Cap 12

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Lessons from Leisure-TimeBudget ResearchImplications for Practice

Jerome F. Singleton

What people do with their free time has been studied by a variety ofauthors from various disciplines during the last 50 years. These studieshave attempted to illustrate patterns of behaviors, often using question-naires. These investigations make observations but often there is minimallink to professional practice. This chapter attempts to illustrate how thefindings from time-budget studies have led to the understanding of activ-ities in later life. It ends with the development of a protocol working witholder individuals who have been diagnosed as having senile dementia ofthe Alzheimer 's type (SDAT).

BACKGROUND

There have been various studies investigating the effects of aging onhousing, preparation for retirement, leisure activities, and victimization ofolder individuals (Forbes, Jackson & Kraus, 1987; Kaplan, 1979; Keddy &Singleton, 1991; MacNeil & Teague, 1987; Mitic, Farquharson & Singleton,

Jerome F. Singleton • School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada B3H 3J5.

Time Use Research in the Social Sciences, editedby WendyE. Pentland, Andrew S. Harvey,M.Powell Lawton, and Mary Ann McColl. Kluwer Academic/Plenum Publishers, New York, 1999.

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246 JEROME F. SINGLETON

1985; Moss & Lawton, 1982). Leisure has been examined from a sociologi-cal, psychological, and a social-psychological perspective (Iso-Ahola, 1980; Kaplan, 1979; Neulinger, 1974). These perspectives have attempted to un-derstand how leisure is experienced. Another area of investigation that has received attention by researchers is the leisure patterns of older individ-uals (Kelly, Steinkamp, & Kelly, 1987; Larsen, Mannell, & Zuzanek, 1985; McGuire, Dottavio, & O'Leary, 1987; Nilson, 1991; Riddick & Keller, 1992;Singleton, 1985). Previous research on the leisure patterns of the elderly has relied on survey and interview methods that have depended on paper-and-pencil measures and the long-term memory of respondents. These studies often depended upon a checklist of activities that were primarily physical and external to the home environment. The results of such studies

appear to indicate that the elderly participate in primarily passive activ-ities (i.e., watching television, reading, writing, arts and crafts), but they may have been limited by the methodology used by the researchers (Harris, 1976; McAvoy, 1979; Nystrom, 1974; Roadburg, 1981; Schmitz-Scherzer, 1979). The activities reported may not reflect the participant's actual use of his or her time but what he/she wished to participate in or participated in previously. Beyond the shortcomings mentioned, the pre-vious studies identified have been limited to selected leisure activities and have not included other dimensions of daily living, including other activ-ities engaged in or, more importantly, other activity dimensions, such as where and with whom activities were done, or in what combination, if any, with other activities. In contrast, time-budget methodology provides in-sights into many such dimensions of a person's activity patterns.

TIME BUDGET

Historically, time budgets have seldom measured the behavior of individuals over the age of 65. The application of this methodology to the understanding of the behavior of older individuals (65+) in the commu-nity is a relatively recent phenomenon (Harvey & Singleton, 1989, 1995; Larsen, Zuzanek, & Mannell, 1985; Lingsom & Ellingsetter, 1983; Moss & Lawton, 1982; Singleton, Mitic, & Farquharson, 1986; Zuzanek & Smale, 1993).

Time-budget methodology has been used to assess the impact of the environment on older individuals (Moss & Lawton, 1982), the impact of handicapped older persons on a family (Nissell, 1982), the activity patterns of the elderly (Carp, 1978, 1979; Harvey & Singleton, 1989; Sidney & Shephard, 1977; Singleton et al., 1986; Zuzanek & Smale, 1993), activity patterns of ethnic minority elderly (Ujimoto, 1978, 1984, 1993), and the

LESSONS FROM LEISURE-TIME BUDGET RESEARCH 247

variation of time spent in various activities over the life course of anindividual. Harvey and Singleton (1995) and Little (1984) provide reviewsof research using time-budget methodology to assess age-related behavior.Researchers from various disciplines and professions have used time bud-get process to understand how individuals use their time (Harvey &Singleton, 1989,1995; Ross, Rideout, Carson, & Danbrook, 1993; Singleton,1975; Yerxa & Locker, 1990). The findings from these studies provideinsight on how people allocate their time.

A review of a number of time-budget studies indicate that sex, em-ployment status, child responsibility, and the presence of children are themajor factors affecting activity participation and time allocation to activ-ities (Cheek & Burch, 1976; Forbes, Singleton, & Agawani, 1993; Harvey,1978; Harvey, Elliott, & Procos, 1977; Lounesbury & Hoopes, 1988; Schnei-der, 1972). The accumulation of family and employment roles, and theattendant responsibilities, are reflected in the time spent in these activities,although the basic sex-role difference means that the responsibilities aredifferentially assumed by men and women (Harvey, Elliott & McDonald,1984; Harvey & Singleton, 1995; Thiessen & Singleton, 1994).

Findings based on longitudinal data suggest that the tendency towardbehavioral stability may be somewhat greater than most would imagine(Harvey et al., 1984; Lounesbury & Hoopes, 1988). The work suggests thatboth the "doing"and "nondoing" of particular activities tend to be consis-tent over time and change that does occur may be structured and predict-able in terms of changes in roles and obligations as one moves through thelife cycle (Harvey et al., 1984). It appears that individuals tend to partici-pate in a core set of activities across the life span related to the home (Harvey et al., 1977; Kelly, 1982; Moss & Lawton, 1982). Individuals appear to leave their homes for various reasons across the life span, such as to go to work, to go shopping, to attend a PTA meeting, to go to church, or to go to the doctors.

TIME BUDGET AND OLDER PERSONS

Harvey and Singleton (1989) conducted a secondary data analysis ofthe 1986 Canadian Time Use Study using age as a predictor in relation to the following primary and secondary activities, number of activities per day, social context, time at home, and time in other locations. The variable that was consistent across the analysis was age. The authors found that there were turning points for individuals based upon age in their activity involvement. A turning point is when the sample spends more or less time in experience compared to the grand societal mean. The major turning


point for the number of reversals was at age 45. The age 45, more precisely the 45–49 age group, average time allocations to 7 of the 15 dimensions examined reversed themselves relative to the grand societal mean. The researchers questioned whether these were age-related shifts in time use or shifts related to a person’s stage of the life cycle.

Harvey and Singleton (1992) compared time use using age and stage of life cycle as a predictors. The independent variables used in this investi-gation were the stage of the person’s life cycle and age. For the purpose ofthe investigation, the variable life cycle was operationalized as single no children, single young children under age 5, single older children, married no children, married young children under 5, and married older children. The age categories used in the analysis were 15–19,20–24,25–29,30–34,35–39,40–44,45–49,50–54,55–59,60–64,65–69 and 70+. The dependent variables used in this investigation were number of activities, number of trips, entertainment time, time spent in sports and hobbies, and time spend in media activities.

The results of this investigation tend to support the previous findings of the authors in regard to turning points (Harvey & Singleton, 1989). Inthis investigation, the age turning point related to media was 30, sport/ hobbies was 50, number of trips was 44, and entertainment was 40. The stage of life cycle used in this investigation indicated that the variables of being married or not married, or having young children or older children, could be used in further analysis as a function of opportunity to participate or not to participate in an activity or spend time in an activity. The patterns of time use or activity participation appear to be related to these variables. The accumulation of family and employment roles, and the attendant responsibilities, are reflected in the time spent in these activities, although the basic sex-role difference means that the responsibilities are differen-tially assumed by men and women (Harvey et al., 1984). Stage of life cycle may provide individuals with opportunities to participate in more or less activities depending on the number of role opportunities that are available.

IMPLICATIONS FOR PRACTICE

Time-budget data provide insights on how individuals appear to use their time. The majority of a person's time across the life span is spent athome (Harvey, 1984; Kelly, 1982). Also a person's time is repackaged whenhe or she enters or leaves a stage of the life cycle (e.g., not married to married) (Harvey & Singleton, 1995).

The findings from time-budget analysis indicate that the context of the activity may change as a person enters or leaves various stages of the


life span. Each stage provides different opportunities for the person. A person who is married with young children may have different oppor-tunities when compared with someone who is married with no children. Placing the activity in the context of the person’s experience provides insights into what the activity means or has meant to the person. An example is someone may enjoy shopping, but is it window shopping, shopping for friend, or grocery shopping, or was shopping only importantif the person went with a friend? The context of the experience is impor-tant. Currently, assessments explore how often the person participated inan activity and whether he or she enjoyed it (McDowell, 1979; McKecknie, 1974). These assessments do not examine when and why the person partic-ipated in the activity. This reflects the early development of understanding of leisure/recreation, which only counted activities and did not examine the context of the activity.

Time-budget data provide a different perspective on how individualsreallocate their time use across the life span. Examining activities such as frequency of involvement loses the context of the experience and themeaning that the individual may attach to participating in the activity. The data gathered using a time-budget approach enable researchers to under-stand the complexity of how people reallocate their time depending on the stage of life cycle they are in or the day of the week they participated in the activity (Harvey & Singleton, 1995; Zuzanek & Smale, 1993). How does this enhance service provision for persons? How do the results from the anal-ysis of time-budget data relate to policy development or service access?

The following section illustrates the shift in understanding of the dimensions of an activity and the benefit of understanding the context of an experience (with whom an individual participates in an activity, when a person participates in activity over the life cycle, and why an individual participates in an activity), rather than frequency of activity involvement. This shift to understand the context of an activity rather than its frequency will enhance service provision for one professional group, Therapeutic Recreation. Colleagues in occupational therapy, nursing, and economics also have used the time budget to provide a broader understanding of time use and its effecton choices or opportunities to participate in activities(Ross et al., 1993; Wilcox, 1993; Yerxa & Locker, 1990).

THERAPEUTIC RECREATION

Canada has the highest rate of institutionalization of the elderly of any Western country, that is, 9.4% compared to 5% in the United States and the United Kingdom (Novak, 1988b). The elderly who reside in institutions


relinquish many opportunities to make decisions concerning daily activ-ities (Goffman, 1961; Hirsch, 1977; Langer & Rodin, 1976). Leisure/recreation opportunities should not further limit the individual. The person should be given the opportunity to control that area of life in the institution by making choices for his or her own leisure activities within his or her abilities (Ostiguy MacNeil, Ritcey & Singleton, 1990).

Therapeutic recreation is a relatively new field within the health caredelivery system (O’Morrow & Reynolds, 1985). Therapeutic recreation was defined, at the Ninth Southern Regional Institute on Therapeutic Recre-ation at the University of North Carolina in 1969, "as a process whichutilizes recreation services for purposive intervention in some physical, emotional, and/or social behavior to bring about a desired change in thatbehavior and to promote the growth and development of the individual"(Kraus, 1978, p. 3). This definition has been revised as the profession has developed. GUM and Peterson (1984) report that a program based on the leisure ability of the individual may be more appropriate.

The leisure ability philosophy provides a foundation from which treatment-oriented therapeutic recreation services can derive a logical andappropriate purpose. Simply stated, if independent leisure functioning is the overall purpose of therapeutic recreation services, then the treatment component can address functional behavioral areas that are prerequisite to or a necessary part of leisure involvement and lifestyle. Behavioral areascan be identified by using acknowledged domains of physical, mental, emotional, and social functioning (Gunn & Peterson, 1984).

The elderly who reside in an institutional setting relinquish many of their opportunities to make decisions concerning daily activities. An indi-vidual should be given the opportunity to choose his or her own leisure activities. Leisure opportunities should be planned with, not for, the indi-vidual, thus allowing the individual to have some sense of control over leisure activities in the institution by building upon previous leisure in-volvement (Davis & Teaff, 1980; Verhoven, 1977). Austin (1982, p. 58) statesthat " therapeutic recreation has historically promoted the goal of self-actualization, for the facilitation of the fullest possible growth and devel-opment of the client." Iso-Ahola (1980, p. 36) proposes that " it is not therecreational activity itself that is crucial, but the extent to which suchan activity induces a sense of control over one’s behavior, environmentand life."

Therapeutic recreators use activities to increase the social, emotional, and physical abilities of the individual. Activities can range from arts and crafts, dance, drama, literature (i.e., reading), music, outdoor recreation, organized camping, social recreation, sports and games, and community service (Carlson, MacLean, Deppe, & Peterson, 1979). An activity needs to

LESSONS FROM LEISURE-TIME BUDGET RESEARCH

be broken into its component parts by the process of activity analysis prior to being used by the recreator. This process enables the therapeutic recre-ator to identify the component(s) of the activity that the individual has not mastered. The therapeutic recreator can thus reinforce the abilities of the individual while identifying the skills that need to be improved.

Leviton and Campanelli (1980) reported that"(1) leisure activities may

contribute significantly to an older individual’s life satisfaction; (2) leisure activities may serve as a "healthy"" stressor, mediators of stress, or re-sponse to stress; (3) empirical and scientific data offer a firm basis for thedevelopment of gerontologically oriented leisure services (p. 220).

Leisure is a component of an individual’s lifestyle prior to entering an institution. Leisure activities should be used as a method of assisting the individual in adjusting to his or her new environment (Davis & Teaff, 1980).

Teaff (1985, p. 137) states that "leisure services are essential to theestablishment of an environment for the rehabilitation and maintenance of residents in institutions for the elderly." The primary purpose of leisureservices is " to create opportunities and reasons for a person affected by acondition requiring long-term care to exercise abilities and continue life tasks which he previously took for granted" (Bachner & Cornelius, 1978, p.3). An environment is created to provide all elderly persons with the opportunity to exercise social, intellectual, and physical abilities alone andwith others. "The opportunity to exercise abilities and continue like tasksmust be provided to the elderly resident in his or her own terms, maximizingand reinforcing independence, dignity and respect" (Teaff, 1985, p. 138).

251

ALZHEIMER' S DISEASE

Alzheimer's disease is a progressive disease of unknown etiologycharacterized by forgetfulness and confusion, followed by progressive de-cline in the individual's cognitive and physiological responses. Alz-heimer’s disease is the most frequent cause of irreversible dementia in anestimated 2.5–4 million Americans aged 40 and older and between 100,000 and 300,000 Canadians (Health and Welfare, 1993). At present, there is no cure for this condition; the only intervention is to maintain the quality of life for the individual.

Family members and professionals are faced with developing new interaction skills to relate to the individuals who are confused. The health care professional has been trained to assist the individual to achieve independence in the rehabilitation process. The professional who works with an individual who is confused is confronted with an interesting challenge: How does he or she identify activities that reduce confusion for


the person with Alzheimer's disease? The continuity theory of aging(Atchley, 1971) may be an appropriate framework for developing activitiesfor individuals with Alzheimer's disease. Recent findings in the leisureand aging literature indicate that activity patterns may be stable across thelife span (Forbes et al., 1993; Harvey & Singleton, 1989). Based on thesefindings, the continuity theory of aging, and time-budget data, the follow-ing methodology was developed to assess the leisure abilities of the personwith Alzheimer's disease.

Process of Understanding Leisure Ability

Individuals who have Alzheimer's disease are affected differently;therefore, the activity selected for the individual needs to be based on hisor her level of ability. As indicated earlier, activity has often been studiedas a unidimensional concept by attempting to identify the number ofactivities in which a person has participated during the last year. Thisperspective has provided a very narrow view of what an activity is. Anactivity will vary depending on who a person participates with, location ofthe activity, amount of time the person spends on the activity, and why theperson participates in the activity (role-obligated or choice). These tempo-ral aspects will vary with the activity as the person travels through the lifespan (Forbes et al., 1993). To understand what the activity represents to theperson, an interview process was established based upon the stages of thelife cycle to elicit information on the types of activities participated in andwhat the activity meant to the person. Ostiguy MacNeil, Ritcey, andSingleton (1990) developed a protocol that would assist the therapist ingathering information on the abilities of the person who has Alzheimer’sdisease. This process enables the therapist to identify the context of theactivity in which the person participated. The following process usesexisting resources in seeking information on the leisure abilities of a per-son (Ostiguy et al., 1990).

1. Review patient's chart, consulting particularly the social historyand what the patient was doing prior to admittance in the hospital.The researchers reviewed the following:a. Family patterns—possible family leisure activities.b. Social patterns—activities with spouse, friends, others.c. Work patterns—the kinds of jobs held—shift work, labor, office

job?d. Groups and organizations—church, legion, card clubs.e. Past interests—person’s self-report and family input, records.


2. Interview individuals (person or family member) to try out areas that interested the patient in the past. a. Talk about where he or she used to live, learn about the pa-

tient's lifestyle—did he or she live by the water? On a farm?(Where an individual lives indicates a lot about his or her leisure time and how it is spent).

b. Talk about jobs, employment, and various activities done around the house—gardening, painting.

c. Discuss with family, whether it be parents, children, and so on, what activities they did with the individual?

d. Attempt to explore areas of interest—may wish to use some activities identified in structure forms such as the Self-InterestLeisure Profile (McKechnie, 1974; McDowell, 1974). Ask the person or caregiver who the patient participated in the activity with, how long he or she participated in the activity, location of activity. Use broad categories of leisure (arts and crafts, dance, drama, literacy, social recreation, music, outdoor recreation, sports, and games, and community services [Carlson et al., 19791 as probes for understanding activity involvement.

3. Interview patient’s family and friends about his or her past inter-ests. Get them to fill out Self-Leisure Interest Profile or other inter-est finders after discussing previous activity patterns. Place activ-ities in the context of a person's stage of life cycle.

4. Interview staff on the present abilities of the patient (check nursing notes) and also ask staff if they know of any activities in which he or she appears to be interested.

5. Observe patient at different daily intervals to note any familiarbehaviors—observation should be done for 1 week in 15-minuteperiods per day.

6. Try various stimuli and see how the patient reacts (music, activ-ities, etc.) based on interest identified in 3, 4, 5. If unavailable, introduce the patient to activities related to his or her previous employment.

a. Reason for assessment b. Past leisure interests c. Current leisure activities d. Future potential areas (open—based on past leisure experience) e. Impressions of the person’s leisure abilities f. Plans to maintain leisure level of functioning

g. Objectives: specific leisure goals and objectives for the person.

7. Document results


The first two components of the process evolved as the result of how individuals appear to package their time across the life span (Harvey & Singleton, 1989; Forbes et al., 1993). It provides the practitioner with infor-mation on the context of the activity that the person participated in. Yerxa and Locker (1992) developed a questionnaire that assists practitioners in placing the activity in a context. The author recommends that practitioners place the activity in the context of the persons experience.

Table 12.1 illustrates how a practitioner may inquire about person’s leisure experiences. The reader may wish to review Searle and Brayley (1993) and Yerxa and Locker (1990) to understand the category of leisure and question format.

The practitioner may ask the person what activity he or she partici-pated in and place the experience in the context of when the participation in the activity occurred (stage of life cycle), why the person participated (role opportunity), with whom the person participated (spouse, children, friends), and where the activity took place (work, home, outside the home in nonwork environment). This process has been used by Camp Hill Medical Center in Halifax, Nova Scotia, to assess the activity patterns of older persons with Alzheimer's. The process is used with the older indi-

Table12.1. Probes for Understanding Context of Experience

When Why With whom Where What were (stage of (motivation to (self, family, (home/outside opportunities lifecycle) participate) others) home)

Arts and crafts

Dance

Drama

Literacy

Music

Outdoorrecreation

Organizedcamping

Socialrecreation

Sports and games

servicescommunity


vidual as well as with family members to assist in placing the activity inthe context of the older person. The information gathered using this pro-cess has enabled the therapeutic recreation staff to develop programsbased upon the person's interests. A video was developed illustrating theprocess of interviewing a person with Alzheimer's, using the stage of lifecycle as prompts for activity involvement (Ritcey & Singleton, 1992).

CONCLUSIONS

Historically, leisure/recreation was examined from the standpoint offrequency of participation. This provided limited insight on what theactivity meant to the person, who the person participated with, or wherethe person participated. Time-budget methodology has enabled researchersto examine the context of the experience via experiential sampling and themore traditional time-budget methodologies (Zuzanek & Smale, 1993;Harvey & Singleton, 1995). This information is beneficial to those individ-uals who deliver services to excluded consumers, since it provides insightsinto the multidimensional components of an activity. To develop programswithout understanding the inherent parts of the activity, such as who theperson participated with in an activity, the time the person spent in anactivity, is replicating the error of treating activity participation as simply afrequency of participation rather than within the context of the activity.

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Cap 12

Documents

Transcript of Cap 12