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Pension coverage among the baby boomers: initial findings from a 1993 survey.

Using data from a series of supplements to the Current Population Survey, this article presents findings on workers' coverage under employer-sponsored retirement plans in 1993, and recent trends in coverage. The analysis focuses on workers 25-54, a group that includes the baby boom generation. Among all wage and salary workers in this age range (including government employees and part-time workers), 55 percent reported participating in a retirement plan on their current primary jobs, and an additional 3 percent were covered from other jobs. After a modest decline in the early 1980's, the coverage rate has remained essentially unchanged over the past 10 years, and limited data suggest that the baby boomers are doing about as well on pension coverage as older workers at similar points in their careers. Beneath this relative stability in overall coverage, however, at least two important changes have occurred: a significant narrowing of the gender gap in coverage and a shift in types of retirement plans. Increasing numbers of workers are being covered solely by 401(k)-type plans, a development that raises new uncertainties about the form and amount of future benefits. On the other hand, limited data in this study suggest that 401(k) plans may be serving their intended purpose for the majority of workers who have them.

Adult↗

[Psychiatric evaluation of patients with neurotic and somatoform disorders within the scope of legal disability pensions].

The problems of the psychiatric expertise of neurotic patients in the field of disability pension in the Federal Republic of Germany are described. Some main ideas for the psychiatric expert are proposed. In consideration of the therapeutic problems, preventive measures should be developed. To prevent a chronic illness, some hints for the treating physician are given. Some research problems are mentioned.

Disability Evaluation↗

[Diagnosis and management of neurotic occupational disorders (before pension application)].

This paper summarizes how neurotic disorders affect working capability, with an emphasis on neurotic working disorders. According to official statistics neurotic disorders account for 5.5% of all disability pensions, but they figure less often as diagnoses in medical certificates issued prior to invalidation. The true impact of neurotic disorders may only be guessed, since the diagnosis is easy to miss and only reluctantly proffered when suspected. In contrast to other neurotic disorder afflicting working behaviour, the neurotic working disorder is thematically centered within the sphere of work and profession itself. The disorder is often treated inadequately and belatedly. Typical somatic complaints clusters, characteristic neurotic conflicts and personality traits often encountered with neurotic working disorder are outlined. Diagnosis requires the taking of a psychobiographic history and some knowledge of psycho- and soziotherapy. There are many options for therapy, and there are a few studies evaluating their efficacy. In order to install treatment early, a routine checkup by a psychotherapist is suggested for all patients exceeding a certain number of days off work per year.

Combined Modality Therapy↗

A theory of technophysio evolution, with some implications for forecasting population, health care costs, and pension costs.

We argue that over the past 300 years human physiology has been undergoing profound environmentally induced changes made possible by numerous advances in technology. These changes, which we call technophysio evolution, increased body size by over 50%, and greatly improved the robustness and capacity of vital organ systems. Because technophysio evolution is still ongoing, it is relevant to forecasts of longevity and morbidity and, therefore, to forecasts of the size of the elderly population and pension and health care costs.

Europe↗

[Disability in the private pension system in Chile].

BACKGROUND: The degree of disability of workers ascribed to the private allowances system in Chile, is judged by Medical Commissions that apply norms that establish percentages of incapacity, without considering prognosis. AIM: To communicate the causes of disability among Chilean workers ascribed to the private allowances system, their mortality and to correlate the causes of death with diagnoses. SUBJECTS AND METHODS: We analyzed 13,456 consecutive cases judged between August 1990 and April 1992. Mortality was registered up to 12 months after judgment. RESULTS: Total incapacity was determined in 4,158 cases (30.9%), partial incapacity in 1,340 (9.9%) and minor incapacity in 7,958 (59.1%). Osteoarticular diseases were the main cause of disability in 4,460 patients (33.1%) and 77.8% of patients with malignant tumors were considered as having total incapacity. Mortality was 17% among subjects with total incapacity, 1.5% among those with partial disability and 1% among those with minor disability. The cause of death was related to the main disabling disease in 94% of subjects with total incapacity and 66.6% of those with partial incapacity. CONCLUSIONS: Osteoarticular diseases are the main cause of inability among workers ascribed to a private pension system.

Chile↗

Public pensions in transition: an optimal policy path.

"The main purpose of this paper is to analyze problems of financing an old-age insurance when birth rates are low and population declines or fertility fluctuates with time....[The author] investigates a theoretical model which analyzes the welfare optimal combination of private savings via the capital market and the state forced savings via a PAYG [pay-as-you-go] financed public pension system. Long-run effects as well as short-run implications are considered. The economic properties of an optimal steady state are determined and additionally an optimal transition path--the best feasible conversion policy--which leads to the new steady state is specified."

Demography↗

Effect of a training programme for pensioners on condition and muscular strength.

Physical training was performed by 22 women aged between 63 and 84 yr and 4 men aged between 74 and 86 yr twice a week for 10 mths. Some subjects had moderate disorders but all of them lived in their own homes. Apart from using body weight and elastic bands, no special equipment was used as resistance. Emphasis was laid on training muscular strength and not especially on endurance training. The effect of the training on physical fitness and muscular strength is presented in the 15 women who, according to predetermined criteria, were able to perform the tests adequately. A conditioning effect was detected by using a product of watts and minutes. The static and dynamic (isokinetic) muscular strength in the knee-extensors increased (6-13%) and, parallel with this, there was an increase in the relative FTa fibre area in the vastus lateralis muscle. The training programme in this study seems to be safe for an older population with diverse disorders, as only one negligible medical incident occurred. The present findings, with objective improvement in physical fitness with training combined with feelings of increased vigour, supports the use of gymnastic activity for pensioners and other means of stimulating the elderly to keep physically active even when they have moderate disorders. Improved physical fitness may help to prevent age-dependent impairments.

Adenylate Kinase↗

Has the perception of disability among COPD patients applying for pension changed during the last 20 years?

The aim is to examine the change in lung function, treatment and pulmonary symptoms in patients with chronic obstructive pulmonary disease (COPD) or chronic bronchitis (CB) applying for a pension during the period 1977-1996. In addition, we compared the perception of disability in males and females. From 1977 to 1996, 947 patients with COPD or CB were evaluated for obtaining economic support due to disability. In order to test the trend, the patients were divided into three periods: (1) 1977-1983, (2) 1984-1989 and (3) 1990-1996. Compared to females, males had substantial more pack-years of smoking (36 vs. 28, P<0.001), but their FEV1 was only slightly decreased (46.9% versus 49.6% predicted, P=0.047). Females reported significantly more often attacks of dyspnoea [OR: 1.5(1.00-2.2)] and any kind of dyspnoea during daytime [OR: 4.0(1.2-13.3)]. From period 1 to period 3, FEV1 increased significantly (45-53% predicted, P<0.001). Despite the increased FEV1, the use of inhaled corticosteroid had increased markedly (9-32% of the patients, P<0.001). The results did not change when patients with asthma were included. Our data suggest that both sexes, especially females, have become more aware of pulmonary symptoms and tend to react to them more actively by demanding evaluation and treatment.

Asthma↗

[Treatment recommendations in psychosomatic rehabilitation -- empirical analyses based on the pension insurers' standardized discharge report].

BACKGROUND: The recommendations for aftercare listed in discharge reports represent a core component of communication between inpatient psychosomatic rehabilitation and ambulatory follow-up care. The standardized discharge report used by the pension insurance institutes makes use of a generic category system for systematization and simplification of recommendations for aftercare. Neither the practice of making recommendations for aftercare as observed by therapists and physicians responsible for treatment in the inpatient setting nor the appropriateness and differentiation of the category system has previously been systematically examined. A randomized sample of discharge reports was analyzed for this purpose. METHODS: A sample of 500 discharge reports from an inpatient-oriented psychosomatic rehabilitation setting were analyzed regarding the categories of recommended aftercare measures and their relationship with socio-demographic variables, clinical diagnosis and sociomedical variables. RESULTS: Outpatient psychotherapy represents the most frequently recommended aftercare treatment, being suggested in nearly 70% of the patients. Further substantial percentages were found in recommendations for areas including occupational rehabilitation, somatic-medical recommendations, and recommendations for health behaviour and self-help groups. In approximately one quarter of the patients, recommendations for aftercare were given that were coded under the category of "other suggestions". In younger and socio-medically burdened patients, recommendations for the fields of occupational rehabilitation and psychotherapy were more frequently given. In patients with a somatic illness or a somatoform disorder as the primary diagnosis, recommendations within the field of outpatient psychotherapy were found less frequently, while recommendations in the somatic-medical area were more commonly found. DISCUSSION: The results give some support for the clinical validity of the form of recommendations given for aftercare measures in an inpatient psychosomatic rehabilitation setting. At the same time, the analyses indicate excessive as well as insufficient differentiation in the generic category system for follow-up treatment recommendations, which could lead to a loss of valuable information at the interface between inpatient and outpatient treatments.

Adult↗

[Assessment and psychotherapeutic options of patients with somatoform disorders and a claim for invalidity pensioning].

Difficulties in the assessment of patients with somatoform disorders and a claim for social security benefits or invalidity pensioning pose a considerable challenge to the medical community. Within the process of delivering a medical expert's opinion, psychiatric and psychological factors often are underestimated. There are ample recommendations to apply specific criteria within the medical expert's report, but there are no empirical studies confirming that these criteria are really used and prognostically valuable. Especially, despite the growing numbers of psychosomatic in-patients and the thereby heightened socioeconomic importance, there are nearly no catamnestic studies which sufficiently evaluate the results of psychotherapy in the specific group of patients with somatoform disorders and a pending desire for financial compensation alone. The rare available data provides a nearly disastrous impression of psychotherapy results in this patient group. This review article highlights important problems of this special patient group and provides some suggestions concerning the further handling of the addressed issues.

Disability Evaluation↗

[Chronic back pain: more than pain in the back. Findings of a regional survey among insurees of a workers pension insurance fund].

BACKGROUND: Surveys with a main focus on back pain tend to isolate the complaint from possibly concomitant pains, other symptoms and disorders. Severe chronic back pain is assumed here to imply more than pain in the back. PARTICIPANTS AND METHODS: We report results from a two stage survey conducted in 1998 - 2000. The initial postal questionnaire addressed all 10,000 actively employed blue collar workers from a regional pension fund (Landesversicherungsanstalt Schleswig-Holstein) aged 40 - 54 and residing in or around Luebeck/Germany (68 % males). Subjects reporting severe and disabling back pain were invited to a socio-medical examination. The response and participation rates were 58 % and 65 % respectively. Non-response and non-participation seem to result in minor though opposite, effects. RESULTS: The prevalence of current back pain (back pain of any severity within the past 7 days) is high (68 %; including 16 % with severe, disabling back pain) despite the preponderance of males and a probable healthy worker effect. 82 % of subjects participating in the second round reported recurrent or persisting back pain on the day of examination, in the majority with a chronic fluctuating and overall deteriorating course pattern. 18 % reported no current back pain and hence gave prospective (and additionally retrospective) evidence of an episodic-intermittent course of the disorder. The former group showed significantly more pains, bodily complaints, dysfunctional cognitions, emotional distress and concomitant disorders. 35 % of them indicated back pain as their dominant health problem; 49 % identified back pain and another disorder as dominant, and 16 % reported other prominent health problems. More than 70 % of "other" disorders originated from the musculoskeletal system often involving the extremities. SUMMARY AND CONCLUSION: Back pain is very common among blue collar workers. Severe disabling back pain is usually associated with numerous other pains, bodily complaints, disorders, and indicators of psychological distress ("amplified back pain"). However, even amplified back pain is not always the sole or dominant health problem. Assessing the degree of "amplification" seems helpful in splitting a previously homogeneous group of severely affected back pain sufferers-with possible prognostic and therapeutic consequences.

Adult↗

Pensioners attending an accident and emergency department.

A three-month prospective study of the 1026 pensioners attending the Accident and Emergency Department (A.E.D.) at Oldham is reported. Although they constituted 9.8% of the total attendance, they formed 36.5% of all admissions. Proportionate admission of males was higher than females. Over half the total admissions were due to medical emergencies, whereas only a quarter were due to injury. Contrary to the general impression, the survey showed that the use of A.E.D. and 999 Emergency services was appropriate. Self-referral rate was high, but most of the old people who tried first to contact their general practitioner succeeded in doing so.

Aged↗

Distributive effects of dental programs for old-age pensioners in Norway.

The purpose of the present paper was to study the distributive effects of different delivery models of dental services to old-age pensioners in the county of Troms in Northern Norway. The empirical basis was formed by a baseline survey at the start of a 50% demand subsidy in 1975/76, and from a delivery experiment along a "market-need" dimension which was started in 1978 and lasted for 1 yr in three research areas (Municipalities). In the control area there was no intervention beyond the 50% demand subsidy, while the two experimental areas differed with regard to improvements of the market mechanism in terms of increasing degree of collective decisions as to which treatment needs should come to treatment. The aggregate consumption of dental services was relatively unaffected by a reduction in the price of dental treatment. The improvements of the market contributed to a net gain in use rate from 16% to 23%, while moving towards the "need" end of the "market-need" dimension. By minimizing the market mechanism, the use of dental services expanded and the cost of the programs increased, but whether the inequalities diminished could not be decided empirically.

Aged↗

Pilot study of old-age pensioners.

Two groups of old-age pensioners in St. Paul's Cray were screened for physical illness, social and family connexions, and personal activities. The first group comprised 100 people (10% random sample of a suburban practice of 12,000 patients), and the second group comprised the total population of a sheltered area (85 people).The findings showed that geographical separation of relatives was a significant factor in the isolation of old people. Lack of exercise and obesity seriously increased the risk of urinary infection; malnutrition and nutritional anaemia were found to be other potentially important problems in the elderly. In 13% of the elderly population three out of five seriously adverse factors (over 80, isolation, housebound, living alone, serious chronic Illness) were found to be present.It is imperative that the group of high-risk elderly should receive the services they need; it is suggested that a policy of an adequate sheltered area supported by a geriatric service should be an extension of group medical practice.

Age Factors↗

A long-term study with co-dergocrine mesylate (Hydergine) in healthy pensioners. Results after 3 years.

Started in 1976, a long-term study in healthy pensioners is now in progress in Basel, Switzerland, to investigate medical, psychological, and electrophysiological aspects of the normal aging process and to establish whether these can be influenced by drug treatment. The subjects are receiving co-dergocrine mesylate (Hydergine) 1.5 three times daily or placebo orally under double-blind conditions. At 1-year intervals each subject's case history is reviewed, a clinical examination and laboratory tests are carried out, an ECG and an EEG are recorded, and a shortened form of the Hamburg-Wechsler Intelligence Test for Adults (German version of the WAIS, i.e., the Wechsler Adult Intelligence Scale), the Raven Coloured Progressive Matrices Test, and the Maudsley Personality Inventory are administered. Treatment compliance is being monitored by pill counting and determination of drug plasma levels. The results after 3 years of the study are presented. The subjects included in this evaluation are those who have undergone all examinations under double-blind conditions (n = 99). During the 3-year period, 27 of the 148 subjects (64 women and 84 men, mean age 63 years) initially recruited for the study have withdrawn, mainly because serious illness has supervened. Three subjects in the placebo group and 1 in the co-dergocrine mesylate group have died. The double-blind code has been broken for medical reasons in 18 cases; these subjects have continued to participate under open conditions. During this 3-year period, the following changes have been observed: A slight but statistically significant rise in systolic and diastolic blood pressure in the sample as a whole (mean increase 12 mm Hg). A decrease in systolic blood pressure in subjects with high initial values (mean decrease 6 mm Hg in the placebo group, and 18 mm Hg in the co-dergocrine mesylate group). An increase in systolic blood pressure in subjects with low initial values (mean increase 17 mm Hg in the placebo group and 16 mm Hg in the co-dergocrine mesylate group). A significant decrease in pulse rate in all subjects (mean decrease 7 beats/min). An increase in the number of subjects with pathological ECGs. A significant decrease in mean serum creatinine and lipid levels (all subjects) and a decrease of about 70% in the number of subjects with pathologically raised values. A decrease in the number of subjects from both groups with pathological signs in the EEG.(ABSTRACT TRUNCATED AT 400 WORDS)

Aged↗

Disability and prognosis in multiple sclerosis: demographic and clinical variables important for the ability to walk and awarding of disability pension.

OBJECTIVE: To evaluate disability and prognosis in an untreated population-based incidence cohort of multiple sclerosis (MS) patients. METHODS: The Expanded Disability Status Scale (EDSS) score was recorded in 220 MS patients. Disease progression was assessed by life table analysis with different endpoints and multivariate Cox regression analysis was performed for evaluation of prognostic factors. RESULTS: The probability of being alive after 15 years was 94.8 +/- 1.8% (s.e.), of managing without a wheelchair (EDSS < 7.0) 75.8 +/- 3.2%, of walking without walking assistance (EDSS<6.0) 60.3 +/- 3.6%, and of not being awarded a disability pension 46.0 +/- 3.7%. The probability of still having a relapsing-remitting (RR) course after 15 years was 62.0 +/- 4.1%. A RR course and long interval between the initial (onset) and second episode (> 3 years) predicted favorable outcome. There was also a trend towards favorable outcome in patients with optic neuritis, sensory symptoms and low age at onset but these factors were associated with the RR course. Motor symptoms and high age at onset indicated unfavorable outcome, but these factors were associated with the primary progressive course. CONCLUSIONS: A RR course and long inter-episode intervals in the early phase of the disease were associated with a better outcome. Other onset characteristics indicating a favorable outcome were associated with the RR course while characteristics indicating an unfavorable outcome were associated with the PP course.

Adult↗

The mortality of male old-age pensioners following spouse's death.

The effect of the death of the spouse on mortality of retired men was investigated. The material comprised 939 married men retired on old age pension, 174 of whom had lost their spouse after retirement. During the first six months following the wife's death, more than the expected number died, though no increase in mortality could be shown over a longer term. Circulatory diseases and tumours were over-represented as causes of death among those who died within six months of the wife's death. Loss of an important object relationship may lead to sudden cardiac death, or the development of a disease may be accelerated.

Aged↗

Arduousness of work, career, and disability pensioning of Finnish iron ore miners.

The career and work arduousness of a population of retired iron ore miners and their contemporaries who continued to work were investigated to find out what aspects of work history were associated with disability pensioning. The retired group had entered the mining industry at a more advanced age than the referents. The retired miners had also started at more strenuous tasks. Later they changed to lighter tasks, but were less often promoted in their career. The risk of early retirement seems thus to be related to the essential indicators of one's progress in the mining vocation.

Adult↗