What is the issue?
Economic inactivity has far-reaching adverse consequences on individuals, families, and the broader economy. Economic inactivity has been shown to be both a cause and consequence of poor health. In June 2024, approximately 9.4 million people in the UK were economically inactive, constituting more than a fifth of the working-age population. This figure reflects a growing concern about the impact of the recent economic climate and the COVID-19 pandemic. Whilst the reasons for economic inactivity are multifaceted, ranging from health issues, caring responsibilities, and retirement; the demographic composition of the economically inactive population has shifted since the pandemic. Individuals with long-term illness have replaced students as the majority of the economically inactive population, and an increasing number of older workers are choosing to retire early or take longer breaks from their careers.
What do we want to know?
Despite extensive research on the factors surrounding economic inactivity, and interventions aiming to support individuals who have been economically inactive to return to work and retain employment, there remain significant policy-relevant gaps in our knowledge. These gaps include (a) understanding the effect of interventions aimed at those with poor health and disabilities; and (b) understanding the nature of interventions that aim to address economic inactivity among older workers. The main aim of this Rapid Evidence Review (RER) is to describe the nature, extent of the research on, and the effect of interventions for economically inactive individuals by answering the following questions:
RQ1: What is the effectiveness of interventions aiming to address economic inactivity or improve economic outcomes in individuals with poor health and disabilities?
RQ2: What is the nature of research evidence and key characteristics of interventions aiming to provide support and assist the transition from economic inactivity to employment and/or staying in employment for older workers?
How did we conduct the rapid evidence review?
We carried out an initial scoping exercise to identify the breadth of the research literature on interventions with employment outcomes for people with ill health, disability and for older workers. The findings from the scoping exercise, interpreted alongside policy stakeholders, suggested potential groups of studies upon which to focus on the RER. The result of this scoping exercise identified a large volume of systematic reviews on people with physical and mental ill health and disabilities, and a sparsity of systematic review evidence for older workers. As a result, the RER has two evidence synthesis components:
PART A) An overview of systematic reviews investigating the effectiveness of interventions designed for people with poor health and disabilities (RQ1)
We included systematic reviews if they were published in or after 2010 and published in English. We searched eight bibliographical databases. We assessed the quality of systematic reviews using the AMSTAR-2 tool and reported a narrative account of the effectiveness of the interventions for individuals with poor health and disabilities based on the findings from meta-analyses.
PART B) A descriptive map of interventions designed for older workers to provide an overview of research evidence for future research. (RQ2)
We conducted a systematic map of primary research to identify and describe the key characteristics of interventions designed for older workers, and how they assessed effectiveness. We conducted searches for quantitative intervention studies using key terms for older workers specifically. We included quantitative primary research that investigated the effectiveness of interventions designed for older workers. Included studies must have been published from 2010 onwards, be available in English, and be specific to older workers. We narratively reported the key characteristics of studies and interventions designed for older workers to inform future research.
What did we find?
For mental health, Individual Placement Support (IPS) programs were effective in helping individuals, including those with severe conditions, secure paid employment and extend job tenure. Cognitive remediation showed positive impacts on employment and income, while psychosocial support, through in-person or e-health interventions, reduced sickness absence. However, enhanced care management had no effect on reducing sick days. Multilevel RTW interventions reduced time to RTW but did not affect overall RTW rates.
For those with both mental and/or physical health conditions, Cognitive Behavioural Therapy (CBT) improved RTW outcomes. Early workplace interventions for short-term sick leave had little effect, while workplace modifications, especially for musculoskeletal disorders, reduced sickness absence. Multilevel interventions combining skill-building and workplace changes showed no significant employment improvements.
In cases of physical health alone, multidisciplinary workplace interventions had no impact on sick leave. For individuals with learning disabilities, cognitive technology like auditory prompts and video-assisted training showed potential in supporting employment, though the evidence was of low quality.
Key characteristics of interventions aimed at supporting older workers in the workforce are:
Structural interventions include raising the retirement age and offering financial incentives to delay retirement, as well as adjusting benefit rules for those with health issues.
Work-focused interventions emphasise preventing illness through workplace safety and adaptations to avoid early retirement due to chronic conditions.
Person-centred interventions focus on enhancing employability through skills training, such as CV writing and job-specific education.
Health promotion interventions use the workplace to encourage physical well-being through exercise programs, diet advice, and relaxation techniques, promoting better health and extended workforce participation.
How to cite this report:
Bangpan M, Mendizabal-Espinosa R, Li Z, Lin D, Kneale D, Vigurs C (2024) Understanding the impact of economic inactivity interventions for people with poor health and disability and the nature of interventions for older workers: a rapid evidence review. London: EPPI Centre, UCL Social Research Institute, UCL Institute of Education, University College London.