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The Four Secrets to a Better Retirement

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Retirement looks different for everyone. Studies have shown that prioritizing four key areas can greatly improve your retirement years, both mentally and physically. Martha Sajatovic, MD, a specialist in geriatric psychiatry, shares more and what to do if you’re already retired and feeling a lack of purpose.


Pete Kenworthy
When you’re in your 20s and 30s, the thought of retirement is glamorous, right? I’m going to travel the world when I retire. That’s what we say, right? It’s so far away that it’s hard to really imagine what it’s really going to be like when we hit 65 or 70 or whenever we decide that we’re ready. Then you hit your 40s and then especially in your 50s, it starts to become more of a reality. Then the thoughts shift to things like, am I financially in good shape to retire at 65? Do I have to work until I’m 70? And maybe, more appropriately, what am I going to do when I retire? If I’m not working, what is my purpose?

Macie Jepson
So many things to think about, Pete. How will I adjust to being around my significant other 24/7? We seldom talk about the emotional hardships of retirement. Today we are. Hi, I’m Macie Jepson.

Pete Kenworthy
And I’m Pete Kenworthy, and this is The Science of Health. Joining us today is Dr. Martha Sajatovic, the Director of Neurological and Behavioral Outcomes Center at University Hospitals in Cleveland. She specializes in geriatric psychiatry, anxiety and depression. Thanks for being with us.

Martha Sajatovic, MD
Thank you for having me.

Pete Kenworthy
So let’s start here. A 2020 study showed that roughly a third of retirees experience some form of depression. So here’s a loaded one word question…why?

Martha Sajatovic, MD
The main reason for that is that challenges and rewards related to retirement or during the retirement time are as different as individuals. However, much of it can be traced to retirement readiness, also sometimes called retirement preparedness. And people definitely can know themselves or learn about themselves so that they can optimally prepare for retirement and hopefully reduce their chances of having challenges.

Macie Jepson
It sounds like challenges are normal though, especially leading up to retirement and probably in the very beginning of retirement as well. So it’s not what we imagined when we were younger. What are the main causes of retirement depression?

Martha Sajatovic, MD
So, Macie, I’m going to back that up a little bit maybe before we charge into depression or challenges and talk about sort of that journey of retirement. When I encourage my patients in discussion about retirement readiness is thinking about both the positives and the potential challenges. And actually, studies have shown, especially for people that have stressful work situations, that that period shortly after retirement can be very beneficial. You’ve removed the stressor of a difficult workplace or a workplace where you may feel you have little agency or little ability to determine what happens. So I think it’s important to put that in the context and talk about retirement as kind of mixed opportunities.

Macie Jepson
That’s good to know. So now let’s talk about some of the causes of these hardships in retirement.

Martha Sajatovic, MD
Right. So those are really an excellent point. And the way I like to think about it is thinking about different life domains, and if an individual might expect to have, or we might be able to foresee that they would have challenges, then that’s an area where we could think about, I might be likely to have depression or anxiety or other difficulties. So there’ve been a lot of studies looking at retirement readiness or retirement preparation and risk factors for challenges. And one way to think about this is kind of four key domains. So one domain is the domain of physical health. How healthy is a person? And do they already have health challenges where maybe not working could impact that some way or another. Mental health is a big one, right? If an individual already has issues with depression and anxiety, as I mentioned earlier, sometimes the removal of a stressful work situation could improve that depression or anxiety, but it may bring a host of additional challenges given that the person may be already vulnerable to mood disorders or having an anxiety condition.

The next thing that I would suggest, just thinking about the domain of financial readiness. We know that individuals will have a different type of income that may or may not meet their financial needs, and you can actually have something called financial anxiety related to depression where people perhaps haven’t projected what their needs are. And there’s always an unknown, right? You don’t know how long somebody’s going to live versus how long their money’s going to last or how it should best be used. And then the last is the social environment or social health. We certainly saw very well during the COVID pandemic how a drop or a closing off of social connections can have a pretty heavy mental health burden.

Macie Jepson
And then of course there is the situation when you’re forced to retire sooner than planned. That’s got to be really stressful.

Martha Sajatovic, MD
Yes, absolutely. And you can still think about that in the way or along the lines of those four domains, right? So people can have different reasons as to forced retirement. So if they’re forced to retire because of physical health, not only do they have whatever health issue they had that caused that retirement, but now they have potentially reduced income or reduced social support. Forced retirement could be related to mental health issues. You can imagine it wouldn’t require too much of a telescope to see ahead that those might continue to persist. And then financial as well. The social environment, if somebody is not going to work every day for instance, or have other activities, sometimes it can exacerbate tensions that are already there in a marriage, in a family relationship or home life.

Pete Kenworthy
I’ve read that for most people, the primary cause of retirement depression is a lack of purpose. And this is a tough one, right? For decades, many people find purpose in their jobs and that’s not there anymore. So what’s the best way to adjust to that or find that purpose outside of work?

Martha Sajatovic, MD
Right. So what is helping you to get up every morning? What is your goal? It’s important for people to continue to have goals, and I would argue that part of retirement readiness is thinking about what is going to be meaningful for you. I don’t think most people who are planning to retire think upfront and consciously, oh, I’m going to just sit in front of the TV from eight in the morning until 10 at night, which in most cases would probably not lead to a strong sense of purpose.

Pete Kenworthy
Some of the things that I read when I looked at that information were things like, don’t retire completely, right? Slowly scale back so you can build maybe a lifestyle and an identity that doesn’t depend on your work.

Martha Sajatovic, MD
So that I think brings up the issue of what you’re going to do with this period of time. So the Social Security Administration and retirement, this whole kind of platform and source of financial support that we have started in the 1930s. And at that time the average life expectancy was around 60. Retirement started at age 65. So you are really looking at in that era a limited number of years in which to use your post-work time. Things are very different now. Our life expectancy is in the high 70s. And so depending on the time that you retire, let’s just say 66 or 67, you might be looking at a decade or two decades or perhaps even more of retirement time period. So that really underscores the need to think about that is a good chunk of time. It’s a new life chapter rather than just a few remaining years, and how am I going to use that in a way that satisfies me emotionally, physically, and nurtures my social network?

Pete Kenworthy
And one of the things pointed out here was the word passion jumped out at me. Either finding new passions like new hobbies, social events, volunteering, that kind of thing, or even teaching an old passion like a musical instrument or art or cooking that, something that allows some focus on projects and honestly, potentially even some income there as well.

Martha Sajatovic, MD
Correct. Correct. So the idea that you’re going to work full-time and then you’re going to instantly go into full-time retirement is something that is up for discussion more. Could you have stepped in kind of employment where people might work a limited number of hours? Certainly, we’ve seen with our virtual work environment that people are finding different ways to do their tasks, and perhaps not driving to work every day and all the expenses and burden associated that might open the door. But then uncompensated employment or different careers. Again, thinking about this could be one or two decades or more, how am I going to use that time? So I need to be a lot more intentional about how I’m going to plan my days.

Macie Jepson
One or two decades more. That’s a lot of time, if you have a significant other. And I found this Census Bureau data really interesting. It goes back to 2016, but the average, national average is at 34% for divorce, but for ages 55 to 64, it goes up to 43%; 65 to 74, it’s still up there, 39%. This can be a tough time. So let’s talk about preparing, first of all, expectations, making sure that you are on the same page with your partner.

Martha Sajatovic, MD
Right. So people talk about financial planning and it’s pretty easy to get folks on track with that. How much money do I have and how long is it going to last? But those other domains, the physical health, the mental health and the social support health are all just as worthy of discussion. And that’s where the spouses and the families come in. How are we going to divide tasks at home, for instance? How am I going to stay physically healthy if I’m no longer going to work every day? Do I need to have an exercise plan? Is my spouse going to participate with me? So having those prep discussions can potentially alleviate the possibility or diminish the possibility of worst conflict or tension a bit further down the road.

Macie Jepson
Is there any concern in retiring at the same time? I’ve heard about couples kind of easing into it. One is home first, get used to that first and then the other retires. Do you see that happen a lot?

Martha Sajatovic, MD
I do. And part of that relates to differential ages of marriage partners, right? Still we often see men being a little bit older, so it may be that they retire earlier perhaps, and so there’s kind of a built-in Petri dish or experiment to see how that goes. But again, having those discussions and how is that working spouse going to adjust to the spouse that’s no longer working, right? And if the couple expects that everything’s going to be exactly the same and the working spouse is going to continue to do just as much, you can imagine that that might lead to some resentment or some conflict or certainly a need to renegotiate how things are going to happen in the home.

Macie Jepson
So we’ve talked a lot about staying physically active, but what about mentally? And I would imagine that your mental aptitude might decline quickly if you’re not using your brain the way you used to.

Martha Sajatovic, MD
Yeah. So again, that’s a complicated issue as well. So if you’ve got a very stressful job and you retire from that stressful job, studies suggests that in those first year or two after retirement, that can be almost like being on vacation or a holiday. And so there’s this sense of, oh, of a weightlifting from me. But if you follow these individuals who’ve had that bump in sort of reduction in stress, what you do see is that they may then go on to encounter new stresses, right? So what is the expectation? If you expect that your life is going to be perfect once you retire, and then you have the kind of stresses that come on that life routinely deals with us, you’re going to continue to have to think about what coping mechanisms do I have and what is constructive and positive for me.

Pete Kenworthy
Is anxiety in the same bucket here? My guess is retirement anxiety is also an issue, right? It’s not just depression.

Martha Sajatovic, MD
Yeah. So retirement or depression anxiety often kind of go hand in hand. There are some slight differences. So one way to think about depression and anxiety is anxiety tends to be future oriented, thinking about the future. Depression sometimes can be more past oriented, right? Things were better or I’ve lost something. But that, again, is where the preparation can be helpful. So I talked about financial anxiety, but there can be more non-specific types of anxieties. How am I going to spend my days? How is it going to be for me? What will it be like for me when I’m no longer working? And again, trying to think about some of those things preemptively can diminish anxiety. But the other thing that I do want to bring up as a psychiatrist, especially for somebody who has a history of depression or a history of anxiety is it is important to make sure that you have healthcare access, right? If your insurance, health insurance status is going to change, what kind of benefits do you have and can you continue to see your same providers as always? If that needs to change, what types of availability is there for you? So that’s a very important point. Ideally, it’s good to know what kind of healthcare resources you have before you’re really in a crunch or a crisis and need those services.

Macie Jepson
So the theme here is planning ahead and obviously for the finances, but equally important, I am hearing from you, is that you need to make sure you have a purpose. You maintain a reason for being. Any final advice on how to make that happen?

Martha Sajatovic, MD
So one word of advice I would have is whatever is rewarding for you, the way you find meaning, the actual activity might change, but try to understand kind of what it is that really kind of revs you up and look for opportunities that will be a good fit for you, whether it’s teaching, whether it’s volunteering, whether it’s working part-time or trying something new that you’ve always wanted to try and never had, just to make sure that that sense of reward continues to be there.

Pete Kenworthy
Even with all this great advice, I go back to the stat that we talked about at the beginning, that a third of retirees experience some sort of depression. How do you know when it’s time to get some help? How do you know when it’s, many people will battle that, oh, I’ll get through this day, or I’ll get through this week and things will get better. Are there signs? Are there clues you should look for that maybe I should talk to someone?

Martha Sajatovic, MD
Yeah. So I would say that that’s true across the lifespan, right? Do I feel a sense of depression or do I feel down? But there is one thing I’d like to mention that is specific to retirement, and it is specific to depression is most people retire later in life, right? Then they’re mid to late 60s or early to mid 70s. And one thing that we do see with older age depression that does differ from depression in younger people is that young people tend to have more of that sense of dysphoria or depression, the blues. I can really feel down, something weighing heavily on me, whereas what you might be particularly likely to see in older people is what we call anhedonia, a lack of interest or lack of pleasure. And so it’s not unusual for me to hear from my older patients, Doc, it’s not that I feel down. I just don’t feel like doing anything. And it’s that symptom that can actually be sort of a hallmark of depression in later life. That is something that the person may notice themselves or their family might notice it or a spouse might notice it. And that’s that important social preparedness to say, let’s just see how you’re doing and let’s just check in and see how you’re doing.

Pete Kenworthy
How do you get through that? How do you get through? I certainly have known older people in my life who I picture their faces when you say that. I don’t feel like doing anything. How do you get over that hump?

Martha Sajatovic, MD
Well, what I would say is if it’s part of a clinical depression, a major depressive disorder, then that has evidence-based treatments. There’s counseling. There’s medication or other biological treatments that can be effective. It may not be to the full scale of a major depressive disorder, but some of the kind of coping mechanisms to particularly address that issue can be useful. For example, we know that exercise is a robust approach to manage depression, right? Is the person becoming a couch potato afterwards? And you could see how that could happen, right? It’s just kind of tough to shift gears and start doing something else, but proactively and preemptively putting in place things that will help both kind of battle the blues and deal with that kind of anhedonia can be helpful.

Macie Jepson
I feel like anyone listening to this, I hope that they will feel relieved to understand that this is normal. What would be your final piece of advice if you could put a bow on this for people who are listening and preparing, or maybe they’re in the middle of it and they’re seeing that it’s not really meeting all of their expectations, what would you have to say to them?

Martha Sajatovic, MD
Yeah, I would say look at those areas. We talked about the four domains, and be willing to try different coping strategies, right? If something isn’t working, you don’t want to necessarily do more of the same. I mean, sometimes you could, if you’re maybe eating a little bit healthfully and it’s better to move to an even more healthy diet, but try new approaches to help you manage stress or communication within your family or within a couple.

Macie Jepson
It sounds like that’s the priority, you know, is okay, you don’t have your job to go to anymore. Make your emotional and physical health your priority.

Martha Sajatovic, MD
So I often tell my patients…they talk about their 401K and financial planning, but that’s only one of those domains. You really need to devote just as much, if not more effort to those other domains, your physical health, your emotional health, and your social health.

Pete Kenworthy
Dr. Martha Sajatovic from University Hospitals in Cleveland, thank you so much for joining us.

Martha Sajatovic, MD
Thank you.

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