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The leisure time and the third age: the experience of a geriatric day hospital
Archives of Gerontology and Geriatrics 33 (2001) 141– 150 www.elsevier.com/locate/archger
The leisure time and the third age: the experience of a geriatric day hospital S. Di Mauro a,*, G. Scalia a, A. Di Mauro a, I. Di Fazio b, F. Giuffrida a, C. Leotta a, M.G. Grasso c, A. Distefano a a
Chair of Geriatrics and Gerontology Cantania Uni6ersity, Day Hospital of Geriatrics, Cannizzaro Hospital Via Messina, 829, I-95124 Cantania, Italy b Institute of Internal Medicine and Geriatrics, Catania Uni6ersity, Day Hospital of Geriatrics, Cannizzaro Hospital, Via Messina, 829, 1 -95124 Catania, Italy c Administrati6e Health Care, Department of Urological and Neurological Aging, Catania Uni6ersity, Day Hospital of Geriatrics, Cannizzaro Hospital, Via Messina, 829, 1 -95124 Catania, Italy Received 18 December 2000; received in revised form 5 April 2001; accepted 24 April 2001
Abstract Leisure time represents an important part of the so-called ‘successful aging’ and contributes to overcome the problems related to the reduction of the social roles, favoring a better subjective adaptation to old age. In this work we observed the elderly population frequenting our Day Hospital, by estimating the affective sphere (geriatric depression scale, GDS), the autosufficiency (activity of daily living, ADL; and instrumental activity of daily living, IADL) and the schooling years in correlation with the type and length of leisure time activities during the day. These data have been compared with those of the national statistics (ISTAT). The analyses revealed a very wide diffusion of the utilization of mass media and a large interindividual differentiation of the modes of using leisure time. The correlations between the indices of affectivity and autosufficiency show an effect on the types of leisure time activities, while the scholarity of the subjects has no influence on it. These results suggest considering leisure time as an indispensable part of the relational life of elderly subjects, having an important ‘valency’ for the affective sphere and the individual expectations and needs. © 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Leisure time in elderly; Depression; Mood disorders; Autosufficiency in elderly
* Corresponding author. Present address: Via Etnea (Complesso Stella Elea), I-96013 Carlentini (SR), Italy. Tel.: + 39-095-783-1787; fax: +39-095-726-2487. E-mail address: [email protected] (S. Di Mauro). 0167-4943/01/$ - see front matter © 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 7 - 4 9 4 3 ( 0 1 ) 0 0 1 1 1 - X
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1. Introduction Elderly subjects differ from the average-age population by displaying a lower social, physical and psychological involvement, i.e. by disengaging from everyday life (Lilja and Borell, 1997). Old age has been defined as a retirement or resting time in contrast to the ages of infancy and youth, a time for playing and learning or to the adult age, a time for production and reproduction (Grimby and Svanborg, 1997; Ido et al., 1997; Seitsamo and Ilmarinen, 1997). The above-mentioned psychological theories are contradicted by other approaches, emphasizing that the individual behavior is not dependent only on age, but on lifestyle, which is influenced by personal and social characteristics, by the state of health and cognitive capacity. Parallel with the decreasing participation in various basic institutionalized activities, the leisure time activities become of increasing importance for many elderly subjects. These latter activities represent a considerable dimension, which has to be analyzed with attention, in order to understand better the mechanisms helping to overcome the problems related to the third age (Dumazedier, 1987). Free time may frequently become simply an ‘empty’ period that may provoke delusions and emarginations, and when this is associated with the decrease of incomes and social relationships, also a crisis for the elderly subject related to his/her incapacity to handle the rapid changes in his/her own lifestyle (Butt and Beiser, 1987; Bonaiuto et al., 1994). In addition, one has to take into account the general ideas of considering leisure time as a residual period, well distinguished from other periods dedicated to the work or familiar engagements. Therefore, leisure time should be used as a tool to overcome the loss of own social role after retirement. Recreative activities of the elderly should increase the level of self-esteem and could be helpful against depression, and improve health status and longevity (Drettner and Ahlborm, 1983). The present study was aimed at investigating the use of leisure time of our patients older than 75 years. We compared the data obtained with the patients’ mood, autosufficiency level and scholarity.
2. Subjects and methods The present study was carried out at the Geriatric Day Hospital of the University of Catania, on 260 patients (128 males and 132 females) in the age range of 67–91 years (on average 78.19 6.0 years). The clinical records used in our Day Hospital contain data regarding the depression measured by the geriatric depression scale (GDS) (Brink et al., 1982), the autosufficiency of the patients, estimated by means of the scales of activities of daily living (ADL) (Katz et al., 1963) and the instrumental activities of daily living (IADL) (Lawton and Brody, 1969), as well as the scholarity of them. Each patient filled in a questionnaire having a specific column for leisure time activities (recreative activities). This column listed 13 items with several alternative answers. In addition, we asked what type of activities they were engaged in during
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the 24-h cycle, divided into six categories, such as leisure time, personal cures, work for payment, home and family tasks, shopping, and social participations. The answers were evaluated separately for the sexes. All these data, and the school years, as well as the scores obtained in GDS, ADL and IADL scales were considered when dividing the patients into groups.
2.1. Statistical analysis Univariate correlation analysis has been carried out (Rosner, 1986), considering as significance limit P B 0.05. The following pairs of variables have been compared: age and sex, scholarity and recreative activities, recreative activities and GDS score, recreative activities and ADL and IADL scores, the length of time dedicated to leisure activities of the day.
3. Results The distribution of the daily activities is summarized in Table 1. While the men and women displayed almost no differences in the time length dedicated to the so-called personal cures (including sleeping, bathing, etc.), the average length of leisure time was longer for the men than for the women. On the other hand, the women spent considerably longer time with domestic activities and family care, while the men spent longer time with social activities. Table 2 lists the prevalence of various recreative activities within the leisure time. This table lists numbers and percentages of men and women who declared performing a certain type of activity, but without indicating the length of that activity within the day. Of course, this method of estimation allowed them to give more than one response to the questions. From the data, one can see that the most frequent recreative activities are watching television and walking (although the latter was less frequent in women). There have been some characteristic differences between the activities of men and women: in some cases, these differences are conspicuous. For example, 98.4% of men take part in public servicing, while in women this activity occurs only in 5.3%, or religious activity occurs in 67.3% of the women, and only in 20.3% of men, etc. (Table 2). Table 1 The distribution of the daily activities in hours (mean 9S.D.) Type of activity
Men
Women
Total
Leisure time Personal cures Paid work Domestic, familiar Shopping Social
9.69 4.8 11.49 1.8 0.5 9 0.2 0.29 2.8 0.1 9 2.8 2.2 9 4.5
6.89 2.0 11.2 9 1.6 0.1 90.1 4.69 1.6 0.3 91.2 1.09 3.1
8.2 93.4 11.3 91.7 0.3 90.1 2.4 92.2 0.2 92.0 1.6 93.8
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Table 2 The prevalence of recreative activities: number of subjects and (%) Type of activity
Walking Television Reading Playing cards Meeting friends Phone calls Knitting, sewing Public servicing Grandchildren Dancing Cinema, theater Religious activity Gardening Animal care
Men
Women
Total
n= 128
n =132
n = 260
125 109 98 99 38 9 1 126 42 41 21 26 125 66
75 131 55 15 37 51 33 7 56 49 11 89 2 98
200 240 153 114 75 60 34 133 98 90 32 115 127 164
(97.6) (85.1) (76.5) (77.3) (29.6) (7.2) (0.7) (98.4) (32.8) (32.0) (16.4) (20.3) (97.6) (51.5)
(56.8) (99.2) (41.6) (11.3) (28.0) (38.6) (25.0) (5.3) (42.4) (37.1) (8.3) (67.3) (1.5) (74.2)
(76.9) (92.3) (58.8) (43.8) (28.8) (23.0) (13.0) (51.1) (37.6) (37.1) (12.3) (44.2) (48.8) (63.0)
When analyzing the scholarity of the study population, the following distribution was observed: high school and university degree level were achieved by 113 subjects (43.5%) of the total pool, 59 subjects (22.7%) finished only junior high school, 86 subjects (33.1%) were educated only at elementary school level, and 2 subjects (0.7%) were illiterate. These latter subjects were included in the lowest scholarity group. The sex- and education-dependence of the recreative activities has also been evaluated (Table 3). The subjects were divided into three groups, namely those with only one activity, those with two to four activities, and those with five or more activities. Table 3 does not show any great differences in the numbers of activities within the above groups and the three basic scholarity classes, the junior high school education group being the only exception, where five and more activities occurred in 20 subjects, and 18 of them were women.
Table 3 The sex- and education-dependence of the recreative activities Number of activities
Only 1 2–4 5+
Elementary school
Junior high school
High school+university
n=88
n =59
n =113
5 (F) 52 (30 F/22 M) 31 (17 F/14 M)
5 (4 F/1 M) 34 (19 F/15 M) 20 (18 F/2 M)
2 (F) 68 (31 F/37 M) 43 (22 F/21 M)
Note: M and F indicate males and females, respectively.
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Table 4 The correlation between education and the time-distribution of the daily activities (average length in hours) Type of activities
Leisure time Personal cures Paid work Domestic, familiar Shopping Social
Elementary school
Junior high school
High school+university
n= 88
n =59
n =113
8.39 1.6 11.7 9 2.9 0.2 9 0.8 2.9 9 2.6 0.1 9 2.1 0.89 0.9
8.5 9 4.2 11.5 9 2.1 0.2 9 1.3 2.1 93.3 0.2 91.8 1.5 92.9
7.8 93.8 10.6 91.7 0.8 91.2 1.8 92.8 0.4 9 1.5 2.6 9 4.5
Table 4 demonstrates the interrelationships between scholarity and the time-distribution of the daily activities. As a matter of fact, the length of leisure time does not depend significantly on the scholarity level, although it is somewhat shorter in the highest education group, where a longer social activity has been recorded (Table 4). Table 5 lists the recreative activities as distributed among the various scholarity groups. It is evident from the data that certain activities like reading, public servicing, visiting cinema and theater occur with increasing frequency in the highest scholarity group. Other activities, like taking care of grandchildren, gardening and religious activity occur less frequently with increasing education levels. It should also be noted that certain activities based on the social contacts of the subjects, like Table 5 The distribution of various recreative activities in relationship to the school years: number of subjects and (%) Type of activities
Walking Television Reading Playing cards Meeting friends Phone calls Knitting, sewing Public servicing Grandchildren Dancing Cinema, theater Religious Gardening Animal care
Elementary school
Junior high school
High school+university
n= 88
n = 59
n =113
59 82 20 38 20 32 15 33 39 35 2 48 47 57
51 56 43 19 20 9 7 27 23 18 4 29 39 45
90 102 90 57 35 19 12 73 36 37 26 38 41 62
(67.0) (93.1) (22.7) (43.1) (22.7) (36.2) (17.0) (37.5) (44.3) (39.7) (2.2) (54.4) (53.4) (64.7)
(86.4) (94.9) (72.8) (32.2) (33.8) (15.2) (11.8) (45.7) (38.9) (30.5) (6.7) (49.1) (66.1) (76.2)
(79.6) (90.2) (79.6) (50.4) (30.9) (16.8) (10.6) (64.6) (31.8) (32.7) (23.0) (35.3) (36.2) (54.8)
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Table 6 The distribution of ADL and IADL scores in relationship to the GDS evaluation: number of subjects and (%) GDS scores
ADL (0)
ADL (1–5)
ADL (6)
B11 11–16 \17
105 (40.4) 38 (14.6) 25 (9.6)
– 59 (22.7) 10 (3.9)
– – 23 (8.8)
IADL (\27)
IADL (14–26)
IADL (B14)
13 (5.0) 66 (25.4) 24 (9.2)
1 (0.3) 2 (0.7) 23 (8.8)
B11 11–16 \17
87 (33.5) 28 (10.7) 16 (6.1)
meeting friends, dancing or religious activity are present in almost one third or even larger proportion of the subjects (Table 5). The GDS scores of the patients were divided into three classes, namely, below 11 (no depression), 11– 16 (slightly depressed), as well as 17 and above (severely depressed) (Table 6). Similarly, the ADL and IADL scores were classified also into three groups of each, as shown in Table 6. It should be noted that these latter two scores behave in opposite sense, i.e. in case of ADL increase of score means decreased functional abilities, while in case of IADL, a decreased score means functional losses. The results of univariate correlation analysis are shown in Table 7. They show that both ADL and IADL scores display a significant correlation with the GDS scores (the sign of the correlation coefficient is positive for ADL and negative for IADL, as explained above). IADL scores show a weak correlation also with the length of leisure time. On the other hand, the leisure activities are in correlation with the age and sex of the subjects, i.e. the type of such activities change with advancing age. At last, there was no significant correlation between scholarity and the type of leisure time activities.
Table 7 Univariate correlation coefficients between various pairs of parameters and their statistical significance (P =) Parameters
ADL
IADL
Leisure time activity
Sex
ADL Leisure time (h) Age Sex
0.5689 (0.01) – – –
−0.286 (0.01) 0.1456 (0.02) – –
– – −0.1609 (0.01) −0.2309 (0.001)
– −0.1649 (0.01) – –
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4. Discussion and conclusions Leisure time activities may be defined as a complex of actions aimed at relaxing, entertaining and realizing subjects’ own personality. These are carried out in the time that is not occupied by professional, familiar or social involvement. However, it is necessary to distinguish among the leisure time activities those that are of essentially disinterested character, from those that are of mixed character, i.e. represent only a semi-entertaining or semi-obligation, such as the religious or social activities satisfying certain needs of autoregulation, and at the same time correspond to some social and ethical obligations (Kalf, 1995; Kivela et al., 1996; Ido et al., 1997; Lilja and Borell, 1997; Seitsamo and Ilmarinen, 1997). If we compare our results with those of ISTAT (1993b), obtained in a multipurpose study in the Italian families, it turns out that the activity of the elderly is considerably heterogeneous, and depends strongly on the sex, the age and the actual state of health of the individuals. Anyway, it is a general phenomenon that the women dedicate more time to the domestic works, while the men take part more in social activities (social and political clubs of public utility) (ISTAT, 1994a). The types of leisure time activities are bound to individual habits, personal characteristics and course of the aging process, and therefore, it is difficult to generalize the behaviors characterizing the third age. As a matter of fact, it is generally assumed that the practiced activities depend on the personality, the cultural level, the socio-economic situation, and the previous lifestyle (Meiring and Blake, 1984; Westlie et al., 1984). This expectation has been confirmed also by our study: we described individuals with high scholarity dedicated longer time to leisure time activities requiring a higher cultural involvement. Another important factor is the accessibility of cultural and entertaining structures for the elderly (ISTAT, 1994a,b). The advancing age is inversely correlated with the length of leisure activities, and influences also the types of activities, pushing toward those requiring lower psychophysical efforts (ISTAT, 1993a,b, 1994a). The television, even if it is a passive type of occupation, may satisfy several needs, information, entertainment, culture, and does not limit the human relationships. The socializing activities are frequent among the elderly, mainly in form of meeting the family, parents and friends. These may be entertaining or also a sort of obligation (like looking after grandchildren, etc). In the relationships with friends and neighbors, the elderly try to replace emotions of parents, forming some nuclei or groups organizing meetings, offering mutual help in various problems and needs in everyday life (Amoretti et al., 1989). This is particularly valid for Southern Italy and less so for the Northern regions (Rozzini et al., 1991), as confirmed also by our results. Another leisure time activity of the elderly is the reading of journals, magazines and reviews. Our data, however, do not agree with those of ISTAT (1994b) collected at national level, because we have shown a net decrease of reading by the elderly. This type of activity is bound to the scholarity level, the cultural exigence and also on sex of the individuals. In Southern Italy, the scholarity level has been
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low particularly in the women, and generally speaking, they represent the lowest levels of cultural consumption, even if it should be recognized that the educational level of the elderly has raised progressively during the recent years (ISTAT, 1994a). This is proven by the popularity of the so-called universities of the third age, the number of which has more than doubled in Italy, with a major interest of the elderly women (ISTAT, 1993a,b, 1994a). The educational levels are less important, when considering the strongly diffused physical and sport activities (like walking, gardening), which were represented also in our sample. Among the sedentary activities, playing cards involves about one third of the men, while for women sewing and knitting were more diffuse; however, these latter activities represent lower levels of socializing (ISTAT, 1993a). As regards the semi-entertaining activities, religious activity is diffuse, which is practiced by more than half of the women in Southern Italy. The increasing interest toward the voluntary, self-help groups may indicate an evolution in the habits of the elderly in Italy toward a major social participation and involvement (Dumazedier, 1987; Rozzini et al., 1991; ISTAT, 1993a; Bonaiuto et al., 1994). After all, one can conclude that on the basis of this type of investigation, it is quite difficult to understand fully the subjective models applied in leisure time activities, and the roles played by physical, psychological, economic and social factors. The analysis of the depressive state performed in our population has revealed the interaction between the good utilization of leisure time and the possibilities of overcoming the psychological crisis accompanying retirement, as well as the possible therapeutic application of it in disturbed adaptations to the conditions of older ages (Pahkala et al., 1991). In order to achieve a better quality of life through a better use of leisure time, it seems to be important to assure the visibility of proper services and structures, and easy access by the elderly to them. The proper preparation of people for elderly life is a cardinal problem of modern geriatrics, and the use of leisure time is a fundamental part of stimulating the elderly subjects for a more positive judgement of their own capacities and needs (Pahkala et al., 1990, 1991; Lu and Argyle, 1994). The proper socialization of the elderly may be achieved through educative and cultural processes started already in the younger ages and maintained until the retirement. The preparation and the updating of it become essential in the moment when the elderly should face a new lifestyle and choose new activities that had not even been considered before (Miyata et al., 1997; Lu and Argyle, 1994). Therefore, leisure time activities represent a channel of intervention in a global policy of prevention of decays and recovery of them for the elderly. An operative education project in the elderly, based on creative, recreative and cultural programs should work together with the elderly, and not only for the elderly. It should develop the idea that the leisure time activity is a tool of prevention and rehabilitation, aimed at maintaining the somatic and mental health as long as possible (Meiring and Blake, 1984).
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The leisure time and the third age: the experience of a geriatric day hospital S. Di Mauro a,*, G. Scalia a, A. Di Mauro a, I. Di Fazio b, F. Giuffrida a, C. Leotta a, M.G. Grasso c, A. Distefano a a
Chair of Geriatrics and Gerontology Cantania Uni6ersity, Day Hospital of Geriatrics, Cannizzaro Hospital Via Messina, 829, I-95124 Cantania, Italy b Institute of Internal Medicine and Geriatrics, Catania Uni6ersity, Day Hospital of Geriatrics, Cannizzaro Hospital, Via Messina, 829, 1 -95124 Catania, Italy c Administrati6e Health Care, Department of Urological and Neurological Aging, Catania Uni6ersity, Day Hospital of Geriatrics, Cannizzaro Hospital, Via Messina, 829, 1 -95124 Catania, Italy Received 18 December 2000; received in revised form 5 April 2001; accepted 24 April 2001
Abstract Leisure time represents an important part of the so-called ‘successful aging’ and contributes to overcome the problems related to the reduction of the social roles, favoring a better subjective adaptation to old age. In this work we observed the elderly population frequenting our Day Hospital, by estimating the affective sphere (geriatric depression scale, GDS), the autosufficiency (activity of daily living, ADL; and instrumental activity of daily living, IADL) and the schooling years in correlation with the type and length of leisure time activities during the day. These data have been compared with those of the national statistics (ISTAT). The analyses revealed a very wide diffusion of the utilization of mass media and a large interindividual differentiation of the modes of using leisure time. The correlations between the indices of affectivity and autosufficiency show an effect on the types of leisure time activities, while the scholarity of the subjects has no influence on it. These results suggest considering leisure time as an indispensable part of the relational life of elderly subjects, having an important ‘valency’ for the affective sphere and the individual expectations and needs. © 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Leisure time in elderly; Depression; Mood disorders; Autosufficiency in elderly
* Corresponding author. Present address: Via Etnea (Complesso Stella Elea), I-96013 Carlentini (SR), Italy. Tel.: + 39-095-783-1787; fax: +39-095-726-2487. E-mail address: [email protected] (S. Di Mauro). 0167-4943/01/$ - see front matter © 2001 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 1 6 7 - 4 9 4 3 ( 0 1 ) 0 0 1 1 1 - X
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1. Introduction Elderly subjects differ from the average-age population by displaying a lower social, physical and psychological involvement, i.e. by disengaging from everyday life (Lilja and Borell, 1997). Old age has been defined as a retirement or resting time in contrast to the ages of infancy and youth, a time for playing and learning or to the adult age, a time for production and reproduction (Grimby and Svanborg, 1997; Ido et al., 1997; Seitsamo and Ilmarinen, 1997). The above-mentioned psychological theories are contradicted by other approaches, emphasizing that the individual behavior is not dependent only on age, but on lifestyle, which is influenced by personal and social characteristics, by the state of health and cognitive capacity. Parallel with the decreasing participation in various basic institutionalized activities, the leisure time activities become of increasing importance for many elderly subjects. These latter activities represent a considerable dimension, which has to be analyzed with attention, in order to understand better the mechanisms helping to overcome the problems related to the third age (Dumazedier, 1987). Free time may frequently become simply an ‘empty’ period that may provoke delusions and emarginations, and when this is associated with the decrease of incomes and social relationships, also a crisis for the elderly subject related to his/her incapacity to handle the rapid changes in his/her own lifestyle (Butt and Beiser, 1987; Bonaiuto et al., 1994). In addition, one has to take into account the general ideas of considering leisure time as a residual period, well distinguished from other periods dedicated to the work or familiar engagements. Therefore, leisure time should be used as a tool to overcome the loss of own social role after retirement. Recreative activities of the elderly should increase the level of self-esteem and could be helpful against depression, and improve health status and longevity (Drettner and Ahlborm, 1983). The present study was aimed at investigating the use of leisure time of our patients older than 75 years. We compared the data obtained with the patients’ mood, autosufficiency level and scholarity.
2. Subjects and methods The present study was carried out at the Geriatric Day Hospital of the University of Catania, on 260 patients (128 males and 132 females) in the age range of 67–91 years (on average 78.19 6.0 years). The clinical records used in our Day Hospital contain data regarding the depression measured by the geriatric depression scale (GDS) (Brink et al., 1982), the autosufficiency of the patients, estimated by means of the scales of activities of daily living (ADL) (Katz et al., 1963) and the instrumental activities of daily living (IADL) (Lawton and Brody, 1969), as well as the scholarity of them. Each patient filled in a questionnaire having a specific column for leisure time activities (recreative activities). This column listed 13 items with several alternative answers. In addition, we asked what type of activities they were engaged in during
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the 24-h cycle, divided into six categories, such as leisure time, personal cures, work for payment, home and family tasks, shopping, and social participations. The answers were evaluated separately for the sexes. All these data, and the school years, as well as the scores obtained in GDS, ADL and IADL scales were considered when dividing the patients into groups.
2.1. Statistical analysis Univariate correlation analysis has been carried out (Rosner, 1986), considering as significance limit P B 0.05. The following pairs of variables have been compared: age and sex, scholarity and recreative activities, recreative activities and GDS score, recreative activities and ADL and IADL scores, the length of time dedicated to leisure activities of the day.
3. Results The distribution of the daily activities is summarized in Table 1. While the men and women displayed almost no differences in the time length dedicated to the so-called personal cures (including sleeping, bathing, etc.), the average length of leisure time was longer for the men than for the women. On the other hand, the women spent considerably longer time with domestic activities and family care, while the men spent longer time with social activities. Table 2 lists the prevalence of various recreative activities within the leisure time. This table lists numbers and percentages of men and women who declared performing a certain type of activity, but without indicating the length of that activity within the day. Of course, this method of estimation allowed them to give more than one response to the questions. From the data, one can see that the most frequent recreative activities are watching television and walking (although the latter was less frequent in women). There have been some characteristic differences between the activities of men and women: in some cases, these differences are conspicuous. For example, 98.4% of men take part in public servicing, while in women this activity occurs only in 5.3%, or religious activity occurs in 67.3% of the women, and only in 20.3% of men, etc. (Table 2). Table 1 The distribution of the daily activities in hours (mean 9S.D.) Type of activity
Men
Women
Total
Leisure time Personal cures Paid work Domestic, familiar Shopping Social
9.69 4.8 11.49 1.8 0.5 9 0.2 0.29 2.8 0.1 9 2.8 2.2 9 4.5
6.89 2.0 11.2 9 1.6 0.1 90.1 4.69 1.6 0.3 91.2 1.09 3.1
8.2 93.4 11.3 91.7 0.3 90.1 2.4 92.2 0.2 92.0 1.6 93.8
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Table 2 The prevalence of recreative activities: number of subjects and (%) Type of activity
Walking Television Reading Playing cards Meeting friends Phone calls Knitting, sewing Public servicing Grandchildren Dancing Cinema, theater Religious activity Gardening Animal care
Men
Women
Total
n= 128
n =132
n = 260
125 109 98 99 38 9 1 126 42 41 21 26 125 66
75 131 55 15 37 51 33 7 56 49 11 89 2 98
200 240 153 114 75 60 34 133 98 90 32 115 127 164
(97.6) (85.1) (76.5) (77.3) (29.6) (7.2) (0.7) (98.4) (32.8) (32.0) (16.4) (20.3) (97.6) (51.5)
(56.8) (99.2) (41.6) (11.3) (28.0) (38.6) (25.0) (5.3) (42.4) (37.1) (8.3) (67.3) (1.5) (74.2)
(76.9) (92.3) (58.8) (43.8) (28.8) (23.0) (13.0) (51.1) (37.6) (37.1) (12.3) (44.2) (48.8) (63.0)
When analyzing the scholarity of the study population, the following distribution was observed: high school and university degree level were achieved by 113 subjects (43.5%) of the total pool, 59 subjects (22.7%) finished only junior high school, 86 subjects (33.1%) were educated only at elementary school level, and 2 subjects (0.7%) were illiterate. These latter subjects were included in the lowest scholarity group. The sex- and education-dependence of the recreative activities has also been evaluated (Table 3). The subjects were divided into three groups, namely those with only one activity, those with two to four activities, and those with five or more activities. Table 3 does not show any great differences in the numbers of activities within the above groups and the three basic scholarity classes, the junior high school education group being the only exception, where five and more activities occurred in 20 subjects, and 18 of them were women.
Table 3 The sex- and education-dependence of the recreative activities Number of activities
Only 1 2–4 5+
Elementary school
Junior high school
High school+university
n=88
n =59
n =113
5 (F) 52 (30 F/22 M) 31 (17 F/14 M)
5 (4 F/1 M) 34 (19 F/15 M) 20 (18 F/2 M)
2 (F) 68 (31 F/37 M) 43 (22 F/21 M)
Note: M and F indicate males and females, respectively.
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Table 4 The correlation between education and the time-distribution of the daily activities (average length in hours) Type of activities
Leisure time Personal cures Paid work Domestic, familiar Shopping Social
Elementary school
Junior high school
High school+university
n= 88
n =59
n =113
8.39 1.6 11.7 9 2.9 0.2 9 0.8 2.9 9 2.6 0.1 9 2.1 0.89 0.9
8.5 9 4.2 11.5 9 2.1 0.2 9 1.3 2.1 93.3 0.2 91.8 1.5 92.9
7.8 93.8 10.6 91.7 0.8 91.2 1.8 92.8 0.4 9 1.5 2.6 9 4.5
Table 4 demonstrates the interrelationships between scholarity and the time-distribution of the daily activities. As a matter of fact, the length of leisure time does not depend significantly on the scholarity level, although it is somewhat shorter in the highest education group, where a longer social activity has been recorded (Table 4). Table 5 lists the recreative activities as distributed among the various scholarity groups. It is evident from the data that certain activities like reading, public servicing, visiting cinema and theater occur with increasing frequency in the highest scholarity group. Other activities, like taking care of grandchildren, gardening and religious activity occur less frequently with increasing education levels. It should also be noted that certain activities based on the social contacts of the subjects, like Table 5 The distribution of various recreative activities in relationship to the school years: number of subjects and (%) Type of activities
Walking Television Reading Playing cards Meeting friends Phone calls Knitting, sewing Public servicing Grandchildren Dancing Cinema, theater Religious Gardening Animal care
Elementary school
Junior high school
High school+university
n= 88
n = 59
n =113
59 82 20 38 20 32 15 33 39 35 2 48 47 57
51 56 43 19 20 9 7 27 23 18 4 29 39 45
90 102 90 57 35 19 12 73 36 37 26 38 41 62
(67.0) (93.1) (22.7) (43.1) (22.7) (36.2) (17.0) (37.5) (44.3) (39.7) (2.2) (54.4) (53.4) (64.7)
(86.4) (94.9) (72.8) (32.2) (33.8) (15.2) (11.8) (45.7) (38.9) (30.5) (6.7) (49.1) (66.1) (76.2)
(79.6) (90.2) (79.6) (50.4) (30.9) (16.8) (10.6) (64.6) (31.8) (32.7) (23.0) (35.3) (36.2) (54.8)
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Table 6 The distribution of ADL and IADL scores in relationship to the GDS evaluation: number of subjects and (%) GDS scores
ADL (0)
ADL (1–5)
ADL (6)
B11 11–16 \17
105 (40.4) 38 (14.6) 25 (9.6)
– 59 (22.7) 10 (3.9)
– – 23 (8.8)
IADL (\27)
IADL (14–26)
IADL (B14)
13 (5.0) 66 (25.4) 24 (9.2)
1 (0.3) 2 (0.7) 23 (8.8)
B11 11–16 \17
87 (33.5) 28 (10.7) 16 (6.1)
meeting friends, dancing or religious activity are present in almost one third or even larger proportion of the subjects (Table 5). The GDS scores of the patients were divided into three classes, namely, below 11 (no depression), 11– 16 (slightly depressed), as well as 17 and above (severely depressed) (Table 6). Similarly, the ADL and IADL scores were classified also into three groups of each, as shown in Table 6. It should be noted that these latter two scores behave in opposite sense, i.e. in case of ADL increase of score means decreased functional abilities, while in case of IADL, a decreased score means functional losses. The results of univariate correlation analysis are shown in Table 7. They show that both ADL and IADL scores display a significant correlation with the GDS scores (the sign of the correlation coefficient is positive for ADL and negative for IADL, as explained above). IADL scores show a weak correlation also with the length of leisure time. On the other hand, the leisure activities are in correlation with the age and sex of the subjects, i.e. the type of such activities change with advancing age. At last, there was no significant correlation between scholarity and the type of leisure time activities.
Table 7 Univariate correlation coefficients between various pairs of parameters and their statistical significance (P =) Parameters
ADL
IADL
Leisure time activity
Sex
ADL Leisure time (h) Age Sex
0.5689 (0.01) – – –
−0.286 (0.01) 0.1456 (0.02) – –
– – −0.1609 (0.01) −0.2309 (0.001)
– −0.1649 (0.01) – –
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4. Discussion and conclusions Leisure time activities may be defined as a complex of actions aimed at relaxing, entertaining and realizing subjects’ own personality. These are carried out in the time that is not occupied by professional, familiar or social involvement. However, it is necessary to distinguish among the leisure time activities those that are of essentially disinterested character, from those that are of mixed character, i.e. represent only a semi-entertaining or semi-obligation, such as the religious or social activities satisfying certain needs of autoregulation, and at the same time correspond to some social and ethical obligations (Kalf, 1995; Kivela et al., 1996; Ido et al., 1997; Lilja and Borell, 1997; Seitsamo and Ilmarinen, 1997). If we compare our results with those of ISTAT (1993b), obtained in a multipurpose study in the Italian families, it turns out that the activity of the elderly is considerably heterogeneous, and depends strongly on the sex, the age and the actual state of health of the individuals. Anyway, it is a general phenomenon that the women dedicate more time to the domestic works, while the men take part more in social activities (social and political clubs of public utility) (ISTAT, 1994a). The types of leisure time activities are bound to individual habits, personal characteristics and course of the aging process, and therefore, it is difficult to generalize the behaviors characterizing the third age. As a matter of fact, it is generally assumed that the practiced activities depend on the personality, the cultural level, the socio-economic situation, and the previous lifestyle (Meiring and Blake, 1984; Westlie et al., 1984). This expectation has been confirmed also by our study: we described individuals with high scholarity dedicated longer time to leisure time activities requiring a higher cultural involvement. Another important factor is the accessibility of cultural and entertaining structures for the elderly (ISTAT, 1994a,b). The advancing age is inversely correlated with the length of leisure activities, and influences also the types of activities, pushing toward those requiring lower psychophysical efforts (ISTAT, 1993a,b, 1994a). The television, even if it is a passive type of occupation, may satisfy several needs, information, entertainment, culture, and does not limit the human relationships. The socializing activities are frequent among the elderly, mainly in form of meeting the family, parents and friends. These may be entertaining or also a sort of obligation (like looking after grandchildren, etc). In the relationships with friends and neighbors, the elderly try to replace emotions of parents, forming some nuclei or groups organizing meetings, offering mutual help in various problems and needs in everyday life (Amoretti et al., 1989). This is particularly valid for Southern Italy and less so for the Northern regions (Rozzini et al., 1991), as confirmed also by our results. Another leisure time activity of the elderly is the reading of journals, magazines and reviews. Our data, however, do not agree with those of ISTAT (1994b) collected at national level, because we have shown a net decrease of reading by the elderly. This type of activity is bound to the scholarity level, the cultural exigence and also on sex of the individuals. In Southern Italy, the scholarity level has been
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low particularly in the women, and generally speaking, they represent the lowest levels of cultural consumption, even if it should be recognized that the educational level of the elderly has raised progressively during the recent years (ISTAT, 1994a). This is proven by the popularity of the so-called universities of the third age, the number of which has more than doubled in Italy, with a major interest of the elderly women (ISTAT, 1993a,b, 1994a). The educational levels are less important, when considering the strongly diffused physical and sport activities (like walking, gardening), which were represented also in our sample. Among the sedentary activities, playing cards involves about one third of the men, while for women sewing and knitting were more diffuse; however, these latter activities represent lower levels of socializing (ISTAT, 1993a). As regards the semi-entertaining activities, religious activity is diffuse, which is practiced by more than half of the women in Southern Italy. The increasing interest toward the voluntary, self-help groups may indicate an evolution in the habits of the elderly in Italy toward a major social participation and involvement (Dumazedier, 1987; Rozzini et al., 1991; ISTAT, 1993a; Bonaiuto et al., 1994). After all, one can conclude that on the basis of this type of investigation, it is quite difficult to understand fully the subjective models applied in leisure time activities, and the roles played by physical, psychological, economic and social factors. The analysis of the depressive state performed in our population has revealed the interaction between the good utilization of leisure time and the possibilities of overcoming the psychological crisis accompanying retirement, as well as the possible therapeutic application of it in disturbed adaptations to the conditions of older ages (Pahkala et al., 1991). In order to achieve a better quality of life through a better use of leisure time, it seems to be important to assure the visibility of proper services and structures, and easy access by the elderly to them. The proper preparation of people for elderly life is a cardinal problem of modern geriatrics, and the use of leisure time is a fundamental part of stimulating the elderly subjects for a more positive judgement of their own capacities and needs (Pahkala et al., 1990, 1991; Lu and Argyle, 1994). The proper socialization of the elderly may be achieved through educative and cultural processes started already in the younger ages and maintained until the retirement. The preparation and the updating of it become essential in the moment when the elderly should face a new lifestyle and choose new activities that had not even been considered before (Miyata et al., 1997; Lu and Argyle, 1994). Therefore, leisure time activities represent a channel of intervention in a global policy of prevention of decays and recovery of them for the elderly. An operative education project in the elderly, based on creative, recreative and cultural programs should work together with the elderly, and not only for the elderly. It should develop the idea that the leisure time activity is a tool of prevention and rehabilitation, aimed at maintaining the somatic and mental health as long as possible (Meiring and Blake, 1984).
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