12 Lessons from Leisure-Time Budget Research Implications for Practice Jerome F. Singleton
What people do with their free time has been studied by a variety of authors from various disciplines during the last 50 years. These studies have attempted to illustrate patterns of behaviors, often using questionnaires. These investigations make observations but often there is minimal link to professional practice. This chapter attempts to illustrate how the findings from time-budget studies have led to the understanding of activities in later life. It ends with the development of a protocol working with older individuals who have been diagnosed as having senile dementia of the Alzheimer 's type (SDAT) .
BACKGROUND There have been various studies investigating the effects of aging on housing, preparation for retirement, leisure activities, and victimization of older individuals (Forbes, Jackson & Kraus, 1987; Kaplan, 1979; Keddy & Singleton, 1991; MacNeil & Teague, 1987; Mitic, Farquharson & Singleton, Jerome F. Singleton â€˘ School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada B3H 3J5. Time Use Research in the Social Sciences, editedby Wendy E. Pentland, Andrew S. Harvey, M. Powell Lawton, and Mary Ann McColl. Kluwer Academic/Plenum Publishers, New York, 1999. 245
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1985; Moss & Lawton, 1982). Leisure has been examined from a sociological, psychological, and a social-psychological perspective (Iso-Ahola, 1980; Kaplan, 1979; Neulinger, 1974). These perspectives have attempted to understand how leisure is experienced. Another area of investigation that has received attention by researchers is the leisure patterns of older individuals (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 paperand-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 activities (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; SchmitzScherzer, 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 previous studies identified have been limited to selected leisure activities and have not included other dimensions of daily living, including other activities 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 insights 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 community 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
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variation of time spent in various activities over the life course of an individual. Harvey and Singleton (1995) and Little (1984) provide reviews of research using time-budget methodology to assess age-related behavior. Researchers from various disciplines and professions have used time budget 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 provide insight on how people allocate their time. A review of a number of time-budget studies indicate that sex, employment status, child responsibility, and the presence of children are the major factors affecting activity participation and time allocation to activities (Cheek & Burch, 1976; Forbes, Singleton, & Agawani, 1993; Harvey, 1978; Harvey, Elliott, & Procos, 1977; Lounesbury & Hoopes, 1988; Schneider, 1972). 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 differentially assumed by men and women (Harvey, Elliott & McDonald, 1984; Harvey & Singleton, 1995; Thiessen & Singleton, 1994). Findings based on longitudinal data suggest that the tendency toward behavioral stability may be somewhat greater than most would imagine (Harvey et al., 1984; Lounesbury & Hoopes, 1988). The work suggests that both the "doing"and " nondoing" of particular activities tend to be consistent over time and change that does occur may be structured and predictable in terms of changes in roles and obligations as one moves through the life cycle (Harvey et al., 1984). It appears that individuals tend to participate 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 of the 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
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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 investigation were the stage of the person’s life cycle and age. For the purpose of the 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). In this 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 differentially 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 at home (Harvey, 1984; Kelly, 1982). Also a person's time is repackaged when he 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
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life span. Each stage provides different opportunities for the person. A person who is married with young children may have different opportunities when compared with someone who is married with no children. Placing the activity in the context of the personâ€™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 important if the person went with a friend? The context of the experience is important. Currently, assessments explore how often the person participated in an activity and whether he or she enjoyed it (McDowell, 1979; McKecknie, 1974). These assessments do not examine when and why the person participated 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 individuals reallocate their time use across the life span. Examining activities such as frequency of involvement loses the context of the experience and the meaning that the individual may attach to participating in the activity. The data gathered using a time-budget approach enable researchers to understand 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 analysis 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
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relinquish many opportunities to make decisions concerning daily activities (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 care delivery system (Oâ€™Morrow & Reynolds, 1985). Therapeutic recreation was defined, at the Ninth Southern Regional Institute on Therapeutic Recreation at the University of North Carolina in 1969, "as a process which utilizes recreation services for purposive intervention in some physical, emotional, and/or social behavior to bring about a desired change in that behavior 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 and appropriate 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 areas can 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 individual should be given the opportunity to choose his or her own leisure activities. Leisure opportunities should be planned with, not for, the individual, thus allowing the individual to have some sense of control over leisure activities in the institution by building upon previous leisure involvement (Davis & Teaff, 1980; Verhoven, 1977). Austin (1982, p. 58) states that " therapeutic recreation has historically promoted the goal of selfactualization, for the facilitation of the fullest possible growth and development of the client." Iso-Ahola (1980, p. 36) proposes that " it is not the recreational activity itself that is crucial, but the extent to which such an activity induces a sense of control over oneâ€™s behavior, environment and 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
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be broken into its component parts by the process of activity analysis prior to being used by the recreator. This process enables the therapeutic recreator 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 response to stress; (3) empirical and scientific data offer a firm basis for the development 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 the establishment of an environment for the rehabilitation and maintenance of residents in institutions for the elderly." The primary purpose of leisure services is " to create opportunities and reasons for a person affected by a condition 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 and with others. " The opportunity to exercise abilities and continue like tasks must be provided to the elderly resident in his or her own terms, maximizing and reinforcing independence, dignity and respect" (Teaff, 1985, p. 138).
ALZHEIMER' S DISEASE Alzheimer's disease is a progressive disease of unknown etiology characterized by forgetfulness and confusion, followed by progressive decline in the individual's cognitive and physiological responses. Alzheimer’s disease is the most frequent cause of irreversible dementia in an estimated 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
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the person with Alzheimer's disease? The continuity theory of aging (Atchley, 1971) may be an appropriate framework for developing activities for individuals with Alzheimer's disease. Recent findings in the leisure and aging literature indicate that activity patterns may be stable across the life span (Forbes et al., 1993; Harvey & Singleton, 1989). Based on these findings, the continuity theory of aging, and time-budget data, the following methodology was developed to assess the leisure abilities of the person with 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 his or her level of ability. As indicated earlier, activity has often been studied as a unidimensional concept by attempting to identify the number of activities in which a person has participated during the last year. This perspective has provided a very narrow view of what an activity is. An activity will vary depending on who a person participates with, location of the activity, amount of time the person spends on the activity, and why the person participates in the activity (role-obligated or choice). These temporal aspects will vary with the activity as the person travels through the life span (Forbes et al., 1993). To understand what the activity represents to the person, an interview process was established based upon the stages of the life cycle to elicit information on the types of activities participated in and what the activity meant to the person. Ostiguy MacNeil, Ritcey, and Singleton (1990) developed a protocol that would assist the therapist in gathering information on the abilities of the person who has Alzheimer’s disease. This process enables the therapist to identify the context of the activity in which the person participated. The following process uses existing resources in seeking information on the leisure abilities of a person (Ostiguy et al., 1990). 1. Review patient's chart, consulting particularly the social history and 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.
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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 patient'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-Interest Leisure 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 interests. Get them to fill out Self-Leisure Interest Profile or other interest finders after discussing previous activity patterns. Place activities 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 familiar behaviors—observation should be done for 1 week in 15-minute periods per day. 6. Try various stimuli and see how the patient reacts (music, activities, etc.) based on interest identified in 3, 4, 5. If unavailable, introduce the patient to activities related to his or her previous employment. 7. Document results 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.
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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 information 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 personâ€™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 participated 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 What were opportunities Arts and crafts Dance Drama Literacy Music Outdoor recreation Organized camping Social recreation Sports and games community services
When (stage of lifecycle)
Why (motivation to participate)
With whom (self, family, others)
Where (home/outside home)
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vidual as well as with family members to assist in placing the activity in the context of the older person. The information gathered using this process has enabled the therapeutic recreation staff to develop programs based upon the person's interests. A video was developed illustrating the process of interviewing a person with Alzheimer's, using the stage of life cycle as prompts for activity involvement (Ritcey & Singleton, 1992).
CONCLUSIONS Historically, leisure/recreation was examined from the standpoint of frequency of participation. This provided limited insight on what the activity meant to the person, who the person participated with, or where the person participated. Time-budget methodology has enabled researchers to examine the context of the experience via experiential sampling and the more traditional time-budget methodologies (Zuzanek & Smale, 1993; Harvey & Singleton, 1995). This information is beneficial to those individuals who deliver services to excluded consumers, since it provides insights into the multidimensional components of an activity. To develop programs without understanding the inherent parts of the activity, such as who the person participated with in an activity, the time the person spent in an activity, is replicating the error of treating activity participation as simply a frequency of participation rather than within the context of the activity.
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