide the individual to acceptance of the status quo were less beneficial. In any event, retirement preparation programs have been slow to become" institutionalized. Kasschau5 attributes slow initiation of work-exiting procedures to economic forces. Within unions, older workers' needs for retirement pensions, health insurance, seniority, and retirement preparation often go unmet until competing demands from younger workers are satisfied and little else remains to be negotiated. Employers who provide retirement preparation programs have tended to be those offering the more generous private pensions as incentives to move "obsolete" older workers out of the labor force lest social security alone not provide sufficient inducement to leave.
In a recent6 survey of 131 Pittsburgh organizations engaged in labor organization, government, education, religion, health and business, only nine offered programs to assist workers in making the transition from work to retirement. Health and business organiza- tions were the most active in retirement planning; no programs were offered by local religious or govern- mental agencies. Organizations sponsoring retirement programs were those providing a wide range of fringe benefits and more generous pensions. Programs in- cluded lectures and discussions on financial security, medical insurance and health care costs, legal matters, social security, and health promotion and maintenance.
Impact of Retirement
To be sure, there is no loss objectively associated with leaving one's job except loss of income. Still, everyone knows someone whose health deteriorated or who died soon after retirement. Controversy exists as to impact on health status. Thompson and Strieb,1 in a study ol 1,260 males, found that retirement, as compared witt continued gainful employment, led toan improvement in health. A higher incidence of poor health among retirees was better understood in terms of poor health leading to retirement than the reverse. These finding) were corroborated by Shanas2 in a study of noninstitu· tionalized persons aged 65 and over. However, some retirees do not survive the early phase of retirement. The white male aged 65 through 69 has an accomplished suicide rate about five times that of a white female and about two and one-half times that of the entire population.3
Accurate figures on the extent of alcohol and drug abuse among retirees are not available. Two to ten percent of the elderly are estimated to be alcoholics Recent evidence suggests that older drug abuser! (narcotic and nonnarcotic) may have begun their habits in their 40s and thus, are not simply young abuserj growing old.4 Part of the problem in identification comes from the fact that, in general, the elderly aril rather isolated, well hidden by their families, and onlj reluctantly taken into the criminal justice system by th< police. Men approaching retirement tend to employ denial to cope with concerns about retirement disloca tion. This denial is shown as a positive attitude towar< concrete goals and life appraisals and contributes t< retirement "shock" when the event occurs. Today's retirees and preretirees are still a part of the self-relian breed who are accustomed to solving their owii problems and reluctant to use even the least threatening of health or welfare counseling services.
Implications for Nursing Practice
Absence of means to predict retirement adaptation; styles for individuals, lack of agreement as to what constitutes adjustment, and uncertainty as to the future of mandatory retirement policies have contributed to 8 lack of nurse involvement in retirement preparation activities.
As educators, nurses have an obligation to shar information with clients so that clients may assumi increased responsibility for maintaining or improving their health status. The elderly are a particularly appropriate target group for health teaching since the threat of diminishing health status is legitimate and motivation to prevent tends to be higher than is true of younger people. To illustrate, much data related to the: benefits of exercise are available7 in literature which needs to be presented to the elderly by a trusted, concerned, caring person such as a nurse. Health promotional teaching should be a routine component in therapeutic encounters with individual clients but is more efficiently provided to numbers of clients such as employee groups and senior citizen organizations. As professionals, nurses need to take the initiative in locating a group and securing an invitation to speak. The effort may be unpaid initially. However, when the value of the content becomes apparent, a consultants fee may be charged.
Two significant obstacles to nursing involvement in retirement preparation programs exist in the present lack of financial support for preretirement program development and the limited awareness of the contemporary role of the professional nurse. The majority of retirement preparation programs are initiated by private employers when the economy is good as a "fringe" benefit for employees. These programs tend to be offered only to employees within five years of retirement age. Numbers of employees qualifying are thus kept small. Programs are conducted twice each year or less often. Due to small budgets, expert resource people are used primarily on a volunteer basis. When recession occurs, programs are discontinued. A few programs are supported by federal funds as model or pilot projects which run for a limited period.
Lack of awareness on the part of program developers of the role of the nurse as a broadly prepared health promotion and maintenance expert presents a second barrier to nurse involvement. When the topic of health arises, personnel recruiting resource persons turn to the physician. By tradition, the physician has served as head of the health team. However, a strong orientation to treatment of illness may make the physician less suited than the nurse to speak on prevention of illness, promotion of health, and use of related community resources.
Considering these obstacles, the following actions may serve as specific guides for the nurse who is willing to venture into the area of retirement preparation:
1. Prepare proposals for model programs integrating recent research findings to program design.
2. Direct offers of assistance with preretirement program development or implementation to personnel departments via mails and personal interviews. Be prepared to explain the contemporary role of the nurse and interpret the implications of recent research related to retirement preparation program design and benefits.
3. Consider that large organizations (those employing one thousand or more persons) are likely to be more Inceptive than small organizations to suggestions for *program development and modification. If the large organizations planning programs for 1976 implement their plans, 42 percent of the employees considered in the survey6 will have access to retirement preparation programs.
4. Develop and market a preretirement program which offers more breadth and depth of content in a variety of formats suited to both individual and group participation. To appeal to various employee preferences,, an organization may wish to offer a course for home/individual study and one for group participation.
5. Support centralization of programs in an access-able community facility such as a college or library to provide an alternative for workers whose employers fail to provide retirement preparation programs.
As advocates for better health, nurses should support efforts to abolish mandatory retirement policies. Letters to legislators, private employers, and news media are appropriate. Older clients should be encouraged to join power groups working for expanded work opportunities for the elderly. Many people are not aware of the impact of special interest groups in shaping public policy. Encouragement from a nurse may provide the motivation to convert a passive skeptic into a joiner.
In the course of assessing clients, nurses are in an excellent position to gather data from retirees and preretirees related to the life-threatening problems thought to be associated with loss of work opportunity: alcoholism, drug abuse (narcotic and nonnarcotic), and depression (a frequent, but not universal, precursor of suicide). Case studies should be compiled to provide a more accurate incidence description. Individual clients should be queried as to opinions of their own retirements. Preretirees should be encouraged to voice plans very concretely, i.e., describe a typical retirement day from start to finish; discuss feasibility of plans in terms of limited resources such as income, time, health status, significant others, etc. Through such application of interviewing skills, the nurse can facilitate a client's "thinking through" of a potentially critical decision in such a way that future crises may be averted.
Studies should be undertaken in nursing, parallel to those already completed in other fields (e.g., medicine and engineering) to measure skill obsolescence. This information is needed to determine the extent to which continuing education attenuates the process of skill obsolescence and to provide a basis for competency-based retirement criteria for nurses.
Finally, but by no means least important, nurses need to plan for their own retirement. Early efforts to accumulate sufficient financial resources are particularly essential. Nurses tend to be paid at levels below the social security maximum, and thus, to receive proportionately lower social security payments upon retirement. This income, unless supplemented by private pension or investment income will leave a mandatorily retired nurse living on a poverty-level income.
We prepare people for every phase of life except retirement. The family socializes the child for the school years, school and family prepare the child for adolescence, college and family prepare the adolescent for a working career. Employers contribute to this preparation effort through inservice programs for specific job skills. However, family, school, and employer fail to accept responsibility for preparing the worker for a nonworking life. Retirement preparation programs provide an excellent opportunity for nurses to promote health for a group of people highly susceptible to illness. Hopefully the profession won't miss this chance to assume a leadership role as long as mandatory retirement policies remain in effect.
- 1. Thompson WE, Streib GF: Situational determinants: heal and economic deprivation in retirement. J Soc Issues 14(2):1 34, 1958.
- 2. Shanas E: Health and adjustment in retirement. Gerontolo-' 10:19-21, 1970.
- 3. Vital Statistics of the United States, 1973. Rockville, Md.: U National Center for Health Statistics, US Department of Healt Education and Welfare, Health Resources Administration.
- 4. Schuckit MA: Geriatric alcoholism and drug abuse. Gero tologist 17:168-174, 1977.
- 5. Kasschau PL: Retirement and the social system. Ind Gerontology 3:11-24, 1976.
- 6. Robb SS: A comparative description of retirement preparatio activity among organizations engaged in health, educatio religion, labor, government and business within the city Pittsburgh. Unpublished manuscript, 1976.
- 7. Thacker J : Why do some live longer? Activity helps. Perspectiv^ on Aging 6:4-7, 1977.