Interventions to improve work ability and prolong the working life of older workers: a meta-analysis

Abstract Background Aging workforce necessitates actions to prolong the working life to ensure labor availability. However, evidence on the effectiveness of interventions remains limited. This systematic review identified effective interventions designed to enhance work ability and extend the working careers of older workers. Methods Searches were conducted in PubMed, Cochrane Library, Scopus, Web of Science and PsycInfo until February 2025, focusing on studies involving workers aged 40-64 years. The methodological quality of the studies was assessed by two reviewers (JP & RS). The effectiveness of interventions was evaluated using meta-analysis and qualitative synthesis. Results Out of 16,905 publications, 41 studies were included in the review, comprising 14 randomized controlled trials (RCTs, n = 4,123) and 27 non-randomized studies (n = 4,616,452). A meta-analysis of RCTs showed that aerobic or strenthening execises had modest beneficial effects on perceived work ability (pooled standardized mean difference 0.33, 95% CI 0.12-0.54). A qualitative synthesis of RCTs showed that cognitive-behavioral therapy was associated with reduced productivity loss among workers with chronic health conditions. A meta-analysis of non-randomized studies showed that policy reforms raising the eligible retirement age increased employment by 12 percentage points (pp) (95% CI 7-17) and decreased retirement by 29 pp (95% CI 8-50). However, these reforms also increased disability benefits by 6 pp (95% CI 1-11), unemployment by 7 pp (95% CI 2-12), and economic inactivity by 6 pp (95% CI 5-8). Additionally, policy reforms tightening unemployment benefits requirements increased employment and reduced unemployment, but had adverse effect on disability benefits. Conclusions We identified preventive interventions that were effective in improving work ability and reducing productivity loss. Legislative changes in retirement age and unemployment benefits were associated with higher work participation. Key messages • Physical activity programs can enhance the work ability of older workers, and cognitive-behavioral therapy can reduce productivity loss. • Policy reforms raising the retirement age or tightening unemployment benefits requirements increase employment but also have negative spillover effects.