Introduction
Since Havinghurst and Albrecht’s first study of the importance of activity engagement in successful aging in 1953, activity theory has become an important area in gerontological research. The notion that successful aging is inseparable from active lifestyle is as old as social gerontology. As people age, they are forced to give up many roles in life; they retire from employment, become widowed, and give up their membership in clubs, professional organizations and unions.
All these experiences influence their behavior, social interactions, and social participation resulting into a dormant lifestyle hence can negatively affect life satisfaction. Yet, successful aging requires participation in various forms of activity to maintain an active lifestyle. Therefore, activity in late years is very important to boost one’s health as well as to restore one’s strength and sense of belonging.
Activity theory rests on this proposition and carries the idea that the aging adult will only remain psychologically fit if they remain active since one’s self-concept is affirmed through various roles. Havinghurst and Albrecht (1953) were the first to stress the importance of social role in positive adjustment to old age and became the founding fathers of activity theory. The next section of this paper provides a review of literature including empirical findings to support the rationale of this theory for practical gerontology.
Literature Review
Before engaging in a review of literature, it is important to note that empirical studies linking activity theory with aging falls in a broad sphere of disciplines including both social and biological sciences. Aging is a process that can be frustrating given the experiences and hurdles that it presents to different people. While other people may successfully pass these hurdles, others fail and end up living a frustrating old age life. The idea behind activity theory is that people should live a healthy and happy old age life, a goal that can only be achieved through engagement in social roles to replace those lost due to old age. Researchers have carried out empirical studies to test the applicability of this theory in understanding the experiences of older adults in the society.
Havinghurst and Albrecht were the first to carryout an observation study on activity theory. When coining the theory in 1953, the two studied a sample of adults to examine the relationship between activity engagement and optimistic adaptation to aging (Mauk, 2009). From their observations, they concluded that the society expects older adults to remain active and contribute something to the society (Mauk, 2009).
Although their study was not empirical in nature, it provided a framework for developing activity theory. Since then, many researchers have used this framework to study the applicability of activity theory in gerontology as discussed below.
Lemon, Bendston, and Perterson (1972) conducted the first empirical study to test activity theory, but unfortunately, their study yielded disappointing findings (Longino and Kart, 1982). This made the authors criticize activity theory arguing that the theory is based on a single-item activity hence too simple to explain the experiences of elderly people (Longino and Kart, 1982).
Longino and Kart (1982) attempted to replicate the work of Lemon, Bendston, and Perterson (1972), whose study resulted in ambiguous findings about activity theory and aging. The main purpose of their study was to repeat Lemon, Bendston and Perterson’s work with the hope of more positive results. Unlike Lemon, Bendston and Perterson, they used probability sampling to sample three retirement communities with a population of 1209 residents hence providing for a greater variation in background variables (Longino and Kart, 1982).
They also used daily inventories as a source of behaviorally based activity as opposed to single item activity used in the previous research. Unlike the original findings, their findings, although mixed, indicated a strong correlation between activity and successful aging hence lending strong support to activity theory. Informal activity, which represented primary relationships, was positively associated with life satisfaction; solitary activity, being devoid of social contact, had the least effect on life satisfaction (Longino and Kart, 1982)
Jenkins, Pienta and Horgas (2002) conducted an empirical study in two Continuing Care Retirement Communities (CCRCs) to examine the link between activity engagement and health-related quality of life in older adults. Guided by the findings of prior research, which found a positive correlation between activity involvement and healthy aging in similar setups, the authors studied as sample of 167 residents, both assisted and independent dwellers, of the two communities.
In their methodology, they generated eight sub scales, i.e., pain, physical functioning, social functioning among others, to provide a measure of health-related quality of life whereas a self-report questionnaire was used to capture data on activity engagement (Jenkins, Pienta and Horgas, 2002). They analyzed their data using least squares regression models. From their data analysis, the authors found out that discretionary activities are directly linked to higher outcomes in health-related quality of life. Their findings had strong implications for health professionals directly involved in the care of the elderly. Activities for the elderly should be unrestricted to allow older adults participate only in activities that they enjoy and feel free when performing.
In a similar study, Goldberg and Beitz (2007) conducted a study under the title “Aging after Retirement: A Social psychological Process.” As indicated in the abstract, the purpose of their study was to explore theoretical explanations for psychological aging experiences among the elderly (Goldberg and Beitz, 2007). They obtained their data through interviewing fourteen older adults with a healthy lifestyle.
The authors used grounded theory method in their data analysis to derive theoretical explanations for their observations. The results of their study indicated that there was a strong correlation between activity involvement and successful aging process. After sharing their findings with experts in the field of gerontology for feedback, the authors concluded that healthy retirement has two clearly defined stages, early wellness and later illness, whose transition is marked by six variables namely having activity, loosing activity, loosing spouse’s health, loosing personal health, loosing the spouse and loosing financial stability (Goldberg and Beitz, 2007).
Lee and Ishii-Kuntz (1987) examined the relationship between social interaction and emotional well-being among the elderly. The purpose of their study was to examine the effects of interaction with respect to the role played on individual’s well-being. The authors also examined the extent to which these effects reduce the feelings of loneliness. Guided by the hypothesis that as morale (well-being) increases, loneliness decrease, they studied a sample of 2872 adults aged 55 years and above.
After correlating social interactions with emotional well-being, the authors found out that loneliness, which transmits large proportion of effects of social integration measures, has a deleterious effect on well-being. When an elderly person is lonely, his/her emotional health is at risk. Activity involvement reduces loneliness and minimizes chances of depression.
Herzog et al. (1998) carried out a gerontological study whose main purpose was to examine the positive effect of activities on well-being. Their study was guided by the assumption that self-conceptualization, facilitated by socio-economic status, is the main mediator of well-being. Using a sample of 679 adults aged 65 years and above to represent the elderly population in Detroit area, the authors carried out a cross-sectional survey and used the data to estimate the hypothesized processes with LISREL VIII. In their findings, the authors indicated that the frequency with which an activity is performed yields an effect on both physical and emotional health. Besides, the results revealed that socio-economic status facilitates leisure more than productive activity (Herzog et al., 1998).
From this body of literature a conclusion can be drawn that healthy aging is directly related to a person’s level of activity engagement. Active individuals are more likely to be healthy and experience a happy old age compared to less active individuals.
Summary of findings from literature reviewed
Activity engagement has become an important area of focus in gerontological research. Because of its link with successful aging, researchers have found it extremely important to examine the relationship between activity theory and aging. Whereas the first empirical study by Lemon et al. (1972) gave mixed results and did not have any solid backing for activity theory, the subsequent studies managed to forge a strong relationship between activity theory and healthy aging.
The results from the literature reviewed can be summarized as follows: activity involvement, be it voluntary or not, contributes positively to a healthy life, lowers loneliness, leads to a successful aging process and minimizes chances of depression. Another important issue that emerged from the literature reviewed is the importance of the frequency with which an activity is performed. According to Herzog et al. (1998), it is not just the mere engagement in activity, but also the frequency of engagement that yields an effect on both physical and emotional health.
These findings provide implications for future research and form the framework for this intended study. The remaining section of this paper is a proposal of the intended study including the purpose, sample and the methodology of the study.
Research Problem Description
Research question
Based on the above literature review, it is clear that successful aging is a factor of activity engagement. The more active an individual is, in his/her late years of life, the healthier she/he remains. While virtually all the studied literature emphasized the importance of activity involvement, the quality of activity remains a topic for further investigation. Guided by this gap, this study seeks to examine the relationship between the quality of activity and health-related quality of life among the elderly.
Does the quality of activities elderly people engage in have an effect on their well-being? We are all aware of the fact that as people age, they are forced to give up several active roles. Activity theory is about substituting these roles to bring a sense of fulfillment in their old age. New activities may not be perfect substitutes for roles lost due to old age. Does engaging in activity for the sake of being “active” have an effect on the quality of life?
Purpose
This study seeks to examine the relationship between healthy aging and activity involvement with a focus on the quality of activity. The purpose of this study is thus to explore the link between the quality of activity and health-related quality of life among the elderly. The author operationalizes the quality of activity to refer to the participant’s level of enjoyment and she/he accords that particular activity. This study is also purposed to address the implications of this theory in advanced nursing practice in gerontological nursing. To achieve this purpose, the study will focus on the following objectives:
- To determine the relationship between activity enjoyment and life satisfaction
- To determine the relationship between the quality of an activity and individual’s health-related quality of life
- To come up with recommendations for advanced practice in gerontological nursing
Sample
The author intends to sample randomly two Continuing Care Retirement Communities from a list of Continuing Care Retirement Communities in Michigan. Random sampling will ensure that the sampling process is not marred with any sampling bias. The target population will be elderly residents of these communities aged 65 years and above. Hence, any resident below this age category will not be eligible for sampling in this study.
The author will then randomly sample 100 elderly residents of these two communities to represent the whole population. Every community will be assigned a sample size of fifty respondents. Given the large population, the author will use random number table to select individuals for this study. The author believes that a sample of one hundred individuals will be representative enough and will be able to capture important aspects of gender and age, which when analyzed can give some insight into the relationship between activity enjoyment and gender as well as age.
Methodology
In this section, the author discusses the methodology of this study. A discussion of research design, research method as well as data collection and analysis procedures are presented.
Research method and design
The author prefers a mixed research method approach in this study. This will involve both qualitative and quantitative approach. This is because the author designed this study to address the “what”, “why” and “how” and “by how much” type of questions, which will generate both quantitative and qualitative data. The study will take a case study approach in its design and will only consider Continuing Care Retirement Communities (CCRCs). Continuing Care Retirement Communities, commonly referred to as adult homes, are residential setting for the elderly. Residents of such communities may be either independent requiring just minimal assistance or dependent requiring maximum assistance with their housekeeping, personal hygiene and other daily chores.
With the research method and design in place, the study plan will involve collecting information about the quality of life and activity engagement among elderly residents of two sampled Continuing Care Retirement Communities in Michigan.
Data collection procedures
This study will use both primary and secondary data. Secondary data will be obtained through a review of available literature on the subject as well as a review of respondent’s medical files to obtain data on their health-related quality of life. The researcher will use Salamon-Conte Life Satisfaction in the Elderly Scale (SCLSES) to measure the level of life satisfaction of the respondents. SCLSES is a self-report inventory of daily living aspects focusing mainly on the meaning of life, self-concept, and activity enjoyment (Salamon and Conte, 1982).
Apart from medical reports and Salamon-Conte Life Satisfaction in the Elderly Scale, the researcher will also administer a questionnaire to capture information on respondent’s general feelings about the quality of activities they engage in, other aspects of health-related quality of life including pain, depression and feelings of loneliness, as well as their recommendations for improvements.
Data analysis procedures
The author will code all the qualitative information obtained from the case studies to find similarities and differences. The author intends to use SPSS data analysis tool to synthesize the coded information. Descriptive statistics will be used to analyze Salamon-Conte Life Satisfaction in the Elderly Scale scores. To examine the relationship between life satisfaction and the quality of activity, the author will use ANOVA test to measure the strength of correlation between activity enjoyment and self-concept scores. Health outcomes will also be regressed against activity enjoyment to establish the effect of the quality of activity on health outcomes.
Hypothesized Results
The author hopes to find a strong relationship between the quality of activity and health-related quality of life. In this regard, the expected findings of this study can be hypothesized as follows.
- Most elderly people do not enjoy the type of activities they are involved in
- The quality of an activity has a significant effect on health related outcomes
- Self-concept is a factor of activity enjoyment
Nursing Implications for Advanced Practice in Gerontological Nursing
Havinghurst and Albrecht (1953) indicated that activity engagement is the healthiest way to age successfully (Mauk, 2009). Activity theory can be applied in gerontological nursing. In the author’s experience, most people are seeking part-time jobs to keep themselves busy. Some have even resorted to old age learning as a way of keeping their minds busy.
Theories are like maps to help us find direction to where we want to be. Activity theory gives direction on the role of activity involvement on individual’s health-related quality of life. It acts as a framework for research as well as a guideline for practical gerontology. The theory thus has both nursing implications for future research and advanced practice in gerontological nursing.
As a gerontological nursing implication for this theory, the author advocates for awareness creation to enlighten the elderly on the need to engage in activity, be it formal or informal, to promote both physical and emotional health. Such programs should involve both the elderly as well as staff members of homes for the elderly.
Some individuals may become less enthusiastic about role involvement as they grow old. The duty of a gerontological nurse is to encourage such individuals and help them develop an interest in social activity for the sake of their well-being.
Activity and life satisfaction is best understood from activity enjoyment point of view. The author suggests that nurses taking care of the elderly should be more concerned about how much older adults enjoy the activity rather than just the mere activity engagement for the sake of being “active”. Individuals can only develop morale when they enjoy the activity. Lack of activity enjoyment can as well have negative effect on emotional health. As an advanced nursing practice in gerontological nursing, it is recommended that the nurse should keep a daily inventory of participant’s level of enjoyment in every activity they engaged in during the day. A review and synthesis of this information will ensure that older adults are engaged only in roles they enjoy performing.
References
Goldberg, E., & Beitz, J.M. (2007). Aging after retirement: A social psychological process. Activities, Adaptation and Aging, Vol. 31 (1), 41-54.
Herzog et al. (1998). Activities and well-being in older age: Effects of self-concept and educational attainment. Psychology and Aging, Vol. 13, 179-185.
Jenkins, K. R., Pienta, A.M., & Horgas, A.L. (2002). Activity and health-related quality of life in continuing care retirement communities. Research on Aging, Vol. 24 (1), 124-149.
Lee, G. R., & Ishii-Kuntz, M. (1987). Social interaction, loneliness, and emotional well- being among the elderly. Research on Aging, Vol. 9 (4), 459-482.
Longino, C. F., Jr., & Kart, C. S. (1982). Explicating activity theory: A formal replication. Journal of Gerontology, Vol. 37 (6), 13-22.
Mauk, K.L. (2009). Gerontological nursing: Competencies for care (2nd ed.). Sudbury, U.S.A: Jones and Bartlett publishers.
Salamon, M.J., & Conte, V.A. (1982). An objective approach to the measurement and use of life satisfaction with older persons. Measurement and Evaluation in Guidance, Vol. 15 (3), 194-200.