What mid-career physicians need to know about retirement’s effects on cognitive function (Part 2)

By Anne Meneghetti, MD 

Read part 1 of this series.   

Would postponing retirement protect against cognitive decline?  

It seems so. Researchers explored Health and Retirement Study data on fluid intelligence to estimate the cognitive effects of postponing retirement to age 67 or later. Compared with retiring between ages 55 and 66, postponed retirement showed benefits to cognitive function across genders, races/ethnicities, and education levels, for both professional and non-professional occupations (Hale, J., 2021). Those with the highest education levels would enjoy the greatest mitigation to cognitive decline, according to this data model. In a 2022 Forbes poll of recent retirees (Brumberg, 2023), nearly a third of respondents said they wished they had kept on working, and nearly another third admitted they were unprepared for the daily realities of being retired. 

A retirement cliff isn’t the only option 

Before packing up the stethoscope for good, many physicians are aiming to reduce their hours or modify their career, rather than retire completely. Several surveys shine a light on the biggest dissatisfiers for physicians: burdensome administrative tasks, insufficient salaries, and poor work-life balance (Popowitz, 2022). The average physician works around 51 hours a week, which is 16 more hours than typical U.S. employees. Leading up to retirement, 43% of physicians surveyed aspired to reduce their work hours (Jackson, 2023). When asked what would delay their complete retirement, they responded with ways to ramp down gradually, including part-time work (58%) and/or flexible schedules (52%), as well as reduced or eliminated on-call duties (42%). While younger physicians in this survey cited retention bonuses as a motivator to stay, older physicians considered teaching and mentoring as appealing career moves. Locum tenens work, teaching, and volunteering are all great ways to continue reaping the cognitive benefits of practicing medicine. 

Lifestyle approaches to sustain cognitive vibrancy  

If you do opt for full retirement, prioritize ways to mitigate cognitive decline (Prater, 2023). None of the advice will surprise you—exercise, stay socially engaged, prioritize quality sleep, and budget in a way that minimizes financial stress. It’s all the things we tell patients to do, and then silently remind ourselves that we should be doing them, too. Taking care of the body seems to benefit the brain. Better physical health delays cognitive decline, according to a Health and Retirement Study analysis. A meta-analysis of aerobic fitness training found robust benefits to cognition—especially to executive-control processes (Colcombe, 2003). As if we need more reasons to be physically fit! 

Cardiovascular and cerebrovascular health are clearly connected. A heart-mind connection was recently found between lower Framingham 10‐year cardiovascular disease risk scores and better cognitive function in people ages 60 and up. The correlation extended to executive function and processing speed, as well as immediate and delayed memory. Perhaps it’s not surprising, given the components of the 10-year CVD risk score. This connection gives us added incentive to manage hypertension, control hyperglycemia and cholesterol, and avoid smoking. 

Lower risk for incident dementia correlated with higher alignment with the Mediterranean Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet, in a recent study of middle-aged and older adults. Research on multivitamins for cognition has been mixed. In the Physicians Health Study, limited to males aged 65 years or older, daily multivitamin use didn’t offer improvements in cognitive performance. More recently, a study showed that 3 years’ use of a commercial multivitamin-mineral combo benefited cognition, including episodic memory and executive function, in older people (average age, 73 years old). These benefits were more pronounced in patients with cardiovascular disease; baseline cognition was lower for this group. Another study echoed this one, showing benefits to immediate recall memory after a year of taking a daily commercial multivitamin. 

Does cognitive training work? 

Physicians are lifelong learners, and well poised to contine learning post-retirement. You may wonder whether games, puzzles, and cognitive training exercises benefit cognition. There’s not abundant evidence on the subject. A 2019 meta-analysis concluded that that cognitive training programs had minimal effect on general cognitive skills. One small trial of patients (mean age, 71.2 years old) who already had mild cognitive impairment were randomized to cognitive games vs. crossword puzzles on the web at home. At week 78, Alzheimer’s Disease Assessment Scale-Cognitive scores were slightly worse for games but improved with crosswords. Despite these negative findings, do I still play Wordle, Sudoku, Spelling Bee, crosswords, Scrabble, and more daily? Yes, I do. I play them every day, compulsively. It can be stressful to attempt and fail at cognitive exercises that are way beyond my skill level or interest. If I find myself flailing at a super-difficult brainteaser, I remind myself that games are meant to be fun—and there’s no evidence that stressing over a grueling slog of a puzzle will benefit me.   

Perspective on intellect and happiness 

Physicians aren’t getting any younger. While people in every profession value their cognitive abilities, my sense is that physicians have a unique relationship with their intellect. It seems natural for us to place a high value on cognition and assume that robust intellectual capabilities are vital to future satisfaction in life. The relationship between happiness and IQ is a complex one. The Atlantic interview about the book If You’re So Smart, Why Aren’t You Happy? explores the paradox that being more educated, richer, and more accomplished doesn’t necessarily predict happiness (Pinsker, 2016). Being happy depends more on meaningful social relationships, being good at whatever we spend our days doing, and having the freedom to make independent decisions in life. 

AARP research on self-reported happiness in the second half of life concluded that life gets good, especially for older people. Those reporting that they were “very happy” included 34% of those who age 80 and up, 27% of those in their 70s, 21% in their 60s, 18% in their 50s, and 16% in their 40s. Stress, anxiety, and fear seem to abate with advancing age, as do financial concerns. In retirement, there’s a greater sense of control over daily life, and relationships become a focal point for purpose and joy. I take comfort in knowing that managing physical health, mental wellness, and social connections can all make a difference to cognitive health after retirement.  

References 

 Hale, Jo Mhairi. (2021, September). Science Direct. Does postponing retirement affect cognitive function? A counterfactual experiment to disentangle life course risk factors. https://www.sciencedirect.com/science/article/pii/S2352827321001300?via%3Dihub 

Brumberg, Robby. (2023, August 2). Forbes Health. Retirement is One of Life’s Major Transitions—Maintaining Cognitive Health Can Make It Easier. https://www.forbes.com/health/healthy-aging/cognitive-health-in-early-retirement/ 

Popowitz, Ethan. (2022, October). Definitive Healthcare. Addressing the healthcare staffing shortage. https://www.definitivehc.com/sites/default/files/resources/pdfs/Addressing-the-healthcare-staffing-shortage.pdf 

 Jackson Physician Search. (2023, March 16). Preparing for the Waves of Physician Retirements Survey Results https://www.jacksonphysiciansearch.com/white-paper-preparing-for-the-wave-of-physician-retirements-survey-results/ 

 Prater, Erin. (2023, May 19). Fortune Well. Cognitive decline after retirement is a universal trend. Here are 4 ways to reverse it. https://fortune.com/well/2023/05/19/ways-to-reverse-cognitive-decline-after-retirement/  

Colcombe, Stanley, et al. (2003, March). Sage Journals. Fitness Effects on the Cognitive Function of Older Adults: A Meta-Analytic Study. https://journals.sagepub.com/doi/10.1111/1467-9280.t01-1-01430 

Pinsker, Joe. (2016, April 26). The Atlantic. Why So Many Smart People Aren’t Happy. https://www.theatlantic.com/business/archive/2016/04/why-so-many-smart-people-arent-happy/479832/