Premature Retirement Research Articles

The impact of diabetes on the labour force participation, savings and retirement income of workers aged 45-64 years in Australia.

BackgroundDiabetes is a debilitating and costly condition. The costs of reduced labour force participation due to diabetes can have severe economic impacts on individuals by reducing their living standards during working and retirement years.MethodsA purpose-built microsimulation model of Australians aged 45-64 years in 2010, Health&WealthMOD2030, was used to estimate the lost savings at age 65 due to premature exit from the labour force because of diabetes. Regression models were used to examine the differences between the projected savings and retirement incomes of people at age 65 for those currently working full or part time with no chronic health condition, full or part time with diabetes, and people not in the labour force due to diabetes.ResultsAll Australians aged 45-65 years who are employed full time in 2010 will have accumulated some savings at age 65; whereas only 90.5% of those who are out of the labour force due to diabetes will have done so. By the time they reach age 65, those who retire from the labour force early due to diabetes have a median projected savings of less than $35,000. This is far lower than the median value of total savings for those who remained in the labour force full time with no chronic condition, projected to have $638,000 at age 65.ConclusionsNot only does premature retirement due to diabetes limit the immediate income available to individuals with this condition, but it also reduces their long-term financial capacity by reducing their accumulated savings and the income these savings could generate in retirement. Policies designed to support the labour force participation of those with diabetes, or interventions to prevent the onset of the disease itself, should be a priority to preserve living standards comparable with others who do not suffer from this condition.

Effects of cost-related medication nonadherence on financial health and retirement decisions among adults in late midlife

Objectives Suboptimal adherence to prescribed medications due to cost is known to adversely affect physical health. In this study, we examine whether cost-related nonadherence (CRN) also affects ‘financial health’, e.g. an individual's personal finances or the timing of their retirement. Methods We examine this issue for 2927 adults in late midlife with chronic medical conditions who participated in the Health and Retirement Study and who reported regularly taking medication(s) for their condition over the period 1994 to 2004. We hypothesize CRN may indirectly influence financial health by contributing to the occurrence of negative health shocks. We estimate two sets of models, one to quantify the effects of CRN on the occurrence of adverse health events, and another to quantify the effects of adverse health events on personal finances in 2004 and the timing of retirement. We then derive estimates of the indirect effects of CRN on financial health and on retirement decisions. Key findings Among adults in late midlife, CRN contributes significantly to reduced earnings and premature retirements. These effects happen because CRN raises the risk that serious health shocks occur over time, and such adverse events subsequently limit an individual's ability to continue working and accumulating wealth. Conclusions CRN can threaten more than just personal health. In late midlife, CRN can threaten an individual's ability to continue working and saving towards retirement.

How to deal with climate change

Climate change is a complex and contentious public issue, but the risk-management options available to us are straightforward and have well-characterized strengths and weaknesses.

Effort-Reward Imbalance and Mental Health Problems in 1074 German Teachers, Compared with Those in the General Population.

High degrees of premature retirement among teachers warrant investigating the occupational burden and the mental health status of this profession. A sample of 1074 German teachers participated in this study. Two samples of the general population (N = 824 and N = 792) were used as comparison groups. Work distress was assessed with the Effort-Reward-Imbalance questionnaire, and mental health problems were measured with the General Health Questionnaire (GHQ-12). Teachers reported more effort-reward imbalance (M = 0.64) compared with the general population (M = 0.57), and they perceived more mental health problems (GHQ: M = 12.1) than the comparison group (M = 9.5). School type was not associated with work stress and mental health. Teachers with leading functions perceived high degrees of effort and reward, resulting in a moderate effort-reward ratio and no heightened mental health problems. Teachers working full time reported more effort than teachers working part time, but the reward mean values of both groups were similar. This results in a somewhat unfavourable effort-reward ratio of teachers working full time. Moreover, teachers working full time reported more mental health problems. The results support the appropriateness of the effort-reward conception, applied to the profession of teachers. The higher degree of effort-reward imbalance and the level of mental health problems warrant preventive measures. Copyright © 2014 John Wiley & Sons, Ltd.

Medical Equipment to Make Colonoscopy Procedures Safer for Physicians: Control Head Holder and Splatter Shield1

Medical Equipment to Make Colonoscopy Procedures Safer for Physicians: Control Head Holder and Splatter Shield1

Global Estimates of the Burden of Injury and Illness at Work in 2012

This article reviews the present indicators, trends, and recent solutions and strategies to tackle major global and country problems in safety and health at work. The article is based on the Yant Award Lecture of the American Industrial Hygiene Association (AIHA) at its 2013 Congress. We reviewed employment figures, mortality rates, occupational burden of disease and injuries, reported accidents, surveys on self-reported occupational illnesses and injuries, attributable fractions, national economic cost estimates of work-related injuries and ill health, and the most recent information on the problems from published papers, documents, and electronic data sources of international and regional organizations, in particular the International Labor Organization (ILO), World Health Organization (WHO), and European Union (EU), institutions, agencies, and public websites. We identified and analyzed successful solutions, programs, and strategies to reduce the work-related negative outcomes at various levels. Work-related illnesses that have a long latency period and are linked to ageing are clearly on the increase, while the number of occupational injuries has gone down in industrialized countries thanks to both better prevention and structural changes. We have estimated that globally there are 2.3 million deaths annually for reasons attributed to work. The biggest component is linked to work-related diseases, 2.0 million, and 0.3 million linked to occupational injuries. However, the division of these two factors varies depending on the level of development. In industrialized countries the share of deaths caused by occupational injuries and work-related communicable diseases is very low while non-communicable diseases are the overwhelming causes in those countries. Economic costs of work-related injury and illness vary between 1.8 and 6.0% of GDP in country estimates, the average being 4% according to the ILO. Singapore's economic costs were estimated to be equivalent to 3.2% of GDP based on a preliminary study. If economic losses would take into account involuntary early retirement then costs may be considerably higher, for example, in Finland up to 15% of GDP, while this estimate covers various disorders where work and working conditions may be just one factor of many or where work may aggravate the disease, injury, or disorders, such as traffic injuries, mental disorders, alcoholism, and genetically induced problems. Workplace health promotion, services, and safety and health management, however, may have a major preventive impact on those as well. Leadership and management at all levels, and engagement of workers are key issues in changing the workplace culture. Vision Zero is a useful concept and philosophy in gradually eliminating any harm at work. Legal and enforcement measures that themselves support companies and organizations need to be supplemented with economic justification and convincing arguments to reduce corner-cutting in risk management, and to avoid short- and long-term disabilities, premature retirement, and corporate closures due to mismanagement and poor and unsustainable work life. We consider that a new paradigm is needed where good work is not just considered a daily activity. We need to foster stable conditions and circumstances and sustainable work life where the objective is to maintain your health and work ability beyond the legal retirement age. We need safe and healthy work, for life.

Impacto econômico da obesidade no Brasil

Medical expenditures increased more significantly than other sectors of world economy. Obesity is a worldwide epidemic and a serious public health problem with consequences for society and health systems. The economic consequences of obesity are not limited to medical costs, but also include indirect or social costs, such as decreased quality of life, social adjustment problems, productivity loss, premature retirement and death. Cost-of illness studies try to estimate the total costs of a disease to health systems (public and/or private), to society, or to individuals/families. With the knowledge of the costs related to obesity, economic analyses can be performed in local reality, helping managers and policy makers to better understand the dimension of the problem and to develop strategies to improve access and treatment of these individuals, as well as how to invest in preventive measures.

Costs of temporary disability in Spain related to diabetes mellitus and its complications

Abstract Introduction and objectives To ascertain the socioeconomic impact of diabetes, it is essential to estimate overall costs, including both direct and indirect costs (premature retirements, working hours lost, or sick leaves). This study analyzed indirect costs for temporary disability (TD) due to diabetes and its complications in Spain in 2011 by assessing the related ICD-9 MC codes. Material and method For this purpose, the number of TD processes and their mean duration were recorded. The indirect costs associated to loss of working days were also estimated. Results In 2011, diabetes and its complications were related to 2567 TD processes, which resulted in the loss of 154,214 days. In terms of costs, this disease represented for Spanish public health administrations an expense of 3,297,095.3 €, with an estimated cost per patient and year of 141 €. Conclusions These data suggest an urgent need to devise plans for prevention and early diagnosis of diabetes and its complications, as well as programs to optimize the available health care resources by creating multidisciplinary teams where occupational medical services assume an important role. A decrease in absenteeism would result in benefits for diabetic patients, society overall, and companies or public institutions.

Captain Lord's uremia.

The hundredth anniversary of the worst ever civilian maritime disaster was also the fiftieth anniversary of the death of arguably its most controversial character, Captain Stanley Lord, skipper of the Californian, a "tramp" steamer that became entrapped in ice just off the Grand Banks of Newfoundland on April 14, 1912. Although Lord was faulted in two widely publicized inquiries for failing to respond to Titanic's distress signals, there may have actually been a medical reason for his behavior because he suffered from chronic renal disease and most likely had some secondary cognitive impairment due to this disease. An assessment of Lord's health history shows that he fractured his leg as a young man; suffered from poor eyesight, which led to his premature retirement from the sea by the age of 50; and eventually died from renal failure. Furthermore, his death certificate alludes to previous uremic episodes, perhaps encompassing the time period of the Titanic accident. Lord may have been under some pressure not to reveal his infirmity because doing so could have further jeopardized his career. The literature abounds with evidence that renal insufficiency negatively affects cognition, often years before progression to end-stage renal disease. Captain Lord's failure to act in a crisis situation may serve as a case in point.

In Reply:

We are gratified that Drs. Steinbrook and Weinstein have read our article1 in such a depth that they question as “most likely incorrect” our estimate for the mean retirement age (57.4 yr) among anesthesiologists retiring before 1985. Although their conclusion appears valid—because no one older than 58 in 1985 would have been included in a 2006 survey of anesthesiologists aged 50–79 yr—we believe standby our estimate. Similarly, although it seems intuitive that “a broader sample population… [with] anesthesiologists up to age 90 would be needed to estimate retirement age more accurately for those who retired before 1985,” this suggestion overlooks problematic issues in estimating retirement age.Our article conveys only a summary of the most salient information garnered from the survey. A more detailed report, which we noted is available at the American Society of Anesthesiologists (ASA) Web site,† provides further documentation supporting the suspect estimate’s validity (table 1). Although that estimate reflects only seven retirees in the “before 1985” cohort, the four larger cohorts that followed each contained progressively older persons, establishing the reported mean retirement-age trend for anesthesiologists, mirroring that in other medical specialties and the general population, described in the article.Our survey included all ASA members aged 50 yr and older with known email addresses, but we limited the reported results to those aged 50–79 yr because we were comparing anesthesiologists to other medical specialists whose data arose from nine surveys limited to physicians aged 50–79 yr. Response rates decreased with advancing age and, even more important, demographic characteristics increasingly differed from those of the ASA membership,2,3 as suggested in figure 1. Because response rates varied across age cohorts, statistical adjustments were made so that the respondent group resembled the ASA membership on key demographic characteristics, as described in our Methods. Yet, an important bias remained with regard to estimated retirement age. As poor health is associated with premature retirement, surveying increasingly older persons selects for retirement ages progressively above the true mean values (for any given age cohort), because retirees in poor health are more likely than their healthier, same-age colleagues to have died prematurely, before having the opportunity to complete a survey. Thus, to obtain more robust retirement-age estimates, one strategy would be enhanced efforts to bolster survey response rates,2 particularly among those in their 60s, rather than to enlarge the survey population to include individuals in their 80s.

Costes por incapacidad temporal en España derivados de la diabetes mellitus y sus complicaciones

Introduction and objectivesTo ascertain the socioeconomic impact of diabetes, it is essential to estimate overall costs, including both direct and indirect costs (premature retirements, working hours lost, or sick leaves). This study analyzed indirect costs for temporary disability (TD) due to diabetes and its complications in Spain in 2011 by assessing the related ICD-9 MC codes. Material and methodFor this purpose, the number of TD processes and their mean duration were recorded. The indirect costs associated to loss of working days were also estimated. ResultsIn 2011, diabetes and its complications were related to 2.567 TD processes, which resulted in the loss of 154.214 days. In terms of costs, this disease represented for Spanish public health administrations an expense of 3,297.095.3 €, with an estimated cost per patient and year of 141 €. ConclusionsThese data suggest an urgent need to devise plans for prevention and early diagnosis of diabetes and its complications, as well as programs to optimize the available health care resources by creating multidisciplinary teams where occupational medical services assume an important role. A decrease in absenteeism would result in benefits for diabetic patients, society overall, and companies or public institutions.

Annual cost of hospitalization, inpatient rehabilitation, and sick leave for head and neck cancers in Germany

BackgroundData on the economic burden of head and neck cancers (HNCs) in Germany is scarce. About 16%–28% of these cancers are associated with human papillomavirus (HPV) infection. Therefore, the study reported here aimed to assess the annual costs of HPV-related HNCs incurred by hospitalization, inpatient rehabilitation, and sick leave in Germany in 2008.MethodsA cross-sectional retrospective analysis of five German databases covering hospital treatment, inpatient rehabilitation, and sick leave in 2008 was performed. All hospital, inpatient rehabilitation, and sick leave cases due to HNCs in 2008 were analyzed. Associated numbers of HNC hospitalizations, health care resource use, and costs were identified and extracted using the International Classification of Diseases, tenth revision (ICD-10; World Health Organization, Geneva, 1990) codes C01–C06, C09–C14, and C32 as the main diagnoses. Resources were valued with German official prices in 2008 euros (€). The annual costs of HPV-related HNCs were estimated based on the percentage of HNCs likely to be attributable to HPV infection.ResultsIn 2008, there were 63,857 hospitalizations, 4898 inpatient rehabilitations, and 17,494 sick leaves due to HNCs, representing costs of €365.78 million. The estimated annual costs associated with HPV-related HNCs were €78.22 million, mainly attributed to males (80%). Direct costs accounted for 84% (80% for hospital treatment, 4% for inpatient rehabilitation) and indirect costs due to sick leave accounted for 16% of HPV-related HNC costs.ConclusionThe economic burden of HPV-related HNCs in Germany in 2008 has been underestimated, since costs incurred by outpatient management, outpatient chemotherapy, long-term care, premature retirement, and premature death were not included. However, as far as we are aware, this study is the first analysis to investigate the economic burden of HNCs in Germany. The estimated annual costs of HPV-related HNCs contribute to a significant economic burden in Germany and should be considered when assessing the health and economic benefits of HPV vaccination in both sexes.

United States Anesthesiologists Over 50

Background: Anesthesiology is among the medical specialties expected to have physician shortage. With little known about older anesthesiologists’ work effort and retirement decision making, the American Society of Anesthesiologists participated in a 2006 national survey of physicians aged 50–79 yr. Methods: Samples of anesthesiologists and other specialists completed a survey of work activities, professional satisfaction, self-defined health and financial status, retirement plans and perspectives, and demographics. A complex survey design enabled adjustments for sampling and response-rate biases so that respondents’ characteristics resembled those in the American Medical Association Physician Masterfile. Retirement decision making was modeled with multivariable ordinal logistic regression. Life-table analysis provided a forecast of likely clinical workforce trends over an ensuing 30 yr. Results: Anesthesiologists (N = 3,222; response rate = 37%) reported a mean work week of 49.4h and a mean retirement age of 62.7 yr, both values similar to those of other older physicians. Work week decreased with age, and part-time work increased. Women worked a shorter work week (mean, 47.9 vs. 49.7h, P = 0.024), partly due to greater part-time work (20.2 vs. 13.1%, P value less than 0.001). Relative importance of factors reported among those leaving patient care differed by age cohort, subspecialty, and work status. Poor health was cited by 64% of anesthesiologists retiring in their 50s as compared with 43% of those retiring later (P = 0.039). Conclusions: This survey lends support for greater attention to potentially modifiable factors, such as workplace wellness and professional satisfaction, to prevent premature retirement. The growing trend in part-time work deserves further study.

Trajectories of antidepressant medication before and after retirement: the contribution of socio-demographic factors

The association between retirement and mental health is assumed to depend on socio-demographic factors, but there is a lack of empirical evidence. We examined antidepressant medication before and after retirement by age, gender, living arrangements, and social class. The material comprised nationally representative register data from Finland. Linear regression analysis was used to calculate changes in antidepressant medication 7.5years before and after disability (N=42,937) and old-age (N=19,877) retirement in 1997-2007 by socio-demographic factors. No changes in antidepressant medication (mean DDD/3-month period) were observed around old-age retirement regardless of the socio-demographic factors. After a slight initial increase in antidepressant medication there was a substantial rise 1.5-0years before disability retirement, after which there was a marked decrease, particularly during the first 3years. These effects were less pronounced in retirement due to somatic causes. Age was the strongest modifying factor in retirement due to both depression and somatic causes, with a stronger increase and limited decrease in antidepressant medication among the younger age groups. The post-retirement decrease was also somewhat stronger among men, and among those in higher social classes and those living with a spouse in depression-related retirement. In somatic causes, the pre-retirement increase was stronger among those in higher social classes. Prevention and rehabilitation of mental-health problems in association with work disability should focus particularly on young adults, among whom the strong increase in antidepressant medication before disability retirement, and the continued high levels of medication after the transition signify long periods of morbidity and premature retirement.

Improving understanding of early behavioral indicators of lumbosacral disease in working dogs using 3D visualization of skeletal movements during working tasks: Feasibility study

Abstract An improved understanding of the early behavioral indicators of lumbosacral disease in working dogs may allow earlier interventions and help reduce premature retirement because of disability. However, recognition of early behavioral indicators can be challenging in stoic, high-drive working dogs because they often mask clinical signs. The purpose of this feasibility study was to develop a technique for visualizing canine skeletal movements during working tasks and to describe veterinary clinical specialist opinions on the utility of the visualization technique. Three detection-trained police dogs with a recent history of working task deficits and suspected lumbosacral disease were recruited for the study. Conventional and motion capture video recordings were acquired as dogs performed walking and search high working tasks. Whole-body computed tomography (CT) scans were acquired using clinical multislice CT scanners. Image data from motion capture recordings and whole-body CT scans were analyzed and merged. Three-dimensional (3D) computer animation video clips of skeletal movements were created for each dog and each task, using multiple viewing angle perspectives. Interactive meetings with veterinary clinical specialist reviewers were used to refine point placements for the final renderings. Veterinary clinical specialists reviewed final 3D animation movie clips and recorded their opinions on the utility for the visualization technique. Veterinary clinical specialists reported that the computer animations helped them recognize behavioral characteristics that they had not initially noticed in physical examinations. Potential applications for this visualization technique include creating educational training aids for veterinary students, owners, and handlers; assisting veterinarians in planning rehabilitative treatments; and assisting researchers in developing computer models for biomechanical analyses. Future controlled prospective studies are needed in a large number of normal and affected working dogs to improve accuracy of the visualization technique and test the effect of the technique on observer performance.

Annual cost of hospitalization, inpatient rehabilitation and sick leave of anal cancer in Germany

Objective:Literature on the economic burden of anal cancer in Germany is scarce. About 84% of these cancers are associated with human papillomavirus infection. This study, therefore, aimed to assess the annual costs of human papillomavirus-related anal cancer incurred by hospitalization, inpatient rehabilitation, and sick leave in 2008 in Germany.Methods:A cross-sectional retrospective analysis of five German databases covering hospital treatment, inpatient rehabilitation, and sick leave in 2008 was performed. All hospital, inpatient rehabilitation, and sick leave cases due to anal cancer in 2008 were analyzed. Associated numbers of anal cancer hospitalizations, healthcare resource use, and costs were identified and extracted using the ICD-10 code C21 as the main diagnosis. The annual cost of human papillomavirus-related anal cancer was estimated based on the percentage of anal cancer likely to be attributable to human papillomavirus.Results:In 2008, there were 5774 hospitalizations (39% males, 61% females), 517 inpatient rehabilitations, and 897 sick leaves due to anal cancer representing costs of €34.11 million. The estimated annual costs associated with human papillomavirus-related anal cancer were €28.72 million, mainly attributed to females (62%). Direct costs accounted for 90% (86% for hospital treatment, 4% for inpatient rehabilitation) and indirect costs due to sick leave accounted for 10% of human papillomavirus-related costs.Conclusions:The economic burden of human papillomavirus-related anal cancer in 2008 in Germany is under-estimated, since costs incurred by outpatient management, outpatient chemotherapy, long-term care, premature retirement, and premature death were not included. However, this study is the first analysis to investigate the economic burden of anal cancer in Germany. The estimated annual costs of human papillomavirus-related anal cancer contribute to a significant economic burden in Germany and should be considered when assessing health and economic benefits of human papillomavirus vaccination in both genders.

Premature retirement due to ill health and income poverty: a cross-sectional study of older workers

ObjectivesTo assess the income-poverty status of Australians who were aged between 45 and 64 years and were out of the labour force due to ill health.DesignA cross-sectional study using a...

Western Australia facing critical losses in its midwifery workforce: A survey of midwives' intentions

Objectivethe ongoing attrition of the midwifery workforce frustrates future workforce planning and the provision of maternity services in Western Australia. This project determined factors contributing to the intention of the midwives to move jobs and/or leave the profession. Designa cross-sectional survey approach was taken for this descriptive research utilising a self-administered questionnaire developed by the Nursing and Midwifery Office, Department of Health, Western Australia. Settingpublic and private health sectors in Western Australia, April–May 2010. Participants1,600 midwives employed in the public and private health sectors throughout Western Australia were invited to participate: 712 responded (44.5%), one-fifth of the state's registered midwives. Findingsmost midwives worked part-time in a clinical role in public hospitals. Almost half intended moving jobs within 5 years and/or leaving midwifery. Excluding midwives of retirement age, the most common reasons for intending to move jobs were family commitments, working conditions and role dissatisfaction. Those intending to leave midwifery cited work-life balance, career change and family commitments. Midwives thought addressing the following issues would improve midwifery retention: flexible work arrangements, remuneration, staffing and caseload, workplace culture, professional development and models of care. Key conclusionsretaining the midwifery workforce requires attention to workforce practices particularly flexible work arrangements and workloads; models of care to strengthen midwives' relationships with clients and colleagues; and accessible professional development. Implications for practicea review of workplace practices at unit and institution levels is urgently required in Western Australia so that midwives can achieve work-life balance and practice to the full extent of their professional role. These changes are necessary to forestall premature retirement of skilled and experienced midwives from the profession and workforce churn.

United States Anesthesiologists over 50

Anesthesiology is among the medical specialties expected to have physician shortage. With little known about older anesthesiologists' work effort and retirement decision making, the American Society of Anesthesiologists participated in a 2006 national survey of physicians aged 50-79 yr. Samples of anesthesiologists and other specialists completed a survey of work activities, professional satisfaction, self-defined health and financial status, retirement plans and perspectives, and demographics. A complex survey design enabled adjustments for sampling and response-rate biases so that respondents' characteristics resembled those in the American Medical Association Physician Masterfile. Retirement decision making was modeled with multivariable ordinal logistic regression. Life-table analysis provided a forecast of likely clinical workforce trends over an ensuing 30 yr. Anesthesiologists (N = 3,222; response rate = 37%) reported a mean work week of 49.4 h and a mean retirement age of 62.7 yr, both values similar to those of other older physicians. Work week decreased with age, and part-time work increased. Women worked a shorter work week (mean, 47.9 vs. 49.7 h, P = 0.024), partly due to greater part-time work (20.2 vs. 13.1%, P value less than 0.001). Relative importance of factors reported among those leaving patient care differed by age cohort, subspecialty, and work status. Poor health was cited by 64% of anesthesiologists retiring in their 50s as compared with 43% of those retiring later (P = 0.039). This survey lends support for greater attention to potentially modifiable factors, such as workplace wellness and professional satisfaction, to prevent premature retirement. The growing trend in part-time work deserves further study.

Long-term risks following first remission in childhood-onset epilepsy. A population-based study

Although most patients with newly-treated epilepsy enter remission, the risks associated with first remission are not well‐known. It is thus of great clinical interest to assess the long-term risks of poor seizure outcome and premature retirement for those in their very first remission and to determine predictive clinical features. We determined the likelihood of seizure relapse, remission following relapse, and premature retirement after entering first seizure remission of 5years or more in a population-based cohort of 115 medically treated patients, who were followed up since their first seizure during childhood. At the end of the 42-year median follow-up from the onset of adequate medication before the age of 16years, 115 (82%)/141 patients entered a first remission of at least 5years. Although 69 (60%) of the 115 patients had no relapse, at least one seizure relapse was seen in 46 (40%) and 14 (12%) never re-entered five‐year remission. Among the 115 patients, 33 (30%) were prematurely retired. On multivariate analysis of clinical features, cognitive impairment predicted seizure relapse for those entering their first remission of 5years or more. Relapse, symptomatic etiology, and early onset of epilepsy were significant predictors of premature retirement. Despite entering their first remission of 5years or more, individuals with epilepsy face clinically important risks including relapse, failure to re-enter remission following relapse, and premature retirement. Cognitive impairment predicted seizure relapse, while relapse, symptomatic etiology, and early onset of epilepsy were significant predictors of premature retirement.