Examining the Relationship between Work and Perceived Health for Older Adults with Parkinson's Disease

Background and Purpose: Work can promote or degrade health. Under healthy working conditions, employment can support cognitive and physical health, promote psychological well-being and economic security. Conversely, poor working conditions can contribute to adverse health outcomes. This study examines the relationship between work and health after the onset of chronic, progressive disease. Chronic neurological disease affects millions of Americans, with increased incidence of neurodegenerative diseases such as Parkinson’s disease (PD) with age but average onset during prime working years. This research aimed to fill a gap in understanding regarding the employment experiences of adults with PD in their 50s and 60s. How do individuals with PD understand the relationship between their employment status and their health? What circumstances influence how employment or unemployment affects the physical and mental health of individuals with PD?

Methods: A purposive sampling strategy was employed. Recruitment occurred at the Movement Disorders clinic of an urban, safety net teaching hospital, with additional outreach via the state chapter of a national PD-focused organization. The author conducted individual semi-structured, qualitative interviews between 45 to 90 minutes in length, with working, recently unemployed or retired individuals with PD between the ages of 55 to 65 (N=21). Interviews were audio-recorded, transcribed, and data were analyzed utilizing a thematic analysis approach to identify, revise and define salient themes.

Results: The majority of participants working full-time described a positive relationship between work and their mental health, reporting that work provided a sense of purpose and satisfaction, and expressing concerns that unemployment would lead to boredom and depression. Several working participants felt that unemployment might lead to deteriorating health due to reduced activity and stimulation. Notably, participants who described work as positively affecting mental health also reported a supportive work environment (e.g. employers who accommodated requests for shorter work days or time off to attend medical appointments). Among participants who were not working, several described their previous working conditions as contributing to deteriorating health, and reported improved physical and mental health since retiring. Other participants who were not working reported negative effects on their mental health, recounting how previous employment was key to a positive sense of self and describing feelings of worthlessness associated with not working. However, participants who had stopped working described a greater capacity to focus on stabilizing physical health without the daily stresses of demanding full-time employment. Many participants not working emphasized that volunteering part-time contributed to a continued sense of purpose.

Conclusion and Implications: Findings highlight the dynamic relationship between working conditions and perceived health for older adults with Parkinson’s disease, illustrating how supportive working conditions can promote positive mental health. Conversely, ceasing employment led to improved physical health if the demands of previous employment were unsustainable. Notably, all participants emphasized their interest in and pursuit of productive engagement whether paid or unpaid, suggesting the need for access to productive activities in older adulthood regardless of health status or ability.