Objectives
Physical Leisure activities and the risk of moderate dementia in the elderly
The risk of dementia has been associated with old age. The older one gets the higher the chances of dementia. A lot of attention has been provided to dementia and researches on possible ways to prevention strategies. Identification of protective factors is important to the development of effective modes of management of dementia. Several studies link dementia to less participation in leisure activities during the middle adulthood. The leisure activities also play a role in cognitive status in old age. According to Genoe (2010), individuals with a higher level of education are less likely to be exposed to dementia due to the great capacity of cognitive reserve. This paper is a literature review on the leisure activities of dementia among the orderly and the suggestion for further studies.
Objectives
The previous studies suggest that engagement in leisure activities such as physical, social and mental activities are associated to lower risk of dementia. Engagement in leisure activities is associated with successful aging and those above the age of 85 years receive a lot of cognitive impairments that affects their daily activities functioning satisfaction. Few studies have evaluated the link between leisure activities and dementia. Chang, Wray and Lin (2014) also link a person’s engagement in leisure activities to improve the cognitive reserve resulting in lower risk of dementia. Therefore, this paper aims at identifying whether physical leisure activity participation in old age reduces the risks of moderate dementia. In this case, physical leisure activities would include; hiking, swimming, dancing and planned exercise.
Statement of the problem
Improved health care services have increased the life expectancy among the older adult in their mid-60s. An increase in the population of older adults in the world today has seen an increase in cognitive impairment disorders such as dementia. According to the world health organization report (2015), by 2030, 75.6 million of older adults have been diagnosed with dementia. The risk of diagnosis of dementia is seen to increase with age such that 5-8% between the ages of 65-74years and 25-50% for those above the age of 85 is affected with cognitive impairment (American Psychological Association, 2012). The increased prevalence of diagnosis of cognitive impairments disorders such as dementia at an older age has led to research on the link between leisure activities and old age and the possible interventions to manage the disorder.
Statement of the problem
Dementia
Dementia affects an individuals’ short-term memory and the ability to reason. An individual diagnosed with dementia loses their ability to perform daily activities. They are unable to conduct social, physical and cultural activities as they were able to practice before. According to Fernández et al. (2015), dementia is common among patients in the special care unit as they find difficulty in handling the burden they put on family and friends. The progressive decline in daily functioning due to dementia leads to decline in verbal communication skills. These difficulties lead to decrease engagement in activities (Mesman, Buchanan, & Berg, 2011).
Importance of leisure activity engagement
According to Heo, Stebbins, and Lee (2013), leisure time is defined as one’s free or spare time, where they do not take part in any form of work or studying. It is the time one engages in activities that interests them without obligation. It is time one relaxes and enjoys doing what they desire. Leisure is characterised with participation in different activities. According to past studies, a positive relationship exist between leisure activities engagement and increased health benefits. Involvement in leisure activities is associated with reduced risk of chronical illnesses and diseases. Physical leisure activities lead to improved functions and physical strength leading to flexibility in joints and muscle strengths. Heo and Lee (2010) denote that, when older adults practice leisure physical activities, they experience positive mental and psychological health aspects. These include self-enjoyment, happiness, positive emotions and feelings. An attachment to certain activities maintains an involvement and creation of emotional and social connection among the participants with the same interests.
Leading lifestyle activities is critical in maintaining high levels of cognitive functioning in old age. Stern (2017) denotes that cognitive decline can be prevented through the lifestyle activities that stimulate the cognitive reserve in an individual. There are beneficial roles of intellectual leisure activities as learning a new language or engaging in learning activities that leads to the development of the cognitive level of an individual. This explains the inter-individual differences in cognitive functioning which is visible in old age. Increased leisure activities lead to improved cognitive functioning in old age. Leisure activities such as doing sports, attending theatres, participation in clubs and playing games are important for the development of cognitive activities (Wang et al., 2013).
According to Horowitz and Vanner, (2010), active engagement in leisure activities is essential to the cognitive development and physical health. Dementia has been a major health problem, and its prevention is important. Studies have reported that, those engaged in leisure activities during young adulthood are less likely to contract dementia in older adulthood. Also though engaged in leisure activities in older adult hood are at low risk of dementia. According to Jonaitis et al. (2013) higher education level is linked to reduced risks of dementia due to development of greater cognitive reserves as a result of increased neural synapses. Education develops the cognitive ability of an individual. Those with lower level of education are at higher risk of contracting dementia at old age when different changes occurs to the brain. Participation in leisure activities reduces the risks of dementia as it improves the cognitive reserves making it easy for adjustments when the changes occur in the brain. A study conducted by Garcia, Feliciano & Ilem, (2018) showed that older adults who participated in leisure activities had lower risks of dementia compared to those who did not participate in leisure activities.
Dementia
Genoe, (2010), acknowledges that despite the results of their study linking leisure activities to having a protective role in dementia, other alternatives can address the issue in depth. Dementia is characterized by a long period of decline in cognitive functioning. Reduced activities in the preclinical phase of dementia may be as a result of cognitive decline and not the cause. Depression is associated with cognitive issues and a decline in cognitive functioning and may result in dementia. Cognitive status, level of depression, and educational level may confound the relationship between dementia and leisure activities (Adams, Leibbrandt, & Moon, 2011)
Leisure activities represent an individuals social capital from where emotional and support are drawn by the elderly. The individuals who participate in leisure activities are found to have high social networks that prevent loneliness (Sauter, Widmer, & Kliegel, 2018). Loneliness is associated with depression leading to a decline in cognitive functioning. More research has shown evidence that participation and engagement in leisure activities among the elderly people results in considerable health benefits such as social benefits, psychological, physical and cognitive. Psychological and cognitive mental health can lead to serious health issues in the older adults. Leisure activities is linked to happiness and enjoyment that results in healthy mental state. The physical perspective shows that there is a strong link between the physical wellbeing and leisure activities. Reduced leisure activities are linked to slower rate of motor function that results in a decline in chronic diseases in old age (Heo et al., 2013).
Chang, Yu, and Jeng, (2015) argue that the link between leisure activities and cognition depends on the significant extent on leisure activities in young adulthood. Gates & Valenzuela (2010) analyzed the association of reduced cognitive leisure activities with the reduced global functioning of cognition. The decline is evident in the speed of cognition functioning but not in the memory. According to Chang, Yu and Jeng, (2015) several factors have linked to causes and prevent dementia. They affirm that frequent engagement of leisure activities results in reduction of risk of contracting dementia. Social and mentally stimulating activities lessen the risk of dementia. They increase the functioning of the brain and association with positive reinforcement that leads to good health status and general wellbeing.
Cognitive reserve hypothesis
The cognitive reserve hypothesis provides a potential account of the findings of the relationship between leisure activities and dementia. Two related models have been used to illustrate the concept; the active and passive model. The passive model describes that the reserve capacity of each person differs due to the structural neural substrates that are different in different individuals, for instance, the brain weight. The increased number of neurons and synapses in the cortex leads to greater brain reserve which is associated with larger brain weight. The larger brain weight compensates the brain when there is a decline and pathological changes due to increase in age which may lead to dementia disease. When a critical threshold reserve has been achieved in the brain, dementia occurs (Wang et al., 2013).
Importance of leisure activity engagement
On the other hand, the active model of cognitive reserve hypothesis focuses on the capability of an individual to compensate the degradation of the brain in old age. Engagement in leisure activities and positive environmental aspects can lead to an individual gaining a larger cognitive reserve. This leads to more efficient and effective cognitive network. The cognitive networks enable one to compensate for the cognitive decline caused by pathological changes and use the alternative networks in cases of dementia. Physical activities are linked to neural beneficial effects that have also been proposed to prevent dementia, and this is supported by several other studies that linked the physical activities and dementia (Wang et al., 2013).
Physical activity on risk dementia
According to Sofi et al. (2011), there are benefits associated with physical activities such as playing games to the reduction in risk of dementia. The increased physical activities prevent the onset of dementia. However, no evidence presented have confirmed that physical activities prevent dementia (Cohen et al. 2010).
Impact of physical and mental activities on cognitive function
Leisure activities involve a variety of various activities such as reading, playing games that associated with thinking and reasoning. Research shows that cognitive exercise has an impact on the performance of the neuropsychology. The literature above summarizes some of the evidence on leisure activities, cognitive decline and the risk of dementia. They show that physical and mental leisure activities may protect against cognitive decline and dementia. It is also clear that the beneficial impacts of physical activity on the risk of dementia need to be researched further. Cognitive training has an impact on improving the cognitive functions in the older adults which leads to the development of the cognitive reserves that reduces the risk of dementia (Gates &Valenzuela, 2010). Therefore, leisure activities that involve mental actions are critical.
However, according to a study conducted by Wang et al. (2012), certain leisure activities do not show any connection with dementia. There are no relationships between the increased leisure activities and risk of dementia. Therefore there is a need for further studies and evidence to conclude the relationship between engaging in leisure activity and dementia (Horowitz & Vanner, 2010).
The various methods and study populations explain the differences in the previous studies. There are other factors such as physical well-being and health-related behaviors that are related to physical activities. For instance, depression can affect ones’ ability to participate in leisure activities. Therefore the need to control these factors when researching the impact of leisure activities engagement and risk factors of dementia (Chang et al., 2010). (Stern, 2017) also contributes to the need to control other factors when conducting research.
Cognitive reserve hypothesis
Methodology
The paper will use the quantitative research method. The method involves converting data into a numerical form to enable statistical calculations and conclusions to be drawn. The research will have two hypotheses;
- Null hypothesis: there is no significant relationship between physical leisure activities and risk of moderate dementia in older adults.
- Alternative hypothesis:there is a significant relationship between physical leisure activities and the risk of moderate dementia in older adults.
The study will also adopt the use of music therapy with the aim of monitoring its direct and indirect effect in the treatment of dementia. This is because music has been identified as a good therapeutic strategy for many health complications it is has some effects on the patient.
The data collected will be critically examined in order to conclude. Also, other variables such as the physical and social wellbeing will be controlled in order to achieve accurate information and for the conclusion not to be biased. The data will be collected through the means of interviews and questionnaires. The interviews will be informal in order to encourage elderly people to share information. The interviews will obtain data on any history of the diseases and for the participants in the health care facilities; the records will be obtained from the medical history that is the secondary data available in the facilities. The data on leisure activities will be collected using questionnaires with structured questions on how frequent they participate in physical leisure activities such as hiking, swimming, dancing and planned exercise in a three months period. The above mentioned physical leisure activities will be included where they will select the type of activities they participated in and how frequent. The participants will be older adults from the age of 65 and above. The questionnaires will be sent to the participants in their homes and also those at the health centers.
Geriatrics and aging recreational activities will also be used with the aim of reducing behavioral symptoms in dementia. Random sampling will be used to collect data and the selected participants will be taken and will be presented with the questionnaires. A list of different physical activities will be provided on the questionnaires, and the participants asked on how frequently they participate in the physical activities. They will also indicate if they never participate in physical activities. Different physical activities will also be included where the participant will be required to select the type of activities they participate in.
Report on findings
The findings will be reported using descriptive statistics to illustrate the characteristics of the sample tested. The statistical results will be presented using the American psychological association format. Each of the statistical tests will end with one or two sentences that the results explain about the hypothesis. That is it will indicate whether the hypothesis was supported by the data collected. The figures and tables will be used to assist in visualizing the significance of the results. They will also be used to summarize the results of the data collected. The findings will be made simple in order to allow easy interpretations of results and a clear response to the hypothesis.
Suggestions for the future
The studies have focused on moderate stage of dementia. There is a need to identify the different types of dementia and determine the effects of different leisure activities of them. The results from the prior studies conducted are inconsistent; some identified the significant effect of leisure activities on cognitive functions while others did not note the difference. These indicate the limited studies on the topic. Therefore there is a need for further studies to identify the potential link between dementia and different leisure activities. There is also the need for specific research on the specific type of dementia in respect to leisure activities.
Budget and Gantt chart
Budget
An estimated budget for the proposed project will be $ 4500. The money will be used as follows:
Research from online resources, peer reviewed journal and textbooks for the literature review will cost and estimate of $ 1000
Data collection is estimated at $ 2000
Data analysis at $1000
And miscellaneous at $ 500
The table below shows a summary of the activities;
|
Use |
Amount |
|
Literature Review |
$1000 |
|
Data Collection |
$2000 |
|
Data Analysis |
$1000 |
|
Others |
$ 500 |
|
Estimated Total Budget |
$4500 |
Gantt chart
The activities will be undertaken as summarized below;
Table 1.2 Gantt chart
|
Task |
Week 1 |
Week 2 |
Week 3-12 |
Week 13 |
Week 14 |
|
Problem identification |
|||||
|
Literature review |
|||||
|
Data collection |
|||||
|
Data analysis |
|||||
|
Discussions, report and findings |
Matrix
|
Author |
Purpose |
EBP Level and Research Design |
Outcome Measure |
Results |
Conclusion and Method Concerns |
|
Adams, K. B., Leibbrandt, S., and Moon, H |
The study measures the activity among older adults and reported literature on specific dimensions of activity and wellbeing |
Data was collected from secondary sources; PsycInfo, AgeLine, Medline, Academic Search Premiere and CINHAL, and peer-reviewed journals or leisure activity among non-institutionally resident older adults published from 1995 to 2009. |
Of the 42 studies, 24 were cross-sectional and 18 longitudinal. The longitudinal studies spanned from four to 20 years |
Most of the reviewed studies showed positive associations between activity participation and psychosocial wellbeing, survival or health. |
Social, productive and leisure activities have significant associations and predictive relationships with aspects of wellbeing for older adults. The activities need to have specific measures. |
|
Brajsa-Zganec, A., Merkas, M., and Sverko, I |
Shows how leisure activity involvement contributes to subjective wellbeing |
4,000 participants recruited through large scale public opinion and representative of adult population. |
Different subsamples and show moderate, but substantial contribution of leisure activities to social wellbeing. |
The pattern of important leisure activities somewhat varies in different samples |
study ?ndings show that participation in various leisure activities signi?cantly contributes to SWB of Croatian citizens, and this con?rms the general hypothesis about positive relationship between participation in leisure and social wellbeing. |
|
Cardenas, D., Henderson, K. A., and Wilson, B |
Examines how Senior adult participate and are involved in games and their perceived impact on health |
The study used random sample of 1000 Participants from the local community from local events. |
The intrinsic factors for participation included; fun and competition was the highest rated. Doctors’ recommendation was the lowest rated factor. |
The results showed how positive participation into community leisure activities has an impact on older adults. |
The community based physical and social leisure activities motivates individual to participate in them and it contributes to the health of the older population. |
|
Chang, P.-J., Wray, L., & Lin, Y. (2014) |
Purpose is to examined how leisure influences the link between social relationships and health in older age |
Core interviews were conducted in participants’ homes in 1992; follow-up interviews were conducted by phone every two years thereafter. The HRS surveys a representative sample of 26,000 Americans every two years |
Physical and psychological well-being were coded so that the larger the value, the lower the level of physical health and psychological well-being. |
The results of this study confirmed the hypothesis that the links between social relationships and physical health or psychological well-being were enhanced in the presence of leisure activities. |
An improved understanding of the mediating effect of leisure activities in such a link is important for improvement and maintenance of health among the older population, which can be applied to effective intervention development to help older adults during the aging process |
|
Heo, J., Stebbins, R. A., Kim, J., & Lee, I |
examines the relationships among serious leisure, life satisfaction, and health of older adults |
there were 564 older adults who participated in the Indiana Senior Games. They were asked to complete a survey linked to online registration. |
There were benefits associated with serious leisure participation. |
The findings have expanded the body of knowledge, demonstrating that leisure involvement in the context of serious leisure is positively associated with life satisfaction, physical health and mental health |
Confirms the relationship among leisure, life satisfaction and health makes it important to Increase efforts in the involvement of older adults in Serious leisure activities. |
References
Adams, K. B., Leibbrandt, S., & Moon, H. (2011). A critical review of the literature on social and leisure activity and wellbeing in later life. Ageing & Society, 31, 683–712.
American Psychological Association. (2012). Guidelines for the evaluation of dementia and agerelated cognitive change. American Psychologist, 67, 1–9. https://dx.doi.org/10.1037/a0024643
Brajsa-Zganec, A., Merkas, M., & Sverko, I. (2011). Quality of life and leisure activities: How do leisure activities contribute to subjective well-being? Social Indicators Research, 102(1), 81–91
Cardenas, D., Henderson, K. A., & Wilson, B. (2009). Experiences of participation in Senior Games among older adults. Journal of Leisure Research, 41(1), 41–56
Chang, Y., Nien, Y., Tsai, C., & Etnier, J. L. (2010). Physical activity and cognition in older adults: The potential of Tai Chi Chuan. Journal of Aging & Physical Activity, 18(4), 451–472.
Chang, P.-J., Wray, L., & Lin, Y. (2014). Social relationships, leisure activity, and health in older adults. Health Psychology, 33(6), 516–523. https://doi.org/10.1037/hea0000051
Chang, L.-C., Yu, P., & Jeng, M.-Y. (2015). Effects of leisure education on self-rated health among older adults. Psychology, Health & Medicine, 20(1), 34–40. https://doi.org/10.1080/13548506.2014.897914
Cohen-Mansfield, J., Marx, M. S., Thein, K., & Dakheel-Ali, M. (2010). The impact of past and present preferences on stimulus engagement in nursing home residents with dementia. Aging & Mental Health, 14, 67–73.
Fernández-Mayoralas, G., Rojo-Pérez, F., Martínez-Martín, P., Prieto-Flores, M.-E., Rodríguez-Blázquez, C., Martín-García, S., … Forjaz, M.-J. (2015). Active ageing and quality of life: factors associated with participation in leisure activities among institutionalized older adults, with and without dementia. Aging & Mental Health, 19(11), 1031–1041. https://doi.org/10.1080/13607863.2014.996734
Garcia, S., Feliciano, L., & Ilem, A. A. (2018). Preference assessments in older adults with dementia. Behavior Analysis: Research and Practice, 18(1), 78–91. https://doi.org/10.1037/bar0000045
Gates, M. Valenzuela (2010). Cognitive exercise and its role in cognitive function in older adults Curr. Psychiatry Rep., 12 (6), 12-34
Genoe, M. R. (2010). Leisure as resistance within the context of dementia. Leisure Studies, 29(3), 303–320.
Heo, J., Stebbins, R. A., Kim, J., & Lee, I. (2013). Serious Leisure, Life Satisfaction, and Health of Older Adults. Leisure Sciences, 35(1), 16–32. https://doi.org/10.1080/01490400.2013.739871
Heo J, Lee Y. (2010) Serious leisure, heath perception, dispositional optimism, and life satisfaction of Senior Games participants. Educational Gerontology, 36(2):112–126.
Horowitz, B., & Vanner, E. (2010). Relationships among active engagement in life activities and quality of life for assisted-living residents. Journal of Housing for the Elderly, 24, 130 –150
Jonaitis, E., La Rue, A., Mueller, K. D., Koscik, R. L., Hermann, B., & Sager, M. A. (2013). Cognitive activities and cognitive performance in middle-aged adults at risk for Alzheimer’s disease. Psychology and Aging, 28(4), 1004–1014. https://doi.org/10.1037/a0034838
Mesman, G. R., Buchanan, J. A., Husfeldt, J. D., & Berg, T. M. (2011). Identifying preferences in persons with dementia: Systematic preference testing vs. caregiver and family member report. Clinical Gerontologist: The Journal of Aging and Mental Health, 34, 154 –159. https://dx.doi.org/10.1080/ 07317115.2011.539516
Sauter, J., Widmer, E., Ihle, A., & Kliegel, M. (2018). The association of leisure activities in middle adulthood with cognitive performance in old age: Social capital mediates cognitive reserve effects. Psychology & Neuroscience. https://doi.org/10.1037/pne0000146
Sofi, D. Valecchi, D. Bacci, R. Abbate, G.F. Gensini, A. Casini, C. Macchi. (2011). Physical activity and risk of cognitive decline: a meta-analysis of prospective studies J. Intern. Med., (269),107-117.
Stern, Y. (2017). An approach to studying the neural correlates of reserve. Brain Imaging and Behavior, 11, 410–416. https://dx.doi.org/10.1007/s11682- 016-9566-x
Wang, H.-X., Jin, Y., Hendrie, H. C., Liang, C., Yang, L., Cheng, Y.,… Gao, S. (2013). Late life leisure activities and risk of cognitive decline. The Journals of Gerontology: Series A, 68, 205–213. https://dx.doi.org/10.1093/gerona/gls153
World Health Organization. (2015). Governments commit to advancements in dementia research and care [News release]. Geneva, Switzerland. Retrieved from https://www.who.int/mediacentre/ news/releases/2015/action-on-dementia/en/
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