Utilisation of rehabilitation services for non-migrant and migrant groups of higher working age in Germany - results of the lidA cohort study

Background: An ageing and a shrinking labour force implies that the prevention of a premature exit from work due to poor health will become more relevant in the future. Medical rehabilitation is a health service that aims at active participation in working life. The provision of this service will be relevant for an increasing part of the ageing labour force, namely, employees with a migrant background and their different subgroups. Thus, this study examines whether first- and second-generation employees with migrant background differ from non-migrants in their utilisation of rehabilitation services and whether within the subsample of migrant employees, those persons with foreign nationality differ from those with German nationality. Methods: Socially insured employees born in 1959 or 1965 were surveyed nationwide in 2011 as part of the lidA cohort study (n=6303). Survey data of the first study wave were used to identify the dependent variable of the utilisation of rehabilitation (in- and outpatient), the independent variable of migrant status and the covariates of sociodemographic, work- and non-work-related factors. Applying bivariate statistics with tests of independence and block-wise logistic regressions, differences between the groups were investigated. Additionally, average marginal effects were computed to directly compare the adjusted models. Results: The study showed that first-generation migrants had a significantly lower likelihood of utilising outpatient rehabilitation than non-migrants (fully adj. OR 0.42, 95% CI 0.22-0.82) and that average marginal effects indicated higher differences in the full model than in the null model. No significant differences were found between the first- or second-generation migrants and non-migrants when comparing the utilisation of inpatient rehabilitation or any rehabilitation or when analysing German and foreign employees with migrant background (n=1148). Conclusions: Significant differences in the utilisation of outpatient rehabilitation between first-generation migrants and non-migrants were found, which could not be explained by sociodemographic, work- and non-work-related factors. Thus, further factors might play a role. The second-generation migrants resemble the non-migrants rather than their parent generation (first-generation migrants). This detailed investigation shows the heterogeneity in the utilisation of health services such as medical rehabilitation, which is why service sensitive to diversity should be considered

The differentiated roles of health in the transition from work to retirement - conceptual and methodological challenges and avenues for future research

Objective:s The aim of this discussion paper is to (i) identify the differentiated roles of health in the work–retirement transition, and, with respect to these, (ii) highlight topics related to conceptual and methodological problems and challenges in research, and (iii) present avenues for future research. Methods: This discussion paper summarizes an OMEGA-NET working group discussion ongoing from November 2018 to September 2021 with face-to-face and online meetings as well as a written online discourse. Results: ‘Health’ and ‘retirement’ are ambiguous concepts. With respect to both, in retirement research, the choice of concept and indicator influences the findings. In addition, the impact of health on retirement is not necessarily a direct one, but can be influenced by further factors such as the ability, motivation and opportunity to work. The strong overall association of poor health with retiring early (path 1) bears the risk of masking distinct and deviating mechanisms in subgroups. In fact, there is evidence that also good health may lead to early retirement (path 2), while both poor health (path 3) and good health (path 4) may also make people retire later. Conclusions: An increased awareness of the differentiated roles that health may have in the work–retirement transition as outlined in this discussion paper may support research to address questions relevant for policy and practice and increase the impact of research. Recommendations for occupational health and social research are given

The Role of Leisure-Time Physical Activity in the Change of Work-Related Stress (ERI) over Time

Background: Every second employee in Europe complains about work-related stress. Occupational stress due to an imbalance between efforts spent and rewards gained (effort-reward imbalance = ERI) is well investigated and it is associated with mental and physical health. A common guess is that leisure-time physical activity (LTPA) has beneficial effects on work-related stress. Yet, evidence in support of this assumption is weak, especially regarding ERI-stress. Longitudinal studies investigating the role of LTPA on ERI are missing. Therefore, this study aims to investigate the effect of LTPA on work-related stress by ERI over time. Methods: 3961 socially insured employees that were born in 1959 or 1965 and working in the first (t1: 2011) and second wave (t2: 2014) of the lidA-study were included. Work-related stress was measured by ERI, LTPA by the self-rated weekly frequency of physical activities. Besides the direct effect, a moderating effect of LTPA on ERI over time was tested in the multiple linear regression analysis. Results: The ERI at t1 was strongly associated with ERI at t2. While LTPA had no direct effect on ERI(t2), it was a significant moderator of ERI from t1 to t2: The higher the frequency of LTPA, the lower ERI was over time. This interaction of LTPA with ERI remained after adjustment for socio-demographic factors. Conclusions: The long-term moderating effect of LTPA on ERI is in agreement with former investigations on the role of LTPA on work-related stress, generally, and on its cross-sectional effect on ERI-stress, specifically. Some of Hill’s criteria of a causal association in epidemiology (biological gradient, temporality, consistency) support our findings. As LTPA has also been shown to exert a protective effect on health outcomes that are associated with ERI, the moderation of ERI by LTPA could partly explain this protective effect. Future observational and interventional studies are required to support our results over more than two age groups and study times

Medical rehabilitation of older employees with migrant background in Germany: Does the utilization meet the needs?

Schroder CC, Breckenkamp J, du Prel J-B. Medical rehabilitation of older employees with migrant background in Germany: Does the utilization meet the needs? PLoS ONE . 2022;17(2): e0263643.Due to demographic change with an ageing workforce, the proportion of employees with poor health and a need for medical rehabilitation is increasing. The aim was to investigate if older employees with migrant background have a different need for and utilization of medical rehabilitation than employees without migrant background. To investigate this, self-reported data from older German employees born in 1959 or 1965 of the first and second study wave of the lidA cohort study were exploratory analyzed (n = 3897). Subgroups of employees with migrant background were separated as first-generation, which had either German or foreign nationality, and second-generation vs. the rest as non-migrants. All subgroups were examined for their need for and utilization of medical rehabilitation with descriptive and bivariate statistics (chi-square, F- and post-hoc tests). Furthermore, multiple logistic regressions and average marginal effects were calculated for each migrant group separately to assess the effect of need for utilization of rehabilitation. According to our operationalizations, the foreign and German first-generation migrants had the highest need for medical rehabilitation while the German first- and second-generation migrants had the highest utilization in the bivariate analysis. However, the multiple logistic model showed significant positive associations between their needs and utilization of rehabilitation for all subgroups. Further in-depth analysis of the need showed that something like under- and oversupply co-exist in migrant groups, while the foreign first-generation migrants with lower need were the only ones without rehabilitation usage. However, undersupply exists in all groups independent of migrant status. Concluding, all subgroups showed suitable use of rehabilitation according to their needs at first sight. Nevertheless, the utilization does not appear to have met all needs, and therefore, the need-oriented utilization of rehabilitation should be increased among all employees, e.g. by providing more information, removing barriers or identifying official need with uniform standards

Effekte gesundheitsrelevanter Verhaltensweisen auf die subjektive Erwerbsperspektive älterer Beschäftigter in Deutschland

<jats:title>Zusammenfassung</jats:title><jats:sec> <jats:title>Hintergrund und Ziel</jats:title> <jats:p>Die subjektive Erwerbsperspektive (EP) gilt als prädiktiv für die realisierte Erwerbsdauer. Inwieweit spezifische gesundheitsrelevante Verhaltensweisen (GVh) mit der EP älterer Beschäftigter assoziiert sind, wurde bislang nicht erforscht. Vor diesem Hintergrund wurden die Effekte von körperlicher Aktivität, Übergewicht und Rauchen auf die EP älterer Beschäftigter untersucht.</jats:p> </jats:sec><jats:sec> <jats:title>Material und Methoden</jats:title> <jats:p>Analysiert wurden Daten von 3368 älteren Erwerbstätigen, die 2018 an der dritten Befragungswelle der repräsentativen lidA-Studie teilnahmen. EP wurde anhand der Selbsteinschätzung, wie lange man glaubt, noch arbeiten zu können, untersucht. Mittels hierarchischer linearer Regressionsmodelle wurden die Effekte der GVh auf die EP kontrolliert für soziodemografische, arbeits- und gesundheitsbezogene Faktoren querschnittlich untersucht. Durch Interaktionstestung wurde das Zusammenspiel unabhängiger Variablen auf die EP geprüft.</jats:p> </jats:sec><jats:sec> <jats:title>Ergebnisse</jats:title> <jats:p>Körperliche Aktivität und Adipositas waren signifikant mit der EP assoziiert. Regelmäßig körperlich Aktive gehen davon aus, um fünf Monate länger arbeiten zu können als wenig bzw. nicht Aktive. Beschäftigte ohne Übergewicht gehen davon aus, um fünf Monate länger arbeiten zu können als Adipöse. Kontrolliert für die Gesundheit war der Effekt von Adipositas nicht mehr signifikant. Das Rauchverhalten zeigte keinen signifikanten direkten Effekt auf die EP.</jats:p> </jats:sec><jats:sec> <jats:title>Schlussfolgerung</jats:title> <jats:p>Unsere Ergebnisse lassen darauf schließen, dass besonders körperliche Aktivität förderlich für die EP sein kann. Um das Potenzial der spezifischen GVh für die Erwerbsfähigkeit genauer bewerten zu können, sind weitere Untersuchungen notwendig. Betriebliche Akteure sollten die Ergebnisse bei der Planung verhaltens- und verhältnispräventiver Maßnahmen berücksichtigen, um gezielter auf die Bedürfnisse der Beschäftigten, besonders jener mit potenziell kürzerer EP, eingehen zu können.</jats:p> </jats:sec&gt

Zum Gesundheitsverhalten älterer Beschäftigter – inwieweit stimmen Selbsteinschätzung und Realität überein?

<jats:title>Zusammenfassung</jats:title><jats:sec> <jats:title>Ziel der Studie</jats:title> <jats:p>Ältere Beschäftigte sind eine besondere Zielgruppe für die Betriebliche Gesundheitsförderung. Eine realistische Einschätzung des eigenen Gesundheitsverhaltens (EGVh) ist wesentlich für die adäquate Anpassung des Gesundheitsverhaltens (GVh) bei Bedarf. Die EGVh kann nach Sozial- und Gesundheitsaspekten variieren. Daher wird untersucht, wie GVh-Faktoren auf die EGVh älterer Beschäftigter nach soziodemografischen Aspekten und der körperlichen Gesundheit (kGes) wirken.</jats:p> </jats:sec><jats:sec> <jats:title>Methodik</jats:title> <jats:p>Analysiert wurden die Daten von 3347 älteren Beschäftigten der repräsentativen lidA-Studie 2018. Die EGVh wurde mit der Aussage „Ich tue genug für meine Gesundheit“ erfasst. Als GVh-Faktoren wurden die körperliche Aktivität (kA), der BMI und das Rauchverhalten untersucht. Mit hierarchischen logistischen Regressionen wurde der Einfluss der GVh-Faktoren auf die EGVh kontrolliert für Geschlecht, Alter, Bildung und kGes analysiert. Um das Zusammenspiel der unabhängigen Variablen hinsichtlich der EGVh genauer zu untersuchen, wurde zudem auf Interaktionen getestet.</jats:p> </jats:sec><jats:sec> <jats:title>Ergebnisse</jats:title> <jats:p>Gesündere Verhaltensweisen sind positiv mit der Zustimmung, genug für die eigene Gesundheit zu tun assoziiert. Allerdings zeigten die gefundenen Interaktionen für bestimmte Personengruppen abweichende Ergebnisse. So stimmen übergewichtige Raucher gegenüber normalgewichtigen mit einer höheren Chance der Aussage zu, genug für die eigene Gesundheit zu tun. Bei Nichtaktiven stieg die Zustimmungschance mit abnehmendem Bildungsniveau.</jats:p> </jats:sec><jats:sec> <jats:title>Schlussfolgerung</jats:title> <jats:p>Die Identifizierung von Personengruppen, die ihre GVh weniger zutreffend einschätzen als andere, kann helfen, das Angebot an Präventionsmaßnahmen bedürfnisspezifischer zu gestalten. Das Zusammenspiel der Einflussfaktoren auf die EGVh gilt es zukünftig noch genauer zu untersuchen.</jats:p> </jats:sec&gt