Chapter 1. Introduction
With advances in medicine and technology, the increase of aging population is
taking place worldwide, which has a great effect on social, economic, and health. In
Taiwan, the number of people over the age of 65 has also increased rapidly. According
to the statistics from the Ministry of Health and Welfare, in 2018, 14% of the population
is older adults, transforming Taiwan into an “aged society”. In 2025, over 20% of the whole population will be older adults, thrusting into a “super-aged society” (National development council, 2016). Confronted with such rapid growing aging population, maintain one’s health and quality of life throughout late life is of great urgency.
The ratio of chronic diseases and functional disabilities rises along with the extended life expectancy. If aging is to be a positive experience, longer life must be accompanied by continuing activity participation. Increasing activity participation is beneficial to an individual’s health, since remaining involved in meaningful and purposeful activities is a key component in promoting health and extending lives of older adults (Lennartsson & Silverstein, 2001; Rowe & Kahn, 1998). According to activity theory, proposed by Havighurst and Albrecht in 1953, more participation in social and leisure activities have positive relationships with better life satisfaction and adjustment to aging among older adults (Diggs, 2008; Steinkamp & Kelly, 1987). Older adults may gradually be limited to continue many activities and roles due to physical or
cognitive decline or disability. Yet, remaining active and making creative use of spare time to participate in activities has been suggested to be helpful to transition to old age and health (Adams, Leibbrandt, & Moon, 2011; Nimrod, 2007). A concept proposed by World Health Organization, active aging has also expressed similar points of view as activity theory (World Health Organization, 2001; WHO, 2002). Older adults will have more potential to sustain their health and well-being through maintaining participation in a range of activity domains in later life.
Around the age of 60 to 65 years old, most people retire from work, which is a major alteration that portrays aging (Nimrod, 2007). With more free time, leisure often becomes the main activity that these retired older adults participate in (林佳蓉， 2000).
Recent literature noted that older adults today have longer life expectancy and they value more highly about health care and happiness, thus tend to become a more active participant in leisure activities (Agahi & Parker, 2005; 張靜惠，2008). There is a substantial literature on the benefits of participating in leisure activities among older adults. In order to lower their morbidity, mortality, and promote well-being, remaining active in later life has been found to be beneficial. Participating in diverse leisure activities, such as swimming, dancing, taking classes, is advantageous to buffer stress, increase muscle strength and endurance, lower risks of chronic disease, and sustain mental health condition(Ellwardt, Aartsen, Deeg, & Steverink, 2013; Eriksson Sörman,
Sundström, Rönnlund, Adolfsson, & Nilsson, 2014; Fallahpour, Borell, Luborsky, &
Nygård, 2015; Herrera et al., 2011; Pressman, Matthews, Cohen, Martire, Scheier, Baum, & Schulz, 2009; Singh, 2002; Takeda, Noguchi, Monma, & Tamiya, 2015; 尚憶 薇，2000；林佳蓉，2000).
In order to experience the journey of aging positively and actively, longer life expectancy ought to require continuous and readily-achieved opportunities for leisure participation. Therefore, understanding how these older adults manage their additional free time with leisure activities and how they experience these activities is crucial to their health and well-being (Adams et al., 2011; Agahi & Parker, 2005; Strain, Grabusic, Searle, & Dunn, 2002). In order to enhance leisure participation among older adults, from occupational therapists’ perspective, who specialize in promoting health and facilitating active participation, obtaining in-depth and inclusive information of leisure participation is critical. Despite the far-reaching interest in leisure participation among older adults, there is still no assessment tool which could comprehensively profile older adults’ leisure participation, blindfolding a broader perception on this topic (Menec, 2003; Nilsson & Fisher, 2006; Wang, Karp, Winblad, & Fratiglioni, 2002; 李月萍、陳 清惠，2010). Current leisure participation assessment tools used in literatures vary
widely in definition, categorization and how to measure participation in leisure activities (Agahi, Ahacic, & Parker, 2006; Agahi & Parker, 2008; Chen & Fu, 2008;
Fallahpour et al., 2015; Friedland et al., 2001; Herrera et al., 2011; Hyyppa, Maki, Impivaara, & Aromaa, 2006; Iwasa et al., 2012; Lee, Lee, & Park, 2014; Lennartsson &
Silverstein, 2001; Maselko et al., 2014; Minhat & Amin, 2012; Nummela, Sulander, Rahkonen, & Uutela, 2008; Pressman et al., 2009; Scarmeas, Levy, Tang, Manly, &
Stern, 2001; van der Meer, 2008; Verghese et al., 2006; Verghese et al., 2003; Crowe, Andel, Pedersen, Johansson, & Gatz, 2003; Schooler & Mulatu, 2001; van der Meer, 2008；吳秀汝、林金定、張必正、陳麗美, 2012；李月萍、陳清惠，2010；李維靈、
施建彬、邱翔蘭，2007；李錦東、張峻嘉，2009；林聰哲、李世昌，2008；柳立 偉、王嘉淳，2009；張俊一、許建民，2012；莊智鈞，2005；陳俊宏、陳鎰明，
2008；陳祥慈，2012；湯幸芬、楊明青、黃詩閔，2010；黃淑貞，2011；李素箱、
林志偉、李文裕、傅善恆，2013；莊婷婷，2013). Based on literature review, most studies
measures frequency of participation or domains of leisure activities (Agahi et al., 2006;
Agahi & Parker, 2008; Chen & Fu, 2008; Fallahpour et al., 2015; Friedland et al., 2001;
Herrera et al., 2011; Hyyppa et al., 2006; Iwasa et al., 2012; Lee et al., 2014;
Lennartsson & Silverstein, 2001; Maselko et al., 2014; Minhat & Amin, 2012;
Nummela et al., 2008; Pressman et al., 2009; Scarmeas et al., 2001; van der Meer, 2008;
Verghese et al., 2006; Verghese et al., 2003; 吳秀汝等人，2012；李月萍、陳清惠，
2010；李維靈 等人，2007；李錦東、張峻嘉，2009；林聰哲、李世昌，2008；柳 立偉、王嘉淳，2009；張俊一、許建民，2012；莊智鈞，2005；陳俊宏、陳鎰明，
2008；陳祥慈，2012；湯幸芬等人，2010；黃淑貞，2011；鄭政宗、賴昆宏，2007；
李素箱等人，2013；莊婷婷，2013). The naming of activity domains were also
inconsistent among these reviewed literatures(Iwasa et al., 2012; Lee et al., 2014;
Morrow-Howell et al., 2014; 吳秀汝等人，2012；李維靈等人，2007；盧俊吉等人，
2011；莊婷婷，2013). For example, “exercise”, “physical activities”, “sports and outdoor activities” and “fitness exercise” all included similar leisure activities, like jogging, playing table tennis and swimming. Also, an older adult’s value and preference of each leisure activity to have yet been investigated jointly (Agahi & Parker, 2005;
Agahi & Parker, 2008; Chen & Fu, 2008; Diggs, 2008; Herrera et al., 2011; Hyyppa et al., 2006; Iwasa et al., 2012; Lee et al., 2014; Lennartsson & Silverstein, 2001; Maselko et al., 2014; Minhat & Mohd Amin, 2012; Ingeborg Nilsson & Fisher, 2006; I. Nilsson, Nyqvist, Gustafson, & Nygard, 2015; Nummela et al., 2008; Pressman et al., 2009; van der Meer, 2008; 李月萍、陳清惠，2010；何麗芳，1992). Leisure participation among older adults have long been investigated (Godbey, Caldwell, Floyd, & Payne, 2005; Liu, Yeh, Chick, & Zinn, 2008), however, such basic questions about how to profile older adults’ leisure participation remain unclear.
Therefore, the purpose of this study is two-fold: (1) to develop a leisure
participation questionnaire to comprehensively profile how older adults participate in leisure activities, considering not only frequency and types of activities, but also with
whom, where, preference and value jointly, and (2) to investigate the profile of leisure participation among community-dwelling older adults.