Is Retirement Stressful for Your Heart?

Many people look forward to the day that they can afford to retire, and I personally know a great many people who are
thriving in retirement. Paradoxically though, leaving the workforce can be a serious life stress for some people. Indeed, one study reported that people in the first year of their retirement were 40% more likely to suffer a heart attack or stroke compared to similar people who kept working.

Waiting to retire till after age 65 might be good for longevity too, according to a study published in the Journal of Epidemiology & Community Health. Researchers at Oregon State University analyzed data from about 3,000 people who were employed at the beginning of the study and then followed them closely for the next 18 years to note when they retired and then correlated that with how their health fared. Compared with the cohort retiring at age 65, the workers who deferred retirement until age 67 had a 21% lower risk of dying during follow-up. The people who waited until 70 to retire had a 44% lower risk of death, and by age 72 the risk was 56% lower. These apparent longevity benefits of delaying retirement occurred irrespective of other lifestyle factors, including gender, education, income, and occupation.

“Use it or lose it” is probably relevant to why postponing retirement for some people seems to delay age-related declines in physical and mental functioning. Mandatory retirement in the U.S. was abolished in 1986 except for a few professions such as airline pilots and judges, though in recent years, age limits even for those occupations have been pushed out to older ages. My father was a judge in North Dakota. When he finally retired at about age 65, he told me, “The worst part of being retired is that you never get a vacation.”

For a while, leaving behind a long commute, workplace politics, time pressure, and a harsh boss can feel like a welcome relief. However, many recent retirees discover that after a few months, the novelty of a neverending vacation wears off, and they find that they miss the sense of purpose and social connections that came with their job, as well as the satisfaction of being productive. And then there’s the loss of salary, health insurance, and other work-related perks. All this should make you think twice before retiring fully.

New retirees can be at increased risk for mood problems like depression and anxiety. Instead of feeling untethered, relaxed, and content, you may feel complacent, bored, and isolated. You may mourn the loss of your identity at work, feel stressed about your loss of focus, or worry that being at home all day might affect your relationship with your significant other.

I’ve been a doctor for more than 40 years, and many of my contemporaries are retiring. But I can assure you that voluntary retirement is not in my foreseeable future. I have always been grateful to be in a profession that heals, and I enjoy my work more than ever. I feel like I’m doing what I was meant to do. Why retire? I love caring for my patients, many of whom have become personal friends. I am privileged to work at Saint Luke’s Hospital of Kansas City, whose motto is “The best place to get care. The best place to give care.” It’s a pleasure to teach young doctors, whose curiosity and intelligence are inspiring.

Our cardiology group, Saint Luke’s Cardiovascular Consultants of the Mid-America Heart Institute is one of the very best cardiology practices in the nation, and many of my colleagues and co-workers are dear friends. I’m genuinely happy and enthused to go to work each morning even after all these years. Our ability to prevent and treat heart disease and improve our patient’s quality of life and longevity are better than ever. Confidentially, I would probably keep doing what I’m doing even if I wasn’t getting paid. The other key issue here is that my wife, Joan, is much happier when I leave the house at 8:00 each morning and don’t come home until dinner.

In Okinawa, Japan, the culture with the best life expectancy in the world, they don’t even have a word for retirement. Instead, they focus on ikigai, which means “the reason for which you wake up in the morning.” Okinawans don’t stop being productive once they reach retirement age. Instead, they transition from full employment to being fully engaged in other endeavors, like a second career, volunteering, gardening, spending time visiting and helping their friends, and supporting family members. My Grandmother Dorothy O’Keefe, who I lived with during my four years at the University of North Dakota was a cheerful source of love and inspiration during my formative years. I was the first of 10 grandkids for whom she provided free room and board while we went to college. Never a negative word out of her, and she lived to age 103.

Retirement Was Invented

Retirement in the United States was invented in the 1950s as the post-war American economy boomed and Social Security provided a government-subsidized pension for people at least 62 to 65 years of age. This first generation of retirees were mostly males who had lived through and maybe fought in world wars, then labored at physical jobs they held for decades. Back then, life expectancy was only about 65 to 70 years for men, and they often yearned for a few years of fun in the sun with their spouses.

My father-in-law, Leonard, could have been a poster boy for the 20th-century American ideal of retirement. He was a union dockworker on Fisherman’s Wharf in San Francisco until he retired at age 62, when he and his wife Kathleen bought a modest but comfortable home in Sun City West, Arizona. He lived another 32 years and spent his days enthusiastically gardening, playing golf, feeding the wildlife in the Arizona desert, doing crossword puzzles, and socializing with his wife and friends at happy hour. He thoroughly enjoyed a second childhood after retirement because he reinvested his time and energy into personal passions that made him excited to greet each new day.

Generally, people who are enjoying happy and healthy retirements have re-engaged their energy and interests in fun and productive endeavors. I tell my patients who are nearing or at retirement age, “If you enjoy your work, it might be good for you to put off retirement for a while, but at the very least, make sure you are not overworking. You should take plenty of time off for play, rest, and relaxation.” Understandably, as people near retirement age they usually do not want to put in more than 40 or 45 hours per week or work weekends and holidays. They would instead prefer to have more time off to do what they want when they want, and with whom they want. Engaging in hobbies, especially creative, playful, or social activities, enhances mental well-being and cognitive function. A study from Japan found that hobbies also reduce the risks of heart attack and stroke. A hobby helps to develop an alter ego that’s not defined by your job. Having more than one “identity” boosts self-esteem and helps to avoid burnout.

In 2022, things are very different from 70 years ago, when retirement was a foreign concept. For the first time ever, there are more women than men in the American workforce. Most of these women and many of their spouses will live not just a few years past 65, but decades longer, often in good mental and physical health. Encouraging them to stay home, watch TV, and sit on the front porch rocker watching the world go by is not in their best interests, nor is it in their nature. All of us will be more vibrant and youthful if we stay engaged with the outside world as much as possible. So whether you decide to retire or not, try to stay in the mix, cultivate a purpose in your life, and search for meaningful ways you can share the wisdom and skills that you earned from decades of productive life in the workplace.

In Good Health,
James O'Keefe, MD