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Utilizing outreach therapeutic recreation to determine the leisure experiences of recently hospitalized.. Gallant, Paul W. 1995-12-31

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UTILIZING OUTREACH THERAPEUTIC RECREATION TO DETERMINE THE LEISURE EXPERIENCES OF RECENTLY HOSPITALIZED OLDER ADULTS  by PAUL W.  GALLANT  B.Rec.H., Dalhousie U n i v e r s i t y ,  1989  A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTERS OF HUMAN KINETICS in THE FACULTY OF GRADUATE STUDIES  School o f Human K i n e t i c s  We accept t h i s t h e s i s as conforming to the r e q u i r e d  standard  THE UNIVERSITY OF BRITISH COLUMBIA April,  1995  ® Paul W. G a l l a n t ,  1995  In presenting this thesis in partial fulfilment  of the  requirements for an advanced  degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department  or by  his  or  her  representatives.  It  is  understood  that  copying  or  publication of this thesis for financial gain shall not be allowed without my written permission.  Department of  Education  The University of British Columbia Vancouver, Canada  D a t e  DE-6 (2/88)  A p r i l 27,  1995  ABSTRACT  The  purpose  meaning that Therapeutic eight  How  Recreation  questions  they benefit  describe  contributed  their  relationships  (T.R.O.P.) h a d f o r  adults.  The s p e c i f i c interests?  of leisure? D i d  What w e r e t h e  facilitating  t h e i r enjoyment  of  leisure?  which prevented p a r t i c i p a n t s  leisure goals  between  the benefits  towards  subjective  i n a  w e r e : What w e r e t h e i r l e i s u r e  What w e r e t h e c o n s t r a i n t s achieving  older  f r o m T.R.O.P.?  which  the  and involvement  Outreach Program  hospitalized  d i dparticipants  factors  s t u d y was t o a n a l y z e  leisure experiences  recently  research  of this  leisure  and i n t e r e s t s ?  from  What w e r e t h e  s a t i s f a c t i o n and  life  satisfaction? A total month p e r i o d the  able  t o speak,  read,  t h e Lower M a i n l a n d  The  Hospital;  at least  of B r i t i s h  case  study design  strategies  that  met  living  Columbia; and,  community  living.  entailed  a number o f d a t a  occurred  during  two s e m i - s t r u c t u r e d  five  o f age;  fluently;  the in-hospital  o u t r e a c h p h a s e s o f t h e T.R.O.P. i n t e r v e n t i o n .  included  a  were: i n -  55 years  and comprehend E n g l i s h area  over  i n T.R.O.P. T h e y  Participants  to non-institutionalized  collection and  Paul's  were r e c r u i t e d  to participate  inclusion criteria.  o f St..  returning  participants  and agreed  following  patients  in  of eight  interviews  with  each  These  Ill  p a r t i c i p a n t , o b s e r v a t i o n s and f i e l d n o t e s throughout T.R.O.P., and a r e v i e w o f m e d i c a l c h a r t s .  In addition, the  p a r t i c i p a n t s completed t h r e e f o r c e d - c h o i c e  l e i s u r e worksheets  which examined t h e i r l e i s u r e i n t e r e s t s , l e i s u r e needs, and l e i s u r e c o n s t r a i n t s . Data a n a l y s i s was based on Huberman and Miles  (1994) i n t e r a c t i v e model o f d a t a d i s p l a y ,  conclusion  drawing, and v e r i f i c a t i o n . The  p a r t i c i p a n t s perceived  l e i s u r e b e n e f i t s t o be:  "enjoyment", "time t o t h i n k and f o r g e t y o u r "relaxation",  "a sense o f s a t i s f a c t i o n " , and " m a i n t a i n i n g  interest i n l i f e " . described  troubles", an  These b e n e f i t s a r e s i m i l a r t o those  i n t h e l i t e r a t u r e . Many o f t h e l e i s u r e i n t e r e s t s o f  the p a r t i c i p a n t s were s o l i t a r y and s p e c t a t o r  types of  e x p e r i e n c e s which tended t o o c c u r w i t h i n t h e i r home o r near t h e i r home. An a d d i t i o n a l f i n d i n g was t h a t p a r t i c i p a n t s were f r u s t r a t e d by n o t b e i n g a b l e t o pursue many o f t h e i r l e i s u r e i n t e r e s t s due t o d e c l i n i n g h e a l t h . The main b e n e f i t s o f T.R.O.P. were i d e n t i f i e d as knowledge o f r e s o u r c e s and increased  s o c i a l contacts.  frequently reported physical d i s a b i l i t y ,  The l e i s u r e c o n s t r a i n t s most  were r e l a t e d t o poor h e a l t h lack of p h y s i c a l s k i l l s ,  status,  lack of  knowledge o f r e s o u r c e s , p r o c r a s t i n a t i o n , and l a c k o f s o c i a l support. S o c i a l s u p p o r t and s o c i a l r e l a t i o n s h i p s were  perceived  t o be major f a c i l i t a t i n g f a c t o r s towards l e i s u r e enjoyment. Several  o f t h e p a r t i c i p a n t s ' e x p e r i e n c e s i n t h e h o s p i t a l were  iv p e r c e i v e d t o a l l e v i a t e s o c i a l i s o l a t i o n , a f i n d i n g t h a t has not  been e x p l o r e d i n t h e l e i s u r e l i t e r a t u r e . S o c i a l  relations  were a l s o p e r c e i v e d t o be i m p o r t a n t c o n t r i b u t o r s towards the l e i s u r e s a t i s f a c t i o n and l i f e The f i n d i n g s  satisfaction.  a l s o r e v e a l e d t h a t t h e most p e r t i n e n t  information related  t o l e i s u r e meaning and i n v o l v e m e n t was  o b t a i n e d through v i s i t i n g and c o n v e r s i n g w i t h p a r t i c i p a n t s t h e i r homes, and not t h r o u g h f o r m a l i n - h o s p i t a l assessment p r o c e d u r e s . The n a t u r e o f t h e f i n d i n g s s t u d y have i m p l i c a t i o n s  f o r f u t u r e r e s e a r c h and  leisure of t h i s practice.  in  v  TABLE OF CONTENTS Abstract Table of Contents L i s t of Tables CHAPTER ONE Introduction The L e i s u r e E x p e r i e n c e and H e a l t h The D e m o g r a p h i c s o f O l d e r A d u l t s Rehabilitation Services Resources New D i r e c t i o n s i n H e a l t h C a r e L e i s u r e and L i f e S a t i s f a c t i o n Leisure Education.and Counseling Statement of Problem Research Questions Definitions CHAPTER TWO  CHAPTER THREE  Review of the L i t e r a t u r e C h a r a c t e r i s t i c s of Leisure L e i s u r e S a t i s f a c t i o n and Life Satisfaction The L e i s u r e I n t e r e s t s o f O l d e r A d u l t s Constraints to Leisure Health Status of Older A d u l t s I m p l i c a t i o n s of H e a l t h S o c i a l Support Leisure Education Strategies  i i v v i i 1 1 2 4 6 7 8 9 11 11 12 15 15 17 18 19 21 23 25 27  Methodology > Research Design P i l o t Study Investigator's Role Person-Centred Approach P a r t i c i p a n t S e l e c t i o n and R e c r u i t m e n t The T h e r a p e u t i c R e c r e a t i o n O u t r e a c h Program I n i t i a l Interview Group I n - p a t i e n t S e s s i o n s One-to-One S e s s i o n s Outreach Sessions Concluding Interviews  33 33 36 37 40 41  Data C o l l e c t i o n Data O r g a n i z a t i o n Confirming Data Data A n a l y s i s E t h i c a l Review  .49 52 54 55 56  43 44 45 48 48 49  vi CHAPTER FOUR  CHAPTER F I V E  R e s u l t s and D i s c u s s i o n Overview P i l o t Study Main Study P a r t i c i p a n t P r o f i l e s TG FB VB JN JR PP RC MP R e s e a r c h Q u e s t i o n s 1-3 B e n e f i t s of L e i s u r e Benefits of T.R.O.P. F a c i l i t a t i n g Factors R e s e a r c h Q u e s t i o n 4:, L e i s u r e I n t e r e s t s R e s e a r c h Q u e s t i o n 5: Leisure Constraints R e s e a r c h Q u e s t i o n 6: L e i s u r e and L i f e S a t i s f a c t i o n R e s e a r c h Q u e s t i o n 7: A d d i t i o n a l Factors Meaning of L e i s u r e Leisure Goals L e i s u r e Adjustment Health Status Investigator-Participant Relationship C o n c l u s i o n s and R e c o m m e n d a t i o n s Conclusions Recommendations f o r F u t u r e R e s e a r c h Recommendations f o r P r a c t i t i o n e r s H e a l t h System S o c i a l Resources R e s t r u c t u r i n g and Coordinating Resources  REFERENCES APPENDICES  58 58 58 60 61 64 68 72 75 78 81 83 85 85 88 89 91 96 99 101 102 103 104 105 106 108 108 110 113 113 114 115 118  A p p e n d i x 1:  Leisure Education Worksheets Appendix 2: Interview Questions A p p e n d i x 3 : C o n s e n t Form Appendix 4: C e r t i f i c a t e s of A p p r o v a l  127 131 133 135  vii  LIST OF TABLES  Table 1  Key p h r a s e s from p a r t i c i p a n t s ' responses r e l a t e d to research questions one, two, and t h r e e 86  Table 2  Key p h r a s e s from p a r t i c i p a n t s ' responses r e l a t e d to research questions o n e , two a n d t h r e e ( c o n t i n u e d ) 87  Table 3 Table 4  Leisure interests . domain  of p a r t i c i p a n t s  Self-perceived leisure constraints  by 95 99  1 CHAPTER ONE Introduction  The L e i s u r e E x p e r i e n c e a n d H e a l t h The s t u d y o f t h e  l e i s u r e behaviour of older adults  their participation in discretionary  forms o f a c t i v i t i e s  become one o f t h e  " c l a s s i c areas of i n v e s t i g a t i o n "  gerontology  (Lawton, 1994,  field  b e e n made t o t r y t o u n d e r s t a n d the of  leisure the  experience  older adult.  freedom,  and e n c o u n t e r Datillo  timelessness,  & Howard, 1994,  However, pleasant.  leisure  Throughout  of  exhaustion,  frustration,  p.  the  resources  shown t h a t  often  adventure..." (Lee,  always p o s i t i v e  leisure  nervousness, al.,  1994,  or  encounter  experiences.  may be c h a r a c t e r i z e d  (Lee, et  by  feelings  disappointment, p.  203).  a number o f c o n s t r a i n t s leisure.  Examples o f  l a c k o f knowledge r e g a r d i n g  and f a c i l i t i e s ,  when  pleasure,  i n d i v i d u a l s may  and u n p l e a s a n t  apprehension,  include:  of  experience  a c t i v i t i e s they  were n o t  them a n d i m p a c t u p o n t h e i r  constraints  leisure  relaxation,  life-cycle,  I n d i v i d u a l s also encounter confront  have  196).  experiences  and g u i l t  the  p o s i t i v e experiences  experiences  a v a r i e t y of s t r e s s f u l These t r o u b l e s o m e  the  enjoyment,  a v a r i e t y of other  has  specific characteristics  i n recreation fun,  in  Many a t t e m p t s  L e i s u r e r e s e a r c h e r s have  "involvement,  spontaneity,  the  138).  and s p e c i f i c a l l y  individuals participate experience  p.  and  leisure  l a c k o f a p a r t n e r w i t h whom t o  which these  2 participate, (Jackson,  l a c k of income,  1990; S e a r l e  & Mahon, 1 9 9 3 ; Heywood,  Leisure experiences life  and l a c k o f p h y s i c a l a b i l i t y  are  e v e n t s s u c h as d i s e a s e ,  a l s o t h r e a t e n e d by illness,  events are  e v e n more t h r e a t e n i n g  frequently  live  Archibald,  1993, p .  alone  in their  253).  the  t o how h e a l t h  o l d e r members  or d i s a b i l i t y .  These  who  ( L y o n s , Meade, W h i t e &  The c h a n g i n g d e m o g r a p h i c s likely result  and l e i s u r e  of our  significant  to older adults,  homes  segment o f o u r p o p u l a t i o n w i l l attention  1994).  in  resources  of  this  increased  are  allocated  to  communities.  The D e m o g r a p h i c s o f O l d e r A d u l t s In B r i t i s h  Columbia, the percentage of the  a g e d 65 a n d a b o v e was 1 3 . 2 individuals  i n 1990  This figure  i s expected  2006  1990).  (BCPF,  baby boomers,  % or approximately  (BC P o p u l a t i o n F o r e c a s t to r e a c h 626,000  (15.2  expectancy i n the  (Greater Vancouver R e g i o n a l D i s t r i c t  [GVRD],  that  the p r o v i n c e w i l l areas  (GVRD,  largest  continue  aging of  increasing  year the both  population 1993,  p.  5).  population of older adults  t o be i n t h e V a n c o u v e r a n d  It in  Surrey  19 93) .  Statistics so d o e s t h e  the  %) b y t h e  the  are  t h e number a n d p r o p o r t i o n o f s e n i o r s  is predicted  423,500  [BCPF] , 1990) .  The d e c l i n i n g b i r t h r a t e ,  and a l o n g e r l i f e  population  Canada  (1988)  reported  that  as  age  increases,  i n c i d e n c e o f d i s e a s e and h e a l t h p r o b l e m s .  number o f d i s a b l e d i n d i v i d u a l s a g e d 55 y e a r s a n d o l d e r  The in  3 British in  Columbia accounted f o r 25-35 % o f the  total  1988. A p p r o x i m a t e l y 52,580 of these persons  Vancouver households the  (Statistics  h e a l t h problems t h a t  Canada,  d e p r e s s i o n and l o n e l i n e s s  life  in  include:  orthopaedic d i s a b i l i t i e s , 1 9 9 1 ) . Many o l d e r  inevitable losses  or  changing  c i r c u m s t a n c e s w h i c h have made a d d i t i o n a l e m o t i o n a l  demands o n t h e m . spouse,  These l i f e  retirement,  a decreased life  experience  (Riddick & K e l l e r ,  i n d i v i d u a l s have a l s o s u s t a i n e d  resided  1988). Examples of  some o l d e r a d u l t s  c a r d i o v a s c u l a r and r e l a t e d d i s e a s e s ,  population  changes  often  declining health,  number o f f r i e n d s .  i n c l u d e : loss of a  change o f r e s i d e n c e ,  and  U l t i m a t e l y a l o s s o f meaning i n  i s e x p e r i e n c e d b y some o l d e r a d u l t s  (Burbank,  1992,  p.  21) . On t h e active,  many o l d e r a d u l t s  a n d have n o t e x p e r i e n c e d t h e  mentioned. risk  o t h e r hand,  These  "healthier"  who e x p e r i e n c e d r a m a t i c conditions. function  at  the  and h o s p i t a l i z a t i o n as  changes  Many o l d e r a d u l t s  were n o t  same  those  and d e c l i n i n g m e d i c a l  have t h e  ability  to  adequately  i n t h e i r communities without the p r o v i s i o n of  additional  supports  nursing care, However, older adults services.  life  healthy,  losses previously  older adults  of l o n e l i n e s s , depression,  were  s u c h as h o m e - m a k i n g , M e a l s o n W h e e l s , home  and o u t r e a c h o r t h e r a p e u t i c there i s a s i g n i f i c a n t l y aged 65 a n d a b o v e ,  For example, persons  o c c u p i e d 228 i n p a t i e n t  recreation  services.  higher percentage  who a r e u t i l i z i n g 65 y e a r s  h o s p i t a l days p e r  of  health  o f age a n d o v e r 100 p e r s o n s  i n 1990.  4 This  figure  inpatient  i s more t h a n f o u r t i m e s h i g h e r t h a n t h e  days per  100 p e r s o n s  i n the under  (Greater Vancouver Regional D i s t r i c t , 40 % o f t h e of  h e a l t h care  age a n d o l d e r  65 age  1993, p .  51 category  10).  s e r v i c e s are used by persons  (Neufield,  1991, p .  235).  I n Canada, 65  years  These i n d i v i d u a l s  f r e q u e n t l y undergo e v a l u a t i o n s and t r e a t m e n t by a v a r i e t y o f m e d i c a l and s u p p o r t i v e p r o f e s s i o n a l s geriatric workers,  specialists,  nurses,  such as:  s o c i a l workers, p a s t o r a l  dieticians, physiotherapists,  therapists,  speech t h e r a p i s t s  professionals,  physicians,  occupational  and r e c r e a t i o n t h e r a p i s t s .  f r e q u e n t l y w o r k as p a r t  o f an  These  multidisciplinary  team t o p r o v i d e r e h a b i l i t a t i o n s e r v i c e s t o o l d e r  Rehabilitation  care  adults.  Services  According to McLellan  (1992general  s e r v i c e s perform a v a r i e t y of functions,  rehabilitation  which i n c l u d e :  (1) a s s e s s m e n t s o f p e r s o n s w i t h a d i s a b i l i t y t o i d e n t i f y s e l f - p e r c e i v e d o b j e c t i v e s and n e e d s ; (2) t h e i d e n t i f i c a t i o n o f o b j e c t i v e s a n d n e e d s o f d i s a b l e d i n d i v i d u a l s and t h e e s t a b l i s h m e n t o f p r i o r i t i e s f o r h e a l t h maintenance; (3) t h e i d e n t i f i c a t i o n o f l i k e l y o u t c o m e s r e l a t e d t o h e a l t h a n d d i s a b i l i t y i f t h e r e i s no i n t e r v e n t i o n ; (4) t h e a s s e s s m e n t o f t h e i n d i v i d u a l ' s p o t e n t i a l t o o b t a i n new s k i l l s , r e s p o n d t o a s p e c i f i c f o r m o f t h e r a p y o r t r e a t m e n t , and t h e l i k e l y r e s u l t o f s u c h t h e r a p y , o r treatment; (5) t h e n e e d f o r a d a p t i v e e q u i p m e n t o r m o d i f i c a t i o n o f t h e p h y s i c a l e n v i r o n m e n t . The a s s e s s m e n t o f o t h e r p e r t i n e n t e n v i r o n m e n t s , s u c h as t h e w o r k p l a c e o r l e i s u r e time, are a l s o e s s e n t i a l to the o v e r a l l assessment process.  5 (6)  the  implementation of the  plan;  (7) a s s i s t a n c e i n t h e h o s t c o m m u n i t y t h r o u g h e d u c a t i o n and p l a n n i n g o f h e a l t h p r o m o t i o n and d i s a b i l i t y a w a r e n e s s a c t i v i t i e s ( M c L e l l a n , 1 9 9 2 , p . 56.) . Therapeutic  recreation  services,  as a component  of  r e h a b i l i t a t i o n program,  p e r f o r m t h e s e same f u n c t i o n s .  as Lyons  has  (1993, p .  problem w i t h recreation contends  the  there i s  " i n t r o d u c i n g the n o t i o n of  that  "often  department  there i s resistance  has  al.,  1993, p .  responsible  to the  recreation  258). At St.  for therapeutic  e q u a l s t a t u s among t h e  departments i n v o l v e d i n the therapists,  other  Paul's  patient  physiotherapists,  speech  dieticians,  and p h a r m a c i s t s  have a n i m p o r t a n t  their patients'  care.  language  unfamiliar  w i t h the  society,  and o t h e r  staff  r o l e of r e c r e a t i o n  which frequently  well-being"  (Neulinger,  i n our  Hospital,  services  and m i s s i t s 1981).  The  pathologists, contribution  members who  therapy.  the  are  In a work-  r e l i e s h e a v i l y on  potential  to  have  legitimacy of  m e d i c a l model o f h e a l t h care p r o v i s i o n , "people l e i s u r e and r e c r e a t i o n  that  occupational  However, t h e r e  o c c a s i o n a l l y been problems e s t a b l i s h i n g the s e r v i c e w i t h some p a t i e n t s  She  r e h a b i l i t a t i o n of p a t i e n t s .  nurses,  a  recreation  s o c i a l workers,  make t o w a r d s  idea  functions  therapists,  oriented  sometimes  (therapeutic)  and l e i s u r e p e r f o r m s u b s t a n t i v e  (Lyons et  services,  indicated,  However  as a l e g i t i m a t e r e h a b i l i t a t i o n s e r v i c e . . . " .  recreation lives"  258)  the  the  undervalue  for  increasing  6 Resources Many o f t h e  h e a l t h care  resources,  although designed  to  a d d r e s s t h e p h y s i c a l and mental h e a l t h o f o l d e r a d u l t s ,  do  address s p e c i f i c issues  life,  life  satisfaction,  s u c h as l o n e l i n e s s ,  q u a l i t y of  and the u t i l i z a t i o n o f l e i s u r e .  Services  w h i c h f o c u s on the  i n d i v i d u a l ' s awareness and u t i l i z a t i o n  l e i s u r e resources,  a l t h o u g h r e l a t i v e l y new t o t h e  system, i n the  are  becoming w i d e l y r e c o g n i z e d f o r the  r e h a b i l i t a t i o n of the g e r i a t r i c  Keller,  care  r o l e they  play  community  when t h e y l e a v e t h e h o s p i t a l s e t t i n g literature  Core S e r v i c e s Report,  Boyce,  (Riddick &  1991).  been c i t e d i n the 1983;  of  health  The n e e d f o r a d d i t i o n a l c o m m u n i t y s u p p o r t s adults  not  1993).  (Biette,  has  Matthews,  1994; O ' N e i l l  However, h o s p i t a l - b a s e d  British  & Schwenger,  recreation  ( B u l l o c k & Howe, 1 9 9 1 ) . A r e c e n t  1991; Peat & therapists  home-based  survey of  larger  C o l u m b i a H o s p i t a l s and r e h a b i l i t a t i o n f a c i l i t i e s  indicated that  therapeutic  recreation  seldom f o l l o w e d through to support discharge  i n t o the  services,  when p r e s e n t ,  clients after  community ( G a l l a n t ,  1993).  their  Of t h e  surveys returned  from h o s p i t a l s  Gallant's  o n l y two r e s p o n d e n t s i n d i c a t e d t h a t  study,  c o n s i s t e d o f v i s i t s t o the  in clients'  clients'  residences  16  and r e h a b i l i t a t i o n c e n t r e s  in  follow-up  home.  Through the p r o v i s i o n of outreach services  older  frequently  & Reid,  have t y p i c a l l y not been i n v o l v e d i n o u t r e a c h , services  for  therapeutic  and i n t h e i r  recreation  community,  7 recreation  therapists  meet t h e i r  clients'  d e s i r e d by the include:  c a n w o r k o n a more e x t e n d e d b a s i s  goals.  G o a l s w h i c h have b e e n  c l i e n t s and t h e p r o f e s s i o n a l s  facilitating integration  i n c r e a s i n g awareness of s e l f socialization, in life  and,  satisfaction  Steinkamp & K e l l e y , recreation future  most  i n t o the  through l e i s u r e 1987).  for such  will  services  community,  an o v e r a l l (O'Neill  The f u t u r e  as a h e a l t h r e s o u r c e  d i r e c t i o n of h e a l t h  frequently  as a l e i s u r e r e s o u r c e ,  importantly,  to  improvement  & Reid,  of outreach depend,  increasing  1991;  therapeutic  in part,  on  the  care.  New D i r e c t i o n s i n H e a l t h C a r e H e a l t h p o l i c i e s of the maintaining people's and i n t h e  are  l i k e l y t o f o c u s more o n  h e a l t h a n d k e e p i n g them o u t o f  c o m m u n i t y . The P r o v i n c i a l Government o f  Columbia has on t h e  1990's  hospitals British  e s t a b l i s h e d new p r i o r i t i e s f o r h e a l t h c a r e  recommendations  of the  and C o s t s . T h e s e p r i o r i t i e s  based  R o y a l C o m m i s s i o n on H e a l t h C a r e  include:  1.  Whenever a p p r o p r i a t e , d e l i v e r h e a l t h s e r v i c e s c l o s e t o home a s p o s s i b l e i n s t e a d o f i n hospital.  2.  Make t h e p r o m o t i o n o f g o o d h e a l t h a n d t h e p r e v e n t i o n o f i l l n e s s a n d i n j u r y a m a j o r new emphasis o f government p o l i c y .  3.  Give p r i o r i t y a t t e n t i o n to removing o b s t a c l e s t h a t now r e s u l t i n some B r i t i s h C o l u m b i a n s f a l l i n g through the c r a c k s i n our system ( B r i t i s h Columbia R o y a l C o m m i s s i o n on H e a l t h C a r e a n d C o s t s [BCRCHCC], 1991) .  These p r i o r i t i e s f u r t h e r  support  the need  for  as  8 therapeutic to  recreation practitioners  individuals in their  t o become more  c o m m u n i t i e s . The p r o m o t i o n o f g o o d  h e a l t h t h r o u g h l e i s u r e and o u t r e a c h s e e k i n g ways t o remove b a r r i e r s reflect  the  to  education, leisure,  o v e r a l l new d i r e c t i o n i n h e a l t h  L e i s u r e and L i f e  responsive  which  includes  seems t o  be  care.  Satisfaction  A number o f r e s e a r c h e r s h a v e f o u n d c o r r e l a t i o n s leisure 1989). for  the  satisfaction.and  contention that  (Gilbert,  support  1992; S e a r l e  & Mahon,  literature  participation  (Brown,  Regarding l i f e  satisfaction  becoming  are  areas of l i f e  life  (Mobily,  sessions,  knowledge and s k i l l s  general  happier,  ( D a t i l l o & Murphy,  i n general,  1984).  can a t t a i n  and a p o t e n t i a l  not  leads  satisfied  leisure  awareness,  t o new l e i s u r e  increased  1991) .  some d e g r e e o f  Through p a r t i c i p a t i o n i n  i n d i v i d u a l s ' increased often  with  s a t i s f a c t i o n w h i c h may  i n w h i c h i n d i v i d u a l s , who a r e  o r happy w i t h t h e i r  in  a n d b e c o m i n g more s a t i s f i e d  be ' ' i n f l u e n c e d b y ^ l e i s u r e e d u c a t i o n L e i s u r e i s an a r e a  in  recreation  t o an i n c r e a s e  as more m e a n i n g f u l ,  contacts  increase  F r a n k e l & F e n n e l l , 1991) .  having higher self-esteem, one's social  adults  1993) . A p o t e n t i a l  can a l s o c o n t r i b u t e  satisfaction  interests,  i n the  leisure or recreation  s a t i s f a c t i o n through therapeutic  education  (Purcell & Keller,  to the p s y c h o l o g i c a l h e a l t h of o l d e r  intervention, life  satisfaction  T h e r e was a l s o c o n s i d e r a b l e  contributes  leisure  life  between  insights,  satisfaction within  their  9 leisure  (Riddick & K e l l e r ,  Wilhite,  1991; S e a r l e  & Iso-Ahola,  1988;  1992).  L e i s u r e E d u c a t i o n and L e i s u r e C o u n s e l l i n g There are leisure  education  therapeutic Datillo  and l e i s u r e  recreation  practitioners  each i n d i v i d u a l recreation  client,  the  professional,  or service provider.  clients,  values  and t h e  the  clients'  last  personal decreased  and r e s o u r c e s  the  manner,  future  According to Mobily  It  leisure (1984),  Increased  to affect  freedom o f leisure to  the  may be one o f exhibit on  services,  traditional  older adults'  c r u c i a l that  a n d c o u n s e l l i n g a p p r o a c h be a d o p t e d  their  recreation  and a l a c k o f c h o i c e i n t h e  is therefore  Counselling  t o t a k e more c o n t r o l o f  dependency  satisfaction.  exhibit  i s one m e t h o d o f  c o n t r o l and c h o i c e .  likely  the  particular  able  m e d i c a l system are  of  organization  areas e l d e r l y ' i n d i v i d u a l s are  health,  therapist  involvement i n l e i s u r e .  i s a n o t h e r method u t i l i z e d by  t h e r a p i s t s t o promote individual.  p o l i c i e s of the  1980;  Kurtz &  and i d e a l o g y o f  P r o v i d i n g i n f o r m a t i o n on  i n a supportive  own l e i s u r e  the  1983; Whittman,  needs and c h a r a c t e r i s t i c s  community f a c i l i t i e s , programs, facilitating  to  (Allen & Hamilton,  1987) . The s p e c i f i c a p p r o a c h u s e d b y t h e  depend on the p a r t i c u l a r  models of  counselling available  & Murphy, 1991; McDowell,  Nichols, will  a v a r i e t y o f w e l l - k n o w n and a c c e p t e d  life  a leisure  to encourage  education  clients  some d e g r e e o f c h o i c e a n d c o n t r o l i n t h e i r  lives.  to  10 L e i s u r e e d u c a t i o n and c o u n s e l l i n g a r e by  recreation  therapists  established goals. frequently clients'  to f a c i l i t a t e  typically  c l i e n t progress  Goal s e t t i n g w i t h i n t h i s  done w i t h i n p u t . f r o m t h e  context  clients.  satisfaction,  increased  which i s l i n k e d to o v e r a l l l i f e  ( D a t i l l o & Murphy,  1991; K e l l y ,  Steinkamp & K e l l y ,  1987).  towards  is  Increasing  awareness of l e i s u r e through e d u c a t i o n  c o u n s e l l i n g i s designed to lead to  utilized  the  and  leisure satisfaction  Sainsbury & Bruce,  1994;  11 Problem  Statement  of  the  This study involvement (T.R.O.P.)  Research  Problem examined the  in had  the for  Therapeutic eight  meaning t h a t  Recreation  recently  leisure  Outreach  hospitalized older  and  Program adults.  Questions  . The i n v e s t i g a t o r benefits  of  constraints adults.  subjective  leisure, to  Also,  positive  given that  relationship the  participants'  1. How. d i d o l d e r  and  previous  questions  studies  describe  adults  feel  of  have  older found  life  in  the  As a r e s u l t ,  the  formulated. the  benefits  of  leisure? 2.  How d i d o l d e r benefit  3.  from  What w e r e  self-perceived  towards  enjoyment  4.  What w e r e  the  leisure  5.  What  the  self-perceived  were  participants interests?  they  benefitted/did  not  T.R.O.P.?  the  contributed  that  from  facilitating of  interests  factors  which  leisure? of  the  participants?  constraints  achieving their  leisure  which goals  a  and  interested  relationship.  adults  enjoyment,  satisfaction  was  were  perceived  satisfaction  leisure  this  leisure  research  investigator of  of  leisure  between  perception  research  i n d e s c r i b i n g the  facilitators  leisure,  satisfaction,  following  was i n t e r e s t e d  prevented and  12 6.  What w e r e t h e p e r c e i v e d r e l a t i o n s h i p s b e t w e e n satisfaction  and l i f e  s a t i s f a c t i o n among  7 . What a d d i t i o n a l u n a n t i c i p a t e d  factors  leisure  participants?  warrant  further  e x p l o r a t i o n and i m p a c t e d upon the p a r t i c i p a n t s ' leisure  satisfaction,  and l i f e  leisure,  satisfaction?  Definitions The t e r m  Leisure:  "leisure"  has  been  conceptualized  number o f w a y s . The t e r m ' s m e a n i n g has b e e n f r e q u e n t l y and  debated  contain  some  subjective 1994) . free  in  reference  Defining is  experiences  (Dattilo  the  and  and  role  a  in  and  Definitions  non-obligatory sense  terms  limiting  of  Murphy,  of  they The  which prevent  leisure,  or t h e i r  (Lee  recreation  These  or l i m i t  et  al. ,  activity  not  focus  investigator  leisure  because  services.  refer  to  has it  or  3).  self-perceived  the p a r t i c i p a n t s '  attainment of l e i s u r e goals  on  perception  1991, p . the  or  Leisure  i n meaningful, enjoyable,  ( D a t t i l o and M u r p h y ,  Constraints:  barriers  do  often  activities,  "a s t a t e o f mind i n v o l v i n g t h e  experiences"  Leisure  freedom  1991) .  therapeutic  and  a  discussed  leisure  recreational  because  freedom t o choose t o p a r t i c i p a t e  satisfying  of  of  time  Murphy's d e f i n i t i o n of  was c o n c e p t u a l i z e d as of  to  leisure too  Datillo  reflects  literature.  experiences  time  chosen  the  in  enjoyment  (Jackson,  of  1990) .  Leisure Counselling: a p r o b l e m - c e n t r e d f a c i l i t a t i o n p r o c e s s w h i c h may be v i e w e d a s  a subset  counselling  individuals  assists  of  leisure with  education. problem  Leisure solving,  13 decision-making, interests, Joswiak,  and c o n f l i c t  awareness,  values,  with opportunities in  those  to  is  Leisure  leisure  (Chinn  &  provide  the  awareness,  knowledge,  leisure  Leisure  present,  interests  regarding  to l e i s u r e  Satisfaction: life  as  or future  leisure  health,  contacts  (Beard & Ragheb, taking  pleasure goodness  p o s i t i v e mood t o n e , financial  security,  (Salamon & C o n t e ,  in  preferences.  of  fit  and  purpose  e x p r e s s i o n o f an a p p r o p r i a t e physical,  (National Yermalkoff,  mental,  Therapeutic 1983) .  the  self-concept,  o f age  development,  leisure  emotional  Recreation  desired  with  1984).  The  facilitate  activities,  satisfaction  Therapeutic to  are  situations  between  positive  55 y e a r s  Recreation:  and  daily  age  is  the  1980).  Older A d u l t : a n i n d i v i d u a l  recreation  to  degree to which i n d i v i d u a l s  meaningful,  and a c h i e v e d g o a l s , perceived  and  involvement  refer  or pleased with t h e i r general experiences  Life  individual  1991).  past,  as t h e y r e l a t e  with  to  facilitate  Leisure Satisfaction: the  social  opportunities  their  which  Interests:  participants'  designed  increase  areas  ( D a t t i l o & Murphy,  content  and  with regard to  1981) .  Leisure Education:  skills  management  of  and  above.  therapeutic  maintenance,  and  l i f e s t y l e for individuals and  social  Society,  1982;  limitations Schleien  and  14 Therapeutic outpatient residence  based or  in  Recreation program, a  Outreach  which  community  Program  takes  based  set  of  Support:  "the  interaction  persons, m o b i l i z e d  (Rubenstein et  al.  1994,  p.  or 62).  in  recreational  o p p o s e d t o a more t r a d i t i o n a l i n p a t i e n t Social  place  (T.R.O.P.):  relied  based or on  the  client's  setting,  as  program.  non-interaction in  an  special  of  a  times"  15 CHAPTER TWO Review of the  Literature  C h a r a c t e r i s t i c s of L e i s u r e Numerous a u t h o r s have a t t e m p t e d characteristics recent  shift  towards about  of the  leisure experience.  leisure  the  (Lee e t  subjective  a l . , 1994).  l e i s u r e have emphasized the (Hultsman, B l a c k ,  Lee et of  leisure  and f u n , Kelly,  al.  (1994,  p.  Steinkamp & K e l l y  than a time f i l l e r  Seehafer  (1987)  L e i s u r e i s an i m p o r t a n t  to  elements:  because i t  factor  own s e l f - d e v e l o p m e n t  t o meet t h e i r  24).  Through l e i s u r e ,  more  generally  coping  the  affairs potential  has  needs  d e m o n s t r a t e r e s p o n s i b i l i t y and c o n t r o l i n t h e i r 1989, p .  is  and community  i n d u c e a sense o f r e s p o n s i b i l i t y and c o n t r o l ,  & Keller,  is  consistently  L e i s u r e , w h i c h has  for older adults  choice.  r o l e s , and  i n the  e s p e c i a l l y f o r t h o s e who h a v e b e e n  opportunities  nature enjoyment  leisure  patterns of people's  a l . , 1987, p . 1 1 4 ) .  1987) .  subjective  concur that  resources.  ( K e l l y et  have  past views of  c o n d i t i o n o f freedom o f  i n t o the  involved i n their  people  and H o v e l l ,  d e f i n e d the  integrated  process,  In contrast,  f o r an empty l i f e , life  a  a c t i v i t y or s t a t e of mind  202)  and the  been  professionals  perspectives  i n r e l a t i o n to three prominent  relaxation,  the  There has  i n the o r i e n t a t i o n of l e i s u r e  understanding  approaches  to understand  provided  to  lives  (Purcell  older adults  c a n meet  t h e s e n e e d s b y a v a r i e t y o f means a n d p e r s o n a l  choices.  For  16 example,  m e r e l y c h o o s i n g what s p e c i f i c f o r m o f l e i s u r e  pursue,  who t o p u r s u e i t w i t h ,  exercises  al.  (1994)  contend t h a t  by v a r i o u s  forms o f e x p e r i e n c e ,  unpleasant  ones.  older adults,  Informants  leisure  in their  frustration,  study,  or  w h i c h i n c l u d e d two  Zuzanek,  recalled  nervousness,  al.,  1994,  and L a r s o n (1988)  w h i c h were f r e e l y c h o s e n .  also  a n d g u i l t when a s k e d t o  (Lee e t  l e i s u r e " to refer  individual  characterized  including stressful  apprehension,  experiences  Mannell,  more e f f o r t ,  is  F o r example p a r t i c i p a n t s  of exhaustion,  disappointment,  "serious  leisure  d i d not v i e w l e i s u r e as c o n s i s t i n g e n t i r e l y o f  p o s i t i v e experiences.  their  it,  o n e ' s a b i l i t y t o make c h o i c e s .  Lee e t  feelings  a n d when t o p u r s u e  to  p.  203) .  used the  term  to e x t e r n a l l y motivated "Serious l e i s u r e "  more  activities  appears to  commitment and o b l i g a t i o n o n b e h a l f  r a t h e r than f r e e l y chosen,  discuss  of  require  the  intrinsically  motivated a c t i v i t i e s . "Being at  leisure"  forms o f e x p e r i e n c e s experiences  are  recreational  the  i s often  attained  through  ( B a l l a n t y n e , 1987) . T h e s e result  a c t i v i t y w h i c h may be s o c i a l ,  of  ( B a l l a n t y n e , 1987, pp.  the  "experience"  intellectual,  1-2).  of l e i s u r e ,  grouped i n t o categories spectator,  recreational  o f p a r t i c i p a t i n g i n some f o r m o f physical,  o r i n t e l l e c t u a l i n n a t u r e and w h i c h t a k e s p l a c e time  recreational  such as:  To e m p h a s i z e  a c t i v i t i e s are social,  and s o l i t a r y  creative  i n our the  leisure  importance  commonly  physical,  (Ballantyne,  creative, 1987) . From  17 a leisure  education perspective,  individuals experience  Leisure  i s important  t o be e x p o s e d t o a b a l a n c e category  for  of a c t i v i t i e s  (see A p p e n d i x One f o r  S a t i s f a c t i o n and L i f e  remarked t h a t  and s a t i s f y i n g l e i s u r e Russell  the  i s a major  (1987)  achievement  aged  60 y e a r s a n d o v e r r e s i d i n g i n a g e - s e g r e g a t e d found t h a t o l d e r a d u l t s '  studied r e t i r e d  satisfaction  with  frequency  of p a r t i c i p a t i o n i n recreation  significantly  related  T h i s and o t h e r recreation than 1982;  to  studies  and l e i s u r e  life  recreation  Keller,  have m a i n t a i n e d t h a t  leisure  c o n t r i b u t i o n of the v a r i a b l e s satisfaction  satisfaction life  (1991)  not  1987).  satisfaction  with  satisfaction  (Ragheb a n d  examined  and h a p p i n e s s  T h e i r study,  sample o f o l d e r a d u l t s ,  predicting  the  (Russell,  c o n t r i b u t e d more t o l i f e  F r a n k e l and F e n n e l l  w e l l - b e i n g of adults.  leisure  that  Griffith,  1983).  r e l a t i o n s h i p between  and l e i s u r e  life  a c t i v i t i e s was  satisfaction  d i d a c t i v i t y p a r t i c i p a t i o n p e r se  Brown,  large  same s t u d y r e v e a l e d  persons  situations.  had a s i g n i f i c a n t p o s i t i v e r e l a t i o n s h i p w i t h t h e i r However, t h i s  of  developmental  for older adults.  satisfaction.  each  examples).  task  Russell  from  Satisfaction  Munson a n d Munson (1986) meaningful  it  the  or psychological  which also contained  d e s c r i b e d the of l e i s u r e  relative  activity,  age,  t o w e l l - b e i n g . They c o n c l u d e d  i s t h e most  satisfaction  important  (Brown e t  al.,  a  variable 1991, p .  gender that  in 369).  18 The L e i s u r e I n t e r e s t s o f O l d e r A number o f r e c e n t leisure  Adults  studies  have i d e n t i f i e d  i n v o l v e m e n t s among o l d e r a d u l t s .  Carpenter  (1994),  patterns of  Patterson  and  i n t h e i r r e s e a r c h on o l d e r a d u l t s who w e r e  widows and w i d o w e r s , f o u n d t h a t  t h e most p o p u l a r  activities  "home-based a c t i v i t i e s s u c h as  reading,  o f o l d e r p e o p l e were  w a t c h i n g TV, g a r d e n i n g ,  f a m i l y and f r i e n d s "  (Patterson  hobbies,  leisure  and s o c i a l i z i n g  & Carpenter,  1994, p .  V e r y few o f t h e most p o p u l a r a c t i v i t i e s were  114) .  agency-dependent.  T h i s s u g g e s t s t h a t what m a t t e r e d most t o o l d e r a d u l t s involvements with family, health,  pleasant  (Patterson  & Carpenter,  and R e i d  a c t i v i t i e s o f 199 h e a l t h y ,  i n a M o n t r e a l b a s e d s t u d y were calisthenics,  were  physical  and fun and  enjoyment  1994) .  According to O ' N e i l l physical  surroundings,  relaxation, being with others,  with  (1991),  top  ranked  a d u l t s over the  "walking,  b o w l i n g and dance"  the  (O'Neill  age o f 5 5 ,  swimming, and R e i d ,  1991,  p.  395) . M a c N e i l a n d Teague  (1987)  n o t e d t h a t as age  t h e r e i s a t r e n d away f r o m a c t i v i t i e s w h i c h a r e  increases physically  e x e r t i n g a n d t o o k p l a c e o u t s i d e o f t h e home t o w a r d a c t i v i t i e s , to a c t i v i t i e s that home-centred and C a r p e n t e r  are  l e s s p h y s i c a l l y d e m a n d i n g a n d more  (MacNeil & Teague, (1994, p .  107)  1987). S i m i l a r l y ,  found t h a t the  leisure a c t i v i t i e s for older adults and i n f o r m a l  Patterson  core of  lifetime  of r e l a t i v e l y a c c e s s i b l e  l e i s u r e a c t i v i t i e s , s u c h as  "conversations i n  the  19 household,  reading,  watching t e l e v i s i o n , walking,  (Patterson  & Carpenter,  1994,  p.  107).  The s o c i a l  gained through l e i s u r e p a r t i c i p a t i o n are beneficial elderly  to the maintenance  (Patterson  a. common e l e m e n t  leisure  (Sneegas,  1989, p .  30).  Yet,  K e l l y et  al.  interests  and s o c i a l  1994).  resources  190)  interactions  noted that  interests  t o s e e k n o v e l t y t h r o u g h new  as one a d v a n c e s  i n age  is  range of  becomes  They c o n t e n d  c h o i c e " . There  the  adults"  the  f o r many o l d e r  "reduced m o b i l i t y and  r a t h e r than a personal  d e c l i n i n g tendency  be  interaction  l i f e s t y l e o f most  (1987, p .  r e d u c t i o n i s due t o  believed to  "Social  s m a l l e r and s m a l l e r w i t h i n c r e a s i n g age. this  experiences  o f p o s i t i v e m o r a l e among  & Carpenter,  of the  shopping"  that  social is also  a  leisure  ( I s o - A h o l a , J a c k s o n & Dunn,  1994) . In  contrast,  it  has b e e n s u g g e s t e d  l e i s u r e which c o n s i s t s s o c i a l l y acceptable  of w o r k - l i k e q u a l i t i e s are  than the  experiences  e x a m p l e s o f t h e s e more s o c i a l l y a c c e p t e d i n c l u d e d l e i s u r e t h a t : was s e r i o u s , high standards, excellence  required s k i l l ,  (Argyle,  Constraints O'Neill  to  by A r g y l e  (1992) more  c i t e d above. forms o f  Argyle's  leisure  was o f u s e t o o t h e r s ,  and l e a d t o the  that  met  r e c o g n i t i o n of  1992).  Leisure  and R e i d  perceived barriers  (1991)  found t h a t  the  number o f  to p h y s i c a l a c t i v i t y for older adults  was  20 significantly  r e l a t e d t o age a n d i l l n e s s o r h a n d i c a p .  The  p r i m a r y b a r r i e r t o p h y s i c a l a c t i v i t y was k n o w l e d g e b a s e d ,  and  may h a v e r e p r e s e n t e d  lack  of  knowledge about  older adult,  either  the  attitude  toward or  e x e r c i s e and l e i s u r e e x p e r i e n c e .  frequently  the  such  life  data  from  constraints.  Hayward and Agwani  (1991)  analyzed the  H e a l t h and A c t i v i t y L i m i t a t i o n S u r v e y and t h e  Social  For  l i v i n g a l o n e i n t h e i r home,  e v e n t s may m a g n i f y l e i s u r e Forbes,  a negative  General  S u r v e y . B o t h o f t h e s e C a n a d i a n s u r v e y s were u s e d  estimate  the p r e v a l e n c e of v a r i o u s mental,  agility,  to  mobility,  sight  a n d h e a r i n g i m p a i r m e n t s i n t h e o l d e r p o p u l a t i o n . The  risks  f o r i m p a i r m e n t s was e s t i m a t e d b a s e d o n i n c o m e ,  status,  housing tenure,  revealed that  low income a p p e a r e d  on s e l f - r e p o r t e d the  and l i v i n g arrangements.  marital  The s u r v e y  t o have t h e g r e a t e s t  impact  i m p a i r m e n t s among o l d e r p e o p l e r e s i d i n g i n  community. M a n n e l l and Z u z a n e k  (1991, p .  frequently reported constraint adults  was " b e i n g t o o b u s y " .  stereotypes of o l d e r adults  reported  b y 92 a c t i v e o l d e r  that  the  as b e i n g i s o l a t e d and  In fact  their  a  d i s c r e p a n c y b e t w e e n what t h e y a c t u a l l y do a n d w o u l d l i k e do.  Leisure constraints  research reveals  that  to  a lack of  k n o w l e d g e r e g a r d i n g where t o l e a r n a s p e c i f i c a c t i v i t y , to participate  the  idle.  are not able to spend there i s frequently  most  retired  T h i s f i n d i n g was c o n t r a r y t o  A number o f o l d e r a d u l t s l e i s u r e as t h e y w i s h .  346)  i n an a c t i v i t y , and l a c k o f a p a r t n e r  where  w i t h whom  21 to p a r t i c i p a t e ,  have a s i g n i f i c a n t l y  constraining effect  upon  ( S e a r l e and Mahon,  1993).  l e i s u r e b e h a v i o u r among o l d e r a d u l t s Jackson  (1990)  refers  to  "antecedent c o n s t r a i n t s "  another  form o f l e i s u r e c o n s t r a i n t .  reflect  "a m o d i f i c a t i o n o f a n i n d i v i d u a l ' s p r e f e r e n c e s  than a general constraints facilities 1990,  p.  constraints  Examples of such  antecedent  i n a given area,  or family circumstances  (1994, p .  14)  discusses  potential constraint. i s common, i t  age s p e c i f i c l a b e l l i n g  He c o n t e n d s  "serves  members o f s o c i e t y " . W h i l e t h e  frail  population"  t h a t n e e d s t o be t r e a t e d  in general,  are not  constraint  that  as a d e t e r r e n t  b e i n g u n i v e r s a l l y a c c e p t e d as v i b r a n t ,  t h a t program. Older a d u l t s  welfare/social  separately, 14). A  older  Health Status  adults  further  hesitancy to  become  due t o a n i n c r e a s e d  s e r v i c e s t i g m a w h i c h may be a t t a c h e d  (Heywood, 1994,  adults  contributing  are becoming r e l u c t a n t  c o m m u n i t y s e r v i c e s o f any k i n d ,  type of  to older  active,  as  e l d e r l y may be a " s p e c i a l  (Heywood, 1 9 9 4 , p .  may be t h e o l d e r a d u l t s '  this  i n v o l v e d i n s p e c i f i c p r o g r a m s due t o t h e i r n e g a t i v e  centres  (Jackson,  67) .  labelling  of  rather  include sex-role s o c i a l i z a t i o n , a c c e s s i b i l i t y of  Heywood another  lack of i n t e r e s t " .  Antecedent  as  perception to  use  social to  the  p.16).  of Older Adults  This section reflects  some o f t h e most common h e a l t h  problems  e x p e r i e n c e d by the o l d e r a d u l t p o p u l a t i o n . T h i s i s not  to  say  22 t h a t most o l d e r a d u l t s majority  experience  of older adults  c o n d i t i o n and l i v e  these problems.  fairly  Canada,  a c t i v e community l i v e s ,  the  (1994,  problem of greatest  population".  this  with, d i s a b i l i t i e s  p.  549)  stated that  frequency  has b e e n e s t i m a t e d  that  r e s i d i n g i n the  community, between  10 a n d 25% h a v e  diagnosed depression. w i t h age  decreasing  social  In p a r t i c u l a r ,  the  with depression  F e e l i n g s o f l o n e l i n e s s can p r e d i s p o s e physical  and m e n t a l h e a l t h problems  Mintzer,  1994) .  Two o r t h o p a e d i c  the  of  the  of a l l persons  functioning problems.  for  or  stressors  toward  ( R u b i n s t e i n , Lubben &  (1988)  65 s u f f e r  R i d d i c k and K e l l e r  and r e s t o r a t i o n  to  loneliness.  ( R i d d i c k and K e l l e r ,  o v e r age  and  have been f o u n d  and  l e i s u r e e d u c a t i o n programs  maintenance  clinically  and  a l s o common p h y s i c a l h e a l t h p r o b l e m s  chronic a r t h r i t i s .  suggest that  aged  adults  e l d e r l y persons  Center for Health S t a t i s t i c s  nearly half  losses  d i s a b i l i t i e s , osteoporosis  g e r i a t r i c population  National  among o l d e r  and economic r e s o u r c e s )  are  i n the  ( s u c h as w i d o w h o o d , d e c l i n i n g h e a l t h ,  be s t r o n g l y a s s o c i a t e d  osteoarthritis,  depression  and magnitude  It  associated  also  1988).  E b e r s o l e and Hess is  the  aged 65 a n d o l d e r h a v e no d i s a b l i n g  i n c l u d e s a l a r g e number o f s e n i o r s (Statistics  In fact  1991).  The  reported,  that  f r o m some  (1991, p .  in  form  154)  have a r o l e t o p l a y i n  of muscular h e a l t h  i n d i v i d u a l s w i t h t h e s e and o t h e r  and  orthopaedic  23 Chronic i l l n e s s e s degrees adults  (Verbrugge, experience  frequency,  There are  most o l d e r a d u l t s  Lepkowski,  episodes  progress  (Hickey-Stilwell,  affect  and Imanaka,  of i l l n e s s , with  towards  1992, p .  improvement  of  disease  p.  2).  It  obvious differences  s t r a t e g i e s which are and a t t i t u d e s .  increasing slowed  between o l d e r  adults'  acute  illnesses  a m u l t i - d i m e n s i o n a l approach to the  important  (Hickey & S t i l w e l l ,  t o d e v e l o p and c u s t o m i z e  consistent  management  w i t h the  time  individual's beliefs  This i s e s p e c i a l l y important  (Hickey & S t i l w e l l ,  1992, p .  1992,  treatment  i f adherence  t r e a t m e n t r e g i m e n i s t o be m a i n t a i n e d o v e r a n e x t e n d e d of  older  1).  and o v e r a l l h e a l t h c a r e is  1989) . Where  i s often  e x p e r i e n c e s , o f c h r o n i c c o n d i t i o n s and t h e i r which require  to varying  to  a  period  2).  Implications of Health Older adults age,  i s the  19 9 4 , p .  are  like  other people,  determining factor  12).  34 0 s u b j e c t s  i n that health,  of t h e i r  differences  Based upon a C a n a d i a n r e s e a r c h a g e d 55 a n d a b o v e ,  study  not  (Heywood, involving  i t was d e m o n s t r a t e d  that  participants'  h e a l t h had a d i r e c t p o s i t i v e e f f e c t  participation  i n l e i s u r e a n d t h e number o f a c t i v i t i e s i n w h i c h  they p a r t i c i p a t e d  (Searle  H i c k e y and S t i l w e l l status,  & Iso-Ahola, (1992)  w h i c h were a t t r i b u t e d  1988).  referred  to age.  on r a t e o f  to changes  in  They s t a t e d t h a t  i m p a c t o f i l l n e s s a n d d i s a b i l i t y on p e o p l e ' s  personal  health the autonomy  24 and l i f e - s t y l e , r e p r e s e n t e d  a significant challenge  older people  and h e a l t h c a r e p r o f e s s i o n a l s  1992,  However, S a i n s b u r y and Bruce  p.  1).  older adults life  who p a r t i c i p a t e d  satisfaction  in spite  accomplished w i t h the  in their  which included therapeutic  (1994)  problems.  that improved  health.  T h i s was  o f a m u l t i d i s c i p l i n a r y team,  recreation. importance  r e d u c t i o n of s p e c i f i c  R i d d i c k and K e l l e r  r e c r e a t i o n programs  found  study reported  A number o f a u t h o r s have e m p h a s i z e d t h e l e i s u r e e d u c a t i o n i n the  both  (Hickey-Stilwell,  of poor or f a i l i n g  assistance  for  (1991)  stressed  s h o u l d be d e s i g n e d  of  health-related  that  therapeutic  to:  s t r e s s l e i s u r e e d u c a t i o n , e x e r c i s e , and r e l a x a t i o n i n o r d e r . t o reduce the r i s k of c a r d i o v a s c u l a r and c e r e b r o v a s c u l a r d i s e a s e s and i l l n e s s e s i n g e r i a t r i c p o p u l a t i o n s ( R i d d i c k a n d . K e l l e r , 1991, p . 1 5 4 ) . O t h e r a u t h o r s see recreation living that  therapists.  after  N i s s e n a n d Newman (1992)  therapists  assisting patients  avenues  for  In d i s c u s s i n g r e i n t e g r a t i o n  amputation,  recreation  experiences,  additional related  to  find  may n e e d t o s p e n d more acceptable,  o r some a d a p t i v e  to  recognized time  alternative  means t o c o n t i n u e  normal  recreation  their  previous  interests. It  has been n o t e d t h a t  depression in  often  require  leisure pursuits,  socialization  individuals suffering  h e l p l e a r n i n g how t o e n j o y  learning relaxation,  ( R i d d i c k and K e l l e r ,  and  1991, p .  also obvious ramifications for addressing g e r i a t r i c populations,  from themselves  learning  155).  There  loneliness  in  are the  t h r o u g h the p r o m o t i o n and f a c i l i t a t i o n  25 of  socialization opportunities  therapeutic  through l e i s u r e education  r e c r e a t i o n programs  ( R i d d i c k and K e l l e r ,  As t h e r e i s an a p p a r e n t l a c k o f l i t e r a t u r e therapeutic other  recreation  f o r the  frail  on  older adult,  t a r g e t g r o u p s were r e v i e w e d . F o r e x a m p l e ,  Curran  (1994)  1991). outreach  sources  Clark  for  o v e r c o m i n g i s o l a t i o n i n u r b a n y o u t h and young a d u l t s . the  interdependency  community i n w h i c h t h e y l i v e . emphasize  the  importance of r e g u l a r  This  among a l l p e r s o n s  C l a r k and C u r r a n  on  and  d e v e l o p e d a model f o r l e i s u r e o u t r e a c h  model r e c o g n i z e s  and  and  (1994,  p.  the  30)  communication l i n k a g e s  as  one way o f o v e r c o m i n g f e e l i n g s o f i s o l a t i o n a n d s u s t a i n i n g involvement of p a r t i c i p a n t s  i n community-based r e c r e a t i o n  the and  leisure. U n a v o i d a b l e m u l t i p l e changes health,  loss of finances,  to o l d e r persons their  ability  helplessness.  the  sense o f mastery  1991,  p.  (e.g.,  failing  widowhood) a r e  environment can prevent  for losses  their  events  "shocks"  in individuals loosing faith  These f e e l i n g s  a c t i n g t o compensate  Social  retirement,  and r e s u l t  to affect  in life  over the  or i n feelings o l d e r persons  and c o n s e q u e n t l y environment  it  in  of from  influences  (Riddick & K e l l e r ,  158) .  Support  L e i s u r e has feelings  a capacity to provide i n d i v i d u a l s with  of s o c i a l  when p e r s o n s  are  support  and i t  faced with l i f e  c a n be a s o u r c e o f crises.  coping  "People appear to  be  26 able  t o cope p s y c h o l o g i c a l l y w i t h l i f e  stressors,  t h a t t h e y w o u l d be s u p p o r t e d when i n d i f f i c u l t y " 1993,  p.  "social  352).  R u b i n s t e i n et  relations"  are  support  the  support  adults  ( R u b i n s t e i n et  increased support the  towards  for i t s  (Ross,  al.,  importance older  that  i d e n t i f i e d by o l d e r  adults  They p r o v i d e d e m p i r i c a l e v i d e n c e networks  h e a l t h and w e l l - b e i n g o f  older  1994,  been  p.  58).  o l d e r members.  There have  This decline is  distances  1991).  between  The r e - e n t r y  the  as women a r e  of l o o k i n g towards  i n part  and  and  the  due  e l d e r l y and  primary  of to  the  women i n t o t h e  These c h a n g i n g demographics  their  workforce  in-home  highlight  the  alternative  sources  of  support  that  support  buffers  adults.  Coleman  (1993)  impact of l i f e s t r e s s e s are  suggested  s t r e s s e s on h e a l t h ,  h i g h . He i n d i c a t e s  social but  but  contacts  c o u l d a c t u a l l y be  "detrimental  1993,  359).  inappropriate  o n l y when t h e s e  that this  c o n s i s t e n t l y demonstrated,  p.  (Coleman  stated  contributions of s o c i a l  the  an a d d i t i o n a l f a c t o r  caregivers.  or  60)  d e c l i n e i n m u l t i - g e n e r a t i o n a l households  families  for  p.  feel  l i m i t a t i o n s p l a c e d u p o n f a m i l i e s t o be a s o u r c e  i n c r e a s i n g geographic  is  need.  important  social  (1994,  frequently  as b e i n g a fundamental to  al.  i f they  effect  cautioned that  had  life  been  t o o many  to health"  social  (Coleman,  F o r e x a m p l e o n e ' s s t r e s s may be i n c r e a s e d or c o n f l i c t i n g  the  a d v i c e b e i n g o f f e r e d by  by  friends  family. F r i e d l a n d and M c C o l l  (1992, p .  573)  suggest that  while  27 the  r e l a t i o n s h i p between  established,  social  t h e r e was e v i d e n c e t h a t  i n t e r v e n t i o n may be d i f f i c u l t for  support  providing social  support  to  and h e a l t h  "social  implement".  seems t o  be  support Their  suggestions  intervention includes  ensuring  that: i)  a c l i e n t - c e n t r e d approach  ii)  t h e t h e r a p i s t ' s r o l e i s t o be a n a d v o c a t e c l i e n t promoting s o c i a l support;  iii)  the network, not intervention;  iv)  the i n f o r m a l support system i s of s p e c i a l importance; the importance of s o c i a l support w e l l - b e i n g must be c o n v e y e d b y t h e t h e r a p i s t c l i e n t a n d n e t w o r k members;  v)  i n t e r v e n t i o n should.be p r o v i d e d at individual is actively adjusting;  vi)  t h e p r o g r a m n e e d s t o be o f s u f f i c i e n t i n t e n s i t y duration to provide a " c r i t i c a l exposure". ( F r i e d l a n d & M c C o l l , 1992, p .  Leisure Education Traditional roles  the  is central  client,  i s the  to  the  for  target  describe  failing  to  l e i s u r e e d u c a t i o n and l e i s u r e  l e i s u r e e d u c a t i o n and l e i s u r e  because t r a d i t i o n a l p r a c t i c e s  h e a v i l y on d i a g n o s t i c k i n d s o f The t e r m numerous  for  to to both the and 576)  Strategies  f o c u s on i d e n t i f y i n g t h e n e e d e d  individuals,  the  a t i m e when  counselling  have r e c e n t l y been s c r u t i n i z e d . H u t c h i s o n and  (1994)  program;  l e i s u r e e d u c a t i o n as t h e  c o u n s e l l i n g as  supports  for  have r e l i e d  too  assessments.  "leisure education"  debates over the past  McGill  has b e e n t h e  subject  15 o r more y e a r s .  "umbrella" term which i s  of  Some v i e w frequently  28 used i n a v a r i e t y of c l i n i c a l perspective  encompasses " l e i s u r e  related  techniques  towards  leisure  1990).  In the  education  past,  1981).  c o u n s e l l i n g as  resolve  s p e c i f i c issues  Munson,  1986) .  a n d what  "problem focused"  (Bedini,  i n determining their  approaches  is constructed  i s not based  lifestyles,  l i f e s t y l e s w h i c h m i m i c some m o d e l "  p.  and l e i s u r e  processes designed They d e s c r i b e d and l e i s u r e process  i s to create  (1985, p .  c o u n s e l l i n g f o r the  education  "personally  125),  elderly,  in their  leisure" the  satisfying (Searle  and  book on  stated that both  counselling referred  to  leisure  "helping  to f a c i l i t a t e maximal l e i s u r e w e l l - b e i n g "  leisure  e d u c a t i o n as a s e l f - d i r e c t e d  process  c o u n s e l l i n g as an i n d i v i d u a l i z e d o r s m a l l  l e a d by a l e i s u r e  following  some  11).  L e i t n e r and L e i t n e r leisure  on  or bad a c t i v i t y " . R a t h e r ,  education  1993,  assist action  "good  goal of l e i s u r e  Mahon,  to  to  s p e c i f i c needs and  The p r o c e s s  "unhealthy  viewed  1 9 8 1 ; Munson &  f o r m u l a t e d m o d e l o f what c o m p r i s e s  not  leisure  and d e s i g n e d  (Chinn & Joswiak,  education process  comprises  instruction  to view  separate  This  other  These e a r l i e r p e r s p e c t i v e s  f o r a c h i e v i n g them.  externally  and  and k n o w l e d g e  c o u n s e l l i n g as  leisure  individuals  skills  o t h e r s have p r e f e r r e d  and l e i s u r e  The l e i s u r e  c o u n s e l l i n g " and  w h i c h f o c u s on g u i d a n c e  awareness,  (Chinn & Joswiak,  plans  and c o m m u n i t y s e t t i n g s .  techniques  counsellor.  They s u g g e s t e d  when c o n d u c t i n g l e i s u r e  group the  counselling  29 interventions  for older  adults:  (1)  plan sessions  (2)  conduct  (3)  at the s t a r t purpose;  (4)  t a p e r e c o r d an t a k e n o t e s on  (5)  c h o o s e a s u i t a b l e s t y l e o f c o u n s e l l i n g a n d be f l e x i b l e e n o u g h t o change s t y l e s ( L e i t n e r and L e i t n e r , 1985, p p . 135-136) .  Caldwell,  sessions  Adolph,  study of patients facility  f o r a d u r a t i o n o f 30 t o 45 m i n u t e s ; a minimum o f o n c e p e r  of each s e s s i o n ,  and G i l b e r t  define  week;  and s t a t e  sessions;  (1989)  found t h a t  in a  who were h o s p i t a l i z e d i n a r e h a b i l i t a t i o n  a n d who r e c e i v e d l e i s u r e c o u n s e l l i n g , a l o w e r  p e r c e i v e d number o f b a r r i e r s was r e l a t e d t o h i g h e r satisfaction.  Also,  patients  counselling also felt post-discharge  the  free  p a r t i c i p a t i n g i n the  leisure leisure  better prepared to deal with  t i m e as compared t o p a t i e n t s  self-  their  who d i d n o t  r e c e i v e l e i s u r e c o u n s e l l i n g . H o w e v e r , one s u r p r i s i n g r e s u l t this  same s t u d y was t h a t  i n d i v i d u a l s who r e c e i v e d  c o u n s e l l i n g p e r c e i v e d more i n t e r n a l b a r r i e r s and f e l t  more b o r e d t h a n t h o s e who d i d n o t  leisure  to p a r t i c i p a t i o n  receive  leisure  counselling. Heywood stages of l i f e  (1994, p .  14)  of  recently stated that  the  later  is:  a n i d e a l t i m e t o c u l t i v a t e d o r m a n t o r e v e n new i n t e r e s t s and expand p e r s o n a l and p r o f e s s i o n a l h o r i z o n s a n d r e l a t i o n s h i p s . To do s o r e q u i r e s r e c o g n i t i o n o f the p o t e n t i a l o f o l d e r a d u l t s and r e a l i z a t i o n that addressing t h e i r potentials i s a s i m p o r t a n t as a d d r e s s i n g t h e i r p r o b l e m s .  30 A v a r i e t y of approaches  to  leisure education  d e s c r i b e d by L e i t n e r and L e i t n e r the  (1985).  They s u g g e s t  L e i s u r e Resource Guidance Approach i s the  strategy  for healthy older adults  who a r e  regarding recreation opportunities, i n broadening t h e i r  ( L e i t n e r and L e i t n e r ,  1985, p .  most  seeking  b u t who a r e  h o r i z o n s beyond t h e i r  were  appropriate information  not  current  1 2 7 ) . The r e s o u r c e  that  interested interests  guidance  approach i n v o l v e s : (1)  an i n i t i a l client;  i n t e r v i e w t o get  acquainted with  (2)  administration of l e i s u r e c o l l e c t i o n of demographic  (3)  data  (4)  m a t c h i n g o f c l i e n t ' s i n t e r e s t s and demographic w i t h appropriate r e c r e a t i o n programs;  data  (5)  d i s c u s s i o n of r e s u l t s s u i t a b l e programs;  to  (6)  a f o l l o w - u p m e e t i n g t o examine the c l i e n t ' s s a t i s f a c t i o n w i t h the programs t o w h i c h t h e y referred;  (7)  t e r m i n a t i o n o f the c o u n s e l l i n g once the c l i e n t has been s a t i s f a c t o r i l y matched and i s p a r t i c i p a t i n g i n one's desired recreational a c t i v i t i e s ( L e i t n e r and L e i t n e r , 1985, p p . 127-128) .  interest data;  the  inventories  analysis;  w i t h c l i e n t and r e f e r r a l  The D e v e l o p m e n t a l - E d u c a t i o n A p p r o a c h i s u t i l i z e d assist  the  lifestyle" between  participant  actual  involved i n this (1)  i n i d e n t i f y i n g an " i d e a l  a n d h e l p them move t o w a r d s  their  and  decreasing  l e i s u r e and i d e a l l e i s u r e .  include:  pre-assessment;  were  to  leisure the The  distance steps  31 (2)  building  rapport;  (3)  d e f i n i n g concepts and work;  (4)  identifying leisure  needs;  (5)  identifying leisure  goals;  (6)  i d e n t i f y i n g and d i s c u s s i n g o b s t a c l e s achievement;  (7)  i d e n t i f y i n g performance goals;  (8)  explore  (9)  disseminate  (10)  p a r t i c i p a t i o n and  (11)  t e r m i n a t i o n and f o l l o w - u p ( L e i t n e r and L e i t n e r ,  leisure  related  to l e i s u r e ,  ideal  to  goal  c r i t e r i a through  alternatives  and  refining  consequences;  information; evaluation; 1985,  pp.  129-133) .  The T h e r a p e u t i c - R e m e d i a l A p p r o a c h i s a p p r o p r i a t e lower functioning older adults related  problems  focus the  loneliness,  This approach  e s t a b l i s h i n g a c l o s e empathic  for  or those w i t h s p e c i f i c  s u c h as b o r e d o m ,  chronic t e l e v i s i o n watching.  participant.  leisure  leisure  depression,  requires  relationship with  the  The c o u n s e l l o r s h o u l d become more d i r e c t i v e  on s p e c i f i c p r o b l e m s .  L e i t n e r a n d L e i t n e r recommend  and that  s t e p s o u t l i n e d i n t h e D e v e l o p m e n t a l - E d u c a t i o n A p p r o a c h be  u t i l i z e d w i t h these objectives specific  i n m i n d when w o r k i n g  problems of o l d e r a d u l t s '  towards  leisure:  (1)  identify leisure-related  problems and t h e i r  (2)  i d e n t i f y d e s i r e d changes t o a l l e v i a t e  (3)  d e v e l o p an i n d i v i d u a l i z e d p r o g r a m o f r e c r e a t i o n a c t i v i t i e s t o a s s i s t i n community l e i s u r e  the  causes;  problems;  32 integration; (4)  initiate  involvement i n a c t i v i t i e s w i t h s u p e r v i s i o n ;  (5)  develop a p o s i t i v e self-image community l i v i n g ;  (6)  d e v e l o p community c o n t a c t s t o e n a b l e the c l i e n t t o p a r t i c i p a t e i n the community w i t h o u t s u p e r v i s i o n ( L e i t n e r and L e i t n e r , 1985, 1 3 3 - 1 3 4 ) .  C o u n s e l l i n g older people i n adapting crises 1986,  to  "changing circumstances  and b a r r i e r s p.  towards  to l e i s u r e  1 3 ) . What b e g i n s more a w a r e ,  in their  leisure  fulfilment"  independently  them  life  (Munson a n d M u n s o n , leads  clients  participating individuals,  a g r e a t e r sense of  own l e i s u r e  towards  can a s s i s t  and overcome  as a form o f t h e r a p y ,  who h a v e h o p e f u l l y a t t a i n e d and freedom  towards  and a t t i t u d e s  and  life.  satisfaction  33 CHAPTER THREE Methodology  This chapter the  describes  the  case  study u t i l i z e d  r e s e a r c h p r o b l e m and r e s e a r c h q u e s t i o n s .  u s e d q u a l i t a t i v e methods  i n t h e i r research,  d e s c r i b i n g the methodology i n the (Henderson,  1991; Mactavish,  sequence  1994; P a t t o n ,  to  explore  A u t h o r s who h a v e have  that  recommended it  occurred  1980) .  Research Design H e n d e r s o n r e m i n d s us t h a t  l e i s u r e has p e r h a p s  best understood through a subjective paradigm 1991,  p.  leisure  195).  The  terms  (Henderson,  of the  173).  older adults permitted a greater  patients  at  St.  these p a t i e n t s . differing  life  case  depth of  to data which c o u l d not  through q u a n t i t a t i v e  investigator's  methods  alone.  have  The  e a r l i e r e x p e r i e n c e w i t h many o f t h e  older  adult  P a u l ' s H o s p i t a l had r e v e a l e d t h e u n i q u e n e s s This uniqueness experiences,  was p a r t i a l l y a t t r i b u t e d  systems.  of  to  medical conditions, perceptions  and a v a i l a b l e support  the p a r t i c i p a n t s '  studies.  1990, p .  p r i m a r i l y q u a l i t a t i v e approach used i n the  been g a t h e r e d  of  (Henderson,  t h a t the h i g h l y complex n a t u r e of  a n a l y s i s and a l l o w e d f o r access  leisure,  been  c a n no l o n g e r be d e c i p h e r e d o n l y b y p o s i t i v i s t i c a n d  quantitative  studies  She c o n t e n d s  always  of  The e x p e c t e d d i v e r s i t y  experiences presented  eight  unique  case  34  The u s e o f q u a l i t a t i v e m e t h o d s , some q u a n t i t a t i v e  d a t a d e r i v e d from the  p r o v i d e d the  researcher  d e s c r i b e the  s u b j e c t i v e meaning t h a t  in  the  T.R.O.P.  section,  leisure  with opportunities  i n the T . R . O . P . ,  worksheets,  t o examine  and  The  individualized  which i s ' e x p l a i n e d l a t e r  y i e l d e d a d d i t i o n a l i n s i g h t s which would not  been adequately  revealed i n a s t r i c t l y quantitative  research  needs r a t h e r t h a n a r e s e a r c h e r ' s  supported the  investigator's  t i m e - l i n e s and c o n t e n t therapeutic not  recreation inpatient  participants' this  T.R.O.P.  and o u t r e a c h  sessions  In fact,  was somewhat u n i q u e .  the  the were  each The p u r p o s e  of  relationship  i n v e s t i g a t o r and e a c h p a r t i c i p a n t .  r e l a t i o n s h i p helped to e s t a b l i s h goals, adjustments  forms,  Therefore,  d e s i g n was t o f a c i l i t a t e a s u p p o r t i v e  between the  prognosis,  sessions.  i d e n t i c a l f o r each p a r t i c i p a n t .  the  participants'  choice of a v a r i e t y of  of T . R . O . P .  have  predetermined  d e s i g n . The e x p e c t e d d i v e r s i t y o f e a c h  m e d i c a l c o n d i t i o n s and o f t e n u n p r e d i c t a b l e  in  design.  The c a s e s t u d y d e s i g n was i n t e n d e d t o be r e s p o n s i v e t o participants'  by  l e i s u r e and i n v o l v e m e n t  had f o r the p a r t i c i p a n t s .  approach u t i l i z e d this  w h i c h was s u p p l e m e n t e d  This  w h i l e making r e a l i s t i c  t o t h e method i n o r d e r t o a c c o m p l i s h t h e m . When  s i t u a t i o n w a r r a n t e d g o a l o r method r e v i s i o n ,  the. scope o f the  it  i n t e r v e n t i o n t o make t h e  necessary  research problem, research  questions,  was  within  adjustments. Given the  need f o r f l e x i b i l i t y  w i t h i n the method,  t h e most  and  the  appropriate  35 c a s e s t u d y d e s i g n was a c o m b i n e d q u a l i t a t i v e a n d approach.  As P a t t o n s t a t e d ,  q u a l i t a t i v e and q u a n t i t a t i v e  c o l l e c t i o n measures are not strategies". (Patton,  approaches, approaches  p.14).  stating  (Henderson,  data  researcher  1991, p .  in-house  tools  study  use o f  both  comprised  leisure  interests,  leisure  1 9 8 7 ; BC R e h a b i l i t a t i o n S o c i e t y , are  individuals'  l e i s u r e needs,  (Ballantyne,  The w o r k s h e e t s  leisure  constraints  frequently  1989; W i t t &  utilized  hospital  a s s e s s m e n t t o o l s and by c l i e n t s o f s p e c i f i c  programs  for adults  adapted  by the  Ballantyne  choices.  (1987)  outreach  and W i t t and E l l i s completed the  (1989).  three forced-choice  leisure  w h i c h p r o v i d e d a way o f c o m p a r i n g f r e q u e n c i e s  The w o r k s h e e t s  also provided a resource  to f a c i l i t a t e  participants  i n the  for  the  a d d i t i o n a l r e s p o n s e s from  the  of  subsequent q u a l i t a t i v e data c o l l e c t i o n  The q u a l i t a t i v e methods  observations,  in-  w i t h p h y s i c a l d i s a b i l i t i e s . They were  investigator  phase.  as  B r i t i s h Columbia R e h a b i l i t a t i o n S o c i e t y from  Participants worksheets  with  the  were d e v e l o p e d t o e n c o u r a g e  a n d ways o f o v e r c o m i n g l e i s u r e  1989).  same  179).  constraints,  Ellis,  research  more t o o l s  c o l l e c t i o n d i m e n s i o n . These  education worksheets explore their  the  data  t h a t the v a l u e of c o n s i d e r i n g both  The u s e o f . t h r e e quantitative  i n the  Henderson supports  " l i e s i n g i v i n g the  w h i c h t o work"  to  "mutually exclusive  T h e y c a n ' b o t h be u t i l i z e d  1990,  quantitative  and f i e l d  notes.  included interviews, It  appeared  from the  results  of  36 the p i l o t  study,  that  t h e more d e t a i l e d q u a l i t a t i v e f o r m s o f  r e s p o n s e s w e r e more i n f o r m a t i v e t h a n t h e i n d i c a t e d on the  Pilot  worksheets.  Study A pilot  project, the  r e s p o n s e s w h i c h were  study,  similar  was c o m p l e t e d May 1 7 ,  impact, of a t h e r a p e u t i c  older adults,  procedures  s t u d y examined  r e c r e a t i o n o u t r e a c h p r o g r a m o n two at  St.  the researcher  Paul's Hospital.  critically  examine the  appropriateness  and t o d e t e r m i n e the  of the  i n c l u d e d i n the  results  found i n  of the  s e c t i o n of t h i s report.  study The  s t u d y r e v e a l e d a need f o r s l i g h t r e v i s i o n s t o the i n terms of the  interview questions.  to start  question related.to  the  i n t e r v i e w w i t h a more  the T . R . O . P .  are  pilot  methodology  The o r d e r a n d number o f  c o n c l u d i n g i n t e r v i e w q u e s t i o n s was r e v i s e d .  appropriate  to  required.  study are  (1994). H i g h l i g h t s of the r e s u l t s  It  interview  a c t u a l time-frame  of the p i l o t  itself,  It  seemed more  concrete  r a t h e r than the  more  a b s t r a c t q u e s t i o n s o n l e i s u r e . The s e c o n d c h a n g e r e s u l t e d the  a d d i t i o n of a question to determine  i f the  for future  in  participants  p e r c e i v e d any n e g a t i v e components t o t h e p r o g r a m and t o any feedback  was  w i t h the p r a c t i c a l  i n v e s t i g a t o r w i t h an o p p o r t u n i t y  The c o m p l e t e r e s u l t s  the  It  i n v o l v e d i n implementing the r e s e a r c h d e s i g n .  a l s o p r o v i d e d the  questions  research  1 9 9 4 . The p i l o t  who were p a t i e n t s  designed t o . f a m i l i a r i z e  Gallant  i n format t o t h i s  obtain  improvements. T h i s a d d i t i o n a l q u e s t i o n  37 provided a natural  concluding point  A p p e n d i x Two c o n t a i n s  a list  of the  f o r the  interviews.  concluding interview  questions.  Investigator's  Role  The r e s e a r c h e r  was one o f t h e  collection  and a n a l y s i s  researcher  and the p r o f e s s i o n a l r e s p o n s i b l e  the  specific T.R.O.P.  inpatient  sessions  (Merriam,  instruments  which s p e c i f i c patients  would undergo at  professional  duties  after  education  St.  treatment  Paul's  Hospital. sessions,  n o t e s were n o t a s s o c i a t e d w i t h t h e investigator,  r e l a t e d t o h i s r o l e as r e s e a r c h e r . the p a t i e n t  leisure  interviews, tape-recorded  of the  t h e i r discharge  The c o n t i n u e d l i a i s o n from t h e h o s p i t a l and  specific  and r e c r e a t i o n t h e r a p i s t  advantages  One a d v a n t a g e investigator.  as w e l l  (1991,  p.  34)  included  observing patients'  the  the  behaviour,  with a v a r i e t y of medical c o n d i t i o n s .  v a l u a b l e elements commented,  role  a number o f  c r e d i b i l i t y of  His professional experience  treating patients  the  as l i m i t a t i o n s .  was r e l a t e d t o t h e  i n t e r v i e w i n g of patients,  brought  presented  with  the  e x i s t i n g r e s p o n s i b i l i t i e s of the p r o f e s s i o n a l . T h i s d u a l researcher  usual  but were d i r e c t l y  c o n d u c t i n g o f o u t r e a c h s e s s i o n s were a l s o n o t w i t h i n  of  as  for implementing  of the normal course o f  The u s e o f s e m i - s t r u c t u r e d and f o r m a l i z e d f i e l d  data  1 9 9 1 ) . He h a d a d u a l r o l e  He i m p l e m e n t e d t h e  as p a r t  of  to t h i s  research project.  "training i n observation  and These  As Merriam  and  38  interviewing,  though necessary,  a s p i r i n g case  study researchers".  professional of  or p a r t i c i p a n t s '  recreation therapist's  f a m i l i a r i t y w i t h t h e team a n d  r e l a t e d to the p a t i e n t s '  w o u l d have b e e n d i f f i c u l t likelihood, as the  hospital  of the researcher  care,  which  The r e s e a r c h e r ' s  a l s o b e i n g the  The  the  otherwise in all  recreation  general f a m i l i a r i t y  of  the  r o u t i n e f a c i l i t a t e d a smoother d e l i v e r y o f (1991, p .  r e s e a r c h s e t t i n g i s where t h e  access,  members  and exchange o f  t o o b t a i n . There was,  r e s e a r c h program. As Henderson ideal  of  a c l o s e r more e f f e c t i v e r e l a t i o n s h i p e s t a b l i s h e d  result  therapist.  with other  m u l t i d i s c i p l i n a r y team.  enhanced the r e f e r r a l p r o c e s s  information  to  R e l a t e d t o t h i s advantage  e x p e r i e n c e was h i s f a m i l i a r i t y  the p a t i e n t s '  patients,  i s not r e a d i l y a v a i l a b l e  establishes  r e l a t e d to the  researcher  immediate r a p p o r t ,  research  107)  the  stated,  "the  obtains  and g a t h e r s  easy  data  interests.  One l i m i t a t i o n o f t h i s d u a l r e s p o n s i b i l i t y was  the  demanding n a t u r e o f c o m b i n i n g r e s e a r c h w i t h p r o f e s s i o n a l duties.  For example,  conducting the  the  recreation therapist  l e i s u r e e d u c a t i o n program c o u l d not  o b s e r v e a l l t h e p a r t i c i p a n t s a n d be a t t e n t i v e d i s c u s s i o n o c c u r r i n g between d i f f e r e n t a l s o be n o t e d h o w e v e r , participant  who was  to  always  the  participants.  t h a t the r e l a t i o n s h i p between  and t h e r a p i s t / r e s e a r c h e r  It  should  the  became more t r u s t i n g  over  time. An a d d i t i o n a l l i m i t a t i o n o r p o t e n t i a l p r o b l e m a r e a  was  39 d i s c u s s e d i n Merriam  (1991). T h i s i s s u e r e f l e c t s  concern i n q u a l i t a t i v e studies.  That i s ,  becoming i n v o l v e d i n the  and s i t u a t i o n s  attempted  to study,  participants. effect"  issues  likely  Patton  has  (1980)  the  some e f f e c t  researchers they  have  o r i n f l u e n c e on  also stated a similar  Such an e f f e c t  of the  evaluator"  may have r e s u l t e d  (Patton,  i n the  o v e r s t a t i n g the p o s i t i v e b e n e f i t s  reacted, effect  performance  believes effects  appeared,  that  the  staff  investigator to  However t h e  were l i k e l y  due t o h i s p r e s e n c e ,  as t h e  colleague performing a f a m i l i a r  "evaluator" influence  investigator  e v a l u a t o r was a as  the  the  to experience only  role,  and  the  and i n t e r a c t i o n s w i t h  i n v e s t i g a t o r and p a r t i c i p a n t s .  333) .  themselves  o r commented. R e l a t e d t o t h i s p o t e n t i a l  staff's  staff  of l e i s u r e p a r t i c i p a t i o n .  " w a n t e d " them t o h a v e  was t h e p o t e n t i a l f o r t h e  hospital  1980, p .  i n a manner w h i c h t h e y p e r c e i v e d  i n v e s t i g a t o r would have  and  participants  P a r t i c i p a n t s may have p u r p o s e f u l l y p r e s e n t e d "stories"  the  "evaluator  w h i c h may be e x p e r i e n c e d b y t h e p a r t i c i p a n t s  due t o t h e p r e s e n c e  their  a common  far  as t h e y  minimal  familiar were  concerned. Patton effects not  (1980)  which are  discussed several additional important  remain a constant.  occur to the These changes observation.  to consider.  That i s ,  The e v a l u a t o r  there are  i n v e s t i g a t o r through the  likely  does  changes  course of the  are c e n t r a l t o t h e method o f T h e y o c c u r as t h e  evaluator  which  study.  participant  e v a l u a t o r becomes  personally  40 i n v o l v e d w i t h the p a r t i c i p a n t s . to the  full  The r e s e a r c h e r ' s s e n s i t i v i t y  range of events o c c u r r i n g i n the  setting  d e c r e a s e d when he o r she becomes i n v o l v e d w i t h t h e "subject"  under i n v e s t i g a t i o n (Patton,  H o w e v e r , - Howe  (1991)  very  334-335).  cautioned that while there are  r e s e a r c h e r s who b e l i e v e t h a t the p a r t i c i p a n t s  1980, p .  is  s e p a r a t i n g the  researcher  facilitates objectivity, "it is  from  through  i n t e r a c t i o n w i t h t h e p a r t i c i p a n t s t h a t t h e most a c c u r a t e r e v e a l i n g data are a person-centred  c o l l e c t e d " (Howe,  approach r e q u i r e s  become i n v o l v e d i n t h e  1991, p .  that  the  some  and  5 0 ) . The u s e o f  investigator  process.  Person-Centred Approach The i n v e s t i g a t o r p r a c t i s e d a p e r s o n - c e n t r e d p h i l o s o p h y when he i n t e r a c t e d w i t h p a r t i c i p a n t s  in this  study  1990).  T h i s e n a b l e d h i m t o be f l e x i b l e  of  c o n c e r n s a r i s i n g from t h e p a r t i c i p a n t s .  the  enough t o d i s c u s s  r e c r e a t i o n s e r v i c e s have f r e q u e n t l y u t i l i z e d approach and t r e a t e d p a t i e n t s with  (Egan,  a  any  Therapeutic person-centred  or c l i e n t s . a s unique  individuals  "unknown p o t e n t i a l f o r g r o w t h a n d l e a r n i n g " ( H u t c h i s o n  and M c G i l l ,  1994, p .  enhanced the investigator. support  1 2 ) . The u s e o f a p e r s o n - c e n t r e d  responsiveness Pedlar,  between the p a r t i c i p a n t s  Gilbert,  for a person-centred  a n d Gove  approach.  (1994)  found  approach and  the  further  I n an i n v e s t i g a t i o n o f  a l e i s u r e i n t e g r a t i o n program w i t h o l d e r d i s a b l e d a d u l t s , these a u t h o r s found t h a t  "not a l l o w i n g f o r p e o p l e ' s  strengths  41 and s e l f - a w a r e n e s s be f r u s t r a t i n g l e a r n e d about  i n terms o f l e i s u r e p r e f e r e n c e s  and a g g r a v a t i n g t o p a r t i c i p a n t s " . the  older adults'  interests  proved  to  M o r e was  and c a p a b i l i t i e s by  s i m p l y i n v i t i n g them t o t a l k a b o u t who t h e y w e r e a n d what interested  them,  assessment t o o l s  Participant  t h a n b y h a v i n g them c o m p l e t e s t a n d a r d (Pedlar et  25).  S e l e c t i o n and R e c r u i t m e n t  To p a r t i c i p a t e t o be i n p a t i e n t s years  a l . , 1994, p .  leisure  o f age,  in this  of St.  study p a r t i c i p a n t s  Paul's Hospital,  a n d be a b l e t o s p e a k ,  were  t o be a t  r e a d and  required  least  comprehend  E n g l i s h f l u e n t l y . A n a d d i t i o n a l s e l e c t i o n c r i t e r i a was t h e p a r t i c i p a n t s ' . u s u a l p l a c e o f r e s i d e n c e was i n t h e Mainland of B r i t i s h  Columbia i n a n o n - i n s t i t u t i o n a l  T h e s e c r i t e r i a were d e s i g n e d t o e n s u r e  that the  v i s i t s w o u l d be w i t h i n a s u i t a b l e d i s t a n c e  for  i n v e s t i g a t o r t o t r a v e l . The r e l a t i v e l y s h o r t i n v o l v e d enabled the  researcher  w i t h the p a r t i c i p a n t s , building effective the p a r t i c i p a n t s Shea,  Volpe,  Lower  setting.  the  distances contact  i n c r e a s e d the p o t e n t i a l  r e l a t i o n s h i p s between the  (Flynn,  that  outreach  to maintain d i r e c t  and t h e r e b y  55  researcher  Boschen, Lewko,  for  and  Salhani &  1993). Because of the  "outreach"  nature of the  study,  w e r e e x c l u d e d i f t h e y were a w a i t i n g p l a c e m e n t  patients  i n a L o n g Term  C a r e F a c i l i t y o r s i m i l a r i n s t i t u t i o n a l s e t t i n g w h i c h may restrict  t h e i r p a r t i c i p a t i o n i n the  community.  Also  42  i n d i v i d u a l s known t o h a v e a c o g n i t i v e d e f i c i t "mild",  as d e t e r m i n e d by t h e o c c u p a t i o n a l t h e r a p i s t ,  or other  qualified  patient,  w o u l d n o t be e l i g i b l e  staff  i n v o l v e d i n the  physician  assessment of  to p a r t i c i p a t e .  p r o b a b l e t e r m i n a l i l l n e s s and w i t h l i f e than  exceeding  the  Persons w i t h  expectancy of  a  less  s i x months were a l s o e x c l u d e d f r o m p a r t i c i p a t i n g i n  this  study. It  was o r i g i n a l l y p l a n n e d t o r e c r u i t  participants,  a total  a g e d 55 y e a r s a n d above f o r t h i s  of  eight  study.  A letter  c o n t a i n i n g a n o u t l i n e o f t h i s p r o p o s a l was d i s t r i b u t e d t o m e d i c a l and n u r s i n g s t a f f  s e r v i n g the p o t e n t i a l  b a s e i n o r d e r t o n o t i f y them o f t h e Hospital age  inpatient  55 a n d a b o v e ,  Nursing Units,  study.  consent  process.  i n v e s t i g a t o r reviewed the  brief  the  the  informal  voluntary  in this project.  The  charts of r e f e r r e d p a r t i c i p a n t s  e l i g i b i l i t y b a s e d on t h e  d e s c r i p t i o n of the  Three)  potentially  through an  The i n v e s t i g a t o r s o u g h t  of the p a t i e n t s to p a r t i c i p a t e  confirm t h e i r  Paul's  were i n f o r m e d and e n c o u r a g e d t o n o t i f y  i n v e s t i g a t o r of p o t e n t i a l p a r t i c i p a n t s , referral  participant  A l l St.  with patients  all  to  inclusion criteria. A  s t u d y and a c o n s e n t  was p r e s e n t e d t o e a c h p a r t i c i p a n t .  form  (Appendix  The s i g n e d f o r m o f  e a c h c o n s e n t i n g p a r t i c i p a n t was k e p t o n t h e i r m e d i c a l c h a r t . copy o f t h i s  f o r m was a l s o g i v e n t o t h e p a r t i c i p a n t  for  A  their  records. The r e c r u i t m e n t  of eight  eligible participants  required a  l o n g e r t h a n a n t i c i p a t e d amount o f t i m e due t o a number o f  43  circumstances.  The i n c l u s i o n c r i t e r i a i m m e d i a t e l y d i s m i s s e d a  h i g h p r o p o r t i o n of the instances,  available participant pool.  t h e r e were l e s s  than ten percent  55 a n d a b o v e who q u a l i f i e d patients the  appeared  consent  f o r the  reluctant  form.  later,  Another patient  Three  aged  non-consenting "wordiness" of  s t a t e d t h a t he d i d n o t One p a t i e n t ,  could not p a r t i c i p a t e  changing circumstances  of p a t i e n t s  t o s i g n due t o t h e  he h a d e n o u g h t i m e t o p a r t i c i p a t e . consented  study.  I n some  i n the  regarding her discharge  who  think  initially  study because of location.  The T h e r a p e u t i c R e c r e a t i o n O u t r e a c h Procrram ( T . R . O . P . ) T.R.O.P. outpatient  interviews,  therapeutic  recreation  participants needs,  c o n s i s t e d of a combination of i n p a t i e n t  T.R.O.P.  to-one  interventions,  i n exploring their  constraints  interview.  leisure education sessions  It  and  which a s s i s t e d  leisure interests,  t o p a r t i c i p a t i o n , and l e i s u r e  began i n the h o s p i t a l w i t h the  and  the  leisure goals.  initial  c o n t i n u e d w i t h a c o m b i n a t i o n o f group and  l e i s u r e education sessions  and G e r i a t r i c U n i t of S t .  on t h e R e h a b i l i t a t i o n U n i t  Paul's Hospital.  w i t h a number o f o u t r e a c h s e s s i o n s  one-  T.R.O.P.  concluded  and a c o n c l u d i n g i n t e r v i e w .  The s p e c i f i c l e i s u r e e d u c a t i o n s t r a t e g i e s u t i l i z e d b y therapist  i n c l u d e d the  techniques  Leitner  (1985)  leisure  e d u c a t i o n approaches  the  recommended b y L e i t n e r a n d  and c o n s i s t e d o f a c o m b i n a t i o n o f t h e  three  which are a l s o d e s c r i b e d i n  C h a p t e r Two. T h i s c o m b i n a t i o n o f t h e L e i s u r e R e s o u r c e G u i d a n c e  44 Approach,  the  D e v e l o p m e n t a l - E d u c a t i o n A p p r o a c h , and  Therapeutic-Remedial Approach ( L e i t n e r & L e i t n e r , p r o v i d e d the different  therapist  abilities,  w i t h enough s t r a t e g i e s  needs,  and "problems"  the  1985)  t o work w i t h  the  participants'  presented. Each p a r t i c i p a n t  attended a v a r i e t y of  recreation  sessions  and c o m p l e t e d f o u r  which w i l l  be d e s c r i b e d  later  therapeutic  leisure  worksheets  i n the methodology.  The  o u t l i n e d b e l o w r e p r e s e n t s t h e minimum p a r t i c i p a t i o n to complete  the  required  program:  Initial Group  list  Interview Session(s)  Leisure Interests  Worksheet  L e i s u r e Needs  Worksheet  Challenges to  (Leisure)  P a r t i c i p a t i o n Worksheet  Goal Setting/Overcoming Challenges  Worksheet  Outreach Session 1 Outreach Session 2 Concluding  Initial  Interview  Interview  Immediately f o l l o w i n g i n f o r m a t i o n was s o u g h t structured format  initial  informed consent,  by the  interview  investigator  through a semi-  (Appendix Two). T h i s  was s i m i l a r t o t h a t d e s c r i b e d  interview questions  demographic  was d e v e l o p e d b u t  interview  i n Howe ( 1 9 8 8 ) . the  interviewer  A core of was  45 permitted  to deviate  g r e a t e r depth"  i n order to  (Howe, 1 9 8 8 , p .  308).  d e s i g n e d t o be a n o n - t h r e a t e n i n g demographic  " e x p l o r e emergent The i n i t i a l  areas  i n t e r v i e w was  method o f g a t h e r i n g  medical chart.  to express  their  reaction  b e i n g h o s p i t a l i z e d , and i n f o r m a t i o n r e g a r d i n g t h e i r l e v e l s w i t h i n the Efforts  of  the  were t a k e n b y t h e  investigator  recreation  participants  p r i o r to the  and p a r t i c i p a n t  therapist.  about  investigator  Then t h e  his research  t o d i s c l o s e some p e r s o n a l  "break  the  to  establish  interviews.  For  d i s c u s s e d the  investigator  role  told  the i n an  i n f o r m a t i o n which would  help  ice".  The i n i t i a l  i n t e r v i e w was d e s i g n e d t o be 2 0 - 4 0 m i n u t e s  I n t e r v i e w s were a u d i o t a p e d  and t r a n s c r i b e d .  n o t e s were a l s o t a k e n d u r i n g a n d a f t e r highlight  activity  and u n i v e r s i t y s t u d i e s ,  effort  length.  to  hospital.  w i t h each p a r t i c i p a n t the  the  The i n t e r v i e w a l s o p r o v i d e d a n  o p p o r t u n i t y f o r the p a r t i c i p a n t s  example,  basic  i n f o r m a t i o n w h i c h may o r may n o t h a v e b e e n o n  participants'  rapport  with  observations  made b y t h e  emphasize key p o i n t s or i s s u e s  Group I n p a t i e n t Inpatients  the  interview  investigator  mentioned by the  and  Field to to  participants.  Sessions  attended  a minimum o f one g r o u p  leisure  e d u c a t i o n s e s s i o n w h i c h was h e l d i n t h e A c t i v i t y Room o f  the  R e h a b i l i t a t i o n Unit  of  T.R.O.P.  and o t h e r  at  St.  Paul's Hospital.  hospital patients  Participants  were a l s o  in  invited  to  46  attend  additional recreation  a c t i v i t i e s i n the  hospital  p a r t of t h e i r normal h o s p i t a l treatment course.  These  as  groups  o c c a s i o n a l l y i n c l u d e d p a r t i c i p a t i n g i n such a c t i v i t i e s baking,  bingo,  entertainment, All  current  event  social  "pubs",  inpatient  sessions  with physiotherapy,  from S t .  each p a r t i c i p a n t hospital. these  were s c h e d u l e d i n c o o r d i n a t i o n  care  team.  future  nursing,  P r i o r to the  Paul's Hospital,  to discuss  musical  and community o u t i n g s .  the  and  other  participants'  i n v e s t i g a t o r met  v i s i t s outside  of  with  the  A r r a n g e m e n t s were made f o r f o l l o w - u p v i s i t s  during  discussions. P a r t i c i p a n t s were i n f o r m e d a t  an upcoming s e s s i o n , friends,  or other  sessions  w i t h them.  investigator,  least  a n d were e n c o u r a g e d  significant individual Participants  i n a p o s i t i o n which ensured the  gardening,  occupational therapy,  members o f t h e p a t i e n t ' s discharge  discussions,  as  the  offered  w i t h any d i e t  restrictions.  The i n v e s t i g a t o r  refreshments  l e i s u r e behaviours  gave a b r i e f  i n t r o d u c t i o n about  and  other  session or after  were  patients,  which complied  related the  related  and i n t e r e s t s .  i n the  themselves  and c o n c e r n s  family,  the  f a c i l i t a t e d information sharing  and a l l o f the p a r t i c i p a n t s  anytime d u r i n g the  the  of  t e l e v i s i o n monitor.  investigator  interests  to attend  around a t a b l e  and the  the p a t i e n t s  t o p r e v i o u s and c u r r e n t  share t h e i r  t o i n v i t e any  t h e y c o u l d see  slides,  The v o l u n t e e r  sat  one d a y i n a d v a n c e  group  The  session  and were i n v i t e d to l e i s u r e  session i n  at  private.  to  47 T h e s e comments were r e c o r d e d b y t h e  investigator.  C o n v e r s a t i o n s among t h e p a r t i c i p a n t s  and t h e  investigator  promoted t h r o u g h the use o f a v a r i e t y o f s l i d e s ,  a  overheads,  and b r o c h u r e s  life  enjoyment.  The s l i d e s r e v e a l e d t h e  leisure  interests,  related  to  l e i s u r e and investigator's  n e e d s and some f a c i l i t a t o r s  videotape,  personal  to  leisure.  T h e r e were a d d i t i o n a l s l i d e s o f community f a c i l i t i e s , hospital  leisure pursuits  were  and l e i s u r e a d a p t a t i o n s .  in  The 12  minute v i d e o c o n t a i n e d i n f o r m a t i o n about v a r i o u s Vancouver community r e c r e a t i o n  resources  and  facilities.  R e c r e a t i o n a n d community i n f o r m a t i o n b r o c h u r e s d i s t r i b u t e d to p a r t i c i p a n t s . the  participants'  information schedules,  Overheads  were s p e c i f i c  recreation  centres,  events,  time  costs. a n d an e r a s a b l e m a r k e r b o a r d w e r e o c c a s i o n a l l y  utilized  to h i g h l i g h t s p e c i f i c points discussed i n  the  session.  T h e s e p o i n t s were o f t e n p r e s e n t e d b y b o t h  the  participants  and the  Towards the permitted,  to  investigator.  c o n c l u s i o n of each group s e s s i o n ,  participants  worksheets.  c o m p l e t e d one o f t h e  I f t h e r e was n o t  sufficient  complete a s p e c i f i c worksheet  w o u l d be c o m p l e t e d l a t e r ,  if  leisure  time f o r the  d u r i n g the  time education subject  group s e s s i o n ,  on a s u b s e q u e n t v i s i t  by  the  investigator. A total  to  n e i g h b o u r h o o d and community. They c o n t a i n e d  on l o c a l and  These b r o c h u r e s  were  of four worksheets  were c o m p l e t e d b y e a c h  it  participant  d u r i n g the program  the p a r t i c i p a n t s ' goals  ( A p p e n d i x One) . T h e s e e x p l o r e d  leisure interests,  ( B a l l a n t y n e , 1987; E l l i s  needs,  & Witt,  constraints,  1986; W i t t  and  & Ellis,  1989) .  One-to-One  Sessions  One-to-one  (1:1)  sessions  i n t e r a c t i o n between o n l y the Such s e s s i o n s hospital  refer  to.any session  i n v e s t i g a t o r and t h e  or  participant.  were c o n d u c t e d b o t h i n s i d e and o u t s i d e  setting.  They i n c l u d e d the  initial  of  and c o n c l u d i n g  i n t e r v i e w s and the m a j o r i t y o f the o u t r e a c h s e s s i o n s interactions  w i t h the  D u r i n g 1:1  challenges  participant  telephone  participant.  sessions,  the p a r t i c i p a n t  f r e q u e n t l y worked towards the of  the  and  identification  investigator and  to p a r t i c i p a t i o n . Steps towards  prioritizing  obtaining  g o a l s were a l s o d i s c u s s e d t h o r o u g h l y a t  these  sessions.  Outreach  Sessions  At  one week f o l l o w i n g t h e p a r t i c i p a n t ' s  from the  least  h o s p i t a l a n d t h e i r r e t u r n t o home,  telephoned each p a r t i c i p a n t session. two  These t e l e p h o n e  to schedule the  If  participant  t o be v i s i t e d  investigator  initial  c a l l s were s c h e d u l e d a t  days i n advance of a v i s i t ,  preference.  the  based on the  discharge  outreach  least  one  to  participants  i t . w a s then found i n c o n v e n i e n t f o r f o r an o u t r e a c h s e s s i o n ,  a the  planned  49 s e s s i o n was s c h e d u l e d f o r a more c o n v e n i e n t The o u t r e a c h interactions  sessions  between  consisted of  the p a r t i c i p a n t s  one-to-one  and the  The i n v e s t i g a t o r  a l s o made s e v e r a l t e l e p h o n e  the  to schedule  participants  time.  investigator. c a l l s to each of  or c o n f i r m the next  session.  T e l e p h o n e c a l l s were a l s o made t o c h e c k on e a c h  participant's  progress  session.  and t o e s t a b l i s h the  Concluding  focus of the next  Interview  The c o n c l u d i n g i n t e r v i e w was h e l d i n t h e home,  i n a room o f t h e i r  participants'  c h o i c e . The a i m o f t h i s  to assess the p a r t i c i p a n t s '  subjective  The c o n c l u d i n g i n t e r v i e w s e s s i o n s  i n t e r v i e w was  perception of  lasted  f r o m 30 t o  T.R.O.P. 45  minutes.  Data  Collection D a t a c o l l e c t i o n was a c c o m p l i s h e d t h r o u g h a v a r i e t y o f  m e t h o d s as o u t l i n e d b e l o w . M e d i c a l Chart Review: R e v i e w o f t h e p a r t i c i p a n t s ' charts assisted h i s t o r y on t h e chart  the  investigator  participants.  i n c l u d e d : reason  i n obtaining a brief  for admission to h o s p i t a l ,  the  admission to h o s p i t a l , participant  participants'  living  doctor,  Progress  the  other  situation,  and m e d i c a l p r o c e d u r e s  i s undergoing.  nurses,  medical  I n f o r m a t i o n o b t a i n e d from  m e d i c a l c o n d i t i o n s and m e d i c a l h i s t o r y , of  medical  or  notes from  date  treatments the  s o c i a l w o r k e r w h i c h were  present  50 i n t h e i r medical chart the  were a l s o r e v i e w e d .  i n v e s t i g a t o r b e l i e v e d was r e l e v a n t  i n v o l v e m e n t and p r o g r e s s their profile.  Review of p a t i e n t s '  h o s p i t a l procedure hospital  i n T.R.O.P.  Information  t o the  which  participants'  was r e c o r d e d as p a r t  medical charts  u t i l i z e d by r e c r e a t i o n  of  i s a common  therapists  and  other  staff.  F i e l d notes: F i e l d n o t e s w e r e r e c o r d e d c h r o n o l o g i c a l l y o n each p a r t i c i p a n t ,  u s u a l l y immediately f o l l o w i n g each  and d a t a g a t h e r i n g o p p o r t u n i t y .  Occasionally brief  session  field  notes  were t a k e n d u r i n g a s e s s i o n .  T h e s e were d e s i g n e d t o r e m i n d  investigator  w h i c h c o u l d be r e c o r d e d  of observations  greater d e t a i l  f o l l o w i n g the  session.  These  field  i n c l u d e d b o t h i n t u i t i v e and o b j e c t i v e w r i t i n g 1993,  p.  266).  The i n f o r m a t i o n c o l l e c t e d ,  where p e o p l e were s i t t i n g , intimacy, events.  date,  place,  interpreting  the  and d e s c r i b i n g the  in  notes  ( M a l k i n & Howe,  included notes  social  and  investigators interviews,  on:  circumstances,  i n t e r a c t i o n and i n i t i a t i o n , b a r r i e r s  Note-taking assisted  the  unforeseen  recording,  conversations  and  observations. Interviews: At least each p a r t i c i p a n t . hospital  at  the  two f o r m a l i n t e r v i e w s w e r e h e l d  The i n i t i a l  start  i n t e r v i e w s were c o n d u c t e d i n  of the program.  homes a t  the  program.  Conversing with p a r t i c i p a n t s : formal  the  The c o n c l u d i n g  i n t e r v i e w s were c o n d u c t e d i n the p a r t i c i p a n t s ' c o n c l u s i o n of the  with  conversations  On o c c a s i o n ,  between the p a r t i c i p a n t s  i n f o r m a l and  and  the  51 investigator provided a d d i t i o n a l data. frequently visit of  t o o k p l a c e when t h e  the p a r t i c i p a n t s  upcoming s e s s i o n s .  telephone  contacts  Other conversations  consisted of in their  care-givers  and d i s c h a r g e  brief  homes.  Occasional conversations  with  i n the h o s p i t a l p r o v i d e d  i n v e s t i g a t o r w i t h i n f o r m a t i o n on i n d i v i d u a l s ' prognosis  briefly  h o s p i t a l rooms t o r e m i n d them  w i t h the p a r t i c i p a n t s  other  conversations  i n v e s t i g a t o r would  in their  Conversing with staff: participants'  These  dates to t h e i r  the the  progress,  home.  I n f o r m a t i o n f r o m f a m i l y members: O c c a s i o n a l l y , unsolicited  i n f o r m a t i o n was m e n t i o n e d t o t h e  one o f t h e p a r t i c i p a n t s ' found t h i s  Participant  of  the p a r t i c i p a n t observation:  The p a r t i c i p a n t s '  had from t h e i r  c o n t r i b u t i o n at  the p a r t i c i p a n t s '  participants  and l i f e s t y l e i n  leisure  and  Observations in  interests,  general. field  n o t e s were r e v i e w e d  These a d d i t i o n a l r e v i e w s o f the  designed to increase  the  investigator's  a n d t o h e l p h i m g a i n any f u r t h e r w o r l d of the  were  l i v i n g c o n d i t i o n s were a l s o h e l p f u l  The i n v e s t i g a t o r ' s T.R.O.P.  interact  e a c h s e s s i o n were o b s e r v e d .  d e t e r m i n i n g p h y s i c a l comfort and a c c e s s ,  the  family.  Observations of the  w i l l i n g n e s s to  by  investigator  l e i s u r e e d u c a t i o n group and o n e - t o - o n e s e s s i o n s  also noted. their  The  additional information helpful i n establishing  degree of support  i n the  f a m i l y members.  investigator  participants.  field  notes  depth of  insights  throughout  i n t o the  were  understanding subjective  52 Leisure worksheets: were u t i l i z e d about  their:  t o o b t a i n i n f o r m a t i o n from the leisure interests,  participation, Ellis,  Four l e i s u r e e d u c a t i o n  participants  l e i s u r e needs,  and l e i s u r e g o a l s  worksheets  constraints  ( B a l l a n t y n e , 1987; W i t t  1989) . T h e s e w o r k s h e e t s c o n s i s t e d o f l i s t s o f  which p a r t i c i p a n t s checked o f f . interests,  values,  participation  ( A p p e n d i x O n e ) . The g o a l s e t t i n g  " c o n s t r a i n t s " worksheet p r o v i d e d a format participant  to  generated  their  leisure or  f o r more  s t r a t e g i e s f o r change.  and  items  These i t e m s d e s c r i b e d  and p e r c e i v e d c o n s t r a i n t s  to  open-ended,  P a r t i c i p a n t s were  e n c o u r a g e d t o s u g g e s t ways t o o v e r c o m e up t o t h r e e p r e v i o u s l y identified leisure  constraints  and t o s e t  goals related to  their  experiences.  Data O r g a n i z a t i o n Computerized data  files  were c r e a t e d on t h e  participants  and o r g a n i z e d c h r o n o l o g i c a l l y by the date o f the and a l s o by the types of e x p e r i e n c e s  that the  w e r e i n v o l v e d i n . A s M a l k i n a n d Howe h a v e  occurrence,  participants  stated,  t h e i d e a i s t o c r e a t e r e c o r d s o f c l i e n t s ' TR (therapeutic recreation) interventions that permit r e v i e w o f the e x p e r i e n c e from n a t u r a l s t a r t t o a n a t u r a l e n d ( M a l k i n & Howe, 1 9 9 3 , p . 265) . Participants' hospitalization,  experiences  initial  to  i n t e r v i e w s , p a r t i c i p a t i o n i n group  l e i s u r e education sessions, sessions.  included their leisure p r i o r  one-to-one  sessions  Other experiences d u r i n g the program,  and  outreach  and i n c e r t a i n  53  cases,  experiences  program,  d i s p l a y , c o n s i s t i n g of comparative tables  (Henderson,  assisted  the  manageable of  formal completion of  the  were a l s o i n c l u d e d .  A data created  which followed the  1 9 9 1 ; Huberman & M i l e s ,  i n v e s t i g a t o r i n reducing the  c h u n k s . The t a b l e s  1994) .  data  to  was  These more  a l s o p r o v i d e d an i n i t i a l  comparing a l l the p a r t i c i p a n t s '  responses to the  interview questions.  Summary t a b l e s  review s e l e c t e d data  r e l a t e d to each s p e c i f i c  means  specific  were a l s o d e v e l o p e d  to  research  question. A p a r t i c i p a n t p r o f i l e was c r e a t e d the  study.  f o r each i n d i v i d u a l  These p r o f i l e s c o n t a i n e d i n f o r m a t i o n o b t a i n e d  through the  investigator's  interviews,  and the  field  notes,  l e i s u r e education  the  p r o f i l e s presented  participants'  h e a l t h and h e a l t h h i s t o r y ,  situation.  additional involvement  data  i n T.R.O.P.,  tables the  from the  of the  social  support  The p r o f i l e s were t h e n e x p a n d e d t o  constraints  t h e i r general perception.of  isolated  information r e l a t e d to  on the p a r t i c i p a n t s '  Key p h r a s e s ,  participant  worksheets.  These i n i t i a l  living  in  results  s p e c i f i c research  and  include  history,  affecting leisure,  and  leisure.  which v e r i f i e d data  leisure  the  emergent  findings,  a n d were i n c l u d e d i n t h e  text  were and  s e c t i o n . These p h r a s e s were r e l a t e d questions.  to  54 Confirming  Data  Triangulation refers data  t o the use o f m u l t i p l e methods  c o l l e c t i o n o r the use o f d i f f e r e n t  or sources  to study the  same p r o g r a m  evaluation  (Patton,  methods  of i n c r e a s i n g the  research methods  ( M a l k i n & Howe,  for obtaining data  clarifying  the  findings  the  (Howe & K e l l e r ,  researcher  t r i a n g u l a t i o n " was w i d e l y u t i l i z e d  research  project.  necessary  in  1988). T h i s form of  "methods  q u a l i t a t i v e methods,  qualitative  2 8 7 ) . The u s e o f m u l t i p l e  assisted  While the m a j o r i t y of the  in this  d a t a c o l l e c t e d was  the use o f q u a n t i t a t i v e  measures  (Flynn,  Patton,  Volpe,  B o s c h e n , Lewko,  1 9 8 0 ) . Howe a n d K e l l e r  (1988)  has been c o n s i d e r a b l e debate r e g a r d i n g the  and  numerous  stated  that  there  c o m p a t i b i l i t y of  However, the  was a n e e d t o u t i l i z e  aspects of both approaches  particular  also  S a l h a n i & Shea,  t h e s e two a p p r o a c h e s .  investigator believed there in  this  study.  Source t r i a n g u l a t i o n r e f e r s ( M a l k i n & Howe,  1993, p .  to comparing m u l t i p l e  c r o s s - c h e c k i n g the  information consistency obtained  t i m e s and by d i f f e r e n t  data  288). T h i s form o f  t r i a n g u l a t i o n p r o v i d e d a means o f d a t a c o m p a r i s o n ,  different  was  a n d b e n e f i c i a l . The i n t e g r a t i o n o f q u a n t i t a t i v e  researchers  sources  specific  through  q u a l i t a t i v e methods h a s b e e n f a v o u r a b l y v i e w e d b y  1993;  329;  established  convergent v a l i d i t y of 1993, p .  strategies  1980, p .  M e r r i a m 1 9 9 1 ) . T r i a n g u l a t i o n i s one o f t h e b e s t  for  methods o f d a t a  and o f at  collection  55 (Patton,  Data  1980, p. 3 3 1 ) .  Analysis Data a n a l y s i s  was o n - g o i n g .  As i n f o r m a t i o n  t h r o u g h T.R.O.P. s e s s i o n s ,  interviews,  of  utilized.  c o n s t a n t , c o m p a r i s o n was The  investigator  information  i n the participants'  responses. hospital, several  frequently  Following  the participants'  the investigator  additional  was d e s i g n e d  to bring  information,  and t o f i l l  The d a t a participants'  reviewed  occasions. further  analysis  looked  physical  actions  symbolic  language.  properties  t h e i r medical  of  from t h e charts  on  of secondary  transcripts  key points  data  which  of the were  o r observed by t h e i n v e s t i g a t o r .  f o rrepetitious  sadness,  t o ensure  and t o analyze  f o radditional  words, p h r a s e s ,  laughter,  the  and  transcribed  the participants' such  as  r e f l e c t i v e moments a n d o t h e r  responses which might  meaning t o t h e t r a n s c r i p t i o n s obtained  that  details. Characteristics  of their verbal  Information  form  their  discharge  analysis  a  t o a s s i s t him i n i s o l a t i n g and i d e n t i f y i n g  responses were a c c u r a t e  enthusiasm,  each p i e c e  t o study  reviewing  and noting  A u d i o t a p e s were r e v i e w e d  responses  notes,  meaning t o t h e e x i s t i n g  included  interviews  investigator  This  obtained  i n some o f t h e u n k n o w n s .  mentioned by the p a r t i c i p a n t s The  and f i e l d  reviewed files  was  were  add  noted.  from t h e interviews  and t h e  further  56  completed worksheets  was f r e q u e n t l y s u p p o r t e d when t h e  p a r t i c i p a n t s p r o v i d e d s i m i l a r o r c o n s i s t e n t responses o v e r a p e r i o d o f time on s i m i l a r q u e s t i o n s . I n f o r m a t i o n was a l s o s u p p o r t e d , on o c c a s i o n , through r e p o r t s o r feedback  from o t h e r  s t a f f i n v o l v e d i n t h e p a r t i c i p a n t s ' / p a t i e n t s ' t r e a t m e n t . The c o n t e n t s o f t h e s o c i a l worker's  notes on t h e m e d i c a l c h a r t  were r e v i e w e d i n a l l c a s e s , t o c o n f i r m p a r t i c i p a n t  responses  and t o seek a d d i t i o n a l i n f o r m a t i o n when p o s s i b l e . The p a r t i c i p a n t responses t o q u e s t i o n s r e g a r d i n g t h e i r g o a l s were a l s o accounted  leisure  f o r i n the a n a l y s i s .  E t h i c a l Review T h i s s t u d y was s u b m i t t e d f o r a p p r o v a l t o b o t h t h e S t . P a u l ' s H o s p i t a l E t h i c s Committee f o r Human E x p e r i m e n t a t i o n and t h e U n i v e r s i t y o f B r i t i s h Columbia B e h a v i o u r a l S c i e n c e s S c r e e n i n g Committee. The p r o j e c t was approved by b o t h o f t h e s e committees i n January, Due  1994 (see Appendix F o u r ) .  t o t h e apparent  r e l u c t a n c e o f some p a t i e n t s t o  p r o v i d e w r i t t e n consent, who o t h e r w i s e appeared t o v e r b a l l y agree and endorse T.R.O.P., t h e i n v e s t i g a t o r d i s c u s s e d p o t e n t i a l r e v i s i o n s t o t h e consent p r o c e s s w i t h t h e S t . P a u l ' s H o s p i t a l E t h i c s Committee f o r Human E x p e r i m e n t a t i o n . Based on feedback r e c e i v e d from t h i s Committee, no changes were made t o t h e i n i t i a l consent  form o r p r o c e s s .  C o n f i r m i n g p o r t i o n s o f t h e d a t a and e n s u r i n g i t s a u t h e n t i c i t y t h r o u g h v e r i f i c a t i o n c o u l d have p r e s e n t e d  certain  57 ethical have  issues.  "hurt"  For example,  the p a r t i c i p a n t s  c o n f i r m i n g some i n f o r m a t i o n may e m o t i o n a l l y . The i n v e s t i g a t o r  t o d e c i d e when i t was a p p r o p r i a t e the p a r t i c i p a n t for  the  rather negative  It  was n o t  t o c o n f i r m w i t h one p a r t i c i p a n t  the  interview,  as t h i s  Some i n f o r m a t i o n c o u l d be v e r i f i e d  the p a r t i c i p a n t with other  scope of  without  t h r o u g h m e d i c a l r e c o r d r e v i e w and  members o f t h e p a t i e n t s '  care  the close  information  s p e c i f i c r e l a t i o n s h i p problems beyond the  study.  appropriate  u n s o l i c i t e d i n f o r m a t i o n o f f e r e d by a  f a m i l y member a f t e r to  t o seek c o n f i r m a t i o n from  a n d when i t was n o t .  investigator  had  team.  related this  "harming" discussions  58 CHAPTER FOUR R e s u l t s and  Discussion  Overview The findings  results  s e c t i o n begins with a b r i e f  from the  each of the  two p i l o t  summary o f  study p a r t i c i p a n t s .  eight participants  A p r o f i l e of  of the main study  follows.  These p r o f i l e s i n c l u d e s e l e c t e d demographic d a t a from the  interviews, medical records,  Summaries o f t h e worksheets to the  leisure interests,  are presented  next.  completes  this  participant  chapter.  and f i e l d  challenges  The r e s u l t s  s p e c i f i c research questions  sentence or f o l l o w i n g the  the p a r t i c i p a n t .  S i x out of the  became i n e l i g i b l e  Pilot  questions  either  at  the  eight participants  in  the  c o u r s e o f t h e p r o g r a m . Two t o c o n t i n u e as t h e y  both  their  have been i n c l u d e d .  Study The  results  of the p i l o t  study revealed that  c o u l d p r o v i d e an a d d i t i o n a l community s u p p o r t recently hospitalized older adults multitude of medical problems. who  relevant  s t a t e m e n t s made b y  r e q u i r e d extended r e - h o s p i t a l i z a t i o n . However, incomplete results  goals  to a s p e c i f i c  b e g i n n i n g of the  participants  and  and i n t e r v i e w  Any r e f e r e n c e  entire  notes.  which are  i s d e n o t e d by t h e i r code l e t t e r s ,  main study completed the  collected  for  T.R.O.P. two  who w e r e e x p e r i e n c i n g a  "MA" was a 58 y e a r o l d woman  was i n r e n a l f a i l u r e a n d a w a i t i n g a k i d n e y  transplant.  59 She h a s a l s o h a d 14 o p e r a t i o n s a spinal curvature, common  in less  t h a n two y e a r s  due  to  a n d she was a l l e r g i c t o a v a r i e t y o f  substances.  The s e c o n d p a r t i c i p a n t  (TU) was a 75 y e a r o l d man. He  was a n o n - i n s u l i n d e p e n d e n t amputation of h i s r i g h t  diabetic,  leg. Also,  with a  below-the-knee  he h a d a h i s t o r y o f  a l c o h o l i s m and a n g i n a . In response enjoy her  to questions  leisure,  the  r e a l l y good f r i e n d s " 1994, p . 3 0 ) . participant with"  first participant  was a f a c i l i t a t i n g  In response stated,  to the  stated factor  of the p i l o t  as b e i n g i n t e r r e l a t e d .  " T h e y go t o g e t h e r .  That's  by i m p r o v i n g the  1994, p .  second  study i n d i c a t e d that  satisfaction  (Gallant,  the  p.45).  v i e w e d l e i s u r e s a t i s f a c t i o n and  i m p r o v e my l i f e  31).  The o t h e r  The f i r s t  interviewee  l a r g e l y where  I  leisure things interviewee  not happy w i t h y o u r l i f e  i n general  h a r d t o be h a p p y w i t h i n d i v i d u a l 1994, p .  would  I do" stated:  things  you're  g o i n g t o be (such as  very  leisure)"  46).  Both p a r t i c i p a n t s following benefits  it's  both  life  " I t h i n k t h e y go h a n d i n h a n d . . . W e l l I w o u l d s a y i f  (Gallant,  "having  company y o u ' r e  participants  stated:  that  i n the p i l o t  study described  r e l a t e d to T.R.O.P.  f o c u s e d my i n t e r e s t s  her  (Gallant,  same q u e s t i o n ,  " I guess sometimes the  ( G a l l a n t , 1994, Other r e s u l t s  r e l a t e d t o what h a d h e l p e d  a bit better".  MA s t a t e d  the  "it  She was r e f e r r i n g  has to  60  l e i s u r e education helping make d e c i s i o n s .  h e r t o c l a r i f y h e r i n t e r e s t s and  TU s t a t e d , " I  e n j o y e d your programs... i t broke  the r o u t i n e up".  Main Study P a r t i c i p a n t P r o f i l e s T h i s s e c t i o n p r o v i d e s a p r o f i l e on each o f t h e e i g h t p a r t i c i p a n t s who were i n v o l v e d  i n t h e main T.R.O.P. s t u d y .  Each p r o f i l e p r e s e n t s i n f o r m a t i o n  related to the  p a r t i c i p a n t s ' h e a l t h and p h y s i c a l appearance,  early  background and s o c i a l s u p p o r t , work and l e i s u r e h i s t o r y , i n v o l v e m e n t i n T.R.O.P., c o n s t r a i n t s perceptions of leisure..  t o l e i s u r e , and  61 TG H e a l t h and P h y s i c a l T.G.  Appearance  was a 56 y e a r o l d woman, a d m i t t e d t o h o s p i t a l  a fractured  left  l e g due t o a f a l l .  h i s t o r y of medical problems.  T h e r e was no  The m a j o r i t y o f h e r  with  other hospital  a d m i s s i o n .and t r e a t m e n t was o n t h e R e h a b i l i t a t i o n U n i t . shared  her  semi-private  expected to return T.G.  While i n the  room w i t h one o t h e r woman. T . G . was  to her previous  was a t a l l  level  of  functioning.  i n s t a t u r e a n d h a d a medium b u i l d .  h o s p i t a l and d u r i n g the  u s u a l l y appeared  She  c a s u a l l y dressed  outreach  sessions,  she  i n sweat p a n t s and a  t-  shirt. E a r l y B a c k g r o u n d and S o c i a l T.G.,  who h a d b e e n d i v o r c e d , l i v e d a l o n e  K i t s i l a n o house, two s o n s , that  Support  where  who l i v e d  finding  many o f h e r  friends  her  she h a d r e s i d e d f o r 30 y e a r s .  She h a d  i n B r i t i s h C o l u m b i a w i t h whom s h e  she was v e r y c l o s e .  difficulty  in  She s a i d t h a t  friends  she h a d  some  a v a i l a b l e d u r i n g the  were s t i l l  daytime  w o r k i n g a n d she was n o t .  h a d numerous v i s i t o r s a n d a v a r i e t y o f c a r d s were d i s p l a y e d on h e r b e d s i d e  stated  and  as She  flowers  table.  Work a n d L e i s u r e H i s t o r y T.G.  was r e c e n t l y r e t i r e d  from h e r j o b  administration with a local u t i l i t y t o be h i g h l y a c t i v e organizations  in  company. She  continued  i n a v a r i e t y o f community s e r v i c e  and r e c r e a t i o n p u r s u i t s  including:  attending  62  baseball  games,  swimming, s o c i a l i z i n g w i t h numerous  and h o l d i n g t h r e e v o l u n t e e r i n d i c a t i o n of a p a r t i c u l a r medical record.  However,  was some m e n t i o n o f h e r meals  on a s h o r t - t e r m Involvement  in  positions.  later  her there  r e c e i v i n g some a s s i s t a n c e w i t h  basis  from a  T.R.O.P.  cheerful,  i n the  grateful,  both  and community.  hospital  T.R.0.P.  sessions  and i n t e r a c t i v e .  and r e s o u r c e f u l  be f o u n d r e a d i n g n o v e l s  In the  She  hospital  she  or  TG s t a t e d  that  b e i n g h o s p i t a l i z e d made h e r a w a r e o f how l u c k y she h a s life  so f a r  investigator  and how t h a n k f u l  felt  she  she was t o be a l i v e .  demonstrated e x c e l l e n t  h e r m e d i c a l c o n d i t i o n and l e i s u r e regard,  insight  constraints.  she  individual  and m a g a z i n e s  c o n v e r s i n g w i t h o t h e r p a t i e n t s and s t a f f .  in  her  church.  motivated  could often  initial  on h e r m e d i c a l r e c o r d  was a v e r y o u t g o i n g , i n the  T h e r e was no  r e l i g i o u s a f f i l i a t i o n on  During her p a r t i c i p a t i o n was c o n s i s t e n t l y  friends,  In  been  The into  this  TG s t a t e d :  when I ' m r e p a i r e d t o t h e p o i n t where I t h i n k I w i l l b e . . . I w i l l be e x a c t l y t h e same a s b e f o r e my a c c i d e n t . . . i f n o t b e t t e r b e c a u s e I w i l l be a stronger person. W i l f u l l y stronger. During T . R . O . P . ,  she was p a r t i c u l a r l y i n t e r e s t e d  s p e c i a l i z e d swimming p o o l p r o g r a m , p r e v i o u s l y unaware. this  was  We i n i t i a t e d an a p p l i c a t i o n t o  swimming p r o g r a m .  programs  o f w h i c h she  She a l s o  f o r an i s o l a t e d  i n q u i r e d about  in a  attend  available  d i s a b l e d f r i e n d of h e r s . T . G .  63  achieved her  a d d i t i o n a l goals which consisted of going  Gambier I s l a n d and r e s u m i n g Constraints  to  to  driving.  Leisure  W h i l e h e r knowledge of n o n - s p e c i a l i z e d ' community facilities unaware  a n d s e r v i c e s was i m p r e s s i v e ,  o f s p e c i f i c programs  She a l s o a p p e a r e d leisure  time.  She i n d i c a t e d ,  as  she  sometimes  these f a c i l i t i e s .  "I j u s t  of  her  never  have  I t h i n k I may c h a n g e my l i f e s t y l e  s o m e w h a t . . . s l o w down a b i t " . constraint,  at  t o have a g o o d u n d e r s t a n d i n g  constraints.  enough f r e e  offered  she was  She was a l s o a w a r e  of  another  stated:  My p r o b l e m r i g h t now i s t h a t I d o n ' t h a v e a n y b o d y i n my own age g r o u p who i s f i n a n c i a l l y a b l e . . . p h y s i c a l l y a b l e . . . o r without other i n c u m b e r s o m e s l i k e h u s b a n d s t o (be a b l e t o ) t r a v e l w i t h me". T h e r e was no i n d i c a t i o n o f a n y e m o t i o n a l , cultural,  or f i n a n c i a l barriers  which affected  spiritual, TG's  leisure  involvement. P e r c e p t i o n of  Leisure  T.G.  to value being active,  appeared  p e r c e i v e d the more.  but  n e e d t o s l o w down a n d e n j o y h e r  She r e c o g n i z e d t h a t  different  things".  lifestyle  p r i o r to the  to return  to her previous  leisure  She a p p e a r e d accident level  c o u l d be  she  also  leisure  even  " s o many  t o be h a p p y w i t h  her  a n d she was h i g h l y m o t i v a t e d of l e i s u r e  involvement.  64  FB H e a l t h and P h y s i c a l Appearance F.B. admitted leg. to  was a 58 y e a r o l d r e t i r e d man, most  t o h o s p i t a l due t o i n t e r n a l b l e e d i n g i n h i s  He h a d b e e n p r e v i o u s l y a d m i t t e d ,  a right  January  recently  of  stroke.  i n O c t o b e r o f 1992  due  T h i s was f o l l o w e d b y a n o t h e r a d m i s s i o n  1993 due t o a l e f t  some d i f f i c u l t y  left  with his  stroke.  He c o n t i n u e d t o  s p e e c h c l a r i t y as a r e s u l t  in  have  of  these  strokes. F.B.  was w e l l - d r e s s e d ,  wore g l a s s e s . one  side,  well-groomed,  He was o v e r w e i g h t  when he  where  and s l i g h t l y l e a n e d  he h a d l i v e d  towards  Support  was b o r n i n I t a l y a n d he c o n t i n u e d t o  close. connections  usually  stood.  E a r l y B a c k g r o u n d and S o c i a l F.B.  a n d he  to the  maintain  I t a l i a n community i n V a n c o u v e r ,  f o r a p p r o x i m a t e l y 30 y e a r s .  moved t o a n a p a r t m e n t a t  a seniors  He  recently  c o m p l e x , w h e r e he  lived  alone. F.B. contact  was d i v o r c e d a n d h a d two s o n s w i t h whom he was  w i t h on a w e e k l y b a s i s .  V a n c o u v e r a r e a and the w i t h one o f h i s  sons,  other  in  the  i n Manitoba. F . B .  s o c i a l c l u b and s e v e r a l  Community C e n t r e .  lived  for  F . B . r e c e n t l y moved t o a n  c o m p l e x , where he l i v e s a l o n e .  attended a stroke Italian  lived  i n a Burnaby apartment,  a p p r o x i m a t e l y one y e a r . apartment  One s o n l i v e d  in  Italian  He r e g u l a r l y events at  the  He s t a t e d he was h a p p y i n  the  65 comfort  of the  h o s p i t a l w i t h company a r o u n d h i m . He was  extremely w e l l  l i k e d by the  hospital's  t o them due t o h i s p r e v i o u s t o make f r i e n d s  staff  admissions.  e a s i l y i n the  hospital,  A l t h o u g h he he d i d n o t  h a v e a n y o n e w i t h whom he r e g u l a r l y s p e n t h i s F.B.'s bright,  one b e d r o o m a p a r t m e n t a p p e a r e d  and c l e a n .  c o u l d be s e e n outside  the  living  There were s e v e r a l in this  garden  apartment.  types of vegetables  appear  to  time.  cozy,  and  statues  T h e r e was a l s o a  room w h i c h seemed w e l l  seemed  leisure  neat,  Several religious pictures  i n the  and w e l l - k n o w n  garden  looked  after.  and f l o w e r s  growing  area.  Work a n d L e i s u r e H i s t o r y F.B.  w o r k e d as a t r u c k  a l s o as a p l a n t reduction used to  foreman.  and  He s t a t e d t h a t he h a d a m a r k e d  i n his participation in leisure pursuits  i n c l u d e : opera  painting,  d r i v e r f o r a l o g g i n g camp  singing,  walking with his  sons,  cooking, w r i t i n g and a v a r i e t y o f  which poetry, other  interests. Involvement F.B.  in  T.R.O.P.  s t a t e d he t h a t he e n j o y e d b e i n g i n v o l v e d i n  p r o g r a m b e c a u s e he l e a r n e d and i n l i f e  again".  to  "become  The i n v e s t i g a t o r  interested  substantial  medical setbacks,  s e n s e o f humour a n d s p i r i t . regarding  his  future.  things  f o u n d i t was i n s p i r i n g  t o t a l k w i t h F . B . as he h a d e n c o u n t e r e d rather  in  the  a number o f  y e t he r e t a i n e d  F . B . appeared  generally  He was i n s i g h t f u l i n t o h i s  recent, a good positive  condition  66  and had r e a l i s t i c o u t l o o k towards h i s f u t u r e ,  considering  h i s u n c e r t a i n p r o g n o s i s and s i g n i f i c a n t d i s a b i l i t y .  He  stated: " I h a d i t i n my m i n d f o r t h e l a s t few y e a r s t h e r e was s t i l l a hope o f g e t t i n g b e t t e r a n d m a r r i e d a n d n o w . . . a l l hope i s g o n e . I w o u l d l i k e i t t o h a p p e n , but I d o n ' t see i t h a p p e n i n g " . F.B.  stated  opportunities  that  the  i n v e s t i g a t o r had p r o v i d e d  f o r s o c i a l i z a t i o n , d i s c u s s i n g -problems,  "bringing ideas  t o my m i n d " . A t t i m e s d u r i n g t h e  FB became t i r e d a n d h i s s p e e c h c o h e r e n c e seemed t o f r u s t r a t e and e d u c a t i o n F.B.'s  interviews,  decreased.  him d u r i n g p o r t i o n s of the  This  interviews  sessions.  g o a l s were t o c o n t i n u e g o i n g t o t h e  and t o improve h i s p h y s i c a l s k i l l s walking outdoors.  stroke  enough t o r e t u r n  He was a b l e t o meet h i s f i r s t  club  to  g o a l however  h i s m e d i c a l problems d i d not t o t a l l y r e s o l v e p r i o r t o completion of  and  the  T.R.O.P.  Constraints to Leisure F.B.  r e q u i r e d a n a s s i s t i v e a i d t o become m o b i l e ,  he f r e q u e n t l y u s e d a s c o o t e r o r c a n e t o commute distances  around h i s apartment  also stated his  that  financial  thus  short  c o m p l e x a n d n e i g h b o u r h o o d . He  and p h y s i c a l c o n c e r n s  restricted  leisure. Perception of L e i s u r e It  role  appeared  in his l i f e .  important  that F . B . f e l t His interests  l e i s u r e p l a y e d an  important  i n o p e r a and m u s i c were  t o h i m . More r e c e n t l y he r e f l e c t e d o n l e i s u r e  very and  67  stated: life,  "certain things  are  g o o d . They k e e p me i n t e r e s t e d  a n d i n t h e w o r l d . " He seemed t o be  emotionally to his d e c l i n i n g health for  p h y s i c a l improvements  i n the  him t o enjoy w a l k i n g outdoors  but  yet  still  which would  once a g a i n .  be a n u n l i k e l y g o a l t o a c h i e v e , impossible goal.  adjusting  status,  future  in  hoped  permit  T h i s now seemed  c e r t a i n l y not  an  to  68 VB H e a l t h and P h y s i c a l V.B.  Appearance  was a 70 y e a r o l d woman who was a d m i t t e d t o  P a u l ' s H o s p i t a l G e r i a t r i c Assessment and Treatment to  St.  Unit  due  some a b d o m i n a l p a i n she was e x p e r i e n c i n g . T h i s p a i n was  associated with internal bleeding,  f o r w h i c h she  t r e a t m e n t a n d from w h i c h she r e c o v e r e d . medical record,  received  According to  V.B.'s  she was a l s o d i a g n o s e d a s h a v i n g m a j o r  d e p r e s s i o n and d i f f i c u l t y  a d j u s t i n g to the  aging  process.  T h i s d e p r e s s i o n became h e r most s i g n i f i c a n t p r o b l e m r e q u i r i n g treatment. V . B . ' s  medical record indicated  s h e h a d become i n c r e a s i n g l y i s o l a t e d V.B.  frequently  recently.  seemed c o n c e r n e d a b o u t  She a l w a y s a p p e a r e d n e a t ,  that  well-dressed,  how s h e l o o k e d .  a n d she u s u a l l y w o r e  a s m a l l amount o f m a k e - u p . E a r l y B a c k g r o u n d and S o c i a l  Support  She h a s b e e n w i d o w e d f o r s e v e n y e a r s has  l i v e d alone i n her Burnaby apartment.  and s i n c e t h e n The  investigator  o b s e r v e d h e r a p a r t m e n t t o be d a r k a n d c l u t t e r e d . appeared  to seclude h e r s e l f  frequently  yet  She  in practice  she  s p o k e o f t h e n e e d t o be a r o u n d o t h e r s . V . B .  opened her c u r t a i n s  a little  a n d was a n x i o u s d u r i n g t h e inpatient  from o t h e r s ,  she  and o u t r e a c h  when t h e  initial  investigator  visited  p o r t i o n s o f many o f  the  sessions..  She h a s two d a u g h t e r s who l i v e w i t h whom she has b e e n i n c o n t a c t  i n the Lower  Mainland,  on a r e g u l a r b a s i s . V B ' s  69  medical record satisfied  also  now  i n a long time.  investigator, lives  in  that  her," . F a m i l y v i s i t o r s  a n d more p o s i t i v e her  indicated  ( i n the  "very l i t t l e  remarked  hospital)"  During conversations  VB f r e q u e n t l y  spoke  Before adults.  hospital. unit,  t h a t VB " i s  with  shared her  retiring  the  sister,  VB was h i g h l y i n d e p e n d e n t w h i l e i n  She o f t e n  hospital  spent a p a r t of her  day o f f  t h r e e women,  go o u t s i d e t h e  hospital.  the the  observing  discussion  g r o u p s . . V . B . a l s o enjoyed  to music w h i l e i n her  hospital  she  hospital  and a c t i v i t i e s  bed.  consisted  reading  C a n a d a o n a one month d r i v i n g  listening  leisure  her  vacation.  for  community c e n t r e and p l a n n i n g a  completion of t h i s  t o Edmonton t o accompany  and  attending  of going outdoors local  a walk  crafts,  Her r e c e n t  w i t h a few women f r i e n d s , Upon t h e  for  recreation  l i v e music e n t e r t a i n m e n t and  o c c a s i o n a l l y a t t e n d i n g her  travelled  hospital  w i t h whom  These i n c l u d e d :  gardening,  Edmonton.  for  room.  programs w h i l e i n the  have a c o f f e e  early  a s m a l l c a r e home  a n d she was i n v o l v e d i n a v a r i e t y o f t h e r a p e u t i c  to  who  she was i n h e r  she w o r k e d a t  She w o u l d f r e q u e n t l y  walks,  seen  History  o r t a l k i n g w i t h one o f t h e  interests  happier  t h a n t h e y have  about her  VB s t a t e d she h a d w o r k e d s i n c e  older  ever  Edmonton.  Work a n d L e i s u r e  teens.  has  study  sister  trip  , V.B. to  to  eastern  70 Involvement V.B.  in  T.R.O.P.  was a n e n e r g e t i c ,  also frequently  s t i m u l u s s e e k i n g women who was  a n x i o u s and l a c k i n g i n  d u r i n g many o f t h e  T.R.O.P.  sessions.  busy doing crossword p u z z l e s , attending  social  hospitalized.  inpatient  confirmed the  and  was  as r e s t l e s s  a n d was  She h a d no p h y s i c a l l i m i t a t i o n s a n d  p r i m a r i l y from t h e  social  T.R.O.P.  Home v i s i t s  investigator's  sessions.  beliefs regarding  anxiousness  and low s e l f - c o n f i d e n c e .  included to  find  seniors,  start  to  frequently  l i s t e n i n g to music,  V . B . described herself  seemed t o b e n e f i t  through the  She was  r e c r e a t i o n programs w h i l e she  not used to being alone. she  self-confidence  contact  V.B.'s  Her l e i s u r e  goals  o u t more a b o u t v o l u n t e e r o p p o r t u n i t i e s t r a v e l l i n g , and t o f i n d  o u t what  a n d f a c i l i t i e s were a v a i l a b l e . P r i o r t o t h e i r  programs  completion of  T.R.O.P.  s h e met a l l t h r e e g o a l s w i t h some d e g r e e o f  success.  She t r a v e l l e d t o Edmonton t o a c c o m p a n y h e r  o n a one m o n t h d r i v e t o w a r d s obtained  e a s t e r n Canada a n d  also  She was u n c e r t a i n o f when s h e w o u l d  p h y s i c a l l y and m e n t a l l y r e a d y t o p u r s u e any v o l u n t e e r Constraints During the  her.  sister  i n f o r m a t i o n on v o l u n t e e r i n g a n d c o m m u n i t y  r e c r e a t i o n programs.  cultural,  with  to  work.  Leisure  i n t e r v i e w s t h e r e were no i n d i c a t i o n s o f  financial,  be  or s p i r i t u a l concerns which  H o w e v e r , she d i d i n d i c a t e t h a t money was a  when r e s p o n d i n g t o t h e  l e i s u r e worksheets  yet  her  any  affected constraint choice of  71 g o a l s and h e r  list  of steps to overcoming b a r r i e r s  i n d i c a t e t h a t money was a b a r r i e r . of  companionship towards the  she c o m p l a i n e d t h a t  V . B . focused on h e r  end o f t h i s  she l a c k e d t h e  she was e x p o s e d t o i n t h e  d i d not  social  study.  At her  lack home,  s t i m u l a t i o n which  hospital.  Perception of Leisure V.B. appeared i n her  indicated that  l e i s u r e was i m p o r t a n t  t o have a good u n d e r s t a n d i n g  life.  of the  to her.  role i t  n e e d s . V . B . seemed t o f u n c t i o n v e r y w e l l w i t h i n of the  the  the  i n t h e h o s p i t a l . She  social  forms o f  and  apartment.  i n having other people  t i m e a n d seemed t o p r e f e r  especially  programs.  somewhat o v e r w h e l m e d ,  d i s o r g a n i z e d o n c e she was d i s c h a r g e d b a c k t o h e r She e m p h a s i z e d h e r e n j o y m e n t  was  leisure  h o s p i t a l and h o s p i t a l r e c r e a t i o n  She seemed much more a n x i o u s ,  all  plays  Her d i v e r s e and a c t i v e l i f e s t y l e w h i l e she  h o s p i t a l i z e d h e l p e d h e r t o cope w i t h some o f h e r  structure  She  around  leisure,  stated,  I ' m n o t u s e d t o b e i n g a l o n e . I ' v e b e e n away ( i n h o s p i t a l ) f o r q u i t e a w h i l e you k n o w . . . 1 t h i n k I ' d be b e t t e r o f f i f I j u s t s t a y e d t h e r e ( i n h o s p i t a l ) h a v i n g t h i n g s t o do a n d p e o p l e a r o u n d me.  72 JN H e a l t h and P h y s i c a l J.N. Paul's  Appearance  was a 71 y e a r o l d m a l e who was a d m i t t e d t o  for a r i g h t below-the-knee  Rehabilitation Unit,  below-the-knee  a l s o had a h i s t o r y o f a n g i n a ,  J.N. small  "sick"  f o r 12  dressed  amputation.  He  i n worn, s l i g h t l y t o r n c l o t h e s .  and has  He was  face.  Support  lived  i n V a n c o u v e r f o r 25 y e a r s .  i n a West E n d a p a r t m e n t b u i l d i n g ,  were r e s p o n s i b l e  He l i v e d  which  they  f o r m a n a g i n g . J . N . was d i v o r c e d f r o m  this  f o r 22 y e a r s ,  but r e m a r r i e d her f i v e y e a r s  ago.  T h e y have f i v e  children, a l l living  There appeared  t o be a h i g h l e v e l o f c a r e - g i v e r s t r e s s .  was d o c u m e n t e d i n t h e m e d i c a l c h a r t investigator. stale pet  first  lived  outreach  i n Winnipeg, Manitoba.  and o b s e r v e d by  The a p a r t m e n t was c l u t t e r e d ,  smoky s m e l l .  bird  T h e r e was a s m a l l ,  i n a cage i n the session their  dusty,  converse.  This  the  and had a  o l d dog p r e s e n t a n d a  l i v i n g room. D u r i n g  i n v e s t i g a t o r asked i f  the the  t e l e v i s i o n v o l u m e c o u l d be t u r n e d down, a s i t was t o o to  he  was b o r n i n F i n l a n d b u t grew up i n a M o n t r e a l  with his wife  same, w i f e  men.  years.  E a r l y B a c k g r o u n d and S o c i a l  orphanage  the  and a c c o r d i n g t o h i s w i f e ,  i n s t a t u r e and had a r o u g h l y shaven  J.N.  He was on  i n a room w i t h t h r e e o t h e r  P r e v i o u s l y J . N . had a l e f t  has been  amputation.  St.  loud  73  Work a n d L e i s u r e H i s t o r y Earlier  in his  copper mines.  life  His previous  repairing electronic g o i n g to the  he w o r k e d as a l a b o u r e r leisure  equipment,  horse races,  hunting,  attending  community c e n t r e w i t h h i s w i f e , television.  the  recreation become  in  or other  to  v i s i t s by the  to start  i n most o f t h e s e f o r  investigator  hospital.  and the  A l t h o u g h he  to overstate h i s desire interests,  scooter, hobby,  who s u g g e s t e d  and  The i n v e s t i g a t o r to take  c a l l s . A n o t h e r g o a l was  o b t a i n i n f o r m a t i o n o n West E n d p r o g r a m s .  The  the to  investigator  i n h i s expression of  he was u n m o t i v a t e d t o  the  contacted  initiative  b e l i e v e d J . N . was s i n c e r e  goals  that JN  reluctant  yet  begin  T h i s was a c h i e v e d t h r o u g h  t h e s e c e n t r e s as J N a p p e a r e d phone  to  c i t i n g he  He a c h i e v e d one o f t h e s e l e i s u r e  investigator,  t o make t h e  the  therapeutic  resume h i s e l e c t r o n i c s  two c o m m u n i t y c e n t r e s .  interest,  a  s o c i a l i z e , he s t a t e d t h a t he d i d  by f i n d i n g a chess companion. a s s i s t a n c e o f the  conversation with  g o i n g o u t more w i t h h i s  a chess p a r t n e r .  contact  relaxing,  neighbourhood  i n the  He a p p e a r e d  water-colour painting, find  initiate  patients  like  program.  to  involved in specific leisure  would l i k e  fishing,  T.R.O.P.  was r e l u c t a n t  s t a t e d he d i d n o t enjoy  included:  time.  Involvement  investigator  a  the  p l a y i n g chess and w a t c h i n g  He has n o t p a r t i c i p a t e d  long p e r i o d of  J.N.  interests  in  this  f o l l o w - t h r o u g h w i t h any  74  specific  action related  to pursuing other  interests.  seemed t o  lack problem-solving a b i l i t i e s related  his goals  a n d he a p p e a r e d  providers  and h i s w i f e )  retrospect,  the  to expect  others  to solve problems  investigator  He  to  reaching  (such as for him.  believed that  J.N.  health In  overstated  h i s a b i l i t i e s and p r e s e n t e d g o a l s w h i c h were beyond h i s p r e s e n t a b i l i t i e s and p e r h a p s i n t e r e s t s .  He  may h a v e p r o v i d e d r e s p o n s e s w h i c h he p e r c e i v e d w o u l d be p l e a s i n g to the  investigator.  Constraints J.N. needs.  to  Leisure  seemed t o have p o o r i n s i g h t  He h a d r e f u s e d  into his  home-making s e r v i c e s ,  own d a i l y  w h i c h were  recommended b y b o t h h i s s o c i a l w o r k e r a n d h i s w i f e ,  thus  placing increased  his  wife. J.N.  r e s p o n s i b i l i t i e s a n d demands u p o n  J . N . used a scooter had l i m i t e d  f i n a n c i a l resources  i n d i c a t i o n t h a t he h a d any P e r c e p t i o n of It leisure  area.  no  friends.  to a s c e r t a i n  how J . N . p e r c e i v e d  H i s p a s t a n d more c u r r e n t  he d i d e n j o y d o i n g s e v e r a l  of p a r t i c i p a t i o n appeared  however,  a n d t h e r e was  as he seemed t o have some d i f f i c u l t y  suggested  West E n d  Leisure  was d i f f i c u l t  his responses.  level  t o move a b o u t t h e  articulating  leisure  activities,  behaviours but  his  t o be d e c l i n i n g . J N d i d  g e n e r a t e any d e f i n i t i v e r e s p o n s e s w h i c h m i g h t  reveal his  leisure  perceptions.  not,  75 JR H e a l t h and P h y s i c a l J.R. Hospital  Appearance  was a 71 y e a r o l d woman, a d m i t t e d t o S t . as t h e  result  of a f a l l  and a f r a c t u r e d  Her p r e v i o u s m e d i c a l h i s t o r y i n c l u d e d a f a i l e d hip replacement  arthritis  She was a n e a t ,  of the  spine with  petite, visit  frail  curtains  drawn around her bed.  well"  cards  her bedside,  rugs,  macrame,  books and p u z z l e s i n the sessions  took p l a c e .  in Seattle,  along  She was  never  apartment complex Her  small  d e c o r a t e d w i t h a number o f  and p a i n t i n g s .  T h e r e w e r e a l s o many  l i v i n g room a r e a w h e r e t h e  J.R. stated that  outreach  she h a d one s i s t e r  W a s h i n g t o n and a s i s t e r - i n - l a w who  i n Vancouver, B r i t i s h  with  flowers.  K i t s i l a n o a r e a o f V a n c o u v e r f o r 10 y e a r s .  hand-made  lived  of  was b o r n i n M o o s e j a w , S a s k a t c h e w a n .  one b e d r o o m a p a r t m e n t was c o z y ,  the  Support  m a r r i e d and had l i v e d a l o n e i n a s e n i o r s i n the  the  T h e r e w e r e a number o f  and an a r r a n g e m e n t  E a r l y B a c k g r o u n d and S o c i a l J.R.  a  w i t h J . R . she was i n , b e d w i t h  n o v e l s and c r o s s w o r d p u z z l e books at "get  total  scoliosis.  woman. D u r i n g  first  several  left  hip.  hip,- n a r c o l e p s y s i n c e c h i l d h o o d ,  investigator's fully  left  and a r i g h t t o t a l h i p r e p l a c e m e n t ,  congenital dislocated left and severe  Paul's  who  lived  Columbia.  Work a n d L e i s u r e H i s t o r y J.R. for  c o n t i n u e d t o v o l u n t e e r as t h e  her s e n i o r ' s  secretary-treasurer  c o m p l e x . T h e r e was no h i s t o r y o f a n y p a i d  76  employment d u r i n g h e r included: reading,  bingo,  knitting, volunteering,  and g o i n g on s h o r t  now d e c e a s e d . has  t o o much t i m e o n h e r  JR appeared interactions responded interview,  in  w i t h the  i n her responses  to each q u e s t i o n d u r i n g  She was somewhat  with  reluctant  s h e now  and  to  She  the  the accept  her.  in providing J.R.  i n f o r m a t i o n but  found i t  get  difficult to  i n f o r m a t i o n on  a n d i n i t i a t e a swimming p r o g r a m a p p l i c a t i o n .  appear i n t e r e s t e d  a p p l i c a t i o n was Constraints  however she  i n p u r s u i n g swimming o n c e  did  her  approved. to  Leisure  r e q u i r e d h e r w h e e l e d w a l k e r t o move a r o u n d  her  apartment,  a n d she s t a t e d i t was i n c r e a s i n g l y d i f f i c u l t  her to get  around.  She r e q u i r e d a v a r i e t y o f  reaching devices for completing d a i l y tasks dressing.  for  with  J . R . i n d i c a t e d three goals which were:  She d i d s u c c e s s f u l l y a c h i e v e t h e s e g o a l s ,  J.R.  is  T h i s l e a d t o some d e g r e e o f d i s a p p o i n t m e n t  o b t a i n a means o f t r a n s p o r t a t i o n ,  not  that  i n v e s t i g a t o r and o t h e r p a t i e n t s .  some c o m m u n i t y r e c r e a t i o n  programs,  who  T.R.O.P.  i n v e s t i g a t o r who was i n t e r e s t e d  "reach"  church,  w i t h her b r o t h e r ,  a n d r a r e l y made eye c o n t a c t  information.  attending  hands.  very reserved  only briefly  investigator.  to  trips  interests  She s t a t e d on s e v e r a l o c c a s i o n s ,  Participation  the  l i f e t i m e . Her l e i s u r e  for  assistive such  as  A l t h o u g h J . R . s t a t e d she was s a t i s f i e d w i t h  her  77  life,  her r e s p o n s e s sometimes  difficult  life  not  that  w i t h v e r y few c l o s e f r i e n d s .  t h a t most o f t h e and t h a t  suggested  friends  she h a s She a l s o  she d i d have were no l o n g e r  she now h a d t o o much t i m e on h e r h a n d s .  a p p e a r t o be a n y f i n a n c i a l  had a stated alive  There d i d  concerns.  Perception of Leisure J.R.  i n d i c a t e d she o f t e n  something to do".  During the  h a d " t o o much l e i s u r e  "leisure time".  "usually  same i n t e r v i e w she  and not  t h e r e was some u n c e r t a i n t y her  gets bored but  her a b i l i t y  C e r t a i n l y , she a p p e a r e d  to  l e i s u r e w i t h t i m e a n d she a l s o saw l e i s u r e as which could help people  forget  stated  enough t o do i n i t " .  towards  their  troubles.  finds  to  she  Thus, utilize  equate something  78 PP H e a l t h and P h y s i c a l P.P.  was a 73 y e a r  Hospital, fall  Appearance o l d female,  G e r i a t r i c Assessment  and d e p r e s s i o n .  dependency  to St.  and T r e a t m e n t U n i t ,  Her o t h e r m e d i c a l problems  upon s l e e p i n g p i l l s ,  h i p and r i g h t  admitted  knee,  a left  osteoarthritis  wrist  injury,  due t o  a  included:  a  of her  degenerative  disease,  b r e a t h l e s s n e s s a n d c o u g h i n g when a n x i o u s ,  previous  h i s t o r y of a l c o h o l abuse.  not  satisfied  w i t h her  life,  P.P. stated that  and t h a t  Paul's  right disk  and a she  she was h a p p y t o  was be  hospitalized. She was s m a l l i n s t a t u r e , strong  Scottish accent.  and she  frequently  neatly  She w a l k e d s l o w l y a n d  c o u g h e d when she was  E a r l y B a c k g r o u n d and S o c i a l P.P.  dressed,  and had a laboriously  conversing.  Support  was b o r n i n G l a s g o w , S c o t l a n d and h a s  Vancouver f o r  37 years.  a West E n d a p a r t m e n t . h a d two s i s t e r s ,  one  lived  in  She was d i v o r c e d a n d l i v e d a l o n e  She d i d n o t living  have any c h i l d r e n but  i n V a n c o u v e r and t h e  other  in she  in  Edmonton. H e r a p a r t m e n t was p a r t i c u l a r l y b r i g h t was a l s o t i d y ,  clean,  well  o r g a n i z e d and  i n appearance.  It  spacious.  Work and L e i s u r e H i s t o r y She s t a t e d she h a s b u s y work s c h e d u l e officer.  She a l s o  not  s e e n much o f t h e  p r i o r to her stated that  c i t y due t o  r e t i r e m e n t as a  her  security  she h a d a v e r y d i f f i c u l t  time  79  coping w i t h her retirement. socialized, friends  cooked,  P r e v i o u s l y , she  regularly  a n d a t t e n d e d shows w i t h t w o  who have s i n c e moved a w a y .  She u s e d t o  close ballroom  dance and v o l u n t e e r w i t h a n o n - p r o f i t  organization  with AIDS).  swimming, and  She a l s o e n j o y e d  reading,  She c o n t i n u e d t o a t t e n d a s e n i o r s ' neighbourhood, enjoyed  Involvement P.P.  (people)  She l a c k e d s e l f - c o n f i d e n c e to contribute  seemed v e r y c o n c e r n e d o v e r phone  of  being hurt  abused  d i d not  again,  answer.  as  information  to T.R.O.P.  to her h e a l t h .  believed that this  due t o t h e m u l t i t u d e  her l e i s u r e  times,  goals.  She a c c o m p l i s h e d t h i s b y p u r c h a s i n g the  suggestion  of  her  accomplishment.  also  of the  she  in  afraid  c o u l d not  The self-  of medical c o n d i t i o n s  s h e h a d made some was  who h a d moved a w a y .  an e l e c t r i c  investigator.  Her o t h e r  but  she  One o f t h e s e g o a l s  t o be b e g i n w r i t i n g t o h e r two f r i e n d s ,  at  as  was a r e a s o n a b l e  She was a n x i o u s a t  towards  She  she was e m o t i o n a l l y a n d p h y s i c a l l y  improvements  progress  worried  PP i n d i c a t e d s h e was  any f u t u r e  experienced.  the  c a l l s she r e c e i v e d e a r l y  frustrated  prognosis  cares".  about  and f r e q u e n t l y  She was a l s o  investigator  her  television,  know someone  as a c h i l d .  foresee  in  to conversation w i t h  and she r e v e a l e d p e r s o n a l  morning but  walking.  in T.R.O.P.  about not b e i n g able  the  She w a t c h e d  was e x t r e m e l y r e c e p t i v e  investigator herself.  awareness group  on a w e e k l y b a s i s .  t a l k i n g " l e t t i n g them  (People  typewriter  She was q u i t e  g o a l s were t o  find  proud out  what  80 programs were a v a i l a b l e She  did  review  and  volunteer  suitable The  to  information  currently  awful  to  being  available but  these  t h i s was  the  lot better  I used  to  than  to  Constraints  ability  indicate  any  referred  electric  negative. a  outlook. "What i s  responded:"I going  her  think  into  success  the an  the back  i n no  to longer  drugs.  Leisure  and  her  recent  seemed t o  be  her  declining  social isolation.  She  did  constraints rather  to  not  l e i s u r e which  spontaneous purchase  was  of  the  typewriter.  Perception P.P.  to  not  further.  question  been before  prescription  financial  i n her  was  i n t e r e s t s any  a realistic  P.P.'s m a j o r c o n s t r a i n t s physical  health  again.  programs  a different person getting  She  to  work  recreation  her  investigator's  I had  like  be."  addicted  evident  felt  y o u r h o s p i t a l i z a t i o n ? " , PP  hospital... I feel what  on  pursue  felt  response  outcome of  to pursue volunteer  opportunities,  investigator In  and  of  Leisure  appeared to She  number of  perceive  obviously  years  dancing...go to  ago.  the  but  she  being  at  work.  felt  She  stated  "I used  Queen E l i z a b e t h way  most of  " I was  be  somewhat  e n j o y e d many r e c r e a t i o n a l  shows...1 can't walk the lot",  l e i s u r e to  at  my  to  Theatre  love for  I used to...1 used  her  enjoyment  happiest  activities  in life  w h e n I was  ballroom  different to  read  came  a  from  working."  81 RC T h e r e was l i m i t e d d a t a became was r e - a d m i t t e d t i m e and c o u l d not inpatient  hospital  c o m p l e t e t h e p r o g r a m . He d i d a t t e n d  education  Appearance  was a 75 y e a r o l d w i d o w e d m a l e . He was a d m i t t e d f o r . h i p replacement  bedroom. D u r i n g h i s i n i t i a l  s u r g e r y and l a t e r  he f e l l  was a t a l l  wore g l a s s e s  generated  He  and  a s e n s e o f w a r m t h . He  d i n i n g room o n t h e h o s p i t a l u n i t o r i n h i s Due t o a r e - a d m i s s i o n t o S t . the  four  frequently  a n d u s u a l l y c o u l d be f o u n d r e a d i n g i n  of a f a l l ,  his  scooter.  and o v e r w e i g h t g e n t l e m a n .  s m i l e d and h i s appearance  in  He h a d a 15 y e a r  h i s t o r y of back p a i n r e s u l t i n g i n decreased m o b i l i t y dependency on an e l e c t r i c  to  re-admitted  h o s p i t a l s t a y he was i n a  p e r s o n room o n t h e R e h a b i l i t a t i o n U n i t .  result  two  sessions.  due t o a h i p d i s l o c a t i o n w h i c h o c c u r r e d a f t e r  R.C.  he  t o h o s p i t a l f o r a n e x t e n d e d amount o f  H e a l t h and P h y s i c a l R.C.  c o l l e c t e d on R . C . because  the  bed.  P a u l ' s H o s p i t a l as  the  i n v e s t i g a t o r w i t h d r e w him from  the  s t u d y p r i o r t o c o n d u c t i n g any o u t r e a c h s e s s i o n s . R . C . c o n t i n u e d t o be h o s p i t a l i z e d f o r a t  least  another  three  months. E a r l y B a c k g r o u n d and S o c i a l  Support  He h a d l i v e d a t  Richmond apartment  years. of  h i s present  He p r e v i o u s l y r e s i d e d i n K e l o w n a . W i t h t h e  one n i e c e ,  who l i v e d  i n the Vancouver area,  for  six  exception  t h e r e was no  82  other  mention or documentation of r e l a t i v e s .  he h a d s e v e r a l behind the  close  friends  i n the Richmond a r e a .  head o f h i s bed had s e v e r a l c a r d s  a n d t h e r e w e r e numerous  R.G. indicated The  from  f l o w e r arrangements at  wall  friends  his  bedside.  Work a n d L e i s u r e H i s t o r y R.C.  d i d n o t m e n t i o n what he w o r k e d a t p r i o r  retirement. sailing,  His previously active  swimming, f i s h i n g ,  used to attend  recreation  a w a r e o f many o f t h e  h u n t i n g and r e a d i n g .  his  has n o t to  nearby  level  facilities.  what  R . C . appeared  o f d i s a b i l i t y , and he was future  leisure-related  p r i o r t o b e i n g d i s c h a r g e d from the  He  been  w e r e a v a i l a b l e f o r h i m , a l t h o u g h he  some d i r e c t i o n f o r t h e programs,  hiking,  He s t a t e d he was u n c e r t a i n a s  programs  have a c c e p t e d  lifestyle included  c h u r c h on a r e g u l a r b a s i s but  there recently.  to  was  to  seeking  resources study.  and  83  MP T h e r e was a l s o l i m i t e d d a t a participant  due t o r e - a d m i s s i o n t o t h e  H e a l t h and P h y s i c a l M.P.  the  intensive  transferred  private  to the  room. Her o t h e r  cervix, arthritis  knee  hospital.  was a 77 y e a r o l d w i d o w e d f e m a l e ,  admitted to the  this  Appearance  h o s p i t a l due t o a f r a c t u r e  later  c o l l e c t e d on  of her r i g h t care u n i t  admitted  femur.  i n serious  Rehabilitation Unit  to  She was c o n d i t i o n and  into a semi-  medical h i s t o r y included cancer  i n her hands,  and a l e f t  below  of  the  amputation. M.P.  about  the  was s h o r t  i n s t a t u r e and o v e r w e i g h t .  hospital unit  face presented  the  She moved  s l o w l y i n her w h e e l c h a i r and  her  l o o k o f someone who was a l w a y s i n d e e p  thought. Shortly after  her discharge  she d e v e l o p e d a s o r e Mt.  St.  Joseph's  term care  participating  on h e r r i g h t  Hospital.  facility  a n d became  in this  house.  ineligible  "get  w i t h them.  well"  cards  Hospital,  admitted to a to  to long-  continue  study.  was a w i d o w who l i v e d  l i v e d nearby  Paul's  a n d was a d m i t t e d  Support alone  i n her East Vancouver  She h a d two c h i l d r e n a n d a s i s t e r .  relatives contact  foot  She was l a t e r  E a r l y B a c k g r o u n d and S o c i a l M.P.  from S t .  a n d she d i d n o t  The i n v e s t i g a t o r  and f l o w e r s at  None o f  these  a p p e a r t o be i n  d i d observe  her bedside  close  a number o f  i n the  hospital.  84  These were from her c h i l d r e n , g r a n d c h i l d r e n , and a n e x t door neighbour. P a r t i c i p a t i o n i n T.R.O.P. She p a r t i c i p a t e d i n one o u t r e a c h s e s s i o n p r i o r t o her re-admission t o h o s p i t a l . During t h i s v i s i t , which took p l a c e i n her k i t c h e n , the i n v e s t i g a t o r n o t i c e d h e r o b v i o u s l a c k of m o b i l i t y w i t h i n her home. She found i t d i f f i c u l t  to  move around the k i t c h e n and from one room t o t h e n e x t . She s t a t e d she now spent most of her time i n t h e k i t c h e n r e a d i n g her magazines  because she i s a f r a i d of f a l l i n g  and does not  have the s t r e n g t h t o move about too much. She appeared t o e n j o y the s o c i a l n a t u r e of the f i r s t home v i s i t . She  was  u n a b l e t o be c o n t a c t e d t o s c h e d u l e the second v i s i t due t o her re-admission to h o s p i t a l . Work and L e i s u r e H i s t o r y She p a r t i c i p a t e d i n s e v e r a l r e c r e a t i o n programs w h i l e at  S t . P a u l ' s H o s p i t a l . These i n c l u d e d : b i n g o , p e t v i s i t s ,  and a t t e n d i n g l i v e e n t e r t a i n m e n t programs.  P r e v i o u s l y she  e n j o y e d w a t c h i n g s p o r t s , r e a d i n g , shopping, sewing, and used t o go swimming. She a l s o e n j o y e d w a t c h i n g her husband g a r d e n i n g and the company of h e r 12 y e a r o l d dog w h i c h had d i e d two y e a r s e a r l i e r . Constraints to Leisure M.P.  was u s i n g a w a l k e r t o m o b i l i z e i n s i d e h e r  house,  a f t e r b e i n g d i s c h a r g e d from S t . P a u l ' s . She used a manual w h e e l c h a i r when she l e f t her house. M.P.  had no  apparent  85  financial  concerns.  facilities  M . P . had l i t t l e  knowledge o f  s u c h as b i n g o h a l l s o r s p o r t s  be one f o c u s a r e a o f  accessible  arenas.  T h i s was  to  T.R.O.P.  R e s e a r c h Q u e s t i o n s One, Two, a n d T h r e e The k e y p h r a s e s f r o m p a r t i c i p a n t s ' r e l a t e d to research questions summarized and p r e s e n t e d research 1.  questions  responses which  one t h r o u g h t h r e e  were  are  i n T a b l e s 1 and 2 . These  specific  were:  How d i d o l d e r a d u l t s  d e s c r i b e the b e n e f i t s  of  leisure? 2.  How d i d o l d e r a d u l t s  benefit  from  f e e l that they b e n e f i t t e d / d i d  T.R.O.P.?  3 . What w e r e t h e  self-perceived facilitating  c o n t r i b u t e d towards enjoyment  Benefits  of  factors  leisure?  was t h a t  l e i s u r e p r o v i d e d them  w i t h a time to t h i n k or to c o l l e c t t h e i r thoughts. gave p a r t i c i p a n t s  to the  lives  of  the p a r t i c i p a n t s ,  reported  "freedom". are  These b e n e f i t s ,  consistent  w i t h the  literature  (Lee e t  was  upon  related  as d e s c r i b e d by  elements  a l . , 1994)  of l e i s u r e s e l e c t e d by the  T.R.O.P.  to r e f l e c t  r e l a x a t i o n and freedom o f c h o i c e w h i c h  i n the  definition  additional opportunities  and t h e i r l e i s u r e . A n o t h e r b e n e f i t  element  enjoyment,  which  of Leisure  The most common r e s p o n s e  their  not  of are  and i n  researcher  the  (Datillo &  86  Murphy, 1991) .  TABLE 1: Key p h r a s e s from p a r t i c i p a n t s ' responses r e s e a r c h q u e s t i o n s one, two, and t h r e e Participants  related to  Question Topic  TG  FB  VB  Benefits of Leisure  -provides time t o think - a l l o w s you freedom t o think clearly  -enj oyment -made me realize i t might be b e t t e r t o be alive -keeps me interested i n l i f e , and the w o r l d  -you can r e l a x and collect your thoughts  Benefits of T.R.O.P.  -insight into what i s available -specific resources for the disabled  -enj oyed being involved -became interested in certain things -got me thinking  -enjoyed the activities  Facilitating Factors  -aunt's help - b e i n g a t home -being able t o drive -thinking openly -enjoying people's company -not l i v i n g a hermit's l i f e  -being w i t h my c h i l d r e n -doing physical activities  -being around people -helping others  87  TABLE 2: K e y p h r a s e s f r o m p a r t i c i p a n t s ' t o t a l r e s p o n s e s r e l a t e d t o r e s e a r c h q u e s t i o n s one, two, and t h r e e (continued) Participants Question Topic  JN  JR  PP  Benefits Leisure  of  -time to think - g i v e s you a c h a n c e t o do what y o u want  -forget your troubles - g i v e s you a s o c i a l aspect  -sense of satisfaction  Benefits T.R.O.P.  of  -found a chess p a r t n e r - l e a r n e d from the worksheets -made me interested i n certain things  -made me more aware  - g e t t i n g and having information explained -brightened the h o r i z o n -nice having a visitor  -being able to get around -being able to watch sports -arguing with "the o l d lady"  -being with my r e l a t i v e s and f r i e n d s  -working -being physically active (ballroom dancing)  Facilitating Factors  PP's  response  to t h i s  previous discussions referred of  question  seemed i n c o n s i s t e n t  she h a d w i t h t h e  investigator.  t o o b t a i n i n g a "sense of s a t i s f a c t i o n "  leisure.  During T.R.O.P.  she m e n t i o n e d t h a t  inpatient  she e n j o y e d h e r s e l f  w o r k . Now due t o h e r h e a l t h ,  she  felt  with  as  and o u t r e a c h  benefit  most when s h e was frustrated  with  l i f e s t y l e . T h i s " i n c o n s i s t e n c y " c o u l d be a n  of  increased trust  the p a r t i c i p a n t  a  visits  recent the  She  placed i n  at  her  example  the  88  g  s o f involvement i n T . R . O . P .  P ^3  1 and 2, a l l the p a r t i c i p a n t s c benefit  of the T.R.O.P.  ated m u l t i p l e b e n e f i t s . rom b r i e f  ^-^.-j.—-^erie'iTtrs c7f -  participants social  included:  contact,  opportunities, towards  program  These  comments t o more  T.R.O.P.,  a s d e s c r i b e d by-  "having a v i s i t o r " o r increased  gaining insight  i n t o community  h a v i n g an i n d i v i d u a l  and answer q u e s t i o n s ,  pursuing certain things.  to direct  recreation questions  l e a d i n g t o an i n t e r e s t  in  P . P . was s p e c i f i c i n h e r  d e s c r i p t i o n of the benefits  of T.R.O.P.:  I t ' s g r e a t g e t t i n g i n f o r m a t i o n from y o u . Y o u ' v e e x p l a i n e d a l o t o f t h i n g s t o me t h a t I n e v e r knew a b o u t . . . I t ' s b r i g h t e n e d t h e h o r i z o n . Because I ' m p r e t t y w e l l o n my own. I l e a d a l i f e l i k e a h e r m i t r e a l l y . I t ' s kind of nice having a v i s i t o r . These r e s p o n s e s s u g g e s t s t h a t T . R . O . P . provide f o r a variety of participants' and t h a t o u t r e a c h living  Curran,  s e l f - p e r c e i v e d needs  l e i s u r e education can a s s i s t  i n t h e c o m m u n i t y . The l i t e r a t u r e  populations  was a b l e t o  older  on o t h e r  adult  has reached a s i m i l a r c o n c l u s i o n (Clark &  1994; Lyons e t a l . , 1993).  The i n v e s t i g a t o r  d i d h a v e some i n i t i a l  adults  concerns  89 r e g a r d i n g the benefitted  specific interview question  "Has t h i s  y o u i n a n y w a y ? " T h e r e was some f e a r ,  that  participants  w o u l d have wanted t o p r o v i d e a p l e a s i n g  response.  is difficult  effect  It  occurred or not.  the p a r t i c i p a n t s ' said  "no" o r  to a s c e r t a i n whether  r e s p o n s e s were more a u t h e n t i c  importance of s o c i a l  were s o u r c e s  contributed to t h e i r (PP)  as a f a c i l i t a t i n g  for social  contact  and s u p p o r t  l e i s u r e enjoyment.  O n l y one  decline  i n the  (1991b.)  families'  who s t a t e d t h a t  It  and the  participant  the  t h e r e has been  a b i l i t y to support  their  supports,  "elderly"  households. still  although  these  r e l a t i v e s d i d n o t u s u a l l y l i v e w i t h them o r w i t h i n t h e community.  The two y o u n g e s t p a r t i c i p a n t s  a  geographic  decline in multi-generational  t h e i r r e l a t i v e s were s o c i a l  two  contrasts  w o u i d seem t h a t t h e m a j o r i t y o f t h e p a r t i c i p a n t s  "felt"  or  and  company o f h e r  members w i t h v a r y i n g h e a l t h s t a t u s e s due t o distance  Five  nearby,  who r e c e n t l y moved away. T h i s f i n d i n g o f Ross  factor.  the  i n d i c a t e d t h e i r c h i l d r e n , spouse,  a l t h o u g h she d i d d e s c r i b e e n j o y i n g t h e  research  towards  T h e r e was a s t r o n g e m p h a s i s o n  i n d i c a t e d h a v i n g no r e l a t i v e s o r f r i e n d s  friends  assumed  i f some h a d  p e r c e i v e as c o n t r i b u t i n g  support  six participants  friends  "halo"  Factors  l e i s u r e enjoyment?  the  such a  The i n v e s t i g a t o r c o u l d h a v e  What d i d p a r t i c i p a n t s  of  the  "not much".  Facilitating-  their  program  FB a n d TG w e r e  same very  90 c l o s e e m o t i o n a l l y t o t h e i r c h i l d r e n . They b o t h  indicated  t h e y were i n v o l v e d i n s o c i a l groups w i t h i n t h e i r All  s i x of the p a r t i c i p a n t s  social  contact.  consistent & McColl,  expressed a d e s i r e  for  T h i s need f o r i n c r e a s e d s o c i a l  w i t h the  f i n d i n g s of other  family  s u p p o r t was  increased  relations  researchers  1992; R u b i n s t e i n , Lubben & M i n t z e r ,  suggests that t h e i r  community.  is  (Freidland  1994)  and  inadequate.  The h o s p i t a l e x p e r i e n c e was p e r c e i v e d t o be p o s i t i v e b y a number o f p a r t i c i p a n t s opportunities not  for socializing.  happy b e i n g a l o n e a l l the  lonely, as  due i n p a r t ,  to the  increased  F o r e x a m p l e VB s t a t e d time at  h e r home,  she  " I was v e r y  I c r i e d a l o t . " Close r e l a t i v e s a l s o described  "socially  However,  happier,  hospitalized.  her  i s o l a t e d " p r i o r to her h o s p i t a l i z a t i o n .  t h e s e same r e l a t i v e s d e s c r i b e d h e r a s  positive,  was  i n a b e t t e r mood" when she  VB a l s o became h i g h l y a n x i o u s a s  approached her discharge date,  was she  s t a t i n g she was n o t  how s h e w o u l d manage when she r e t u r n e d She a l s o s a i d t h a t  "more  certain  t o h e r home  alone.  she w o u l d m i s s e v e r y o n e s h e met  in  the  hospital. It  seems a p p r o p r i a t e  within St.  t o form s h o r t - t e r m  hospital units,  patients, structured  environment  P a u l ' s H o s p i t a l provided temporary  for patients specific  to s t a t e that the  "friendships".  opportunities In the  where a l l t h e p a r t i c i p a n t s  t h e y were g i v e n a v a r i e t y o f s t r u c t u r e d opportunities  t o engage i n some f o r m o f  two  were  and non-  91 socialization. Hospital,  Prior  participants  of  After  discharge  social  opportunities.  outlets,  environment,  example,  P.P.  comfort of the  of short-term  loss  increased  hospital  investigation.  a l s o h a d some i n f l u e n c e o v e r t h e  social  been a "temporary"  other  (FB) a n d t h a t t h e y f e l t  s u c h as t h o s e p r o v i d e d i n the  The r e s e a r c h e r participant's  hospital  "happy i n t h e  The e f f e c t s  needs f u r t h e r  Paul's  l a c k e d such a v a r i e t y of  from the  m e n t i o n e d t h e y were  h o s p i t a l w i t h company"  social  admission to St.  many o f t h e p a r t i c i p a n t s  opportunities.  the  to t h e i r  i s o l a t i o n i n the  one  c o m m u n i t y a n d may h a v e  f a c i l i t a t o r towards enjoyment.  For  stated:  L e t me p u t i t t h i s way P a u l , I n e v e r g e t a n y v i s i t o r s . I mean I d o n ' t s e e a n y b o d y e l s e . I t ' s k i n d o f n i c e t o h a v e someone t o come i n t o y o u r house and y o u can s i t and t a l k t o t h e m . . . The i n v e s t i g a t o r f o u n d i t participant  (JN) . who l i v e d w i t h h i s s p o u s e ,  need f o r e x t e r n a l  would appear  (1993)  has  The c a s e  at  the  times that  same.  It  "social  this  only  also indicated a  s p e c i f i c case  r e l a t i o n s " were  " b e n e f i c i a l or supportive". stated  the  s o c i a l i z a t i o n . T h i s was a l s o c o n f i r m e d b y  h i s w i f e who r e q u e s t e d  necessarily  surprising, that  Indeed,  t h e y c o u l d be d e t r i m e n t a l  o f JN,may w e l l  represent  Research Q u e s t i o n 4: L e i s u r e  not  Coleman  i n some  cases.  such a r e l a t i o n s h i p .  Interests  A summary o f t h e p a r t i c i p a n t s T a b l e 3. These i n t e r e s t s  it  interests  i s presented  were g r o u p e d i n t o s e v e n  in  categories  92 comprised of s i x l e i s u r e experience additional  category,  l a b e l l e d as  BC R e h a b i l i t a t i o n S o c i e t y , in  domains and  "other"  1989).  (Ballantyne,  The d o m a i n s w e r e  c a t e g o r i z i n g the v a r i o u s areas of i n t e r e s t .  designed to determine participants.  The " o t h e r "  the p a r t i c i p a n t s i t e m s on t h e  The l e i s u r e  the  leisure  specific interests  interest  worksheet.  table  c o n s i s t e d of responses  provided p r i m a r i l y through t h e i r worksheet,  and any o t h e r  responses  of  (22)  She was t h e b o t h the  VB i d e n t i f i e d t h e most  only participant  "social"  she e n j o y s  thoughts"  the  opportunity  frequency  i n d i c a t e any i n the  interests  and the  situation,  for s o c i a l  requires  support  from h e r  This she  also her  interests.  expressed  interests  knowledge of h i s  JN p r o b a b l y r e l i e s i n a d d i t i o n to other  for his d a i l y care.  some o f t h e m e d i c a l r e c o r d e n t r i e s  in  suggests  was  and d i d  domain. T h i s l a c k of  investigator's  suggests that  but  choices  o n l y seven i n t e r e s t s  social  duration interests.  "to r e l a x and c o l l e c t  of t o t a l  i n d i c a t e d b y J N . He s e l e c t e d  wife  interests  t h r o u g h t h e s e more s o l i t a r y  The l o w e s t  not  to i n d i c a t e a l l the  a v a r i e t y of s o c i a l  appreciates  the  leisure  and " s o l i t a r y " c a t e g o r i e s .  the  completion of  throughout  study.  the  forced-choice  which i n d i c a t e d a d d i t i o n a l i n t e r e s t s the  helpful  c a t e g o r y was f o r m e d f r o m r e s p o n s e s  interests  interest  1987;  They were of  p r o v i d e d i n a d d i t i o n to the  leisure  participants  the  one  social  living  h e a v i l y on  his  assistance  he  T h i s may a c c o u n t  which suggested  for  J N was  93 u n w i l l i n g to accept r e l i e d on h i s w i f e  h e l p from a home-making s e r v i c e f o r most f i n a n c i a l  and  and c a r e - g i v i n g  matters. The i n v e s t i g a t o r was s u r p r i s e d t o o b s e r v e i n d i c a t e any i n t e r e s t s  i n the  T h i s f i n d i n g was i n c o n s i s t e n t  social  and c r e a t i v e  w i t h data  for  sessions  others,  centre.  and t h a t  individuals leisure.  l i k e d to write  (1987)  select  stated that  several participants i n at  interests.  JN d i d not find  FB d i d n o t  PP's,  i n a v a r i e t y of  revealed that  i n d i c a t e any  i n d i c a t e any s o c i a l  a chess p a r t n e r  t o a community c e n t r e  expressed  their  results there  of  were  indicate  least  domains.  he w a n t e d t o  for  i n a d d i t i o n t o P P , who d i d n o t  one o f t h e  physical  the  i t was i m p o r t a n t  domains. V i e w i n g the  L e i s u r e I n t e r e s t s Worksheets,  cook  seniors'  t o m a i n t a i n a sense of balance w i t h i n  from each of the  interests  letters,  them.  He s u g g e s t s t h e y s h o u l d p a r t i c i p a t e  interests  the  several  were l i s t e d as c h o i c e s o n  h o w e v e r PP d i d n o t  Ballantyne  During  she b e l o n g e d t o a l o c a l  These i n t e r e s t s  worksheet,  the  PP s t a t e d she  domains.  obtained during  two i n t e r v i e w s and d u r i n g o u t r e a c h v i s i t s . outreach  PP d i d n o t  a c u r i o s i t y about  interests  although  a n d he r e c e n t l y h a d  with his wife.  or i n t e l l e c t u a l interests,  intellectual  JR d i d n o t  indicate  a l t h o u g h she  later  s w i m m i n g . The d i s c r e p a n c i e s  J N ' s , a n d J R ' s r e s p o n s e s c o u l d be i n d i c a t i v e o f  increased understanding  been any  in their  o f what was b e i n g a s k e d o f them  as  94  the program progressed.  The L e i s u r e I n t e r e s t s w o r k s h e e t  a d m i n i s t e r e d i n the very e a r l y stages of the program, t h e p a r t i c i p a n t s were i n p a t i e n t s .  while  As the program p r o g r e s s e d ,  t h e p a r t i c i p a n t s may have become more f a m i l i a r w i t h issues.  leisure  T h e r e may have b e e n a n i n c r e a s e d u n d e r s t a n d i n g  awareness on the p a r t i c i p a n t s '  was  part.  This suggests  and  that  utilizing  a v a r i e t y o f d a t a c o l l e c t i o n methods a t  inpatient  a n d o u t r e a c h components p r o v i d e d more t h o r o u g h a n d  accurate  results.  the  95 T a b l e 3: L e i s u r e I n t e r e s t s o f • P a r t i c i p a n t s  by Domain  Participants Domains/Leisure I n t e r e s t s Social  writing letters s o c i a l telephone c a l l s visiting friends/family j o i n i n g a group/club caring f o r pet/animal TOTAL  Physical e x e r c i s e class/swimming going f o r walks gardening practising relaxation TOTAL Solitary reading l i s t e n i n g t o music humming o r w h i s t l i n g being outdoors daydreaming TOTAL Creative mechanics crafts painting/doodling woodworking cooking or eating composing planning parties TOTAL Intellectual visiting library/gallery current events discussions hobbies/collecting volunteering TOTAL Spectator w a t c h i n g TV o r m o v i e s b i r d watching people watching concerts/theatre attending l i v e sports TOTAL Others  Chess Entering contests Crosswords/puzzles Singing Travelling Bingo Knitting Baking Skating Bowling TOTAL GRAND TOTAL  TG  FB  VB  JN  JR  PP  RC  MP  3  3 3 4 4 3 17  0  3 4 2 2 11  0  5 4 1 6 2 18  X  X  X  X  X  X  X  X  X  X  X  X  X  X  4  3  5  X  X  X  X  X  X  X  X  3  3  X X X  0  1  1  X X  2  0  1  X  0  2  0 X  X  X  X  X  X  X  X  X  X X  X  X  X  X  X  3.  1  5  X  X  1  2  4  2  X X  X X  X  X  X  X  X X  X  X  X  X  4  3  1  X  X  X  X  2  3  0  1  X  X  2  X X X  X  X  X  3  0  X  X  3  2  0  1  1  1  X  X  X  X  X  X  X  X  x• X  X  X  X  X  X  X  X  4  X  1  3  1  3  X  X  X  X  4  3  3  X X X X X X X X X X  2 20  1 13  0 22  1 7  2 11  4 15  0 8  0 9  1 3 3 2 3 3 1 16 1 4 1 3 2 11 7 2 4 5 . 5 22 1 1 1 1 1 1 1 1 1 1 10  96 R e s e a r c h Q u e s t i o n 5: L e i s u r e The f o l l o w i n g  table  Constraints  ( T a b l e 4) p r e s e n t s t h e  responses to the L e i s u r e Challenges worksheet. "leisure constraints" literature leisure  under the  challenges  has p r e v i o u s l y appeared headings  this  table.  by the  Additional  constraints  are presented  (VB).  staff  and  to l e i s u r e ,  as  familiar with  i n the p a r t i c i p a n t s '  who were d i a g n o s e d  1989) .  appear  in  perceived the  profiles.  v a r i e d from  (TG, RC) t o a h i g h o f 10  The two p a r t i c i p a n t s  depression  the  & Ellis,  The number o f s e l f - p e r c e i v e d c o n s t r a i n t s l o w o f two c o n s t r a i n t s  in  self-perceived constraints  i n v e s t i g a t o r or other  participants  The t o p i c o f  of l e i s u r e b a r r i e r s  ( B a l l a n t y n e , 1987; W i t t  Only the p a r t i c i p a n t s  participants  a  constraints  with  ( P P , VB) i n d i c a t e d t h e g r e a t e s t number o f  perceived constraints.  This finding provides support  for  the  r o l e w h i c h p e r c e i v e d freedom p l a y s i n s e l f - d e t e r m i n a t i o n . As Coleman  (1993, p .  themselves  353)  stated,  t o be c o n s t r a i n e d  determination" . Furthermore, self-determination internal life  "will  fail  persons  least  to exercise  self-  who have a s e n s e o f  and a r e l a t e d d i s p o s i t i o n t o w a r d s  l o c u s of c o n t r o l can "buffer"  stress.  been at  i n d i v i d u a l s who p e r c e i v e  In the  their health  an against  c a s e s o f PP a n d VB d e p r e s s i o n may h a v e  p a r t i a l l y r e l a t e d to t h e i r perception of  a  lack of s e l f - d e t e r m i n a t i o n or a lack of perceived c o n t r o l . S i x out  of the  constraints.  eight participants  These f r e q u e n c i e s  impact these c o n s t r a i n t s experiences.  indicated five  may n o t r e f l e c t  the  had on the p a r t i c i p a n t s '  or  less  potential leisure  97 The most f r e q u e n t l y affected  f o u r out of the  constraints  indicated perceived  constraints  eight participants.  These  were: not having the p h y s i c a l s k i l l s ,  k n o w i n g what p r o g r a m s o r f a c i l i t i e s procrastinating or finding participating,  & Reid,  mentioned they  want t h e y w a n t e d " . and Agwani  difficult  to  start  (1991)  The l a c k o f  has been f r e q u e n t l y r e p o r t e d  (O'Neill  participants  were a v a i l a b l e ,  a n d h a v i n g no one t o go w i t h .  knowledge c o n s t r a i n t literature  it  not  1 9 9 1 ; S e a r l e & Mahon,  in  1 9 9 3 ) . Two  " d i d n o t h a v e e n o u g h money t o  f o u n d " l o w i n c o m e " t o be o f g r e a t e r impairments of o l d e r a d u l t s .  a p p e a r t o be t h e  case i n the m a j o r i t y of p a r t i c i p a n t s  study.  Many o f t h e i r g o a l s d i d n o t r e q u i r e  "costly"  g o a l s appeared  these goals  constraints  s e l e c t e d by any o f the p a r t i c i p a n t s :  " t o o many  "work i s t h e m a i n p r i o r i t y n o w " , a n d "I  have e n o u g h t i m e " .  constraints  to  (TG, P P ) .  family obligations", don't  more  available finances  The f o l l o w i n g t h r e e p o s s i b l e c h o i c e s o f were not  in  additional  a n d s e v e r a l o f t h e p a r t i c i p a n t s who d i d h a v e t o have t h e  impact  This d i d not  finances  pursue  T h e s e c o u l d a l l be c a t e g o r i z e d  related to other  o b l i g a t i o n s or  "lack of  were n o t e x p e r i e n c i n g a  s h o r t a g e o f t i m e due t o o t h e r  commitments. T h i s f i n d i n g  somewhat p r e d i c t a b l e g i v e n t h a t a l l o f t h e p a r t i c i p a n t s r e t i r e d and a p p e a r e d  t o have few o b l i g a t i o n s r e l a t e d  to  time. The i m p o r t a n c e o f d i s c u s s i n g c o n s t r a i n t s  to  as  time"  and suggest t h a t p a r t i c i p a n t s  their  do  The a n a l y s i s c o n d u c t e d b y F o r b e s , H a y w a r d  on s e l f - r e p o r t e d  this  the  leisure  was were  98 p a r t i c i p a t i o n and a i m i n g t o w a r d s o v e r c o m i n g t h e s e constraints  s h o u l d be e m p h a s i z e d . H o w e v e r , t h e r e i s a n e e d  t o be c o n s e r v a t i v e i n g o a l p l a n n i n g f o r t h e h e a l t h or unstable follow-up,  individual.  s u c h as T . R . O . P . ,  clarification increase  other  successes  a n d may l e a d  r e l a t e d to t h e i r  "Staying current  continued  assisted participants  of l e i s u r e c o n s t r a i n t s  future  experiences. barriers  P r o v i d i n g a form o f  in to  and a d d r e s s i n g p r o b l e m s  i n d i v i d u a l s r e q u i r i n g community s u p p o r t s ( C l a r k and C u r r a n , 1994, p .  31).  their  leisure  t o p a r t i c i p a t i o n " have i m p r o v e d s u c c e s s  disability  declining  or  rates of  due  to  99 T a b l e 4: S e l f - p e r c e i v e d . L e i s u r e T G  Constraints  I don't f e e l  l i k e doing  F B  myself  X  I d o n ' t have enough money skills  I d o n ' t have t h e a r t i s t i c  skills  R C  X  X  I  X  X  X  X  X  3  X  4  X  3  X  1  X  X  X  4  X  X X  X  i s difficult  2 3  X  X X  X  2  X  s i t u a t i o n s a r e awkward  =  X  X  procrastinate  M P  X  learning  I h a v e no one t o go w i t h  P P  X  X  I d o n ' t know what p r o g r a m s or f a c i l i t i e s are a v a i l a b l e  making d e c i s i o n s  J R  X X  I don't have t h e p h y s i c a l  social  J N  X  X  I am e m b a r r a s s e d a b o u t s o m e t h i n g new  V B  anything  I r e l y on o t h e r s f o r t r a n s p o r t I overcommit  Constraints Participants  4 3  X  4  X X  X  3  others... - no b a t h i n g - no c h e s s  suit  1  X  partner  1  X  - I don't t h i n k l e i s u r e i s important Total Indicated  Challenges:  X  2  3  10  R e s e a r c h Q u e s t i o n 6 : L e i s u r e and L i f e This research  satisfaction.  between It  5  the p a r t i c i p a n t s '  leisure  satisfaction  became a p p a r e n t t h a t  9  2  4  Satisfaction  q u e s t i o n was a s k e d i n t h e  interview to establish relationship  4  1  concluding  perceptions and  several  of  the  life participants  1 0 0  had d i f f i c u l t y was n o t  understanding the  apparent  i n the p i l o t  interview questions.  s t u d y as b o t h o f t h e  p a r t i c i p a n t s answered t h i s q u e s t i o n w i t h o u t B o t h PP a n d FB r e q u i r e d t h i s reworded before  they responded.  included specific interests  to the  interview question to  The r e w o r d e d  leisure  but  they suggested  r e l a t i o n s h i p s between l e i s u r e s a t i s f a c t i o n and satisfaction.  leisure.  d i d not p r o v i d e a d e f i n i t i v e  interview questions,  For example,  be  questions  examples of the p a r t i c i p a n t s '  responses  pilot  hesitation.  and s a t i s f y i n g e x p e r i e n c e s , r e l a t e d t o  participants'  This  The  answer  positive life  FB s t a t e d :  I r e a l l y d o n ' t t h i n k so. There p r o b a b l y , p r o b a b l y i s . . . b e c a u s e t h e more I g e t i n v o l v e d w i t h s o m e t h i n g . . . 1 e n j o y i t b e t t e r . . . 1 want t o do i t . He p r e v i o u s l y  stated:  g o i n g t o t h e s t r o k e c l u b was t h e o n l y t h i n g t h a t I e n j o y e d s i n c e c o m i n g o u t o f t h e h o s p i t a l . . . I t made me r e a l i z e t h a t d o i n g t h o s e t h i n g s ( a t t e n d i n g c l u b e v e n t s ) m i g h t (make i t ) . . . b e t t e r t o be a l i v e . F o r FB t h e  stroke club provided social  contacts  p e e r s who h a d a l s o e x p e r i e n c e d a s t r o k e . s t a t e m e n t s f r o m t h e s e two p a r t i c i p a n t s o b t a i n e d from o t h e r investigator's field  his  Additional ( P P , FB) w e r e  interview questions notes.  with  and  the  These s t a t e m e n t s s u g g e s t e d  that  t h e s e two p a r t i c i p a n t s p e r c e i v e d a p o s i t i v e r e l a t i o n s h i p between l e i s u r e s a t i s f a c t i o n and l i f e t h e y had d i f f i c u l t y VB s t a t e d right  formulating their  s a t i s f a c t i o n although responses.  she was " v e r y d i s s a t i s f i e d " w i t h h e r  now a n d a t t r i b u t e s  t h i s to  life  " n o t b e i n g a b l e t o go o u t  a n d w a l k a r o u n d t h e way I u s e d t o o r do t h e k i n d s o f  things  101 I'm used t o " . satisfied  This last  w i t h her  dissatisfaction  s t a t e m e n t s u g g e s t s t h a t VB i s  life  at  w i t h her  least  p a r t i a l l y due t o  r e l a t i o n s h i p between  perceived a  A s i m i l a r p o s i t i v e r e l a t i o n s h i p has  substantiated  by the  & Fennel1,  p e r c e p t i o n of the and l i f e  Because I d o n ' t  ( R u s s e l l , 1987;  1991). Another p a r t i c i p a n t r e l a t i o n s h i p between  a day.  frustration  her  satisfaction same.  a n d a l s o my  due t o t h e i r  satisfaction  or f a i l i n g  health.  Additional  Factors  (1994,  s p e c i f i c research  additional  p.  could s t i l l  In a d d i t i o n to the  data.  indicated  interests  change 35)  of  in health.  questions,  and  However,  be i m p r o v e d i n s p i t e  results  past  continuing  have shown t h a t  and d i s c u s s i o n s  seniors of  poor  related  additional results  This section reports  results.  their  from t h e i r  due t o n o t b e i n g c a p a b l e  S a i n s b u r y and Bruce  from the  been  stated  leisure  T h a t ' s my l i f e  of s p e c i f i c l e i s u r e  these i n t e r e s t s  the  also  (TG).  enjoyment  life  life  work o r I c a n p l a y  The m a j o r i t y o f t h e p a r t i c i p a n t s  their  and  Brown,  " T h e y ' r e a l m o s t one i n t h e  have t o w o r r y a b o u t  b a s i c a l l y 24 h o u r s leisure"  literature  satisfaction,  definite  leisure satisfaction  satisfaction.  Frankel  her  leisure.  The f o u r a d d i t i o n a l p a r t i c i p a n t s positive  not  and d i s c u s s e s  to  emerged these  102 Meaning of L e i s u r e The p a r t i c i p a n t s differently. though i t  each viewed l e i s u r e s l i g h t l y  Several participants  discussed leisure  as  c o n s i s t e d p r i m a r i l y of a c t i v i t i e s . Yet others  d w e l l e d more o n l e i s u r e  as a " t i m e t o t h i n k " o r t o  and c o l l e c t y o u r t h o u g h t s " . l e i s u r e was somewhat  "relax  This conceptualization of  consistent  w i t h the  investigator's  c h o i c e o f a l e i s u r e d e f i n i t i o n . L e i s u r e was d e f i n e d a s s t a t e o f mind i n v o l v i n g the p e r c e p t i o n o f freedom t o to p a r t i c i p a t e experiences"  characteristics. leisure  experiences  leisure  choose  satisfying  3).  Perhaps  i s needed.  an  Lee et  even  al.  i s composed o f many  T h e r e i s no one c o n c e p t w h i c h c l e a r l y and o n e ' s i n t e r p r e t a t i o n  changes o v e r time  One p a r t i c i p a n t difficulty  or  1991, p .  d e f i n i t i o n of l e i s u r e  suggest that  defines  enjoyable,  ( D a t t i l o & Murphy,  more f l e x i b l e (1994)  i n meaningful,  "a  adjusting  (Lee e t  of  leisure  a l . , 1994,  (PP) f r e q u e n t l y m e n t i o n e d to retirement.  d e s c r i b e d problems r e l a t i n g to  p.  her  Specifically  feeling  200) .  she  non-productive  b e c a u s e she was i n a c t i v e a n d no l o n g e r w o r k i n g . T h e s e may be i n d i c a t i v e of strong b e l i e f s difficulty findings of  i n a c c e p t i n g the  o f Lee et  the work e t h i c  have m e n t i o n e d the their  time at  themselves work.  al.  i n the  "work e t h i c "  aging process.  (1994)  report  times  association  I n d i v i d u a l s who  in their  w o r k , may have d i f f i c u l t y  her  research  an a p p a r e n t  and f e e l i n g s o f g u i l t . enjoyable  The  and  lives,  as  being  i n enjoying  away f r o m t h e i r work o r t a s k s t h e y p e r c e i v e  to  be  103 Leisure Goals The i n i t i a l across  and f i n a l , i n t e r v i e w s f r e q u e n t l y  a l l participants,  revealed,  t h e i r n e e d t o be m o b i l e .  a b l e t o w a l k a g a i n o r w a l k more" was a f r e q u e n t l y of  many p a r t i c i p a n t s  on o l d e r a d u l t s  and i s c o n s i s t e n t  (O'Neill  & Reid,  w i t h the  "Being cited goal  literature  1991; P a t t e r s o n &  Carpenter,  1994) . The i n v e s t i g a t o r b e l i e v e d t h i s g o a l was  frequently  r e a l i s t i c , g i v e n the p a r t i c i p a n t s '  that  prognoses,  and  t h e y w e r e a b l e t o d e s c r i b e how t h e y w o u l d a c c o m p l i s h  this.  Also,  transit  b e i n g a b l e t o e i t h e r b e t t e r use the  existing  s e r v i c e s s u c h as t h e b u s e s a n d a c c e s s i b l e t a x i s  i n one p a r t i c i p a n t ' s  case,  t h e i r own v e h i c l e w e r e s e e n  or as  common g o a l s t o be a c h i e v e d . The p r i m a r i l y i n d i v i d u a l i z e d d i r e c t e d the  format  of  T.R.O.P.  i n v e s t i g a t o r and t h e p a r t i c i p a n t  reaching mutually established goals, r e v i s i n g these goals.  towards  a n d when  F r e q u e n t l y the g o a l s  necessary  which  participants  i n d i c a t e d were r e l a t e d t o o v e r c o m i n g l e i s u r e  constraints.  F o r example t h r e e p a r t i c i p a n t s  r e l a t e d to finding PP)  o u t what p r o g r a m s a r e  a n d t h e s e same p a r t i c i p a n t s  program or f a c i l i t i e s The s u c c e s s  conditions  a v a i l a b l e " as a  constraint.  v a r i e d among p a r t i c i p a n t s ,  success  with  i n achieving leisure goals  achievement  as  in this  c o n d i t i o n s . For p a r t i c i p a n t s  r e l a t e d to the  (VB, J R ,  i d e n t i f i e d " n o t k n o w i n g what  S e v e r a l of the p a r t i c i p a n t s  degenerative  available  i n a t t a i n i n g these goals or overcoming  these constraints expected.  are  indicated goals  was  s t u d y had degenerative s h o u l d be  of slower rates of d e c l i n e i n  104 health their al.,  (Flynn et  a l . , 1993, p . 2 6 8 ) .  adjustment  process  1993) . The d i f f e r e n t  Individuals differ  t o i l l n e s s and d i s a b i l i t y coping s t y l e s of the  (Lyons et  participants  may h a v e i n f l u e n c e d t h e i r c h o i c e o f g o a l s a n d t h e i r i n a t t a i n i n g these  success  goals.  Although the m u l t i d i s c i p l i n a r y approach used i n c a s e s t u d y s e t t i n g was n o t a f o c u s o f t h i s of  the  effectiveness  of t h i s  study,  approach emerged.  the  same t i m e . W h i l e t h e  The t e a m  health issues increase of  the  of older adults.  those i n v o l v e d i n the p a t i e n t s '  t o g e t h e r towards d e s i r e d g o a l s .  behaviour. successes  utilizing  has  complicated  by e n s u r i n g t h a t  care  are  r e l a t e d to adjustments  the m u l t i d i s c i p l i n a r y  also many  working  I n many o f t h e  O t h e r r e s e a r c h e r s have a l s o f o u n d  (McLennan,  participants  in  leisure  similar  approach  1992).  Leisure  Adjustment  Lyons et as  often  it  A "team" a p p r o a c h c a n  coordination of efforts  cases these goals are  concerns  team a p p r o a c h may  o n l y be u s e d i n s p e c i f i c a r e a s o f h e a l t h c a r e , p a r t i c u l a r v a l u e when w o r k i n g w i t h t h e  the  evidence  a p p r o a c h e n a b l e d a v a r i e t y o f m e d i c a l and p a t i e n t t o be e x a m i n e d a t  in  al.  (1993, p .  254)  defined leisure  "the m o d i f i c a t i o n o f e n j o y a b l e ,  adjustment  valued a c t i v i t i e s i n  responses to i n d i v i d u a l ,  social  The p a r t i c i p a n t s '  t o change t h e i r b e h a v i o u r v a r i e d  from l i t t l e t o change  desire  and/or economical  o r no e x p r e s s e d d e s i r e  their  l e i s u r e behaviour  changes".  ( J R , TG) t o a h i g h  desire  (PP, V B ) . The two m a l e  105 participants  ( F B , JN) e x p r e s s e d o n l y a s l i g h t d e s i r e  change t h e i r b e h a v i o u r . pursuits  present.  interested  JN s t a t e d he w i l l  cause  participants in  leisure  i n changing h i s behaviour at  when h i s l e g g e t s b e t t e r a n d he  then consider these a d d i t i o n a l  This p a r t i c u l a r factor be t h e  several  i n w h i c h he may e v e n t u a l l y become i n v o l v e d ,  he was n o t  better,  JN expressed  to  of great  f o r two o f  the feels  interests.  (leisure adaptation)  frustration  however  seemed  the  ( F B , P P ) . B o t h FB a n d PP d i s c u s s e d a n  interest  i n c r e a s i n g t h e i r p a r t i c i p a t i o n l e v e l s and w a n t i n g  return  to a previous l e i s u r e p u r s u i t .  to  F . B . wanted t o  to return  t o o p e r a s i n g i n g and p a i n t i n g . He h a d become i n v o l v e d i n a stroke  club after  two y e a r s  ago.  h i s second s t r o k e which o c c u r r e d c l o s e  P . P . wanted t o r e t u r n  t o v o l u n t e e r i n g and  g o i n g o u t t o some s h o w s . B o t h p a r t i c i p a n t s were p h y s i c a l l y u n a b l e t o p u r s u e  perceived  these i n t e r e s t s  t h e i r p h y s i c a l l i m i t a t i o n s . F . B . had d i f f i c u l t y and m o b i l i t y , decreased for  due t o h i s s t r o k e  her i n t e r e s t s .  t h a t . F B ' s and P P ' s p e r c e p t i o n s  Health It  level  with  to speech cough,  difficult  The i n v e s t i g a t o r b e l i e v e d  were r e a l i s t i c .  Status  was a p p a r e n t  participants  due  they  and P . P . ' s p e r s i s t e n t  e n e r g y a n d d e c r e a s e d m o b i l i t y made i t  her to pursue  to  in this  from t h e  data,  s t u d y were a t  that  the m a j o r i t y of  a significantly  the  high  o f d i s a b i l i t y and had c o m p l i c a t e d m e d i c a l p r o b l e m s .  The p a r t i c i p a n t p r o f i l e s r e v e a l e d d i v e r s e a n d m u l t i p l e m e d i c a l p r o b l e m s among t h e p a r t i c i p a n t s .  The o n l y  individual  106 who h a d l e s s a fractured  c o m p l i c a t e d p r o b l e m s was T G . She h a d l e g due t o a f a l l  medical h i s t o r y or medical Two p a r t i c i p a n t s  and h a d no o t h e r  sustained  significant  issues.  in particular,  PP a n d FB h a d c o m p l e x  medical c o n d i t i o n s . According to these p a r t i c i p a n t s ' records staff  and d i s c u s s i o n s  the  i n v e s t i g a t o r had w i t h  involved i n these p a r t i c i p a n t s '  care,  medical  other  FB h a d a m e d i c a l  p r o g n o s i s w h i c h was somewhat u n c e r t a i n a n d PP was l i k e l y continue  d e c l i n i n g i n her h e a l t h .  J N ' s h e a l t h appeared  s l o w l y d e c l i n i n g o v e r t h e p a s t 12 y e a r s . assistance  i n managing the  stump o f h i s r e c e n t l y  l e g a n d seemed d e p e n d a n t on h i s w i f e d r e s s i n g and w i t h meal  He r e q u i r e d  for assistance  investigator  the the  s t u d y e v o l v e d . Many o f  participants  were i n i t i a l l y  reluctant  to provide  b e i n g asked by the  The p a r t i c i p a n t s '  investigator  who  i n v e s t i g a t o r over the  total  F o r e x a m p l e V B , P P , and FB a p p e a r e d  in their  r e s p o n s e s and t r u s t  c o m p l e t i o n of the  initial  consistently sincere s e s s i o n to the  i n the  outreach  and t r u s t i n g  w i t h the  course t o be  investigator session.  from the  c o m p l e t i o n of the program.  participant  to  experienced v a r y i n g degrees of  T.R.O.P.  youngest  detailed  25 y e a r s y o u n g e r a n d r e l a t i v e l y u n f a m i l i a r  comfort w i t h the  the  with  and  c h a n g e d as t h e  them.  some  amputated  participants  least  be  Relationship  The r e l a t i o n s h i p b e t w e e n t h e  was a t  to  preparation.  Investigator-Participant  responses to questions  to  of sincere  towards  the  TG was first  She  inpatient  (TG) was  l o w e s t number o f  also  health  107 problems. the  J N and JR were g e n e r a l l y u n w i l l i n g t o f u l l y  investigator enter t h e i r world.  consistently provided brief, not  appear  distant  age gap b e t w e e n t h e  B o t h JN and JR  rather  genuinely interested  vague r e s p o n s e s  i n the T . R . O . P .  researcher  may h a v e b e e n a c o n s t r a i n i n g f a c t o r investigator-therapist not  appear  let  and t h e  i n the  and d i d  process.  The  participants  e v o l u t i o n of  the  r e l a t i o n s h i p w i t h JN and J R . T h i s d i d  t o be a n i s s u e w i t h t h e  other p a r t i c i p a n t s .  The  m a j o r i t y o f t h e p a r t i c i p a n t s were p r e p a r e d t o o f f e r  more  information  familiar  to the  i n v e s t i g a t o r as t h e y became more  w i t h h i m . T h i s may h a v e b e e n a t  least  of  i n v e s t i g a t o r and  their  increased trust  i n c r e a s e d need f o r s o c i a l from the  hospital  i n the  partially indicative  opportunities  their  as t h e i r  t i m e away  increased.  The i n v e s t i g a t o r a l s o became more c o n f i d e n t t r u s t i n g of the m a j o r i t y of the p a r t i c i p a n t VB,  F B , TG) a s t i m e e l a p s e d .  He f e l t  and  responses  the o u t r e a c h  p r o v i d e d him w i t h a c e r t a i n sense of p r i v i l e g e t o p e r m i t t e d to e n t e r the p e r s o n a l participants.  living  space o f  (PP,  sessions be  the  108 CHAPTER F I V E C o n c l u s i o n s and Recommendations Conclusions L e i s u r e r e s e a r c h on o l d e r a d u l t s h a s p a r t i c i p a t i o n and c o n s t r a i n t s ago i t was r e a l i z e d t h a t towards the  individual  the  f o c u s e d on  activity  t o p a r t i c i p a t i o n . Over a f o c u s n e e d e d t o be  and n o t  the  activity  decade  redirected  (Tinsley &  Tinsley,  1982) . The s u b j e c t i v e e x p e r i e n c e o f l e i s u r e a n d  personal  s i g n i f i c a n c e o b t a i n e d t h r o u g h l e i s u r e m a t t e r s more  than the  a c t i v i t i e s per se.  matter  t h e most t o p a r t i c i p a n t s  specific for  F o r e x a m p l e , what a p p e a r e d in this  s t u d y was n o t  to a  a c t i v i t y o r number o f a c t i v i t i e s . I t was t h e i r  social  contact  and s u p p o r t  focused around f r i e n d s  the  need  and  f a m i l y w h i c h was most i m p o r t a n t . . Fulfilling  social  s u p p o r t n e e d s i s more d i f f i c u l t  a c h i e v e f o r some o l d e r a d u l t s who a r e now l i v i n g a l o n e away f r o m t h e i r f r i e n d s o r c h i l d r e n .  Significant  s u c h as t h e d e a t h o f a s p o u s e ,  retirement,  d e c l i n i n g health often present  older adults with  a n d MP) t h e  when t h e r e a r e  friends  providing social It  likely  (TG, V B , P P ,  t o be  reduced,  and f a m i l y a v a i l a b l e and c a p a b l e o f  l e i s u r e r e s e a r c h has  community-dwelling adults,  experienced recent predict  life  support.  appears that  study of older,  are  events  successive  A s some p a r t i c i p a n t s h a v e s u g g e s t e d  impact of such events  and  and i l l n e s s o r  c h a l l e n g e s t o t h e i r l e i s u r e s a t i s f a c t i o n and satisfaction.  life  to  l a r g e l y e x c l u d e d the who h a v e  h e a l t h p r o b l e m s . The p o p u l a t i o n  statistics  a c o n t i n u i n g t r e n d t o w a r d s an i n c r e a s e d number o f  109 older adults, communities  specifically  t o the V a n c o u v e r and S u r r e y  (GVRD). T h e s e p r e d i c t i o n s s u g g e s t  even g r e a t e r  there w i l l  need f o r community-based r e s o u r c e s .  Recreation  p r a c t i t i o n e r s n e e d t o be r e s p o n s i v e t o t h e s e c h a n g e s ,  and  s h o u l d be p r o a c t i v e a n d i n v o l v e d w i t h c l i e n t s i n t h e process.  Closer working r e l a t i o n s  be a n  they  change  and c o o r d i n a t i o n o f  efforts  a r e needed between the  community and i n s t i t u t i o n a l s e t t i n g s  h e a l t h and r e c r e a t i o n .  L e i s u r e has been r e c o g n i z e d  c o n t r i b u t i n g towards  life  w o u l d seem,  in  as  s a t i s f a c t i o n a n d as h a v i n g h e a l t h  benefits.  It  t h a t a more e f f e c t i v e  resources  between h e a l t h and l e i s u r e s e r v i c e s  s h a r i n g of i s needed  to  b e t t e r p r o v i d e f o r a n o l d e r p o p u l a t i o n i n c r e a s i n g i n number and l i f e  expectancy.  "Older adults experience  that  have l i v e d  contributes  (Hawkins & M c l e a n ,  1993, p .  to a h i g h degree 31).  as a g u i d e l i n e t o r e s e a r c h e r s the understanding T.R.O.P.  long l i v e s with a richness  and p r a c t i t i o n e r s  health, goals.  For example,  were n o t  i s probable that  satisfactions,  a  in  constraints  and  their and  class,  culture.  and  s u c h as t h o s e  research  observations  explore areas such as:  F l e x i b l e approaches,  of  homogeneous  m i g h t a l s o be a b l e t o f u r t h e r gender,  in  who w e r e a l l  f o c u s e d upon i n t h i s  F o r e x a m p l e , more p r e c i s e q u e s t i o n s  education,  serve  t h e y a l s o d i f f e r e d o n many  c h a r a c t e r i s t i c s w h i c h were not study.  involved  t h e s e o l d e r a d u l t s were d i v e r s e  leisure interests, It  should  The r e s u l t s  these p a r t i c i p a n t s ,  recently hospitalized older adults, group.  individualism"  Such a statement  of l e i s u r e experiences.  have i n d i c a t e d ,  of  in  utilized  in  social  this  110 person-centred  research  r e v i e w i n g some o f t h e adults.  program appeared  r i c h experiences  These e x p e r i e n c e s  l e i s u r e ' and T . R . O . P . , interests,  r e l a t i o n s h i p between  converse their  (Edginton, Jordan,  i n the  in their  life.  potential  to  have the p o t e n t i a l  leisure  & Edginton,  this  leisure  may n o t  enjoyment,  to decrease l e i s u r e  There i s a need f o r  new o u t l o o k on t h e  1994).  o n l y have but  t h e y may  dissatisfaction  future  studies  to  This  study approach  Murphy's  satisfaction  also and  life  Leisure i s a continuously evolving concept.  adults.  be  examine  relationship.  Recommendations  as  with  the  life  "leisure"  the  should not  and  satisfaction  leisure  a  to areas of  p e r h a p s some a s p e c t s o f s p e c i f i c p a r t i c i p a n t s ' dissatisfaction.  as  experience.  and s i m i l a r programs facilitate  the  satisfaction  dissatisfaction  Therefore  d e p i c t e d p r i m a r i l y as a p o s i t i v e T.R.O.P.  about  study also described  as a c o n t r i b u t i n g f a c t o r  dissatisfaction  beliefs  literature  DeGraaf,  in this  of  leisure  and l i f e  (VB, P P , FB) a n d v i e w e d t h e i r  leisure  older  satisfaction.  leisure  described  Some o f t h e p a r t i c i p a n t s  and t h e i r  and l i f e  The r e l a t i o n s h i p b e t w e e n  p o s i t i v e one  of l e i s u r e ,  to l e i s u r e ,  leisure  has been p r e d o m i n a t e l y  of these eight  in  included their perceived benefits  facilitators  constraints  t o be e f f e c t i v e  it  for Future  assisted  the  case-  researcher i n conceptualizing  relates to eight  Initially, (1991)  the  Research  recently hospitalized  investigator  accepted  older  D a t t i l o and  d e f i n i t i o n of l e i s u r e with a b e l i e f  that  such  Ill a b r o a d and s u b j e c t i v e populations. definition. limited  Now t h e  investigator questions  S u c h a d e f i n i t i o n meant t h a t  f o r many o f t h e s e p a r t i c i p a n t s  T.R.O.P.  this  i n meaningful,  "Freedom  enjoyable,  becomes  a very complicated concept.  participants  in this  s t u d y were r e s t r i c t e d  freedom and t h e r e f o r e , l o s s of l e i s u r e It  of  r e s e a r c h e r s need t o  of older adults  susceptible  to decreased  social benefits  Most o f  the  multiple  a  subjects. for  the  and s o c i a l  i n v e s t i g a t i o n of  the  recreation  supports  are  to  can  There i s a l s o a need t o r e s e a r c h  contact  on o l d e r  the recently  further. on t h e  of community-dwelling older adults,  experienced recent  definitions  l e i s u r e p a r t i c i p a t i o n and  There i s a need f o r a d d i t i o n a l r e s e a r c h  i l l n e s s or d e c l i n i n g h e a l t h .  there i s l i t t l e literature therapeutic  satisfying  w i t h d e c l i n i n g h e a l t h a n d who  which outreach therapeutic  hospitalized adults  experiences  to  continuously  l e i s u r e and t h e i r  i s o l a t i o n . Further  provide i s necessary. impact of s o c i a l  and  imply a loss of  and d e f i n i t i o n s s h o u l d a c c o u n t  experiences  social  or  by t h e i r  l e i s u r e b a s e d on new f i n d i n g s w i t h d i f f e r e n t  increased  of  by D a t t i l o and M u r p h y ' s d e f i n i t i o n ,  t h e i r views towards  Leisure research  a  opportunities.  appears that  reconsider  "restrictions"  course  physical status  experiences"  m e d i c a l c o n d i t i o n s . These  choice of  d u r i n g the  to these p h y s i c a l changes.  to p a r t i c i p a t e  all  " l e i s u r e " was h i g h l y -  due p r i m a r i l y t o t h e i r d e c r e a s e d  l a c k of adjustment choose  d e f i n i t i o n c o u l d be a p p l i c a b l e t o  recreation  in this  field.  area,  leisure  who h a v e At present  especially within  The l i t e r a t u r e  w h i c h does  the  exist  112 on o l d e r a d u l t s older adults  and l e i s u r e ,  i n the  institutionalized. therapists s u c h as the  T h i s i s not  on the  s u r p r i s i n g because  have h i s t o r i c a l l y been employed by  long-term care  will  focuses  healthy  c o m m u n i t y , o r on t h o s e who a r e  facilities  r e s e a r c h w i t h i n the  fields  frequently  institutions  and h o s p i t a l s .  l e i s u r e and t h e r a p e u t i c  be i n f l u e n c e d b y t h e  recreation  Hopefully, recreation  changing d i r e c t i o n of  health  care. The r e s u l t s  of t h i s  improvements i n f u t u r e  s t u d y have o t h e r  research.  implications for  Additional meaningful  c o u l d be o b t a i n e d b y s e l e c t i n g p a r t i c i p a n t s c a t e g o r y o f 59-69 y e a r s unintentional  absence  of age.  i n the  data  age  T h i s p a r t i c u l a r s t u d y h a d an  of p a r t i c i p a n t s  in this  specific  age  range. An a d d i t i o n a l r e c o m m e n d a t i o n i n v o l v e s t h e utilization the  increased  o f a m u l t i d i s c i p l i n a r y team as a n i n t e g r a l p a r t  i n v e s t i g a t i o n . I n t e r v i e w i n g t h e members o f  of  the  m u l t i d i s c i p l i n a r y t e a m may h a v e p r o v i d e d a d d i t i o n a l v a l u a b l e information  to the  researcher.  Additional  i n f o r m a t i o n o n how a  m u l t i d i s c i p l i n a r y team a p p r o a c h c o u l d i n c r e a s e coordination of i n p a t i e n t  and o u t r e a c h h e a l t h  the services.  There a l s o remains a need f o r l o n g i t u d i n a l s t u d i e s examine the  subjective  l e i s u r e experiences  have been r e c e n t l y i l l . Such s t u d i e s longterm effects  of older adults  would p r o v i d e data  w h i c h l e i s u r e e d u c a t i o n and o u t r e a c h  can have on o l d e r a d u l t s  after  which  the passage of  time.  on  who the  services  113 Recommendations f o r  Practitioners  H e a l t h System There i s a need f o r i n c r e a s e d c o o r d i n a t i o n and c o n t i n u i t y of  health-care  reported has  i n the  services.  T h i s need has been  literature  a l s o become e v i d e n t  (Peat  & Boyce,  through the  consistently  1993, p .  results  282)  of t h i s  study.  S e v e r a l p a r t i c i p a n t s who were b e i n g d i s c h a r g e d f r o m  the  h o s p i t a l were f e e l i n g a l a c k o f c o n t i n u i t y w i t h t h e i r care  s p e c i f i c resources.  c o o r d i n a t i o n w o u l d be t h e  R e l a t e d t o t h i s need f o r establishment  system f o r communicating the appropriate  their  service,  o f a more  concerns of the  or to the  increased  effective  older adults  individual  involved  to  in  care. The p l a n n i n g f o r t h e  future  care  of a l l  British  Columbians'  h e a l t h i s p r e s e n t l y under major r e v i s i o n .  the  strategies  initial  result  outlined in this  1991) . The t o t a l h e a l t h n e e d s o f  hospitalized older adults attention  they appear  needs r e l a t e d t o i n c r e a s e d s o c i a l  need and t h e  recently  These i n c l u d e support.  should ensure  hospitalized older adults,  Therefore that  expressed  Health care  t o a r e a s where t h e y see  demand f o r r e s o u r c e s .  leisure practitioners  health  s h o u l d be g i v e n t h e p r i o r i t y a n d  to require.  a l l o c a t e resources  Many o f  health reform should  i n an i n c r e a s e d community r e s p o n s i b i l i t y f o r  (BCRCHCC,  will  health-  (VB, J N , MP & FB) a n d o n o c c a s i o n s d i d n o t know how t o  access  the  and  the  the  health  boards  community and  needs o f  recently  who h a v e n o t b e e n a w a r e o f  resources  and o p p o r t u n i t i e s  have t h e  o p p o r t u n i t y and t h e  a v a i l a b l e t o them i n t h e choice to express  past,  t h e i r needs  to  114 h e a l t h care importance  decision-makers.  These needs i n c l u d e  of p r o v i d i n g outreach  Social  services  the  for older  Resources  There i s a c l e a r l y d e f i n e d need f o r i n c r e a s e d resources  for older adults  may r e q u i r e  from the  of l e i s u r e  t r a d i t i o n a l therapeutic services  living  control,  recreation  leisure  will  roles  be  required  in hospital  t o more o f a f o c u s  on  d e v e l o p i n g c o m m u n i t y - b a s e d s e r v i c e s w h i c h may n e e d t o the  issues  o f s o c i a l n e t w o r k s and s o c i a l  be a move away f r o m h o s p i t a l - b a s e d the  social  needs of o l d e r a d u l t s  those described i n t h i s the  careful  therapists  clarification  supports.  a c t i v i t y programs  This t r a n s i t i o n w i l l  of future  roles  Adequately addressing  for  the  meet like  require  recreation  social will  However,  resources  may n o t be e n o u g h t o e s t a b l i s h what  perceives  t o be  increase  will  programs support  be  dependent  c o o p e r a t i o n and c o o r d i n a t i o n o f h o s p i t a l  community-based r e c r e a t i o n p r a c t i t i o n e r s .  to  to  with declining health  of older community-dwelling adults,  p a r t i a l l y on t h e  address  There  i n l i g h t o f e x i s t i n g community r e c r e a t i o n  and p r a c t i t i o n e r s . concerns  study.  social  t o be p l a c e d o n  and i n t r i n s i c m o t i v a t i o n . A s h i f t  and i n s t i t u t i o n a l - b a s e d  The  e s p e c i a l l y t h o s e who a r e  an i n c r e a s i n g emphasis  improving t h e i r perceptions competence,  social  i n our l o c a l p o p u l a t i o n .  n e e d s o f some o l d e r a d u l t s , alone,  adults.  "social  short-term  support". social  The r e s o u r c e s  contact  o c c u r r e d w h i l e some p a r t i c i p a n t s  the  were i n t h e  B e i n g h o s p i t a l i z e d was n o t n e c e s s a r i l y a  these older  may a c t  s u c h as t h a t  and  which  hospital. "negative"  adult only  115 experience.  T h i s f i n d i n g emerged  several participants underestimate the participation  suggesting  i n T.R.O.P.  experiences.  Older adults  they obtained  that researchers should  present, living  and f u t u r e  health  programs  care services  require  to  a restructuring  support  t o community based o u t r e a c h  future  health  to  see  into  of  i n the  an e m p h a s i s  1994).  therapeutic  is consistent  (Condie,  or inpatient  a n d empowerment  with  field  ( C l a r k and C u r r a n ,  the  health promotion, 1993, p .  28).  reformed p r o v i n c i a l h e a l t h  1994).  towards  w e l l n e s s and t h e  seniors'  i l l n e s s to  r e c o g n i z e d as  Services Report,  The t a r g e t i n g  the  the  and like  therapy  11; MacDonald & G a l l a n t ,  forms o f t r e a t i n g aimed at  future  near  would  to community-based  1992, p .  and P u b l i c H e a l t h S e r v i c e s " a r e under  many  programs  Other r e s e a r c h e r s  recreation  from h o s p i t a l  community-based s e r v i c e s  services  in  inpatient  Health care s e r v i c e d e l i v e r y i s changing i t s  internal  the  existing  c a r e p l a n a n d may be a r e a l i t y i n t h e  and r e h a b i l i t a t i o n 1994).  by o t h e r s ,  additional staffing  programs  (Core S e r v i c e s R e p o r t ,  practitioners  social  Resources  community. A s h i f t i n g from h o s p i t a l based  current  for  involvement of o l d e r adults  will  Perhaps  situation.  R e s t r u c t u r i n g and C o o r d i n a t i n g F a c i l i t a t i n g the  not  a l o n e may h a v e r e c o g n i z e d  from b e i n g surrounded  who were i n a s i m i l a r  outreach  g i v e n by-  p r o v i d e d an o p p o r t u n i t y  on t h e i r p a s t ,  of  comments  s o c i a l impact of h o s p i t a l i z a t i o n .  reflections  enjoyment  from the  focus  from  more wellness,  "Prevention  required care plan  of s p e c i f i c  r e c o g n i t i o n of  (Core  services these  116 s e r v i c e s w h i c h n e e d t o be d e l i v e r e d f r o m a v a r i e t y o f settings,  i n c l u d i n g the  emphasized i n the  home a n d r e c r e a t i o n  latest  M i n i s t r y of Health  report  need f o r  increased  individuals  services  d i r e c t i o n of health care  outreach  Lyons  services.  As the  hospitalization, individuals  older adult, agencies  likely  this  advocates  individual's  benefit  l a r g e numbers  services. t h e r e a r e numerous older adult.  support  standard the  and  Unfortunately by  the  various  d e l i v e r y of these s e r v i c e s  (Core  1994).  more p e r s o n - c e n t r e d  inviting  recreation  l i t t l e awareness of such programs  of a comprehensive  (Riddick & K e l l e r ,  emphasize  existed,  c o m m u n i t y who c o u l d p o t e n t i a l l y  a v a i l a b l e f o r the  component  literature  rehabilitation  frequently  C o n d u c t i n g l e i s u r e e d u c a t i o n programs  service  recreation  elderly  i n v o l v e d i n the  essential  and  and t h e r e i s poor communication between  Services Report,  the  need.  that  function of  p r i o r to the  In the Vancouver area  frequently  perception of  of  from s i m i l a r o u t r e a c h  there i s  257)  need f o r these s e r v i c e s  i n the  s o c i a l programs  supports  a necessary  there are  1994).  investigator's  further  almost without exception,  Columbia  c o m m u n i t y . The l i t e r a t u r e  (1993, p .  s e r v i c e s are  is  to recently h o s p i t a l i z e d e l d e r l y  r e s i d i n g i n the  Furthermore,  from the B r i t i s h  (Core.Services Report,  T h i s study v e r i f i e s the  centres,  the  1991, p .  s h o u l d be  therapeutic  recreation  1 7 0 ) . The r e s u l t s  need f o r l e i s u r e e d u c a t i o n t o  approaches.  These i s a n e e d t o  l e i s u r e assessment.tools  participants  an  and focus  on  de-  i n favour of  t o t a l k a b o u t who t h e y a r e  and  their  117 life  experiences  (Pedlar et  al.,  1994).  118 REFERENCES Allen, L.R. and Hamilton, E.J. c o u n s e l i n g : a continuum of s e r v i c e s . Recreation J o u r n a l , 14(1), 17-22.  (1980) . Leisure Therapeutic  A r g y l e , M . ( 1 9 9 2 ) . The s o c i a l p s y c h o l o g y o f l i f e . London, England: Routledge.  everyday  B a l l a n t y n e , B . (1987). 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S o c i a l i n t e g r a t i o n , l e i s u r e a c t i v i t y and l i f e s a t i s f a c t i o n i n older adults: a c t i v i t y theory r e v i s i t e d . International J o u r n a l A g i n g and Human D e v e l o p m e n t , 25 (4):293-307. T i n s l e y , H . E . A . and T i n s l e y , D . J . ( 1 9 8 2 ) . A h o l i s t i c model of l e i s u r e c o u n s e l i n g . J o u r n a l of L e i s u r e Research, 14(2), 100-116. W h i t t m a n , J . , K u r t z , J . , and N i c h o l s , S . (1987). R e f l e c t i o n , R e c o g n i t i o n , R e a f f i r m a t i o n : A Frame o f Reference for Leisure Education- I n c l u d i n g A c t i v i t i e s , T e c h n i q u e s and R e s o u r c e s . H a m p s t e a d , New H a m p s h i r e : S t e r l i n g Press. W i l h i t e , B . ( 1 9 9 2 ) . In-home a l t e r n a t i v e s f o r c o m m u n i t y r e c r e a t i o n p a r t i c i p a t i o n by o l d e r a d u l t s . J o u r n a l of P h y s i c a l E d u c a t i o n , R e c r e a t i o n and Dance, 6 3 ( 8 ) , 4 4 46 .  W i l h i t e , B . a n d K e l l e r , M . J . ( 1 9 9 2 ) . The r o l e o f t h e r a p e u t i c r e c r e a t i o n i n community i n v o l v e m e n t p a t t e r n s and p e r c e p t i o n s of o l d e r a d u l t s w i t h developmental d i s a b i l i t i e s . Annual i n T h e r a p e u t i c R e c r e a t i o n , 3, 1 8 - 3 2 . W i t t , P . A . a n d E l l i s , G . D . ( 1 9 8 9 ) . The l e i s u r e d i a g n o s t i c b a t t e r y users manual. S t a t e C o l l e g e , Venture P u b l i s h i n g .  Appendix 1  127  LEISURE INTERESTS What are my leisure interests, considering what activities I really enjoy, I am good at, or want to learn? There are several components that contribute to a persons wellbalanced leisure lifestyle and, these components are frequently met in w a y s we do not realize. The activities listed represent only a small sample of leisure possibilities and, everyone's interests will be different - for everyone is a unique individual. Read the following list of leisure activities and check off those you would like to d o . . .  SOCIAL. writing letters making social telephone calls ' visiting friends, family joining a social group or interest club caring for a pet or animal  PHYSICAL.. joining an exercise class going for walks gardening refinishing furniture practising relaxation techniques  SOLITARY. reading listening to music humming or whistling sitting outdoors daydreaming  CREATIVE... doing crafts, woodworking or mechanics doodling cooking or eating fancy food composing poetry,stories or music planning parties  INTELLECTUAL. visiting libraries, museums or galleries ~ keeping up on current events discussing controversial subjects hobby collecting volunteering  SPECTATOR... watching T V or movies bird watching people watching attending concerts/theatre attending live sporting events  OTHER...  Adapted by B C Rehabilitation Society, from Ballantyne 1987, "Leisure Lifestyles...  LEISURE NEEDS Whether you think of leisure as an activity, time or state of mind, it is present in each of our lives. Depending on how you perceive and approach it, leisure can contribute to our feeling of satisfaction, hope, friendship and well-being. Therefore, we need to explore what leisure can be for each of us. What are you looking for in Instructions:  your leisure experience?  Read the following list and check off the items most important to you.  to do something meaningful  to challenge myself  to contribute to my community  to spend time with friends/family  to feel peace  to participate in a variety of activities  to continue learning  to have support from others  to b e physically active  to feel committed to something  to be creative/expressive  to use, improve or develop my skills  to relax or take it easy  to have something to show for my efforts  to b e entertained  to keep busy  to b e able to do what I want  to organize and get things going  to b e spontaneous  to learn more about myself  to laugh and enjoy  to develop friendships  to help others  to be competitive  to improve my self-esteem  to improve my health  Others  Adapted by B C Rehabilitation Society, from Ballantyne 1987, "Leisure Lifestyles...  CHALLENGES TO PARTICIPATION What is preventing me from participating in the leisure activities that interest me? Until these challenges are identified and explored, it will be very difficult for you to increase your satisfaction and enjoyment of leisure participation. Read the following list and check off the items that affect your ability to participate. Often I don't feel like doing anything Too many family obligations Work is the main priority right now School is the main priority right now I rely on others for transportation I have a great deal of daily stress I have a bad habit of over-comrnitting myself I don't have enough money to do what I want I am unemployed and I don't think leisure is possible under these circumstances I don't have the physical skills I don't have the artistic or creative skills I am embarrassed about learning something new I don't have enough time I don't know what programs or facilities are available I find it difficult to start, I procrastinate Social situations are awkward for me I have no one to go with Making decisions is difficult for me Following through on my intentions is difficult Others? Adapted by B C Rehabilitation Society, from Ballantyne 1987, "Leisure Lifestyles..."  ..  130 OVERCOMING CHALLENGES Some of the challenges you identified are within your control to change. Select 3 challenges you think you can change and how you could reduce or overcome them. CHALLENGE  POSITIVE STEPS TO OVERCOMING CHALLENGES  1.  2.  3.  Adapted by BC Rehabilitation Society,fromBallantyne 1987, "Leisure Lifestyles..."  Appendix 2  Initial  Interview Questions  1.  How h a s y o u r h o s p i t a l s t a y b e e n so  2.  Where do y o u l i v e ? How l o n g h a v e y o u l i v e d Does a n y o n e e l s e l i v e w i t h y o u ? Where w e r e y o u b o r n ?  3.  Do y o u h a v e any f a m i l y ? Where do t h e y  4.  T e l l me some o f t h e t h i n g s y o u l i k e d t o do e n t e r i n g the h o s p i t a l o r becoming i l l ?  5.  I s t h e r e a community c e n t r e , a l i b r a r y , a c h u r c h , o r a p a r k (or o t h e r r e c r e a t i o n a l area) n e a r where y o u live?  6. Were y o u h a p p y w i t h y o u r l i f e s t y l e b e f o r e y o u came i n t o h o s p i t a l ? 7.  far?  and  there?  live? before  free-time  I s t h e r e s o m e t h i n g y o u have n o t done, but w o u l d l i k e t o t r y / o r f i n d o u t more a b o u t ? I s t h e r e , s o m e t h i n g y o u u s e d t o do some t i m e ago a n d w o u l d l i k e t o do again?  8. What a r e y o u d o i n g f o r y o u r e n j o y m e n t w h i l e i n hospital? 9 . What i s ( o r what do y o u t h i n k w i l l b e . . . ) outcome o f y o u r s u r g e r y / h o s p i t a l i z a t i o n ?  the  the  1 0 . How do y o u see y o u r s e l f f u n c t i o n i n g i n 6 m o n t h s f r o m now? What w i l l y o u be d o i n g f o r y o u r e n j o y m e n t then ? 11.Is or  there anything you'd l i k e f i n d o u t more a b o u t ?  t o ask q u e s t i o n s  about  Concluding Interview  132  Questions  1. a)  Has t h i s p r o g r a m b e n e f i t t e d y o u i n a n y way? Have , you l e a r n e d a n y t h i n g about y o u r s e l f t h r o u g h t h i s program? b) What do y o u see as some o f t h e b e n e f i t s o f leisure?  2 . a)  b)  Do y o u f i n d y o u r p a r t i c i p a t i o n i n t h i s p r o g r a m changed y o u r awareness o f the importance o f leisure? Has y o u r a t t i t u d e t o w a r d s r e c r e a t i o n / l e i s u r e r e c e n t l y ? ( I f s o , how w o u l d y o u s a y i t h a s changed?)  has  changed  3.  How s a t i s f i e d a r e y o u w i t h y o u r l e i s u r e ? changed r e c e n t l y ?  Has  4.  Has y o u r a w a r e n e s s o f n e i g h b o u r h o o d / c o m m u n i t y l e i s u r e r e s o u r c e s c h a n g e d ? I f s o how h a s i t changed?  5.  Has y o u r c o m m u n i t y p a r t i c i p a t i o n i n r e c r e a t i o n l e i s u r e changed r e c e n t l y ?  6.  I n t h e n e x t 12 months what do y o u s e e y o u r s e l f d o i n g for enjoyment/satisfaction?  7.  What h a s h e l p e d y o u t o e n j o y y o u r recreation/leisure? What h a s h e l p e d y o u t o e n j o y y o u r  or  life?  8.  I f t h i n g s c o u l d be a l i t t l e d i f f e r e n t l i k e t o see changed?  9.  Would you say you are g e n e r a l l y v e r y s a t i s f i e d your l i f e ?  10.  this  what w o u l d y o u  a) G e n e r a l l y s p e a k i n g , w o u l d y o u s a y a t you are s a t i s f i e d w i t h your l i f e ?  the  with  moment,  b) Do y o u t h i n k t h e r e i s a n y r e l a t i o n s h i p b e t w e e n y o u r s a t i s f a c t i o n w i t h y o u r l i f e i n g e n e r a l and y o u r s a t i s f a c t i o n with your l e i s u r e ? 11.  How d i d t h e p r o g r a m make y o u f e e l t o w a r d s y o u r own l e i s u r e , a n d o t h e r p e o p l e ?  yourself,  12.  Were t h e r e a n y n e g a t i v e a s p e c t s t o t h e p r o g r a m ? Was t h e r e a n y t h i n g y o u w o u l d l i k e t o s e e done d i f f e r e n t l y o r improved?  134 Risks/Side  Effects  T h e r e a r e no known o r a n t i c i p a t e d r i s k s o r s i d e e f f e c t s p a r t i c i p a t i n g i n these sessions.  to  Benefits Through p a r t i c i p a t i n g i n t h i s study, you w i l l r e c e i v e s e r v i c e s w h i c h may i n c r e a s e y o u r a w a r e n e s s o f t h e r e c r e a t i o n r e s o u r c e s i n y o u r community and o b t a i n i n f o r m a t i o n and support i n a c c e s s i n g those r e s o u r c e s you choose. You w i l l a l s o h a v e a c l e a r e r u n d e r s t a n d i n g o f how y o u u s e y o u r f r e e time. P a r t i c i p a t i o n i n s u c h a p r o g r a m may l e a d t o a n i n c r e a s e d l e v e l o f i n d e p e n d e n c e a n d t h e c r e a t i o n o f new s o c i a l c i r c l e s i n the community. Monetary Compensation T h e r e w i l l be no m o n e t a r y c o m p e n s a t i o n . H o w e v e r , w i l l be p r o v i d e d f r e e o f c h a r g e .  services  Time Commitment The t o t a l t i m e r e q u i r e d o f y o u b e y o n d t h a t o f t r e a t m e n t / l e i s u r e e d u c a t i o n i s 3-4 h o u r s . Confidentiality A n y i n f o r m a t i o n r e s u l t i n g f r o m . t h i s r e s e a r c h s t u d y w i l l be kept s t r i c t l y c o n f i d e n t i a l . Information reported f o r r e s e a r c h p u r p o s e s w i l l i d e n t i f y you by a code number. You w i l l n o t be i d e n t i f i e d b y name. The r e s u l t s may be p u b l i s h e d i n a p r o f e s s i o n a l j o u r n a l a n d w i l l be p r e s e n t e d a t t h e i n v e s t i g a t o r ' s t h e s i s d e f e n c e . These w i l l a l s o be c o d e d t o p r o t e c t y o u r i d e n t i t y . I f y o u h a v e a n y q u e s t i o n s o r c o n c e r n s a t a n y t i m e d u r i n g t h i s s t u d y , y o u may c o n t a c t P a u l G a l l a n t a t t h e numbers l i s t e d on page o n e .  ********************** I h a v e r e a d t h e above i n f o r m a t i o n a n d I h a v e h a d a n o p p o r t u n i t y t o a s k q u e s t i o n s t o h e l p me u n d e r s t a n d w h a t my p a r t i c i p a t i o n would i n v o l v e . I f r e e l y consent t o p a r t i c i p a t e i n t h e s t u d y and acknowledge r e c e i p t o f a copy o f t h e consent form.  Signature of Participant  Date  Signature of Witness Page 2 o f 2  

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