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Utilizing outreach therapeutic recreation to determine the leisure experiences of recently hospitalized.. 1995

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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 University, 1989 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTERS OF HUMAN KINETICS i n THE FACULTY OF GRADUATE STUDIES School of Human Kinetics We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA A p r i l , 1995 ® Paul W. Gallant, 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 A p r i l 27, 1995 DE-6 (2/88) A B S T R A C T The p u r p o s e o f t h i s s t u d y was t o a n a l y z e t h e s u b j e c t i v e m e a n i n g t h a t l e i s u r e e x p e r i e n c e s a n d i n v o l v e m e n t i n a 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 P r o g r a m (T.R.O.P.) h a d f o r e i g h t r e c e n t l y h o s p i t a l i z e d o l d e r a d u l t s . The s p e c i f i c r e s e a r c h q u e s t i o n s w e r e : What w e r e t h e i r l e i s u r e i n t e r e s t s ? How d i d p a r t i c i p a n t s d e s c r i b e t h e b e n e f i t s o f l e i s u r e ? D i d t h e y b e n e f i t f r o m T.R.O.P.? What w e r e t h e f a c i l i t a t i n g f a c t o r s w h i c h c o n t r i b u t e d t o w a r d s t h e i r e n j o y m e n t o f 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 w h i c h p r e v e n t e d p a r t i c i p a n t s f r o m a c h i e v i n g t h e i r l e i s u r e g o a l s a n d i n t e r e s t s ? What w e r e t h e r e l a t i o n s h i p s b e t w e e n l e i s u r e s a t i s f a c t i o n a n d l i f e s a t i s f a c t i o n ? A t o t a l o f e i g h t p a r t i c i p a n t s w e r e r e c r u i t e d o v e r a f i v e m o nth p e r i o d a n d a g r e e d t o p a r t i c i p a t e i n T.R.O.P. T h e y met t h e f o l l o w i n g i n c l u s i o n c r i t e r i a . P a r t i c i p a n t s w e r e : i n - p a t i e n t s o f St.. P a u l ' s H o s p i t a l ; a t l e a s t 5 5 y e a r s o f a g e ; a b l e t o s p e a k , r e a d , a n d c o m p r e h e n d E n g l i s h f l u e n t l y ; l i v i n g i n t h e L o w e r M a i n l a n d a r e a o f B r i t i s h C o l u m b i a ; a n d , r e t u r n i n g t o n o n - i n s t i t u t i o n a l i z e d c o m m u n i t y l i v i n g . The c a s e s t u d y d e s i g n e n t a i l e d a number o f d a t a c o l l e c t i o n s t r a t e g i e s t h a t o c c u r r e d d u r i n g t h e i n - h o s p i t a l a n d 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 . T h e s e i n c l u d e d two s e m i - s t r u c t u r e d i n t e r v i e w s w i t h e a c h I l l p a r t i c i p a n t , observations and f i e l d notes throughout T.R.O.P., and a review of medical c h a r t s . In a d d i t i o n , the p a r t i c i p a n t s completed three forced-choice 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 Mi l e s (1994) i n t e r a c t i v e model of data d i s p l a y , c o n c l u s i o n 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 p e r c e i v e d l e i s u r e b e n e f i t s to be: "enjoyment", "time to t h i n k and forget your t r o u b l e s " , " r e l a x a t i o n " , "a sense of s a t i s f a c t i o n " , and "maintaining an i n t e r e s t i n l i f e " . These b e n e f i t s are s i m i l a r to those described i n the l i t e r a t u r e . Many of the l e i s u r e i n t e r e s t s of the p a r t i c i p a n t s were s o l i t a r y and spectator types of experiences which tended to occur w i t h i n t h e i r home or 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 that p a r t i c i p a n t s were f r u s t r a t e d by not being able to pursue many of t h e i r l e i s u r e i n t e r e s t s due to 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 of T.R.O.P. were i d e n t i f i e d as knowledge of resources and increased s o c i a l contacts. The l e i s u r e c o n s t r a i n t s most f r e q u e n t l y reported were r e l a t e d to poor h e a l t h s t a t u s , p h y s i c a l d i s a b i l i t y , l a c k of p h y s i c a l s k i l l s , l a c k of knowledge of resources, p r o c r a s t i n a t i o n , and l a c k of s o c i a l support. S o c i a l support and s o c i a l r e l a t i o n s h i p s were perceive d to 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 of the p a r t i c i p a n t s ' experiences i n the h o s p i t a l were i v p e rceived to 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 that has not been explored i n the l e i s u r e l i t e r a t u r e . S o c i a l r e l a t i o n s were a l s o perceived to be important 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 s a t i s f a c t i o n . The f i n d i n g s a l s o revealed that the most p e r t i n e n t i n f o r m a t i o n r e l a t e d to l e i s u r e meaning and involvement was obtained through v i s i t i n g and conversing w i t h p a r t i c i p a n t s i n t h e i r homes, and not through formal i n - h o s p i t a l l e i s u r e assessment procedures. The nature of the f i n d i n g s of t h i s study have i m p l i c a t i o n s f o r f u t u r e research and p r a c t i c e . TABLE OF CONTENTS v A b s t r a c t i i T a b l e o f C o n t e n t s v L i s t o f T a b l e s v i i CHAPTER ONE I n t r o d u c t i o n 1 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 1 The Demographics o f O l d e r A d u l t s 2 R e h a b i l i t a t i o n S e r v i c e s 4 R e s o u r c e s 6 New D i r e c t i o n s i n H e a l t h Care 7 L e i s u r e and L i f e S a t i s f a c t i o n 8 L e i s u r e E d u c a t i o n . a n d C o u n s e l i n g 9 S ta tement o f P r o b l e m 11 R e s e a r c h Q u e s t i o n s 11 D e f i n i t i o n s 12 CHAPTER TWO Rev iew o f the L i t e r a t u r e 15 C h a r a c t e r i s t i c s o f L e i s u r e 15 L e i s u r e S a t i s f a c t i o n and L i f e S a t i s f a c t i o n 17 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 18 C o n s t r a i n t s t o L e i s u r e 19 H e a l t h S t a t u s o f O l d e r A d u l t s 21 I m p l i c a t i o n s o f H e a l t h 23 S o c i a l Suppor t 25 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 27 CHAPTER THREE M e t h o d o l o g y > 3 3 R e s e a r c h D e s i g n 33 P i l o t S tudy 3 6 I n v e s t i g a t o r ' s R o l e 37 P e r s o n - C e n t r e d A p p r o a c h 4 0 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 41 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 43 I n i t i a l I n t e r v i e w 44 Group I n - p a t i e n t S e s s i o n s 45 One- to-One S e s s i o n s 48 O u t r e a c h S e s s i o n s 48 C o n c l u d i n g I n t e r v i e w s 4 9 D a t a C o l l e c t i o n .49 Da ta O r g a n i z a t i o n 52 C o n f i r m i n g Da ta 54 D a t a A n a l y s i s 55 E t h i c a l Rev iew 56 v i CHAPTER FOUR R e s u l t s and D i s c u s s i o n 58 O v e r v i e w 58 P i l o t S t u d y 58 M a i n S t u d y P a r t i c i p a n t P r o f i l e s 60 TG 61 FB 64 VB 68 JN 72 JR 75 PP 78 RC 81 MP 83 R e s e a r c h Q u e s t i o n s 1-3 85 B e n e f i t s o f L e i s u r e 85 B e n e f i t s o f T . R . O . P . 88 F a c i l i t a t i n g F a c t o r s 89 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 91 R e s e a r c h Q u e s t i o n 5: L e i s u r e C o n s t r a i n t s 96 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 99 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 F a c t o r s 101 Mean ing o f L e i s u r e 102 L e i s u r e G o a l s 103 L e i s u r e Ad jus tmen t 104 H e a l t h S t a t u s 105 I n v e s t i g a t o r - P a r t i c i p a n t R e l a t i o n s h i p 106 CHAPTER F I V E C o n c l u s i o n s and Recommendat ions 108 C o n c l u s i o n s 108 Recommendations f o r F u t u r e R e s e a r c h 110 Recommendations f o r P r a c t i t i o n e r s 113 H e a l t h Sys tem 113 S o c i a l R e s o u r c e s 114 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 R e s o u r c e s 115 REFERENCES 118 APPENDICES A p p e n d i x 1: L e i s u r e E d u c a t i o n Workshee t s 127 A p p e n d i x 2 : I n t e r v i e w Q u e s t i o n s 131 A p p e n d i x 3 : Consent Form 133 A p p e n d i x 4 : C e r t i f i c a t e s o f A p p r o v a l 135 LIST OF TABLES v i i T a b l e 1 Key p h r a s e s f rom p a r t i c i p a n t s ' 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 86 T a b l e 2 Key p h r a s e s f rom p a r t i c i p a n t s ' 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 ( c o n t i n u e d ) 87 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 95 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 c o n s t r a i n t s 99 1 CHAPTER ONE I n t r o d u c t i o n 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 s t u d y o f t h e l e i s u r e b e h a v i o u r o f o l d e r a d u l t s and t h e i r p a r t i c i p a t i o n i n d i s c r e t i o n a r y forms o f a c t i v i t i e s has become one o f t h e " c l a s s i c a r e a s o f i n v e s t i g a t i o n " i n t h e g e r o n t o l o g y f i e l d (Lawton , 1994, p . 1 3 8 ) . Many a t t e m p t s have been made t o t r y t o u n d e r s t a n d the s p e c i f i c c h a r a c t e r i s t i c s o f t h e l e i s u r e e x p e r i e n c e and s p e c i f i c a l l y the l e i s u r e e x p e r i e n c e o f t h e o l d e r a d u l t . L e i s u r e r e s e a r c h e r s have shown t h a t when i n d i v i d u a l s p a r t i c i p a t e i n r e c r e a t i o n a c t i v i t i e s t h e y o f t e n e x p e r i e n c e " i n v o l v e m e n t , f u n , en joyment , p l e a s u r e , s p o n t a n e i t y , f reedom, t i m e l e s s n e s s , r e l a x a t i o n , a d v e n t u r e . . . " and e n c o u n t e r a v a r i e t y o f o t h e r p o s i t i v e e x p e r i e n c e s (Lee , D a t i l l o & Howard , 1994, p . 1 9 6 ) . However , l e i s u r e e x p e r i e n c e s were n o t a l w a y s p o s i t i v e o r p l e a s a n t . Throughou t t h e l i f e - c y c l e , i n d i v i d u a l s may e n c o u n t e r a v a r i e t y o f s t r e s s f u l and u n p l e a s a n t l e i s u r e e x p e r i e n c e s . These t r o u b l e s o m e e x p e r i e n c e s may be c h a r a c t e r i z e d by f e e l i n g s o f e x h a u s t i o n , a p p r e h e n s i o n , n e r v o u s n e s s , d i s a p p o i n t m e n t , f r u s t r a t i o n , and g u i l t (Lee , e t a l . , 1994, p . 2 0 3 ) . I n d i v i d u a l s a l s o e n c o u n t e r a number o f c o n s t r a i n t s w h i c h c o n f r o n t them and i m p a c t upon t h e i r l e i s u r e . Examples o f t h e s e c o n s t r a i n t s i n c l u d e : l a c k o f knowledge r e g a r d i n g l e i s u r e r e s o u r c e s and f a c i l i t i e s , l a c k o f a p a r t n e r w i t h whom t o 2 p a r t i c i p a t e , l a c k o f i ncome , and l a c k o f p h y s i c a l a b i l i t y ( J a c k s o n , 1990; S e a r l e & Mahon, 1993 ; Heywood, 1 9 9 4 ) . L e i s u r e e x p e r i e n c e s a r e a l s o t h r e a t e n e d by s i g n i f i c a n t l i f e e v e n t s s u c h as d i s e a s e , i l l n e s s , o r d i s a b i l i t y . These e v e n t s a re even more t h r e a t e n i n g t o o l d e r a d u l t s , who f r e q u e n t l y l i v e a l o n e i n t h e i r homes (Lyons , Meade, W h i t e & A r c h i b a l d , 1993, p . 2 5 3 ) . The c h a n g i n g demograph i c s o f t h i s segment o f o u r p o p u l a t i o n w i l l l i k e l y r e s u l t i n i n c r e a s e d a t t e n t i o n t o how h e a l t h and l e i s u r e r e s o u r c e s a r e a l l o c a t e d t o the o l d e r members o f o u r c o m m u n i t i e s . The Demographics o f O l d e r A d u l t s I n B r i t i s h C o l u m b i a , t he p e r c e n t a g e o f t h e p o p u l a t i o n aged 65 and above was 1 3 . 2 % o r a p p r o x i m a t e l y 423 ,500 i n d i v i d u a l s i n 1990 (BC P o p u l a t i o n F o r e c a s t [BCPF] , 1990) . T h i s f i g u r e i s e x p e c t e d t o r e a c h 626 ,000 (15.2 %) by t h e y e a r 2006 (BCPF, 1 9 9 0 ) . The d e c l i n i n g b i r t h r a t e , t h e a g i n g o f t h e baby boomers , and a l o n g e r l i f e e x p e c t a n c y a r e i n c r e a s i n g b o t h the number and p r o p o r t i o n o f s e n i o r s i n t h e p o p u l a t i o n ( G r e a t e r V a n c o u v e r R e g i o n a l D i s t r i c t [GVRD], 1993, p . 5 ) . I t i s p r e d i c t e d t h a t t he l a r g e s t p o p u l a t i o n o f o l d e r a d u l t s i n the p r o v i n c e w i l l c o n t i n u e t o be i n the V a n c o u v e r and S u r r e y a r e a s (GVRD, 19 93) . S t a t i s t i c s Canada (1988) r e p o r t e d t h a t as age i n c r e a s e s , so does the 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 . The number o f d i s a b l e d i n d i v i d u a l s aged 55 y e a r s and o l d e r i n 3 B r i t i s h C o l u m b i a a c c o u n t e d f o r 25-35 % o f t h e t o t a l p o p u l a t i o n i n 1988 . A p p r o x i m a t e l y 52 ,580 o f t h e s e p e r s o n s r e s i d e d i n V a n c o u v e r h o u s e h o l d s ( S t a t i s t i c s Canada , 1 9 8 8 ) . Examples o f t h e h e a l t h p rob l ems t h a t some o l d e r a d u l t s e x p e r i e n c e i n c l u d e : 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 , o r t h o p a e d i c d i s a b i l i t i e s , d e p r e s s i o n and l o n e l i n e s s ( R i d d i c k & K e l l e r , 1 9 9 1 ) . Many o l d 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 i n e v i t a b l e l o s s e s o r c h a n g i n g l i f e 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 on them. These l i f e changes o f t e n i n c l u d e : l o s s o f a s p o u s e , r e t i r e m e n t , d e c l i n i n g h e a l t h , change o f r e s i d e n c e , and a d e c r e a s e d number o f f r i e n d s . U l t i m a t e l y a l o s s o f meaning i n l i f e i s e x p e r i e n c e d by some o l d e r a d u l t s (Burbank , 1992, p . 21) . On t h e o t h e r hand, many o l d e r a d u l t s were h e a l t h y , a c t i v e , and have no t e x p e r i e n c e d t h e l o s s e s p r e v i o u s l y m e n t i o n e d . These " h e a l t h i e r " o l d e r a d u l t s were n o t a t t h e same r i s k o f l o n e l i n e s s , d e p r e s s i o n , and h o s p i t a l i z a t i o n as t h o s e who e x p e r i e n c e d r a m a t i c l i f e changes and d e c l i n i n g m e d i c a l c o n d i t i o n s . Many o l d e r a d u l t s have t h e a b i l i t y t o a d e q u a t e l y f u n c t i o n i n t h e i r communi t i e s w i t h o u t t h e p r o v i s i o n o f a d d i t i o n a l s u p p o r t s s u c h as home-making , M e a l s on W h e e l s , home n u r s i n g c a r e , and o u t r e a c h o r t h e r a p e u t i c r e c r e a t i o n s e r v i c e s . However , t h e r e i s a s i g n i f i c a n t l y h i g h e r p e r c e n t a g e o f o l d e r a d u l t s aged 65 and above , who a r e u t i l i z i n g h e a l t h s e r v i c e s . F o r example , p e r s o n s 65 y e a r s o f age and o v e r o c c u p i e d 228 i n p a t i e n t h o s p i t a l days p e r 100 p e r s o n s i n 1990. 4 T h i s f i g u r e 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 51 i n p a t i e n t days p e r 100 p e r s o n s i n t h e unde r 65 age c a t e g o r y ( G r e a t e r V a n c o u v e r R e g i o n a l D i s t r i c t , 1993, p . 1 0 ) . I n Canada , 40 % o f t h e h e a l t h c a r e s e r v i c e s a r e u s e d by p e r s o n s 65 y e a r s o f age and o l d e r ( N e u f i e l d , 1991 , p . 2 3 5 ) . 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 s u c h a s : p h y s i c i a n s , g e r i a t r i c s p e c i a l i s t s , n u r s e s , s o c i a l w o r k e r s , p a s t o r a l c a r e w o r k e r s , d i e t i c i a n s , p h y s i o t h e r a p i s t s , o c c u p a t i o n a l t h e r a p i s t s , s p e e c h t h e r a p i s t s and r e c r e a t i o n t h e r a p i s t s . These p r o f e s s i o n a l s , f r e q u e n t l y work as p a r t o f an m u l t i d i s c i p l i n a r y 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 a d u l t s . R e h a b i l i t a t i o n S e r v i c e s A c c o r d i n g t o M c L e l l a n ( 1 9 9 2 g e n e r a l r e h a b i l i t a t i o n s e r v i c e s p e r f o r m a v a r i e t y o f f u n c t i o n s , w h i c h i n c l u d e : (1) a s se s smen 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 and needs 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 m a i n t e n a n c e ; (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 outcomes r e l a t e d t o h e a l t h and 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 assessment o f t he 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 fo rm o f t h e r a p y o r t r e a t m e n t , and the 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 t r e a t m e n t ; (5) t h e need f o r a d a p t i v e equipment 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 assessment 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 t i m e , a r e a l s o e s s e n t i a l t o t h e o v e r a l l a s se s smen t p r o c e s s . 5 (6) t h e i m p l e m e n t a t i o n o f t h e p l a n ; (7) a s s i s t a n c e i n t h e h o s t community 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 awareness a c t i v i t i e s ( M c L e l l a n , 1992, p . 56.) . T h e r a p e u t i c r e c r e a t i o n s e r v i c e s , as a component o f t h e r e h a b i l i t a t i o n p r o g r a m , p e r f o r m t h e s e same f u n c t i o n s . However as Lyons (1993, p . 258) has i n d i c a t e d , t h e r e i s somet imes a p r o b l e m w i t h " i n t r o d u c i n g the n o t i o n o f ( t h e r a p e u t i c ) r e c r e a t i o n 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 . . . " . She c o n t e n d s t h a t " o f t e n t h e r e i s r e s i s t a n c e t o t h e i d e a t h a t r e c r e a t i o n 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 f u n c t i o n s i n o u r l i v e s " (Lyons e t a l . , 1993, p . 2 5 8 ) . A t S t . P a u l ' s H o s p i t a l , t h e depar tment r e s p o n s i b l e f o r t h e r a p e u t i c r e c r e a t i o n s e r v i c e s , has e q u a l s t a t u s among the o t h e r p a t i e n t s e r v i c e s d e p a r t m e n t s i n v o l v e d i n the r e h a b i l i t a t i o n o f p a t i e n t s . The r e c r e a t i o n t h e r a p i s t s , n u r s e s , p h y s i o t h e r a p i s t s , o c c u p a t i o n a l t h e r a p i s t s , s o c i a l w o r k e r s , speech l anguage p a t h o l o g i s t s , d i e t i c i a n s , and p h a r m a c i s t s have an i m p o r t a n t c o n t r i b u t i o n t o make towards t h e i r p a t i e n t s ' c a r e . However , t h e r e have o c c a s i o n a l l y been p r o b l e m s e s t a b l i s h i n g t h e l e g i t i m a c y o f t h e s e r v i c e w i t h some p a t i e n t s and o t h e r s t a f f members who a r e u n f a m i l i a r w i t h the r o l e o f r e c r e a t i o n t h e r a p y . I n a w o r k - o r i e n t e d s o c i e t y , w h i c h f r e q u e n t l y r e l i e s h e a v i l y on t h e m e d i c a l model o f h e a l t h c a r e p r o v i s i o n , " p e o p l e u n d e r v a l u e l e i s u r e and r e c r e a t i o n and m i s s i t s p o t e n t i a l f o r i n c r e a s i n g w e l l - b e i n g " ( N e u l i n g e r , 1 9 8 1 ) . 6 R e s o u r c e s Many o f t he h e a l t h c a r e r e s o u r c e s , a l t h o u g h d e s i g n e d t o a d d r e s s t h e p h y s i c a l and m e n t a l h e a l t h o f o l d e r a d u l t s , do n o t a d d r e s s s p e c i f i c i s s u e s such as l o n e l i n e s s , q u a l i t y o f l i f e , l i f e s a t i s f a c t i o n , and the u t i l i z a t i o n o f l e i s u r e . S e r v i c e s 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 o f l e i s u r e r e s o u r c e s , a l t h o u g h r e l a t i v e l y new t o t h e h e a l t h c a r e s y s t e m , a r e becoming w i d e l y r e c o g n i z e d f o r t h e r o l e t h e y p l a y i n t h e r e h a b i l i t a t i o n o f the g e r i a t r i c communi ty ( R i d d i c k & K e l l e r , 1 9 9 1 ) . The need f o r a d d i t i o n a l community s u p p o r t s f o r o l d e r a d u l t s when t h e y l e a v e the h o s p i t a l s e t t i n g has f r e q u e n t l y been c i t e d i n t h e l i t e r a t u r e ( B i e t t e , Ma t thews , & Schwenger , 1983 ; Core S e r v i c e s R e p o r t , 1994; O ' N e i l l & R e i d , 1 9 9 1 ; Pea t & B o y c e , 1 9 9 3 ) . However , h o s p i t a l - b a s e d r e c r e a t i o n t h e r a p i s t s have t y p i c a l l y no t been i n v o l v e d i n o u t r e a c h , home-based s e r v i c e s ( B u l l o c k & Howe, 1 9 9 1 ) . A r e c e n t s u r v e y o f l a r g e r B r i t i s h 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 i n d i c a t e d t h a t t h e r a p e u t i c r e c r e a t i o n s e r v i c e s , when p r e s e n t , s e l d o m f o l l o w e d t h r o u g h t o s u p p o r t c l i e n t s a f t e r t h e i r d i s c h a r g e i n t o t h e community ( G a l l a n t , 1 9 9 3 ) . Of t h e 16 s u r v e y s r e t u r n e d from h o s p i t a l s and r e h a b i l i t a t i o n c e n t r e s i n G a l l a n t ' s s t u d y , 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 f o l l o w - u p c o n s i s t e d o f v i s i t s t o the c l i e n t s ' home. Through t h e p r o v i s i o n o f o u t r e a c h t h e r a p e u t i c r e c r e a t i o n s e r v i c e s i n c l i e n t s ' r e s i d e n c e s and i n t h e i r communi ty , 7 r e c r e a t i o n t h e r a p i s t s can work on a more ex t ended b a s i s t o meet t h e i r c l i e n t s ' g o a l s . G o a l s w h i c h have been f r e q u e n t l y d e s i r e d by t h e c l i e n t s and t h e p r o f e s s i o n a l s f o r s u c h s e r v i c e s i n c l u d e : f a c i l i t a t i n g i n t e g r a t i o n i n t o t h e communi ty , i n c r e a s i n g awareness o f s e l f as a l e i s u r e r e s o u r c e , i n c r e a s i n g s o c i a l i z a t i o n , and , most i m p o r t a n t l y , an o v e r a l l improvement i n l i f e s a t i s f a c t i o n t h r o u g h l e i s u r e ( O ' N e i l l & R e i d , 1991 ; S te inkamp & K e l l e y , 1 9 8 7 ) . The f u t u r e o f o u t r e a c h t h e r a p e u t i c r e c r e a t i o n as a h e a l t h r e s o u r c e w i l l depend, i n p a r t , on t h e f u t u r e d i r e c t i o n o f h e a l t h c a r e . New D i r e c t i o n s i n H e a l t h Care H e a l t h p o l i c i e s o f t h e 1 9 9 0 ' s a r e l i k e l y t o f o c u s more on m a i n t a i n i n g p e o p l e ' s h e a l t h and k e e p i n g them out o f h o s p i t a l s and i n t h e communi ty . The P r o v i n c i a l Government o f B r i t i s h C o l u m b i a has 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 b a s e d on t h e recommendat ions o f t h e R o y a l Commiss ion on H e a l t h Care and C o s t s . These p r i o r i t i e s i n c l u d e : 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 as c l o s e t o home as p o s s i b l e i n s t e a d o f i n h o s p i t a l . 2 . Make t h e p r o m o t i o n o f good h e a l t h and t h e p r e v e n t i o n o f i l l n e s s and i n j u r y a major new emphas i s o f government p o l i c y . 3 . G i v e p r i o r i t y a t t e n t i o n t o r e m o v i n g 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 t h r o u g h t h e c r a c k s i n o u r sys t em ( B r i t i s h C o l u m b i a R o y a l Commiss ion on H e a l t h Care and 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 s u p p o r t t he need f o r 8 t h e r a p e u t i c r e c r e a t i o n p r a c t i t i o n e r s t o become more r e s p o n s i v e t o i n d i v i d u a l s i n t h e i r c o m m u n i t i e s . The p r o m o t i o n o f good 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 e d u c a t i o n , w h i c h i n c l u d e s s e e k i n g ways t o remove b a r r i e r s t o l e i s u r e , seems t o be r e f l e c t t he 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 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 A number o f r e s e a r c h e r s have found c o r r e l a t i o n s be tween l e i s u r e s a t i s f a c t i o n . a n d l i f e s a t i s f a c t i o n ( P u r c e l l & K e l l e r , 1 9 8 9 ) . There was a l s o c o n s i d e r a b l e s u p p o r t i n t h e l i t e r a t u r e f o r t h e c o n t e n t i o n t h a t l e i s u r e o r r e c r e a t i o n p a r t i c i p a t i o n c o n t r i b u t e s t o the p s y c h o l o g i c a l h e a l t h o f o l d e r a d u l t s ( G i l b e r t , 1992; S e a r l e & Mahon, 1993) . A p o t e n t i a l i n c r e a s e i n l e i s u r e s a t i s f a c t i o n t h r o u g h t h e r a p e u t i c r e c r e a t i o n i n t e r v e n t i o n , can a l s o c o n t r i b u t e t o an i n c r e a s e i n g e n e r a l l i f e s a t i s f a c t i o n (Brown, F r a n k e l & F e n n e l l , 1991) . R e g a r d i n g l i f e as more m e a n i n g f u l , becoming h a p p i e r , h a v i n g h i g h e r s e l f - e s t e e m , and becoming more s a t i s f i e d w i t h o n e ' s s o c i a l c o n t a c t s a r e a r e a s o f l i f e s a t i s f a c t i o n w h i c h may be ' ' i n f l u e n c e d by ^ l e i s u r e e d u c a t i o n ( D a t i l l o & Murphy , 1991) . L e i s u r e i s an a r e a i n w h i c h i n d i v i d u a l s , who a r e n o t s a t i s f i e d o r happy w i t h t h e i r l i f e i n g e n e r a l , c an a t t a i n some degree o f s a t i s f a c t i o n ( M o b i l y , 1 9 8 4 ) . Th rough p a r t i c i p a t i o n i n l e i s u r e e d u c a t i o n s e s s i o n s , i n d i v i d u a l s ' i n c r e a s e d awarenes s , knowledge and s k i l l s o f t e n l e a d s t o new l e i s u r e i n s i g h t s , i n t e r e s t s , and a p o t e n t i a l i n c r e a s e d s a t i s f a c t i o n w i t h i n t h e i r 9 l e i s u r e ( R i d d i c k & K e l l e r , 1991 ; S e a r l e & I s o - A h o l a , 1988; W i l h i t e , 1 9 9 2 ) . 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 a r e 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 mode l s o f 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 a v a i l a b l e t o t h e r a p e u t i c r e c r e a t i o n p r a c t i t i o n e r s ( A l l e n & H a m i l t o n , 1980; D a t i l l o & Murphy , 1991 ; M c D o w e l l , 1983 ; W h i t t m a n , K u r t z & N i c h o l s , 1987) . The s p e c i f i c a p p r o a c h u s e d by t h e t h e r a p i s t w i l l depend on the p a r t i c u l a r needs and c h a r a c t e r i s t i c s o f e a c h i n d i v i d u a l c l i e n t , t he v a l u e s and i d e a l o g y o f t h e r e c r e a t i o n p r o f e s s i o n a l , and t h e p o l i c i e s o f t h e o r g a n i z a t i o n o r s e r v i c e p r o v i d e r . P r o v i d i n g i n f o r m a t i o n on p a r t i c u l a r communi ty f a c i l i t i e s , p r o g r a m s , and r e s o u r c e s i s one method o f f a c i l i t a t i n g t h e c l i e n t s ' i n v o l v e m e n t i n l e i s u r e . C o u n s e l l i n g c l i e n t s , i n a s u p p o r t i v e manner, t o t a k e more c o n t r o l o f t h e i r own 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 r e c r e a t i o n t h e r a p i s t s t o promote t h e f u t u r e l e i s u r e f reedom o f t h e i n d i v i d u a l . A c c o r d i n g t o M o b i l y (1984) , l e i s u r e may be one o f t h e l a s t a r e a s e l d e r l y ' i n d i v i d u a l s a r e a b l e t o e x h i b i t p e r s o n a l c o n t r o l and c h o i c e . I n c r e a s e d dependency on s e r v i c e s , d e c r e a s e d h e a l t h , and a l a c k o f c h o i c e i n t h e t r a d i t i o n a l m e d i c a l s y s t e m a re l i k e l y t o a f f e c t o l d e r a d u l t s ' l i f e s a t i s f a c t i o n . I t i s t h e r e f o r e c r u c i a l t h a t a 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 p p r o a c h be a d o p t e d t o encourage c l i e n t s t o e x h i b i t some degree o f c h o i c e and c o n t r o l i n t h e i r l i v e s . 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 t y p i c a l l y u t i l i z e d by r e c r e a t i o n t h e r a p i s t s t o f a c i l i t a t e c l i e n t p r o g r e s s t o w a r d s e s t a b l i s h e d g o a l s . G o a l s e t t i n g w i t h i n t h i s c o n t e x t i s f r e q u e n t l y done w i t h i n p u t . f r o m t h e c l i e n t s . I n c r e a s i n g t h e c l i e n t s ' awareness o f l e i s u r e t h r o u g h e d u c a t i o n and c o u n s e l l i n g i s d e s i g n e d t o l e a d t o i n c r e a s e d l e i s u r e s a t i s f a c t i o n , w h i c h i s l i n k e d t o o v e r a l l l i f e s a t i s f a c t i o n ( D a t i l l o & Murphy, 1991; K e l l y , S a i n s b u r y & B r u c e , 1994; S t e inkamp & K e l l y , 1 9 8 7 ) . 11 P r o b l e m S t a t e m e n t o f t h e P r o b l e m T h i s s t u d y e x a m i n e d t h e s u b j e c t i v e m e a n i n g t h a t l e i s u r e a n d i n v o l v e m e n t i n t h e 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 P r o g r a m ( T . R . O . P . ) h a d f o r e i g h t r e c e n t l y h o s p i t a l i z e d o l d e r a d u l t s . R e s e a r c h Q u e s t i o n s . The i n v e s t i g a t o r was i n t e r e s t e d i n d e s c r i b i n g t h e p e r c e i v e d b e n e f i t s o f l e i s u r e , f a c i l i t a t o r s o f l e i s u r e e n j o y m e n t , c o n s t r a i n t s t o l e i s u r e , a n d l e i s u r e s a t i s f a c t i o n o f o l d e r a d u l t s . A l s o , g i v e n t h a t p r e v i o u s r e s e a r c h s t u d i e s h a v e f o u n d a p o s i t i v e r e l a t i o n s h i p b e t w e e n l e i s u r e s a t i s f a c t i o n a n d l i f e s a t i s f a c t i o n , t h e i n v e s t i g a t o r was i n t e r e s t e d i n t h e p a r t i c i p a n t s ' p e r c e p t i o n o f t h i s r e l a t i o n s h i p . A s a r e s u l t , t h e f o l l o w i n g r e s e a r c h q u e s t i o n s w e r e f o r m u l a t e d . 1. How. d i d o l d e r a d u l t s d e s c r i b e t h e b e n e f i t s o f l e i s u r e ? 2 . How d i d o l d e r a d u l t s f e e l t h a t t h e y b e n e f i t t e d / d i d n o t b e n e f i t f r o m T . R . O . P . ? 3 . What w e r e t h e s e l f - p e r c e i v e d f a c i l i t a t i n g f a c t o r s w h i c h c o n t r i b u t e d t o w a r d s e n j o y m e n t o f l e i s u r e ? 4 . What w e r e t h e l e i s u r e i n t e r e s t s o f t h e p a r t i c i p a n t s ? 5 . What w e r e t h e s e l f - p e r c e i v e d c o n s t r a i n t s w h i c h p r e v e n t e d p a r t i c i p a n t s f r o m a c h i e v i n g t h e i r l e i s u r e g o a l s a n d i n t e r e s t s ? 12 6. What were the p e r c e i v e d r e l a t i o n s h i p s be tween l e i s u r e s a t i s f a c t i o n and l i f e s a t i s f a c t i o n among p a r t i c i p a n t s ? 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 f a c t o r s w a r r a n t f u r t h e r 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 ' l e i s u r e , l e i s u r e s a t i s f a c t i o n , and l i f e s a t i s f a c t i o n ? D e f i n i t i o n s Leisure: The t e r m " l e i s u r e " has been c o n c e p t u a l i z e d i n a number o f w a y s . The t e r m ' s meaning has been f r e q u e n t l y d i s c u s s e d and d e b a t e d i n the l i t e r a t u r e . D e f i n i t i o n s o f l e i s u r e o f t e n c o n t a i n some r e f e r e n c e t o n o n - o b l i g a t o r y t i m e and a c t i v i t i e s , s u b j e c t i v e e x p e r i e n c e s and a sense o f f reedom (Lee e t a l . , 1994) . D e f i n i n g l e i s u r e i n te rms o f r e c r e a t i o n a l a c t i v i t y o r f r e e t i m e i s t o o l i m i t i n g because t h e y do n o t f o c u s on e x p e r i e n c e s ( D a t t i l o and Murphy, 1991) . The i n v e s t i g a t o r has c h o s e n D a t i l l o and M u r p h y ' s d e f i n i t i o n o f l e i s u r e because i t r e f l e c t s t h e 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 s e r v i c e s . L e i s u r e was c o n c e p t u a l i z e d as "a s t a t e o f mind i n v o l v i n g t h e p e r c e p t i o n o f f reedom t o choose t o p a r t i c i p a t e i n m e a n i n g f u l , e n j o y a b l e , o r s a t i s f y i n g e x p e r i e n c e s " ( D a t t i l o and Murphy, 1991 , p . 3 ) . Leisure Constraints: These r e f e r t o t h e s e l f - p e r c e i v e d b a r r i e r s w h i c h p r e v e n t o r l i m i t t he p a r t i c i p a n t s ' en joyment o f l e i s u r e , o r t h e i r a t t a i n m e n t o f l e i s u r e g o a l s ( J a c k s o n , 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 as a s u b s e t o f l e i s u r e e d u c a t i o n . L e i s u r e c o u n s e l l i n g a s s i s t s i n d i v i d u a l s w i t h p r o b l e m s o l v i n g , 13 d e c i s i o n - m a k i n g , and c o n f l i c t management w i t h r e g a r d t o l e i s u r e i n t e r e s t s , awarenes s , v a l u e s , and o p p o r t u n i t i e s ( C h i n n & J o s w i a k , 1981) . Leisure Education: i s d e s i g n e d t o p r o v i d e the i n d i v i d u a l w i t h o p p o r t u n i t i e s t o i n c r e a s e t h e i r awareness , k n o w l e d g e , and s k i l l s i n t h o s e a r e a s w h i c h f a c i l i t a t e l e i s u r e i n v o l v e m e n t ( D a t t i l o & Murphy , 1 9 9 1 ) . Leisure Interests: L e i s u r e i n t e r e s t s r e f e r t o t h e p a r t i c i p a n t s ' p a s t , p r e s e n t , o r f u t u r e l e i s u r e p r e f e r e n c e s . Leisure S a t i s f a c t i o n : t h e degree t o w h i c h i n d i v i d u a l s a r e c o n t e n t o r p l e a s e d w i t h t h e i r g e n e r a l e x p e r i e n c e s and s i t u a t i o n s as t h e y r e l a t e t o l e i s u r e (Beard & Ragheb, 1 9 8 0 ) . L i f e S a t i s f a c t i o n : t a k i n g p l e a s u r e i n d a i l y a c t i v i t i e s , r e g a r d i n g l i f e as m e a n i n g f u l , goodness o f f i t be tween d e s i r e d and a c h i e v e d g o a l s , p o s i t i v e mood t o n e , p o s i t i v e s e l f - c o n c e p t , p e r c e i v e d h e a l t h , f i n a n c i a l s e c u r i t y , and s a t i s f a c t i o n w i t h s o c i a l c o n t a c t s (Salamon & C o n t e , 1 9 8 4 ) . Older Adult: an i n d i v i d u a l age 55 y e a r s o f age and a b o v e . Therapeutic Recreation: The p u r p o s 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 s t o f a c i l i t a t e t h e deve lopmen t , m a i n t e n a n c e , and e x p r e s s i o n o f an a p p r o p r i a t e l e i s u r e l i f e s t y l e f o r i n d i v i d u a l s w i t h p h y s i c a l , m e n t a l , e m o t i o n a l and s o c i a l l i m i t a t i o n s ( N a t i o n a l T h e r a p e u t i c R e c r e a t i o n S o c i e t y , 1982; S c h l e i e n and Y e r m a l k o f f , 1983) . 14 Therapeutic Recreation Outreach Program (T.R.O.P.): an o u t p a t i e n t ba sed p r o g r a m , w h i c h t a k e s p l a c e i n t h e c l i e n t ' s r e s i d e n c e o r i n a communi ty b a s e d r e c r e a t i o n a l s e t t i n g , as opposed t o a more t r a d i t i o n a l i n p a t i e n t b a s e d p r o g r a m . Social Support: " the i n t e r a c t i o n o r n o n - i n t e r a c t i o n o f a s e t o f p e r s o n s , m o b i l i z e d o r r e l i e d on i n s p e c i a l t i m e s " ( R u b e n s t e i n e t a l . 1994, p . 6 2 ) . 15 CHAPTER TWO Rev iew o f 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 o f 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 t o u n d e r s t a n d t h e c h a r a c t e r i s t i c s o f t he l e i s u r e e x p e r i e n c e . The re has been a r e c e n t s h i f t i n the o r i e n t a t i o n o f l e i s u r e p r o f e s s i o n a l s t owards u n d e r s t a n d i n g the s u b j e c t i v e p e r s p e c t i v e s p e o p l e have about l e i s u r e (Lee e t a l . , 1 9 9 4 ) . I n c o n t r a s t , p a s t v i e w s o f l e i s u r e have emphas ized the a c t i v i t y o r s t a t e o f m i n d app roaches (Hul t sman , B l a c k , S e e h a f e r and H o v e l l , 1987) . Lee e t a l . (1994, p . 202) d e f i n e d t h e s u b j e c t i v e n a t u r e o f l e i s u r e i n r e l a t i o n t o t h r e e p r o m i n e n t e l e m e n t s : en joyment and f u n , r e l a x a t i o n , and the c o n d i t i o n o f f reedom o f c h o i c e . K e l l y , S t e inkamp & K e l l y (1987) c o n c u r t h a t l e i s u r e i s more t h a n a t i m e f i l l e r f o r an empty l i f e , because i t i s g e n e r a l l y i n t e g r a t e d i n t o the l i f e p a t t e r n s o f p e o p l e ' s r o l e s , and r e s o u r c e s . L e i s u r e i s an i m p o r t a n t f a c t o r i n t h e c o p i n g p r o c e s s , e s p e c i a l l y f o r t h o s e who have been c o n s i s t e n t l y i n v o l v e d i n t h e i r own s e l f - d e v e l o p m e n t and communi ty a f f a i r s ( K e l l y e t a l . , 1987, p . 1 1 4 ) . L e i s u r e , w h i c h has t h e p o t e n t i a l t o 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 , has p r o v i d e d o p p o r t u n i t i e s f o r o l d e r a d u l t s t o meet t h e i r needs t o 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 l i v e s ( P u r c e l l & K e l l e r , 1989, p . 2 4 ) . Through l e i s u r e , o l d e r a d u l t s c a n meet t h e s e needs by a v a r i e t y o f means and p e r s o n a l c h o i c e s . F o r 16 e x a m p l e , m e r e l y c h o o s i n g what s p e c i f i c fo rm o f l e i s u r e t o p u r s u e , who t o p u r s u e i t w i t h , and when t o p u r s u e i t , e x e r c i s e s o n e ' s a b i l i t y t o make c h o i c e s . Lee e t a l . (1994) c o n t e n d t h a t l e i s u r e i s c h a r a c t e r i z e d by v a r i o u s forms o f e x p e r i e n c e , i n c l u d i n g s t r e s s f u l o r u n p l e a s a n t o n e s . I n fo rman t s i n t h e i r s t u d y , w h i c h i n c l u d e d two o l d e r a d u l t s , d i d no t 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 e x p e r i e n c e s . F o r example p a r t i c i p a n t s a l s o r e c a l l e d f e e l i n g s o f e x h a u s t i o n , a p p r e h e n s i o n , n e r v o u s n e s s , d i s a p p o i n t m e n t , f r u s t r a t i o n , and g u i l t when a s k e d t o d i s c u s s t h e i r l e i s u r e e x p e r i e n c e s (Lee e t a l . , 1994, p . 203) . M a n n e l l , Zuzanek , and L a r s o n (1988) u s e d t h e t e r m " s e r i o u s l e i s u r e " t o r e f e r t o e x t e r n a l l y m o t i v a t e d a c t i v i t i e s w h i c h were f r e e l y c h o s e n . " S e r i o u s l e i s u r e " a p p e a r s t o r e q u i r e more e f f o r t , commitment and o b l i g a t i o n on b e h a l f o f t h e i n d i v i d u a l r a t h e r t h a n f r e e l y c h o s e n , more i n t r i n s i c a l l y m o t i v a t e d a c t i v i t i e s . " B e i n g a t l e i s u r e " i s o f t e n a t t a i n e d t h r o u g h r e c r e a t i o n a l forms o f e x p e r i e n c e s ( B a l l a n t y n e , 1987) . These r e c r e a t i o n a l e x p e r i e n c e s a r e the r e s u l t o f p a r t i c i p a t i n g i n some fo rm o f r e c r e a t i o n a l a c t i v i t y w h i c h may be s o c i a l , p h y s i c a l , c r e a t i v e 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 i n o u r l e i s u r e t i m e ( B a l l a n t y n e , 1987, pp . 1 - 2 ) . To emphas i ze t h e i m p o r t a n c e o f t h e " e x p e r i e n c e " o f l e i s u r e , a c t i v i t i e s a r e commonly g r o u p e d i n t o c a t e g o r i e s such a s : s o c i a l , p h y s i c a l , c r e a t i v e , i n t e l l e c t u a l , s p e c t a t o r , and s o l i t a r y ( B a l l a n t y n e , 1987) . From 17 a l e i s u r e e d u c a t i o n p e r s p e c t i v e , i t i s i m p o r t a n t f o r i n d i v i d u a l s t o be e x p o s e d t o a b a l a n c e o f a c t i v i t i e s f rom each e x p e r i e n c e c a t e g o r y (see A p p e n d i x One f o r e x a m p l e s ) . L e i s u r e S a t i s f a c t i o n and L i f e S a t i s f a c t i o n Munson and Munson (1986) remarked t h a t t h e a c h i e v e m e n t o f m e a n i n g f u l and s a t i s f y i n g l e i s u r e i s a major d e v e l o p m e n t a l t a s k f o r o l d e r a d u l t s . R u s s e l l (1987) s t u d i e d r e t i r e d p e r s o n s aged 60 y e a r s and 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 s i t u a t i o n s . R u s s e l l f o u n d t h a t o l d e r a d u l t s ' s a t i s f a c t i o n w i t h r e c r e a t i o n 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 l i f e s a t i s f a c t i o n . However , t h i s same s t u d y r e v e a l e d t h a t t h e f r e q u e n c y o f 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 a c t i v i t i e s was n o t s i g n i f i c a n t l y r e l a t e d t o l i f e s a t i s f a c t i o n ( R u s s e l l , 1 9 8 7 ) . T h i s and o t h e r s t u d i e s have m a i n t a i n e d t h a t s a t i s f a c t i o n w i t h r e c r e a t i o n and l e i s u r e c o n t r i b u t e d more t o l i f e s a t i s f a c t i o n t h a n 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 (Ragheb and G r i f f i t h , 1982 ; K e l l e r , 1 9 8 3 ) . Brown , F r a n k e l and F e n n e l l (1991) examined t h e r e l a t i o n s h i p be tween l e i s u r e and h a p p i n e s s o r p s y c h o l o g i c a l w e l l - b e i n g o f a d u l t s . T h e i r s t u d y , w h i c h a l s o c o n t a i n e d a l a r g e sample o f o l d e r a d u l t s , d e s c r i b e d the r e l a t i v e c o n t r i b u t i o n o f t h e v a r i a b l e s o f l e i s u r e a c t i v i t y , age , gende r and l e i s u r e s a t i s f a c t i o n t o w e l l - b e i n g . They c o n c l u d e d t h a t l e i s u r e s a t i s f a c t i o n i s t he most i m p o r t a n t v a r i a b l e i n p r e d i c t i n g l i f e s a t i s f a c t i o n (Brown e t a l . , 1991 , p . 3 6 9 ) . 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 d u l t s A number o f r e c e n t s t u d i e s have i d e n t i f i e d p a t t e r n s o f l e i s u r e i n v o l v e m e n t s among o l d e r a d u l t s . P a t t e r s o n and C a r p e n t e r ( 1994 ) , 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 were widows and w i d o w e r s , f ound t h a t t h e most p o p u l a r l e i s u r e a c t i v i t i e s o f o l d e r p e o p l e were "home-based a c t i v i t i e s s u c h as r e a d i n g , w a t c h i n g TV, g a r d e n i n g , h o b b i e s , and s o c i a l i z i n g w i t h f a m i l y and f r i e n d s " ( P a t t e r s o n & C a r p e n t e r , 1994, p . 114) . 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 a g e n c y - d e p e n d e n t . 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 were i n v o l v e m e n t s w i t h f a m i l y , p l e a s a n t s u r r o u n d i n g s , p h y s i c a l h e a l t h , r e l a x a t i o n , b e i n g w i t h o t h e r s , and fun and enjoyment ( P a t t e r s o n & C a r p e n t e r , 1994) . A c c o r d i n g t o O ' N e i l l and R e i d (1991) , t he t o p r a n k e d p h y s i c a l a c t i v i t i e s o f 199 h e a l t h y , a d u l t s o v e r t h e age o f 55 , i n a M o n t r e a l ba sed s t u d y were " w a l k i n g , swimming, c a l i s t h e n i c s , b o w l i n g and dance" ( O ' N e i l l and R e i d , 1991 , p . 395) . M a c N e i l and Teague (1987) n o t e d t h a t as age i n c r e a s e s t h e r e i s a t r e n d away f rom a c t i v i t i e s w h i c h a r e p h y s i c a l l y e x e r t i n g and 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 , t o a c t i v i t i e s t h a t a r e l e s s p h y s i c a l l y demanding and more h o m e - c e n t r e d ( M a c N e i l & Teague, 1 9 8 7 ) . S i m i l a r l y , P a t t e r s o n and C a r p e n t e r (1994, p . 107) f o u n d t h a t t he c o r e o f l i f e t i m e l e i s u r e a c t i v i t i e s f o r o l d e r a d u l t s o f r e l a t i v e l y a c c e s s i b l e and i n f o r m a l l e i s u r e a c t i v i t i e s , s u c h as " c o n v e r s a t i o n s i n t h e 19 h o u s e h o l d , r e a d i n g , w a t c h i n g t e l e v i s i o n , w a l k i n g , s h o p p i n g " ( P a t t e r s o n & C a r p e n t e r , 1994, p . 1 0 7 ) . The s o c i a l e x p e r i e n c e s g a i n e d t h r o u g h l e i s u r e p a r t i c i p a t i o n a r e b e l i e v e d t o be b e n e f i c i a l t o t h e ma in tenance o f p o s i t i v e m o r a l e among t h e e l d e r l y ( P a t t e r s o n & C a r p e n t e r , 1 9 9 4 ) . " S o c i a l i n t e r a c t i o n i s a. common e lement o f t he l e i s u r e l i f e s t y l e o f most a d u l t s " (Sneegas , 1989, p . 3 0 ) . Y e t , K e l l y e t a l . (1987, p . 190) n o t e d t h a t t h e r ange o f i n t e r e s t s and s o c i a l i n t e r a c t i o n s f o r many o l d e r becomes 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 . They c o n t e n d t h a t t h i s r e d u c t i o n i s due t o " r e d u c e d m o b i l i t y and s o c i a l r e s o u r c e s r a t h e r t h a n a p e r s o n a l c h o i c e " . The re i s a l s o a d e c l i n i n g t e n d e n c y t o seek n o v e l t y t h r o u g h new l e i s u r e i n t e r e s t s as one advances i n age ( I s o - A h o l a , J a c k s o n & Dunn, 1994) . I n c o n t r a s t , i t has been s u g g e s t e d by A r g y l e (1992) t h a t l e i s u r e w h i c h c o n s i s t s o f w o r k - l i k e q u a l i t i e s a r e more s o c i a l l y a c c e p t a b l e t h a n the e x p e r i e n c e s c i t e d a b o v e . A r g y l e ' s examples o f t h e s e more s o c i a l l y a c c e p t e d forms o f l e i s u r e 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 , was o f use t o o t h e r s , met h i g h s t a n d a r d s , r e q u i r e d s k i l l , and l e a d t o t h e r e c o g n i t i o n o f e x c e l l e n c e ( A r g y l e , 1 9 9 2 ) . C o n s t r a i n t s t o L e i s u r e O ' N e i l l and R e i d (1991) found t h a t t h e number o f p e r c e i v e d b a r r i e r s t o p h y s i c a l a c t i v i t y f o r o l d e r a d u l t s was 20 s i g n i f i c a n t l y r e l a t e d t o age and 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 knowledge b a s e d , and may have r e p r e s e n t e d e i t h e r a n e g a t i v e a t t i t u d e t o w a r d o r l a c k o f knowledge about 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 . F o r the o l d e r a d u l t , f r e q u e n t l y l i v i n g a l o n e i n t h e i r home, s u c h l i f e e v e n t s may magn i fy l e i s u r e c o n s t r a i n t s . F o r b e s , Hayward and Agwani (1991) a n a l y z e d t h e d a t a from t h e 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 G e n e r a l S o c i a l 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 t o e s t i m a t e the p r e v a l e n c e o f v a r i o u s m e n t a l , a g i l i t y , m o b i l i t y , s i g h t and 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 r i s k s f o r i m p a i r m e n t s was e s t i m a t e d ba sed on i n c o m e , m a r i t a l s t a t u s , h o u s i n g t e n u r e , and l i v i n g a r r a n g e m e n t s . The s u r v e y r e v e a l e d t h a t low income appea red t o have t h e g r e a t e s t i m p a c t on s e l f - r e p o r t e d 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 t h e communi ty . M a n n e l l and Zuzanek (1991, p . 346) r e p o r t e d t h a t t h e most f r e q u e n t l y r e p o r t e d c o n s t r a i n t by 92 a c t i v e o l d e r r e t i r e d a d u l t s was " b e i n g t o o b u s y " . T h i s f i n d i n g was c o n t r a r y t o t h e s t e r e o t y p e s o f o l d e r a d u l t s as b e i n g i s o l a t e d and i d l e . A number o f o l d e r a d u l t s a r e no t a b l e t o spend t h e i r l e i s u r e as t h e y w i s h . I n f a c t t h e r e i s f r e q u e n t l y a d i s c r e p a n c y between what t h e y a c t u a l l y do and w o u l d l i k e t o d o . L e i s u r e c o n s t r a i n t s r e s e a r c h r e v e a l s t h a t a l a c k o f knowledge 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 , where t o p a r t i c i p a t e 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 w i t h whom 21 t o 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 c o n s t r a i n i n g e f f e c t upon 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 ( S e a r l e and Mahon, 1 9 9 3 ) . J a c k s o n (1990) r e f e r s t o " a n t e c e d e n t c o n s t r a i n t s " as a n o t h e r form o f l e i s u r e c o n s t r a i n t . A n t e c e d e n t c o n s t r a i n t s r e f l e c t "a m o d i f i c a t i o n o f an i n d i v i d u a l ' s p r e f e r e n c e s r a t h e r t h a n a g e n e r a l l a c k o f i n t e r e s t " . Examples o f s u c h a n t e c e d e n t c o n s t r a i n t s i n c l u d e s e x - r o l e 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 o f f a c i l i t i e s i n a g i v e n a r e a , o r f a m i l y c i r c u m s t a n c e s ( J a c k s o n , 1990 , p . 67) . Heywood (1994, p . 14) d i s c u s s e s age s p e c i f i c l a b e l l i n g as a n o t h e r p o t e n t i a l c o n s t r a i n t . He con t ends t h a t t h i s t y p e o f l a b e l l i n g i s common, i t " s e r v e s as a d e t e r r e n t t o o l d e r a d u l t s 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 , a c t i v e , c o n t r i b u t i n g members o f s o c i e t y " . W h i l e t he f r a i l e l d e r l y may be a " s p e c i a l p o p u l a t i o n " t h a t needs t o be t r e a t e d s e p a r a t e l y , o l d e r a d u l t s i n g e n e r a l , a r e not (Heywood, 1994, p . 1 4 ) . A f u r t h e r c o n s t r a i n t may be the o l d e r a d u l t s ' h e s i t a n c y t o become i n v o l v e d i n s p e c i f i c programs due t o t h e i r n e g a t i v e p e r c e p t i o n o f t h a t p r o g r a m . O l d e r a d u l t s a r e becoming r e l u c t a n t t o use communi ty s e r v i c e s o f any k i n d , due t o an i n c r e a s e d s o c i a l w e l f a r e / s o c i a l 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 t o t h e c e n t r e s (Heywood, 1994, p . 1 6 ) . H e a l t h S t a t u s o f O l d e r A d u l t s T h i s s e c t i o n r e f l e c t s some o f t h e most common h e a l t h p r o b l e m s 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 n o t t o say 22 t h a t most o l d e r a d u l t s e x p e r i e n c e t h e s e p r o b l e m s . I n f a c t t h e m a j o r i t y o f o l d e r a d u l t s aged 65 and o l d e r have no d i s a b l i n g c o n d i t i o n and l i v e f a i r l y a c t i v e community l i v e s , t h i s a l s o i n c l u d e s a l a r g e number o f s e n i o r s w i t h , d i s a b i l i t i e s ( S t a t i s t i c s Canada , 1 9 8 8 ) . E b e r s o l e and Hess (1994, p . 549) s t a t e d t h a t d e p r e s s i o n i s t h e p r o b l e m o f g r e a t e s t f r e q u e n c y and magn i tude i n t h e aged p o p u l a t i o n " . I t has been e s t i m a t e d t h a t among o l d e r a d u l t s r e s i d i n g i n t h e communi ty , between 10 and 25% have c l i n i c a l l y d i a g n o s e d d e p r e s s i o n . I n p a r t i c u l a r , t h e l o s s e s o r s t r e s s o r s a s s o c i a t e d w i t h age (such as widowhood, d e c l i n i n g h e a l t h , and d e c r e a s i n g s o c i a l and economic r e s o u r c e s ) have been f o u n d t o be s t r o n g l y a s s o c i a t e d w i t h d e p r e s s i o n and l o n e l i n e s s . 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 e l d e r l y p e r s o n s t o w a r d p h y s i c a l and m e n t a l h e a l t h p rob l ems ( R u b i n s t e i n , Lubben & M i n t z e r , 1994) . Two o r t h o p a e d i c d i s a b i l i t i e s , o s t e o p o r o s i s and o s t e o a r t h r i t i s , a r e 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 i n t h e g e r i a t r i c p o p u l a t i o n ( R i d d i c k and K e l l e r , 1 9 9 1 ) . The N a t i o n a l C e n t e r f o r H e a l t h S t a t i s t i c s (1988) r e p o r t e d , t h a t n e a r l y h a l f o f a l l p e r s o n s o v e r age 65 s u f f e r f rom some fo rm o f c h r o n i c a r t h r i t i s . R i d d i c k and K e l l e r (1991, p . 154) s u g g e s t t h a t l e i s u r e e d u c a t i o n programs have a r o l e t o p l a y i n t h e m a i n t e n a n c e and r e s t o r a t i o n o f m u s c u l a r h e a l t h and f u n c t i o n i n g f o r 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 o r t h o p a e d i c p r o b l e m s . 23 C h r o n i c i l l n e s s e s a f f e c t most o l d e r a d u l t s t o v a r y i n g d e g r e e s ( V e r b r u g g e , L e p k o w s k i , and Imanaka, 1989) . Where o l d e r a d u l t s e x p e r i e n c e e p i s o d e s o f i l l n e s s , w i t h i n c r e a s i n g f r e q u e n c y , p r o g r e s s t owards improvement i s o f t e n s l o w e d ( H i c k e y - S t i l w e l l , 1992, p . 1 ) . The re a r e o b v i o u s d i f f e r e n c e s be tween o l d e r a d u l t s ' 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 a c u t e i l l n e s s e s w h i c h r e q u i r e a m u l t i - d i m e n s i o n a l a p p r o a c h t o t h e management o f d i s e a s e and o v e r a l l h e a l t h c a r e ( H i c k e y & S t i l w e l l , 1992 , p . 2 ) . I t i s i m p o r t a n t t o d e v e l o p and c u s t o m i z e t r e a t m e n t s t r a t e g i e s w h i c h a r e c o n s i s t e n t w i t h t h e i n d i v i d u a l ' s b e l i e f s and a t t i t u d e s . T h i s i s e s p e c i a l l y i m p o r t a n t i f a d h e r e n c e t o a 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 an e x t e n d e d p e r i o d o f t i m e ( H i c k e y & S t i l w e l l , 1992, p . 2 ) . I m p l i c a t i o n s o f H e a l t h O l d e r a d u l t s a r e l i k e o t h e r p e o p l e , i n t h a t h e a l t h , n o t age , i s t h e d e t e r m i n i n g f a c t o r o f t h e i r d i f f e r e n c e s (Heywood, 19 94, p . 1 2 ) . Based upon a C a n a d i a n r e s e a r c h s t u d y i n v o l v i n g 34 0 s u b j e c t s aged 55 and above , i t was d e m o n s t r a t e d t h a t p a r t i c i p a n t s ' 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 on r a t e o f p a r t i c i p a t i o n i n l e i s u r e and the number o f a c t i v i t i e s i n w h i c h t h e y p a r t i c i p a t e d ( S e a r l e & I s o - A h o l a , 1 9 8 8 ) . H i c k e y and S t i l w e l l (1992) r e f e r r e d t o changes i n h e a l t h s t a t u s , w h i c h were a t t r i b u t e d t o age . They s t a t e d t h a t t h e i m p a c t o f i l l n e s s and d i s a b i l i t y on p e o p l e ' s p e r s o n a l autonomy 24 and l i f e - s t y l e , r e p r e s e n t e d a s i g n i f i c a n t c h a l l e n g e f o r b o t h o l d e r p e o p l e and h e a l t h c a r e p r o f e s s i o n a l s ( H i c k e y - S t i l w e l l , 1992 , p . 1 ) . However , S a i n s b u r y and B r u c e (1994) f o u n d t h a t o l d e r a d u l t s who p a r t i c i p a t e d i n t h e i r s t u d y r e p o r t e d i m p r o v e d l i f e s a t i s f a c t i o n i n s p i t e o f p o o r o r f a i l i n g h e a l t h . T h i s was a c c o m p l i s h e d w i t h the a s s i s t a n c e o f a m u l t i d i s c i p l i n a r y team, w h i c h i n c l u d e d t h e r a p e u t i c r e c r e a t i o n . A number o f a u t h o r s have emphas i zed the i m p o r t a n c e o f l e i s u r e e d u c a t i o n i n the r e d u c t i o n o f s p e c i f i c h e a l t h - r e l a t e d p r o b l e m s . R i d d i c k and K e l l e r (1991) s t r e s s e d t h a t t h e r a p e u t i c r e c r e a t i o n programs s h o u l d be d e s i g n e d t o : 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 r educe the r i s k o f 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 a d d i t i o n a l r e l a t e d avenues f o r r e c r e a t i o n t h e r a p i s t s . I n d i s c u s s i n g r e i n t e g r a t i o n t o n o r m a l l i v i n g a f t e r a m p u t a t i o n , N i s s e n and Newman (1992) r e c o g n i z e d t h a t r e c r e a t i o n t h e r a p i s t s may need t o spend more t i m e a s s i s t i n g p a t i e n t s t o f i n d a c c e p t a b l e , a l t e r n a t i v e r e c r e a t i o n e x p e r i e n c e s , o r some a d a p t i v e means t o c o n t i n u e t h e i r p r e v i o u s i n t e r e s t s . I t has been n o t e d t h a t i n d i v i d u a l s s u f f e r i n g f rom d e p r e s s i o n o f t e n r e q u i r e h e l p l e a r n i n g how t o e n j o y t h e m s e l v e s i n l e i s u r e p u r s u i t s , l e a r n i n g r e l a x a t i o n , and l e a r n i n g s o c i a l i z a t i o n ( R i d d i c k and K e l l e r , 1991, p . 1 5 5 ) . The re a r e a l s o o b v i o u s r a m i f i c a t i o n s f o r a d d r e s s i n g l o n e l i n e s s i n t h e g e r i a t r i c p o p u l a t i o n s , t h r o u g h t h e p r o m o t i o n and f a c i l i t a t i o n 25 o f s o c i a l i z a t i o n o p p o r t u n i t i e s t h r o u g h l e i s u r e e d u c a t i o n and t h e r a p e u t i c 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 , 1 9 9 1 ) . 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 on o u t r e a c h t h e r a p e u t i c r e c r e a t i o n f o r t he f r a i l o l d e r a d u l t , s o u r c e s on o t h e r t a r g e t g roups were r e v i e w e d . F o r example , C l a r k and C u r r a n (1994) 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 f o r 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 . T h i s model r e c o g n i z e s the i n t e r d e p e n d e n c y among a l l p e r s o n s and the community i n w h i c h t h e y l i v e . C l a r k and C u r r a n (1994, p . 30) emphas ize t h e i m p o r t a n c e o f r e g u l a r c o m m u n i c a t i o n 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 and s u s t a i n i n g the i n v o l v e m e n t o f p a r t i c i p a n t s i n communi ty -based r e c r e a t i o n and l e i s u r e . U n a v o i d a b l e m u l t i p l e changes i n l i f e e v e n t s ( e . g . , f a i l i n g h e a l t h , l o s s o f f i n a n c e s , r e t i r e m e n t , widowhood) a r e " s h o c k s " t o o l d e r p e r s o n s and r e s u l t i n i n d i v i d u a l s l o o s i n g f a i t h i n t h e i r a b i l i t y t o a f f e c t t he env i ronmen t o r i n f e e l i n g s o f h e l p l e s s n e s s . These f e e l i n g s can p r e v e n t o l d e r p e r s o n s f rom a c t i n g t o compensate f o r l o s s e s and c o n s e q u e n t l y i t i n f l u e n c e s t h e i r sense o f m a s t e r y o v e r the e n v i r o n m e n t ( R i d d i c k & K e l l e r , 1991 , p . 158) . S o c i a l S u p p o r t L e i s u r e has a c a p a c i t y t o p r o v i d e i n d i v i d u a l s w i t h f e e l i n g s o f s o c i a l s u p p o r t and i t can be a s o u r c e o f c o p i n g when p e r s o n s a r e f a c e d w i t h l i f e c r i s e s . " P e o p l e appear t o be 26 a b l e 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 s t r e s s o r s , i f t h e y f e e l 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 " (Coleman 1993 , p . 3 5 2 ) . R u b i n s t e i n e t a l . (1994, p . 60) s t a t e d t h a t " s o c i a l r e l a t i o n s " a r e f r e q u e n t l y i d e n t i f i e d by o l d e r a d u l t s as b e i n g a fundamen ta l need . 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 t o s u p p o r t t h e i m p o r t a n t c o n t r i b u t i o n s o f s o c i a l n e t w o r k s and s o c i a l s u p p o r t t owards the h e a l t h and w e l l - b e i n g o f o l d e r a d u l t s ( R u b i n s t e i n e t a l . , 1994, p . 5 8 ) . There have been i n c r e a s e d l i m i t a t i o n s p l a c e d upon f a m i l i e s t o be a s o u r c e o f s u p p o r t f o r i t s o l d e r members. T h i s d e c l i n e i s i n p a r t due t o t h e 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 h o u s e h o l d s and t h e i n c r e a s i n g g e o g r a p h i c d i s t a n c e s be tween t h e e l d e r l y and t h e i r f a m i l i e s (Ross , 1 9 9 1 ) . The r e - e n t r y women i n t o t h e w o r k f o r c e i s an a d d i t i o n a l f a c t o r as women a r e t h e p r i m a r y in -home c a r e g i v e r s . These c h a n g i n g demograph ic s h i g h l i g h t t h e i m p o r t a n c e o f l o o k i n g t owards a l t e r n a t i v e s o u r c e s o f s u p p o r t f o r o l d e r a d u l t s . Coleman (1993) s u g g e s t e d t h a t s o c i a l s u p p o r t b u f f e r s t he i m p a c t o f l i f e s t r e s s e s on h e a l t h , bu t o n l y when t h e s e l i f e s t r e s s e s a r e h i g h . He i n d i c a t e s t h a t t h i s e f f e c t had been c o n s i s t e n t l y d e m o n s t r a t e d , bu t c a u t i o n e d t h a t t o o many s o c i a l c o n t a c t s c o u l d a c t u a l l y be " d e t r i m e n t a l t o h e a l t h " (Coleman, 1993, p . 3 5 9 ) . F o r example o n e ' s s t r e s s may be i n c r e a s e d by i n a p p r o p r i a t e o r c o n f l i c t i n g a d v i c e b e i n g o f f e r e d by f r i e n d s o r f a m i l y . F r i e d l a n d and M c C o l l (1992, p . 573) s u g g e s t t h a t w h i l e 27 t h e r e l a t i o n s h i p between s o c i a l s u p p o r t and h e a l t h seems t o be e s t a b l i s h e d , t h e r e was e v i d e n c e t h a t " s o c i a l s u p p o r t i n t e r v e n t i o n may be d i f f i c u l t t o i m p l e m e n t " . T h e i r s u g g e s t i o n s f o r p r o v i d i n g s o c i a l s u p p o r t i n t e r v e n t i o n i n c l u d e s e n s u r i n g t h a t : i ) a c l i e n t - c e n t r e d a p p r o a c h i s c e n t r a l t o t h e p r o g r a m ; i i ) t h e t h e r a p i s t ' s r o l e i s t o be an a d v o c a t e f o r t h e c l i e n t p r o m o t i n g s o c i a l s u p p o r t ; i i i ) t h e n e t w o r k , not t he c l i e n t , i s t h e t a r g e t f o r i n t e r v e n t i o n ; i v ) t h e i n f o r m a l s u p p o r t sy s t em i s o f s p e c i a l i m p o r t a n c e ; the i m p o r t a n c e o f s o c i a l s u p p o r t t o w e l l - b e i n g must be c o n v e y e d by t h e t h e r a p i s t t o b o t h c l i e n t and ne twork members; v) i n t e r v e n t i o n s h o u l d . b e p r o v i d e d a t a t i m e when t h e i n d i v i d u a l i s a c t i v e l y a d j u s t i n g ; v i ) t h e p rogram needs t o be o f s u f f i c i e n t i n t e n s i t y and d u r a t i o n t o p r o v i d e a " c r i t i c a l e x p o s u r e " . ( F r i e d l a n d & M c C o l l , 1992 , p . 576) 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 T r a d i t i o n a l 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 r o l e s 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 M c G i l l (1994) d e s c r i b 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 c o u n s e l l i n g as f a i l i n g t o f o c u s on i d e n t i f y i n g the needed s u p p o r t s f o r i n d i v i d u a l s , because t r a d i t i o n a l p r a c t i c e s have r e l i e d t o o 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 a s s e s s m e n t s . The t e r m " l e i s u r e e d u c a t i o n " has been t h e s u b j e c t o f numerous d e b a t e s o v e r the p a s t 15 o r more y e a r s . Some v i e w l e i s u r e e d u c a t i o n as the " u m b r e l l a " t e r m w h i c h i s f r e q u e n t l y 28 u s e d i n a v a r i e t y o f c l i n i c a l and community s e t t i n g s . T h i s p e r s p e c t i v e encompasses " l e i s u r e c o u n s e l l i n g " and o t h e r r e l a t e d t e c h n i q u e s w h i c h focus on g u i d a n c e and i n s t r u c t i o n t o w a r d s l e i s u r e awareness , s k i l l s and knowledge ( B e d i n i , 1 9 9 0 ) . I n t h e p a s t , o t h e r s have p r e f e r r e d t o v i e w 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 as s e p a r a t e a p p r o a c h e s ( C h i n n & J o s w i a k , 1 9 8 1 ) . These e a r l i e r p e r s p e c t i v e s v i e w e d l e i s u r e c o u n s e l l i n g as "p rob lem f o c u s e d " and d e s i g n e d t o r e s o l v e s p e c i f i c i s s u e s (Chinn & J o s w i a k , 1 9 8 1 ; Munson & Munson, 1986) . The l e i s u r e e d u c a t i o n p r o c e s s i s c o n s t r u c t e d t o a s s i s t i n d i v i d u a l s i n d e t e r m i n i n g t h e i r s p e c i f i c needs and a c t i o n p l a n s f o r a c h i e v i n g them. The p r o c e s s i s no t b a s e d on some e x t e r n a l l y f o r m u l a t e d model o f what c o m p r i s e s "good l e i s u r e " and what c o m p r i s e s " u n h e a l t h y o r bad a c t i v i t y " . R a t h e r , t h e g o a l o f l e i s u r e e d u c a t i o n i s t o c r e a t e " p e r s o n a l l y s a t i s f y i n g l i f e s t y l e s , n o t l i f e s t y l e s w h i c h mimic some m o d e l " ( S e a r l e and Mahon, 1993, p . 1 1 ) . L e i t n e r and L e i t n e r (1985, p . 1 2 5 ) , i n t h e i r book on l e i s u r e c o u n s e l l i n g f o r the e l d e r l y , s t a t e d t h a t b o t h 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 r e f e r r e d t o " h e l p i n g p r o c e s s e s d e s i g n e d t o f a c i l i t a t e max imal l e i s u r e w e l l - b e i n g " They d e s c r i b e d l e i s u r e e d u c a t i o n as a s e l f - d i r e c t e d p r o c e s s and l e i s u r e 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 g r o u p p r o c e s s l e a d by a l e i s u r e c o u n s e l l o r . They s u g g e s t e d t h e f o l l o w i n g t e c h n i q u e s when c o n d u c t i n g l e i s u r e c o u n s e l l i n g 29 i n t e r v e n t i o n s f o r o l d e r a d u l t s : (1) p l a n s e s s i o n s 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 ; (2) c o n d u c t s e s s i o n s a minimum o f once p e r week; (3) a t t he s t a r t o f each s e s s i o n , d e f i n e and s t a t e t h e p u r p o s e ; (4) t ape r e c o r d an t a k e n o t e s on s e s s i o n s ; (5) choose 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 and be f l e x i b l e enough 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) . C a l d w e l l , A d o l p h , and G i l b e r t (1989) found t h a t i n a s t u d y o f p a t i e n t s 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 f a c i l i t y and 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 s e l f - 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 l e i s u r e s a t i s f a c t i o n . A l s o , p a t i e n t s p a r t i c i p a t i n g i n t h e l e i s u r e c o u n s e l l i n g a l s o f e l t b e t t e r p r e p a r e d t o d e a l w i t h t h e i r p o s t - d i s c h a r g e f r e e t i m e as compared t o p a t i e n t s 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 . However , one s u r p r i s i n g r e s u l t o f t h i s 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 l e i s u r e 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 t o p a r t i c i p a t i o n and f e l t more b o r e d t h a n t h o s e who d i d no 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 . Heywood (1994, p . 14) r e c e n t l y s t a t e d t h a t t h e l a t e r s t a g e s o f l i f e i s : an i d e a l t i m e t o c u l t i v a t e dormant o r even 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 and r e l a t i o n s h i p s . To do so r e q u i r e s r e c o g n i t i o n o f t h e 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 t h a t a d d r e s s i n g t h e i r p o t e n t i a l s i s as 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 o f app roaches t o l e i s u r e e d u c a t i o n were 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 ( 1985 ) . They s u g g e s t t h a t t h e L e i s u r e R e s o u r c e Gu idance A p p r o a c h i s t h e most a p p r o p r i a t e s t r a t e g y f o r h e a l t h y o l d e r a d u l t s who a r e s e e k i n g i n f o r m a t i o n r e g a r d i n g r e c r e a t i o n o p p o r t u n i t i e s , bu t who a r e n o t i n t e r e s t e d i n b r o a d e n i n g t h e i r h o r i z o n s beyond t h e i r c u r r e n t i n t e r e s t s ( L e i t n e r and L e i t n e r , 1985, p . 1 2 7 ) . The r e s o u r c e g u i d a n c e a p p r o a c h i n v o l v e s : (1) an i n i t i a l i n t e r v i e w t o ge t a c q u a i n t e d w i t h t h e c l i e n t ; (2) a d m i n i s t r a t i o n o f l e i s u r e i n t e r e s t i n v e n t o r i e s and c o l l e c t i o n o f demograph ic d a t a ; (3) d a t a a n a l y s i s ; (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 demograph ic d a t a w i t h a p p r o p r i a t e r e c r e a t i o n p r o g r a m s ; (5) d i s c u s s i o n o f r e s u l t s w i t h c l i e n t and r e f e r r a l t o s u i t a b l e p r o g r a m s ; (6) a f o l l o w - u p m e e t i n g t o examine t h e 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 were r e f e r r e d ; (7) t e r m i n a t i o n o f t he c o u n s e l l i n g once t h e 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 o n e ' s d e s i r e d r e c r e a t i o n a l 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) . 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 t o a s s i s t t h e p a r t i c i p a n t i n i d e n t i f y i n g an " i d e a l l e i s u r e l i f e s t y l e " and h e l p them move towards d e c r e a s i n g t h e d i s t a n c e be tween t h e i r a c t u a l l e i s u r e and i d e a l l e i s u r e . The s t e p s i n v o l v e d i n t h i s i n c l u d e : (1) p r e - a s s e s s m e n t ; 31 (2) b u i l d i n g r a p p o r t ; (3) d e f i n i n g c o n c e p t s r e l a t e d t o l e i s u r e , i d e a l l e i s u r e and work ; (4) i d e n t i f y i n g l e i s u r e needs ; (5) i d e n t i f y i n g l e i s u r e g o a l s ; (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 t o g o a l a c h i e v e m e n t ; (7) i d e n t i f y i n g pe r fo rmance c r i t e r i a t h r o u g h r e f i n i n g g o a l s ; (8) e x p l o r e l e i s u r e a l t e r n a t i v e s and c o n s e q u e n c e s ; (9) d i s s e m i n a t e i n f o r m a t i o n ; (10) p a r t i c i p a t i o n and e v a l u a t i o n ; (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 , 1985, p p . 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 f o r l o w e r f u n c t i o n i n g o l d e r a d u l t s o r t h o s e w i t h s p e c i f i c l e i s u r e r e l a t e d p r o b l e m s s u c h as boredom, l o n e l i n e s s , d e p r e s s i o n , c h r o n i c t e l e v i s i o n w a t c h i n g . T h i s a p p r o a c h r e q u i r e s e s t a b l i s h i n g a c l o s e empa th i c r e l a t i o n s h i p w i t h t h e p a r t i c i p a n t . 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 and f o c u s on s p e c i f i c p r o b l e m s . L e i t n e r and L e i t n e r recommend t h a t t h e 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 t h e s e o b j e c t i v e s i n mind when w o r k i n g t o w a r d s s p e c i f i c p r o b l e m s o f o l d e r a d u l t s ' l e i s u r e : (1) i d e n t i f y l e i s u r e - r e l a t e d p r o b l e m s and t h e i r c a u s e s ; (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 t h e p r o b l e m s ; (3) d e v e l o p an i n d i v i d u a l i z e d p rogram 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 32 i n t e g r a t i o n ; (4) i n i t i a t e i n v o l v e m e n t 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) d e v e l o p a p o s i t i v e s e l f - i m a g e and a t t i t u d e s t o w a r d s 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 t h e 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 o l d e r p e o p l e t owards l e i s u r e can a s s i s t them i n a d a p t i n g t o " c h a n g i n g c i r c u m s t a n c e s and overcome l i f e c r i s e s and b a r r i e r s t o l e i s u r e f u l f i l m e n t " (Munson and Munson, 1986, p . 1 3 ) . What b e g i n s as a form o f t h e r a p y , l e a d s c l i e n t s t o w a r d s more aware , i n d e p e n d e n t l y p a r t i c i p a t i n g i n d i v i d u a l s , who have h o p e f u l l y a t t a i n e d a g r e a t e r sense o f s a t i s f a c t i o n and f reedom i n t h e i r own l e i s u r e and l i f e . 33 CHAPTER THREE M e t h o d o l o g y T h i s c h a p t e r d e s c r i b e s the case s t u d y u t i l i z e d t o e x p l o r e t h e 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 . A u t h o r s who have u s e d q u a l i t a t i v e methods i n t h e i r r e s e a r c h , have recommended d e s c r i b i n g t h e me thodo logy i n the sequence t h a t i t o c c u r r e d (Henderson , 1991 ; M a c t a v i s h , 1994; P a t t o n , 1980) . R e s e a r c h D e s i g n Hende r son r eminds us t h a t l e i s u r e has p e r h a p s a l w a y s been b e s t u n d e r s t o o d t h r o u g h a s u b j e c t i v e p a r a d i g m (Hende r son , 1991 , p . 1 9 5 ) . She con tends t h a t t he h i g h l y c o m p l e x n a t u r e o f l e i s u r e can no l o n g e r be d e c i p h e r e d o n l y by p o s i t i v i s t i c and q u a n t i t a t i v e t e rms (Henderson, 1990, p . 1 7 3 ) . The p r i m a r i l y q u a l i t a t i v e a p p r o a c h u s e d i n t h e c a s e s t u d i e s o f t h e o l d e r a d u l t s p e r m i t t e d a g r e a t e r d e p t h o f a n a l y s i s and a l l o w e d f o r a c c e s s t o d a t a w h i c h c o u l d n o t have been g a t h e r e d t h r o u g h q u a n t i t a t i v e methods a l o n e . The i n v e s t i g a t o r ' s 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 o l d e r a d u l t p a t i e n t s a t S t . 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 o f t h e s e p a t i e n t s . T h i s u n i q u e n e s s was p a r t i a l l y a t t r i b u t e d t o d i f f e r i n g l i f e e x p e r i e n c e s , m e d i c a l c o n d i t i o n s , p e r c e p t i o n s o f l e i s u r e , and a v a i l a b l e suppo r t s y s t e m s . The e x p e c t e d d i v e r s i t y 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 p r e s e n t e d e i g h t u n i q u e c a s e s t u d i e s . 3 4 The use o f q u a l i t a t i v e methods , w h i c h was s u p p l e m e n t e d by some q u a n t i t a t i v e d a t a d e r i v e d f rom t h e l e i s u r e w o r k s h e e t s , p r o v i d e d t h e r e s e a r c h e r w i t h o p p o r t u n i t i e s t o examine and d e s c r i b e t h e s u b j e c t i v e meaning t h a t l e i s u r e and i n v o l v e m e n t i n t h e T . R . O . P . had f o r t he p a r t i c i p a n t s . The i n d i v i d u a l i z e d a p p r o a c h u t i l i z e d i n t h e T . R . O . P . , w h i c h i s ' e x p l a i n e d l a t e r i n t h i s s e c t i o n , 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 w h i c h w o u l d n o t have been a d e q u a t e l y r e v e a l e d i n a s t r i c t l y q u a n t i t a t i v e d e s i g n . 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 t h e p a r t i c i p a n t s ' needs r a t h e r t h a n a r e s e a r c h e r ' s p r e d e t e r m i n e d r e s e a r c h 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 p a r t i c i p a n t s ' 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 p r o g n o s i s , s u p p o r t e d t h e i n v e s t i g a t o r ' s c h o i c e o f a v a r i e t y o f f o r m s , t i m e - l i n e s and c o n t e n t o f T . R . O . P . s e s s i o n s . T h e r e f o r e , t h e t h e r a p e u t i c r e c r e a t i o n i n p a t i e n t and o u t r e a c h s e s s i o n s were n o t i d e n t i c a l f o r each p a r t i c i p a n t . I n f a c t , e a c h p a r t i c i p a n t s ' T . R . O . P . was somewhat u n i q u e . The p u r p o s e o f t h i s 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 r e l a t i o n s h i p be tween t h e i n v e s t i g a t o r and each p a r t i c i p a n t . T h i s r e l a t i o n s h i p h e l p e d t o e s t a b l i s h g o a l s , w h i l e m a k i n g r e a l i s t i c a d j u s t m e n t s t o the method i n o r d e r t o a c c o m p l i s h them. When t h e 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 , i t was w i t h i n the . scope o f t h e i n t e r v e n t i o n t o make t h e n e c e s s a r y a d j u s t m e n t s . G i v e n t h e r e s e a r c h p r o b l e m , r e s e a r c h q u e s t i o n s , and t h e 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 a p p r o p r i a t e 35 c a s e s t u d y d e s i g n was a combined q u a l i t a t i v e and q u a n t i t a t i v e a p p r o a c h . 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 d a t a c o l l e c t i o n measures a r e no t " m u t u a l l y e x c l u s i v e r e s e a r c h s t r a t e g i e s " . They c a n ' b o t h be u t i l i z e d i n t h e same s t u d y ( P a t t o n , 1990, p . 1 4 ) . Henderson s u p p o r t s t h e use o f b o t h a p p r o a c h e s , s t a t i n g t h a t t he v a l u e o f c o n s i d e r i n g b o t h a p p r o a c h e s " l i e s i n g i v i n g the r e s e a r c h e r more t o o l s w i t h w h i c h t o work" (Henderson , 1991, p . 1 7 9 ) . The use o f . t h r e e i n - h o u s e t o o l s c o m p r i s e d t h e q u a n t i t a t i v e d a t a c o l l e c t i o n d i m e n s i o n . These l e i s u r e e d u c a t i o n w o r k s h e e t s were d e v e l o p e d t o encourage i n d i v i d u a l s ' t o e x p l o r e 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 , l e i s u r e c o n s t r a i n t s , and ways o f o v e r c o m i n g l e i s u r e c o n s t r a i n t s ( B a l l a n t y n e , 1987; BC R e h a b i l i t a t i o n S o c i e t y , 1989 ; W i t t & E l l i s , 1 9 8 9 ) . The w o r k s h e e t s a r e f r e q u e n t l y u t i l i z e d as i n - h o s p i t a l a s ses smen 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 o u t r e a c h p rog rams f o r a d u l t s 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 a d a p t e d by t h e B r i t i s h C o l u m b i a R e h a b i l i t a t i o n S o c i e t y f rom B a l l a n t y n e (1987) and W i t t and E l l i s ( 1989 ) . P a r t i c i p a n t s c o m p l e t e d t h e t h r e e f o r c e d - c h o i c e l e i s u r e w o r k s h e e t s 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 o f c h o i c e s . The w o r k s h e e t s a l s o p r o v i d e d a r e s o u r c e f o r t h e i n v e s t i g a t o r t o f a c i l i t a t e a d d i t i o n a l r e s p o n s e s f rom t h e p a r t i c i p a n t s i n t h e subsequent q u a l i t a t i v e d a t a c o l l e c t i o n p h a s e . The q u a l i t a t i v e methods i n c l u d e d i n t e r v i e w s , o b s e r v a t i o n s , and f i e l d n o t e s . I t appea red f rom t h e r e s u l t s o f 36 t h e p i l o t s t u d y , t h a t t h e more d e t a i l e d q u a l i t a t i v e forms o f r e s p o n s e s were more i n f o r m a t i v e t h a n t h e r e s p o n s e s w h i c h were i n d i c a t e d on the w o r k s h e e t s . P i l o t S t u d y A p i l o t s t u d y , s i m i l a r i n fo rmat t o t h i s r e s e a r c h p r o j e c t , was c o m p l e t e d May 17, 1994. The p i l o t s t u d y examined t h e impac t , o f a 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 p r o g r a m on two o l d e r a d u l t s , who were p a t i e n t s a t S t . P a u l ' s H o s p i t a l . I t was d e s i g n e d t o . f a m i l i a r i z e t h e r e s e a r c h e r w i t h t h e p r a c t i c a l p r o c e d u r e s i n v o l v e d i n i m p l e m e n t i n g t h e r e s e a r c h d e s i g n . I t a l s o p r o v i d e d the 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 t o c r i t i c a l l y examine the a p p r o p r i a t e n e s s o f t h e i n t e r v i e w q u e s t i o n s and t o d e t e r m i n e t h e a c t u a l t i m e - f r a m e r e q u i r e d . The c o m p l e t e r e s u l t s o f t h e p i l o t s t u d y a r e f o u n d i n G a l l a n t ( 1994 ) . H i g h l i g h t s o f t h e r e s u l t s o f t h e s t u d y a r e i n c l u d e d i n t h e r e s u l t s s e c t i o n o f t h i s r e p o r t . The p i l o t 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 t h e m e t h o d o l o g y i n t e rms o f t h e i n t e r v i e w q u e s t i o n s . The o r d e r and number o f t h e 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 . I t seemed more a p p r o p r i a t e t o s t a r t t h e i n t e r v i e w w i t h a more c o n c r e t e q u e s t i o n r e l a t e d . t o t h e T . R . O . P . i t s e l f , r a t h e r t h a n t h e more a b s t r a c t q u e s t i o n s on l e i s u r e . The s e c o n d change r e s u l t e d i n t h e a d d i t i o n o f a q u e s t i o n t o d e t e r m i n e i f t h e p a r t i c i p a n t s 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 o b t a i n any f eedback f o r f u t u r e improvemen t s . T h i s a d d i t i o n a l q u e s t i o n 37 p r o v i d e d a n a t u r a l c o n c l u d i n g p o i n t f o r t he i n t e r v i e w s . A p p e n d i x Two c o n t a i n s a l i s t o f t he 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 . I n v e s t i g a t o r ' s R o l e The r e s e a r c h e r was one o f t he i n s t r u m e n t s o f d a t a c o l l e c t i o n and a n a l y s i s (Mer r i am, 1 9 9 1 ) . He had a d u a l r o l e as r e s e a r c h e r 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 f o r i m p l e m e n t i n g t h e s p e c i f i c T . R . O . P . He implemented t h e l e i s u r e e d u c a t i o n i n p a t i e n t s e s s i o n s as p a r t o f t he n o r m a l c o u r s e o f t r e a t m e n t w h i c h s p e c i f i c p a t i e n t s w o u l d undergo a t S t . P a u l ' s H o s p i t a l . The use o f s e m i - s t r u c t u r e d i n t e r v i e w s , t a p e - r e c o r d e d s e s s i o n s , and f o r m a l i z e d f i e l d n o t e s were no t a s s o c i a t e d w i t h t h e u s u a l p r o f e s s i o n a l d u t i e s o f t he i n v e s t i g a t o r , bu t were d i r e c t l y 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 c o n t i n u e d l i a i s o n w i t h t h e p a t i e n t a f t e r t h e i r d i s c h a r g e from t h e h o s p i t a l and t h e 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 t h e e x i s t i n g r e s p o n s i b i l i t i e s o f t he p r o f e s s i o n a l . T h i s d u a l r o l e o f r e s e a r c h e r and r e c r e a t i o n t h e r a p i s t p r e s e n t e d a number o f s p e c i f i c advan t ages as w e l l as l i m i t a t i o n s . One advan tage was r e l a t e d t o t h e c r e d i b i l i t y o f t h e i n v e s t i g a t o r . H i s p r o f e s s i o n a l e x p e r i e n c e i n c l u d e d t h e i n t e r v i e w i n g o f p a t i e n t s , o b s e r v i n g p a t i e n t s ' b e h a v i o u r , and t r e a t i n g p a t i e n t s w i t h a v a r i e t y o f m e d i c a l c o n d i t i o n s . These b r o u g h t v a l u a b l e e l emen t s t o t h i s r e s e a r c h p r o j e c t . As M e r r i a m (1991, p . 34) commented, " t r a i n i n g i n o b s e r v a t i o n and 3 8 i n t e r v i e w i n g , t hough n e c e s s a r y , i s n o t r e a d i l y a v a i l a b l e t o a s p i r i n g ca se s t u d y r e s e a r c h e r s " . R e l a t e d t o t h i s advan tage o f p r o f e s s i o n a l 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 w i t h o t h e r members o f t he p a t i e n t s ' o r p a r t i c i p a n t s ' m u l t i d i s c i p l i n a r y t eam. The r e c r e a t i o n t h e r a p i s t ' s f a m i l i a r i t y w i t h the team and t h e p a t i e n t s , enhanced t h e r e f e r r a l p r o c e s s and exchange o f i n f o r m a t i o n r e l a t e d t o the p a t i e n t s ' c a r e , w h i c h o t h e r w i s e w o u l d have been d i f f i c u l t t o o b t a i n . There was, i n a l l l i k e l i h o o d , 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 as the r e s u l t o f t h e r e s e a r c h e r a l s o b e i n g t h e r e c r e a t i o n t h e r a p i s t . The r e s e a r c h e r ' s g e n e r a l f a m i l i a r i t y o f t h e h o s p i t a l 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 t h e r e s e a r c h p r o g r a m . As Hender son (1991, p . 107) s t a t e d , " the i d e a l r e s e a r c h s e t t i n g i s where t h e r e s e a r c h e r o b t a i n s e a s y a c c e s s , e s t a b l i s h e s immedia te r a p p o r t , and g a t h e r s d a t a r e l a t e d t o t h e r e s e a r c h i n t e r e s t s . 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 t h e 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 d u t i e s . F o r example , t he r e c r e a t i o n t h e r a p i s t who was c o n d u c t i n g t h e l e i s u r e e d u c a t i o n p rogram c o u l d n o t a l w a y s 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 and be a t t e n t i v e t o t h e d i s c u s s i o n o c c u r r i n g be tween d i f f e r e n t p a r t i c i p a n t s . I t s h o u l d a l s o be n o t e d however , t h a t t h e r e l a t i o n s h i p be tween t h e p a r t i c i p a n t and t h e r a p i s t / r e s e a r c h e r became more t r u s t i n g o v e r t i m e . 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 M e r r i a m (1991 ) . T h i s i s s u e r e f l e c t s a common c o n c e r n i n q u a l i t a t i v e s t u d i e s . Tha t i s , t h e r e s e a r c h e r s b e c o m i n g i n v o l v e d i n the i s s u e s and s i t u a t i o n s t h e y have a t t e m p t e d t o s t u d y , l i k e l y has some e f f e c t o r i n f l u e n c e on t h e p a r t i c i p a n t s . P a t t o n (1980) a l s o s t a t e d a s i m i l a r " e v a l u a t o r e f f e c t " w h i c h may be e x p e r i e n c e d by t h e p a r t i c i p a n t s and s t a f f due t o t h e p r e s e n c e o f t he e v a l u a t o r " ( P a t t o n , 1980, p . 333) . S u c h an e f f e c t may have r e s u l t e d i n t h e p a r t i c i p a n t s 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 o f l e i s u r e p a r t i c i p a t i o n . 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 t h e m s e l v e s and t h e i r " s t o r i e s " i n a manner w h i c h t h e y p e r c e i v e d t h e i n v e s t i g a t o r w o u l d have "wanted" them t o have a p p e a r e d , r e a c t e d , 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 " e v a l u a t o r " e f f e c t was t h e p o t e n t i a l f o r t h e i n v e s t i g a t o r t o i n f l u e n c e the h o s p i t a l s t a f f ' s pe r fo rmance and i n t e r a c t i o n s w i t h t h e 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 . However t h e i n v e s t i g a t o r b e l i e v e s t h a t the s t a f f were l i k e l y t o e x p e r i e n c e o n l y m i n i m a l e f f e c t s due t o h i s p r e s e n c e , as t h e e v a l u a t o r was a f a m i l i a r c o l l e a g u e p e r f o r m i n g a f a m i l i a r r o l e , as f a r as t h e y were c o n c e r n e d . P a t t o n (1980) d i s c u s s e d s e v e r a l a d d i t i o n a l e v a l u a t o r e f f e c t s w h i c h a re i m p o r t a n t t o c o n s i d e r . The e v a l u a t o r does n o t r e m a i n a c o n s t a n t . That i s , t h e r e a r e l i k e l y changes w h i c h o c c u r t o t h e i n v e s t i g a t o r t h r o u g h the c o u r s e o f t h e s t u d y . These changes a re c e n t r a l t o t h e method o f p a r t i c i p a n t o b s e r v a t i o n . They o c c u r as the e v a l u a t o r becomes p e r s o n a l l y 40 i n v o l v e d w i t h t h e p a r t i c i p a n t s . The r e s e a r c h e r ' s s e n s i t i v i t y t o t h e f u l l r ange o f e v e n t s o c c u r r i n g i n t h e s e t t i n g i s 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 v e r y " s u b j e c t " u n d e r i n v e s t i g a t i o n ( P a t t o n , 1980, p . 3 3 4 - 3 3 5 ) . However , - Howe (1991) c a u t i o n e d t h a t w h i l e t h e r e a r e some r e s e a r c h e r s who b e l i e v e t h a t s e p a r a t i n g t h e r e s e a r c h e r f rom t h e p a r t i c i p a n t s f a c i l i t a t e s o b j e c t i v i t y , " i t i s t h r o u g h i n t e r a c t i o n w i t h the 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 and r e v e a l i n g d a t a a r e c o l l e c t e d " (Howe, 1991 , p . 5 0 ) . The use o f a p e r s o n - c e n t r e d a p p r o a c h r e q u i r e s t h a t t h e i n v e s t i g a t o r become i n v o l v e d i n the p r o c e s s . P e r s o n - C e n t r e d A p p r o a c h 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 i n t h i s s t u d y (Egan, 1 9 9 0 ) . T h i s e n a b l e d h im t o be f l e x i b l e enough t o d i s c u s s any o f t h e 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 . T h e r a p e u t i c 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 a p e r s o n - c e n t r e d a p p r o a c h and t r e a t e d p a t i e n t s o r c l i e n t s . a s u n i q u e i n d i v i d u a l s w i t h "unknown p o t e n t i a l f o r g r o w t h and 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 . 1 2 ) . The use o f a p e r s o n - c e n t r e d a p p r o a c h enhanced t h e r e s p o n s i v e n e s s be tween t h e p a r t i c i p a n t s and t h e i n v e s t i g a t o r . P e d l a r , G i l b e r t , and Gove (1994) f o u n d f u r t h e r s u p p o r t f o r a p e r s o n - c e n t r e d a p p r o a c h . 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 p rogram w i t h o l d e r d i s a b l e d a d u l t s , t h e s e 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 s t r e n g t h s 41 and s e l f - a w a r e n e s s i n terms o f l e i s u r e p r e f e r e n c e s p r o v e d t o be f r u s t r a t i n g 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 " . More was l e a r n e d about t h e o l d e r a d u l t s ' i n t e r e s t s 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 about who t h e y were and what i n t e r e s t e d them, t h a n by h a v i n g them c o m p l e t e s t a n d a r d l e i s u r e a ssessment t o o l s ( P e d l a r e t a l . , 1994, p . 2 5 ) . 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 To p a r t i c i p a t e i n t h i s s t u d y p a r t i c i p a n t s were r e q u i r e d t o be i n p a t i e n t s o f S t . P a u l ' s H o s p i t a l , t o be a t l e a s t 55 y e a r s o f age, and be a b l e t o speak , r e a d and comprehend E n g l i s h f l u e n t l y . An 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 a t 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 Lower M a i n l a n d o f B r i t i s h C o l u m b i a i n a n o n - i n s t i t u t i o n a l s e t t i n g . These c r i t e r i a were d e s i g n e d t o ensu re t h a t t h e o u t r e a c h 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 f o r t h e 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 d i s t a n c e s i n v o l v e d e n a b l e d t h e r e s e a r c h e r t o m a i n t a i n d i r e c t c o n t a c t w i t h t h e p a r t i c i p a n t s , and t h e r e b y i n c r e a s e d t h e p o t e n t i a l f o r b u i l d i n g e f f e c t i v e r e l a t i o n s h i p s be tween t h e r e s e a r c h e r and t h e p a r t i c i p a n t s ( F l y n n , V o l p e , B o s c h e n , Lewko, S a l h a n i & Shea , 1 9 9 3 ) . Because o f t h e " o u t r e a c h " n a t u r e o f t h e s t u d y , p a t i e n t s were 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 i n a Long Term Care 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 r e s t r i c t t h e i r p a r t i c i p a t i o n i n the communi ty . A l s o 42 i n d i v i d u a l s known t o have a c o g n i t i v e d e f i c i t e x c e e d i n g " m i l d " , 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 , p h y s i c i a n o r o t h e r q u a l i f i e d s t a f f i n v o l v e d i n the a s ses smen t o f t h e p a t i e n t , w o u l d no t be e l i g i b l e t o p a r t i c i p a t e . P e r s o n s w i t h a 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 e x p e c t a n c y o f l e s s t h a n s i x months were a l s o e x c l u d e d from p a r t i c i p a t i n g i n t h i s s t u d y . I t 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 a t o t a l o f e i g h t p a r t i c i p a n t s , aged 55 y e a r s and above f o r t h i s s t u d y . A l e t t e r c o n t a i n i n g an 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 a l l 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 p a r t i c i p a n t base i n o r d e r t o n o t i f y them o f the s t u d y . A l l S t . P a u l ' s H o s p i t a l i n p a t i e n t N u r s i n g U n i t s , w i t h p a t i e n t s p o t e n t i a l l y age 55 and above , 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 t h e i n v e s t i g a t o r o f p o t e n t i a l p a r t i c i p a n t s , t h r o u g h an i n f o r m a l r e f e r r a l p r o c e s s . The i n v e s t i g a t o r sought t h e v o l u n t a r y c o n s e n t o f t h e p a t i e n t s t o p a r t i c i p a t e i n t h i s p r o j e c t . The i n v e s t i g a t o r r e v i e w e d the c h a r t s o f r e f e r r e d p a r t i c i p a n t s t o c o n f i r m t h e i r e l i g i b i l i t y based on the i n c l u s i o n c r i t e r i a . A b r i e f d e s c r i p t i o n o f t h e s t u d y and a c o n s e n t fo rm ( A p p e n d i x Three) was p r e s e n t e d t o each p a r t i c i p a n t . The s i g n e d fo rm 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 on t h e i r m e d i c a l c h a r t . A copy o f t h i s form 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 f o r t h e i r r e c o r d s . The r e c r u i t m e n t o f e i g h t e l i g i b l e p a r t i c i p a n t s r e q u i r e d 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 c i r c u m s t a n c e s . 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 o f t he a v a i l a b l e p a r t i c i p a n t p o o l . I n some i n s t a n c e s , t h e r e were l e s s t h a n t e n p e r c e n t o f p a t i e n t s aged 55 and above who q u a l i f i e d f o r t he s t u d y . Three n o n - c o n s e n t i n g p a t i e n t s a p p e a r e d r e l u c t a n t t o s i g n due t o t h e " w o r d i n e s s " o f t h e c o n s e n t f o r m . A n o t h e r p a t i e n t s t a t e d t h a t he d i d n o t t h i n k he had enough t i m e t o p a r t i c i p a t e . One p a t i e n t , who i n i t i a l l y c o n s e n t e d l a t e r , c o u l d n o t p a r t i c i p a t e i n t h e s t u d y because o f c h a n g i n g c i r c u m s t a n c e s r e g a r d i n g h e r d i s c h a r g e l o c a t i o n . 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 . 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 i n p a t i e n t and o u t p a t i e n t i n t e r v i e w s , l e i s u r e e d u c a t i o n s e s s i o n s and t h e r a p e u t i c r e c r e a t i o n i n t e r v e n t i o n s , w h i c h a s s i s t e d t h e p a r t i c i p a n t s i n e x p l o r i n g 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 n e e d s , c o n s t r a i n t s t o p a r t i c i p a t i o n , and l e i s u r e g o a l s . T . R . O . P . began i n t h e h o s p i t a l w i t h t h e i n i t i a l i n t e r v i e w . I t 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 g roup and one - t o - o n e l e i s u r e e d u c a t i o n s e s s i o n s on the R e h a b i l i t a t i o n U n i t and G e r i a t r i c U n i t o f S t . P a u l ' s H o s p i t a l . T . R . O . P . c o n c l u d e d w i t h a number o f o u t r e a c h s e s s i o n s 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 t h e t h e r a p i s t i n c l u d e d the t e c h n i q u e s recommended by L e i t n e r and L e i t n e r (1985) 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 t h r e e l e i s u r e e d u c a t i o n approaches w h i c h a r e 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 he L e i s u r e R e s o u r c e G u i d a n c e 44 A p p r o a c h , 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 , and t h e 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 ( L e i t n e r & L e i t n e r , 1985) p r o v i d e d t h e t h e r a p i s t w i t h enough s t r a t e g i e s t o work w i t h t h e d i f f e r e n t a b i l i t i e s , needs , and " p r o b l e m s " p a r t i c i p a n t s ' p r e s e n t e d . E a c h p a r t i c i p a n t a t t e n d e d a v a r i e t y o f t h e r a p e u t i c r e c r e a t i o n s e s s i o n s and c o m p l e t e d f o u r l e i s u r e w o r k s h e e t s w h i c h w i l l be d e s c r i b e d l a t e r i n t h e m e t h o d o l o g y . The l i s t o u t l i n e d b e l o w r e p r e s e n t s the minimum p a r t i c i p a t i o n r e q u i r e d t o c o m p l e t e t h e p r o g r a m : I n i t i a l I n t e r v i e w Group S e s s i o n ( s ) L e i s u r e I n t e r e s t s Workshee t L e i s u r e Needs Workshee t C h a l l e n g e s t o ( L e i s u r e ) P a r t i c i p a t i o n Workshee t G o a l S e t t i n g / O v e r c o m i n g C h a l l e n g e s Workshee t O u t r e a c h S e s s i o n 1 O u t r e a c h S e s s i o n 2 C o n c l u d i n g I n t e r v i e w I n i t i a l I n t e r v i e w I m m e d i a t e l y f o l l o w i n g i n f o r m e d c o n s e n t , demograph ic i n f o r m a t i o n was sought by t h e i n v e s t i g a t o r t h r o u g h a s e m i - s t r u c t u r e d i n i t i a l i n t e r v i e w (Append ix Two) . T h i s i n t e r v i e w fo rma t was s i m i l a r t o t h a t d e s c r i b e d i n Howe (1988 ) . A c o r e o f i n t e r v i e w q u e s t i o n s was d e v e l o p e d bu t t h e i n t e r v i e w e r was 45 p e r m i t t e d t o d e v i a t e i n o r d e r t o " e x p l o r e emergent a r e a s w i t h g r e a t e r d e p t h " (Howe, 1988, p . 3 0 8 ) . 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 a n o n - t h r e a t e n i n g method o f g a t h e r i n g b a s i c demograph ic i n f o r m a t i o n w h i c h may o r may n o t have been on t h e p a r t i c i p a n t s ' m e d i c a l c h a r t . The i n t e r v i e w a l s o p r o v i d e d an o p p o r t u n i t y f o r t he p a r t i c i p a n t s t o e x p r e s s t h e i r r e a c t i o n t o 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 a c t i v i t y l e v e l s w i t h i n the h o s p i t a l . E f f o r t s were t a k e n by t h e i n v e s t i g a t o r t o e s t a b l i s h r a p p o r t w i t h each p a r t i c i p a n t p r i o r t o t h e i n t e r v i e w s . F o r e x a m p l e , t he i n v e s t i g a t o r and p a r t i c i p a n t d i s c u s s e d t h e r o l e o f t h e r e c r e a t i o n t h e r a p i s t . Then t h e i n v e s t i g a t o r t o l d t h e p a r t i c i p a n t s about h i s r e s e a r c h and u n i v e r s i t y s t u d i e s , i n an e f f o r t t o d i s c l o s e some p e r s o n a l i n f o r m a t i o n w h i c h w o u l d h e l p " b r e a k the i c e " . 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 0-40 m i n u t e s i n l e n g t h . 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 . F i e l d n o t e s were a l s o t a k e n d u r i n g and a f t e r t h e i n t e r v i e w t o h i g h l i g h t o b s e r v a t i o n s made by t h e i n v e s t i g a t o r and t o emphas i ze k e y p o i n t s o r i s s u e s m e n t i o n e d by t h e p a r t i c i p a n t s . Group I n p a t i e n t S e s s i o n s I n p a t i e n t s a t t e n d e d a minimum o f one g roup l e i s u r e 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 t h e R e h a b i l i t a t i o n U n i t a t S t . P a u l ' s H o s p i t a l . P a r t i c i p a n t s o f T . R . O . P . and o t h e r h o s p i t a l p a t i e n t s were a l s o i n v i t e d t o 4 6 a t t e n d a d d i t i o n a l r e c r e a t i o n a c t i v i t i e s i n the h o s p i t a l as p a r t o f t h e i r n o r m a l h o s p i t a l t r e a t m e n t c o u r s e . These g r o u p s 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 s u c h a c t i v i t i e s as b a k i n g , b i n g o , c u r r e n t even t d i s c u s s i o n s , g a r d e n i n g , m u s i c a l e n t e r t a i n m e n t , s o c i a l "pubs" , and community o u t i n g s . A l l i n p a t i e n t s e s s i o n s were s c h e d u l e d i n c o o r d i n a t i o n w i t h p h y s i o t h e r a p y , o c c u p a t i o n a l t h e r a p y , n u r s i n g , and o t h e r members o f t h e p a t i e n t ' s c a r e team. P r i o r t o t h e p a r t i c i p a n t s ' d i s c h a r g e f rom S t . P a u l ' s H o s p i t a l , t he i n v e s t i g a t o r met w i t h e ach p a r t i c i p a n t t o d i s c u s s f u t u r e v i s i t s o u t s i d e o f t h e h o s p i t a l . Ar rangemen t s were made f o r f o l l o w - u p v i s i t s d u r i n g t h e s e d i s c u s s i o n s . P a r t i c i p a n t s were i n f o r m e d a t l e a s t one day i n advance o f an upcoming s e s s i o n , and were e n c o u r a g e d t o i n v i t e any f a m i l y , f r i e n d s , o r o t h e r s i g n i f i c a n t i n d i v i d u a l t o a t t e n d t h e s e s s i o n s w i t h them. P a r t i c i p a n t s s a t a r o u n d a t a b l e and were i n a p o s i t i o n w h i c h e n s u r e d t h e y c o u l d see t h e o t h e r p a t i e n t s , t he i n v e s t i g a t o r , t he s l i d e s , and t h e t e l e v i s i o n m o n i t o r . The v o l u n t e e r o f f e r e d the p a t i e n t s r e f r e s h m e n t s w h i c h c o m p l i e d w i t h any d i e t r e s t r i c t i o n s . The i n v e s t i g a t o r f a c i l i t a t e d i n f o r m a t i o n s h a r i n g r e l a t e d t o p r e v i o u s and c u r r e n t l e i s u r e b e h a v i o u r s and i n t e r e s t s . The i n v e s t i g a t o r and a l l o f t he p a r t i c i p a n t s i n t h e g r o u p s e s s i o n gave a b r i e f i n t r o d u c t i o n about t h e m s e l v e s and were i n v i t e d t o s h a r e t h e i r i n t e r e s t s and c o n c e r n s r e l a t e d t o l e i s u r e a t a n y t i m e d u r i n g the s e s s i o n o r a f t e r t h e s e s s i o n i n p r i v a t e . 47 These comments were r e c o r d e d by t h e i n v e s t i g a t o r . C o n v e r s a t i o n s among the p a r t i c i p a n t s and t h e i n v e s t i g a t o r were p r o m o t e d t h r o u g h t h e use o f a v a r i e t y o f s l i d e s , a v i d e o t a p e , o v e r h e a d s , and b r o c h u r e s r e l a t e d t o l e i s u r e and l i f e e n j o y m e n t . The s l i d e s r e v e a l e d t h e i n v e s t i g a t o r ' s p e r s o n a l l e i s u r e i n t e r e s t s , needs and some f a c i l i t a t o r s t o l e i s u r e . 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 , i n h o s p i t a l l e i s u r e p u r s u i t s and l e i s u r e a d a p t a t i o n s . The 12 m i n u t e 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 V a n c o u v e r communi ty r e c r e a t i o n r e s o u r c e s and f a c i l i t i e s . R e c r e a t i o n and community i n f o r m a t i o n b r o c h u r e s were d i s t r i b u t e d t o p a r t i c i p a n t s . These b r o c h u r e s were s p e c i f i c t o t h e p a r t i c i p a n t s ' n e i g h b o u r h o o d and communi ty . They c o n t a i n e d i n f o r m a t i o n on l o c a l r e c r e a t i o n c e n t r e s , e v e n t s , t i m e s c h e d u l e s , and c o s t s . Overheads and an e r a s a b l e marke r b o a r d were o c c a s i o n a l l y u t i l i z e d t o h i g h l i g h t s p e c i f i c p o i n t s d i s c u s s e d i n t h e s e s s i o n . These p o i n t s were o f t e n p r e s e n t e d by b o t h t h e p a r t i c i p a n t s and the i n v e s t i g a t o r . Towards t h e c o n c l u s i o n o f each g roup s e s s i o n , i f t i m e p e r m i t t e d , p a r t i c i p a n t s c o m p l e t e d one o f t h e l e i s u r e e d u c a t i o n w o r k s h e e t s . I f t h e r e was not s u f f i c i e n t t i m e f o r t h e s u b j e c t t o c o m p l e t e a s p e c i f i c workshee t d u r i n g t h e g roup s e s s i o n , i t w o u l d be c o m p l e t e d l a t e r , on a subsequen t v i s i t by t h e i n v e s t i g a t o r . A t o t a l o f f o u r works he e t s were c o m p l e t e d by e a c h p a r t i c i p a n t d u r i n g t h e p rogram (Appendix One) . These e x p l o r e d t h e p a r t i c i p a n t s ' l e i s u r e i n t e r e s t s , needs , c o n s t r a i n t s , and g o a l s ( B a l l a n t y n e , 1987; E l l i s & W i t t , 1986; W i t t & E l l i s , 1989) . O n e - t o - O n e S e s s i o n s O n e - t o - o n e (1:1) s e s s i o n s r e f e r t o . a n y s e s s i o n o r i n t e r a c t i o n be tween o n l y t h e 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 . S u c h s e s s i o n s 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 o f t h e h o s p i t a l s e t t i n g . They i n c l u d e d the i n i t i a l 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 t he o u t r e a c h s e s s i o n s t e l e p h o n e i n t e r a c t i o n s w i t h t h e p a r t i c i p a n t . D u r i n g 1:1 s e s s i o n s , t he p a r t i c i p a n t and i n v e s t i g a t o r f r e q u e n t l y w o r k e d towards t h e i d e n t i f i c a t i o n and p r i o r i t i z i n g o f c h a l l e n g e s t o p a r t i c i p a t i o n . S t eps t owards o b t a i n i n g p a r t i c i p a n t 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 t h e s e s e s s i o n s . O u t r e a c h S e s s i o n s A t l e a s t one week f o l l o w i n g the p a r t i c i p a n t ' s d i s c h a r g e f rom t h e h o s p i t a l and t h e i r r e t u r n t o home, t h e i n v e s t i g a t o r t e l e p h o n e d e a c h p a r t i c i p a n t t o s c h e d u l e t h e i n i t i a l o u t r e a c h s e s s i o n . These t e l e p h o n e c a l l s were s c h e d u l e d a t l e a s t one t o two days i n advance o f a v i s i t , ba sed on t h e p a r t i c i p a n t s p r e f e r e n c e . I f i t . w a s t h e n found i n c o n v e n i e n t f o r a p a r t i c i p a n t t o be v i s i t e d f o r an o u t r e a c h s e s s i o n , t h e p l a n n e d 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 t i m e . The o u t r e a c h s e s s i o n s c o n s i s t e d o f o n e - t o - o n e i n t e r a c t i o n s be tween t h e p a r t i c i p a n t s and the i n v e s t i g a t o r . 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 c a l l s t o e a c h o f t h e p a r t i c i p a n t s t o s c h e d u l e o r c o n f i r m t h e n e x t s e s s i o n . Te l ephone c a l l s were a l s o made t o check on each p a r t i c i p a n t ' s p r o g r e s s and t o e s t a b l i s h t h e f o c u s o f t he n e x t s e s s i o n . C o n c l u d i n g I n t e r v i e w 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 the p a r t i c i p a n t s ' home, i n a room o f t h e i r c h o i c e . The a im o f t h i s i n t e r v i e w was t o a s s e s s t h e p a r t i c i p a n t s ' s u b j e c t i v e p e r c e p t i o n o f T . R . O . P . 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 l a s t e d from 30 t o 45 m i n u t e s . D a t a C o l l e c t i o n 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 methods as o u t l i n e d b e l o w . Medical Chart Review: R e v i e w o f the p a r t i c i p a n t s ' m e d i c a l c h a r t s a s s i s t e d the i n v e s t i g a t o r i n o b t a i n i n g a b r i e f m e d i c a l h i s t o r y on t h e p a r t i c i p a n t s . I n f o r m a t i o n o b t a i n e d f rom t h e c h a r t i n c l u d e d : r e a s o n f o r a d m i s s i o n t o h o s p i t a l , o t h e r 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 , l i v i n g s i t u a t i o n , d a t e o f a d m i s s i o n t o h o s p i t a l , and m e d i c a l p r o c e d u r e s o r t r e a t m e n t s t h e p a r t i c i p a n t i s u n d e r g o i n g . P r o g r e s s n o t e s f rom t h e p a r t i c i p a n t s ' n u r s e s , d o c t o r , s o c i a l w o r k e r w h i c h were p r e s e n t 50 i n t h e i r m e d i c a l c h a r t were a l s o r e v i e w e d . I n f o r m a t i o n w h i c h t h e 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 t o the p a r t i c i p a n t s ' i n v o l v e m e n t and p r o g r e s s i n T . R . O . P . was r e c o r d e d as p a r t o f t h e i r p r o f i l e . Rev iew o f p a t i e n t s ' m e d i c a l c h a r t s i s a common h o s p i t a l p r o c e d u r e u t i l i z e d by r e c r e a t i o n t h e r a p i s t s and o t h e r h o s p i t a l s t a f f . F i e l d notes: F i e l d n o t e s were r e c o r d e d c h r o n o l o g i c a l l y on e a c h p a r t i c i p a n t , u s u a l l y i m m e d i a t e l y f o l l o w i n g e a c h s e s s i o n 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 . O c c a s i o n a l l y b r i e f f i e l d n o t e s were t a k e n d u r i n g a s e s s i o n . These were d e s i g n e d t o r e m i n d t h e i n v e s t i g a t o r o f o b s e r v a t i o n s w h i c h c o u l d be r e c o r d e d i n g r e a t e r d e t a i l f o l l o w i n g the s e s s i o n . These f i e l d n o t e s 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 ( M a l k i n & Howe, 1993, p . 2 6 6 ) . The i n f o r m a t i o n c o l l e c t e d , i n c l u d e d n o t e s o n : where p e o p l e were s i t t i n g , d a t e , p l a c e , s o c i a l c i r c u m s t a n c e s , i n t i m a c y , 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 and u n f o r e s e e n e v e n t s . N o t e - t a k i n g a s s i s t e d t h e i n v e s t i g a t o r s r e c o r d i n g , i n t e r p r e t i n g and d e s c r i b i n g the i n t e r v i e w s , c o n v e r s a t i o n s and o b s e r v a t i o n s . I n t e r v i e w s : A t l e a s t two f o r m a l i n t e r v i e w s were h e l d w i t h e ach p a r t i c i p a n t . The i n i t i a l i n t e r v i e w s were c o n d u c t e d i n t h e h o s p i t a l a t t he s t a r t o f t he p r o g r a m . 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 ' homes a t t h e c o n c l u s i o n o f t he p rog ram. 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 : On o c c a s i o n , i n f o r m a l and f o r m a l c o n v e r s a t i o n s between t h e p a r t i c i p a n t s and t h e 51 i n v e s t i g a t o r p r o v i d e d a d d i t i o n a l d a t a . These c o n v e r s a t i o n s f r e q u e n t l y t o o k p l a c e when the i n v e s t i g a t o r w o u l d b r i e f l y v i s i t t h e p a r t i c i p a n t s i n t h e i r h o s p i t a l rooms t o r e m i n d them o f upcoming s e s s i o n s . O t h e r c o n v e r s a t i o n s c o n s i s t e d o f b r i e f t e l e p h o n e c o n t a c t s w i t h t h e p a r t i c i p a n t s i n t h e i r homes. C o n v e r s i n g w i t h s t a f f : O c c a s i o n a l c o n v e r s a t i o n s w i t h t h e p a r t i c i p a n t s ' o t h e r c a r e - g i v e r s i n the h o s p i t a l p r o v i d e d t h e 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 ' p r o g r e s s , p r o g n o s i s and d i s c h a r g e d a t e s t o t h e i r home. I n f o r m a t i o n from f a m i l y members: O c c a s i o n a l l y , u n s o l i c i t e d 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 i n v e s t i g a t o r by one o f t h e p a r t i c i p a n t s ' f a m i l y members. The i n v e s t i g a t o r found t h i s a d d i t i o n a l i n f o r m a t i o n h e l p f u l i n e s t a b l i s h i n g t h e deg ree o f s u p p o r t t he p a r t i c i p a n t had from t h e i r f a m i l y . P a r t i c i p a n t o b s e r v a t i o n : O b s e r v a t i o n s o f t h e p a r t i c i p a n t s i n t h e l e i s u r e e d u c a t i o n g roup and o n e - t o - o n e s e s s i o n s were a l s o n o t e d . The p a r t i c i p a n t s ' w i l l i n g n e s s t o i n t e r a c t and t h e i r c o n t r i b u t i o n a t each s e s s i o n were o b s e r v e d . O b s e r v a t i o n s o f t h e p a r t i c i p a n t s ' 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 i n d e t e r m i n i n g p h y s i c a l comfo r t and a c c e s s , l e i s u r e i n t e r e s t s , and l i f e s t y l e i n g e n e r a l . The i n v e s t i g a t o r ' s f i e l d n o t e s were r e v i e w e d t h r o u g h o u t T . R . O . P . These a d d i t i o n a l r e v i e w s o f t he f i e l d n o t e s were d e s i g n e d t o i n c r e a s e t h e i n v e s t i g a t o r ' s d e p t h o f u n d e r s t a n d i n g and t o h e l p h im g a i n any f u r t h e r i n s i g h t s i n t o t h e s u b j e c t i v e w o r l d o f t he p a r t i c i p a n t s . 52 L e i s u r e w o r k s h e e t s : F o u r l e i s u r e e d u c a t i o n w o r k s h e e t s were u t i l i z e d t o o b t a i n i n f o r m a t i o n f rom the p a r t i c i p a n t s abou t 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 , c o n s t r a i n t s t o p a r t i c i p a t i o n , and l e i s u r e g o a l s ( B a l l a n t y n e , 1987; W i t t and E l l i s , 1989) . These 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 i t e m s w h i c h p a r t i c i p a n t s checked o f f . These i t e m s d e s c r i b e d t h e i r i n t e r e s t s , v a l u e s , and p e r c e i v e d c o n s t r a i n t s t o l e i s u r e p a r t i c i p a t i o n (Appendix One ) . The g o a l s e t t i n g o r " c o n s t r a i n t s " workshee t p r o v i d e d a fo rma t f o r more o p e n - e n d e d , p a r t i c i p a n t g e n e r a t e d s t r a t e g i e s f o r change . 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 sugges t ways t o overcome up t o t h r e e p r e v i o u s l y i d e n t i f i e d c o n s t r a i n t s and t o s e t g o a l s r e l a t e d t o t h e i r l e i s u r e e x p e r i e n c e s . D a t a O r g a n i z a t i o n C o m p u t e r i z e d d a t a f i l e s were c r e a t e d on t h e p a r t i c i p a n t s 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 t h e da t e o f t h e o c c u r r e n c e , and a l s o by t h e t y p e s o f e x p e r i e n c e s t h a t t h e p a r t i c i p a n t s were i n v o l v e d i n . As M a l k i n and Howe have s t a t e d , 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 ( t h e r a p e u t i c r e c r e a t i o n ) i n t e r v e n t i o n s t h a t p e r m i t 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 end ( M a l k i n & Howe, 1993, p . 265) . 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 c l u d e d t h e i r l e i s u r e p r i o r t o h o s p i t a l i z a t i o n , i n i t i a l 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 g roup l e i s u r e e d u c a t i o n s e s s i o n s , o n e - t o - o n e s e s s i o n s and o u t r e a c h s e s s i o n s . O t h e r e x p e r i e n c e s d u r i n g t h e p r o g r a m , and i n c e r t a i n 5 3 c a s e s , e x p e r i e n c e s w h i c h f o l l o w e d t h e f o r m a l c o m p l e t i o n o f t h e p r o g r a m , were a l s o i n c l u d e d . A d a t a d i s p l a y , c o n s i s t i n g o f c o m p a r a t i v e t a b l e s was c r e a t e d (Hender son , 1991 ; Huberman & M i l e s , 1994) . These a s s i s t e d t h e i n v e s t i g a t o r i n r e d u c i n g t h e d a t a t o more manageable c h u n k s . The t a b l e s a l s o p r o v i d e d an i n i t i a l means o f c o m p a r i n g a l l t h e p a r t i c i p a n t s ' r e s p o n s e s t o t h e s p e c i f i c i n t e r v i e w q u e s t i o n s . Summary t a b l e s were a l s o d e v e l o p e d t o r e v i e w s e l e c t e d d a t a r e l a t e d t o each s p e c i f i c r e s e a r c h q u e s t i o n . 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 f o r e a c h i n d i v i d u a l i n t h e s t u d y . 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 t h r o u g h t h e i n v e s t i g a t o r ' s f i e l d n o t e s , t h e p a r t i c i p a n t i n t e r v i e w s , and the l e i s u r e e d u c a t i o n w o r k s h e e t s . These i n i t i a l p r o f i l e s p r e s e n t e d i n f o r m a t i o n r e l a t e d t o t h e p a r t i c i p a n t s ' h e a l t h and h e a l t h h i s t o r y , s o c i a l s u p p o r t and l i v i n g s i t u a t i o n . The p r o f i l e s were t h e n expanded t o i n c l u d e a d d i t i o n a l d a t a on t h e p a r t i c i p a n t s ' 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 a f f e c t i n g l e i s u r e , and t h e i r g e n e r a l p e r c e p t i o n . o f l e i s u r e . Key p h r a s e s , w h i c h v e r i f i e d emergent f i n d i n g s , were i s o l a t e d f rom t h e d a t a and were i n c l u d e d i n t h e t e x t and t a b l e s o f t h e r e s u l t s s e c t i o n . These p h r a s e s were r e l a t e d t o t h e s p e c i f i c r e s e a r c h q u e s t i o n s . 54 C o n f i r m i n g D a t a T r i a n g u l a t i o n r e f e r s t o t h e use o f m u l t i p l e methods f o r d a t a c o l l e c t i o n o r t h e use o f d i f f e r e n t e v a l u a t i o n s t r a t e g i e s o r s o u r c e s t o s t u d y t h e same p rogram ( P a t t o n , 1980, p . 329 ; 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 e s t a b l i s h e d methods o f i n c r e a s i n g t h e c o n v e r g e n t v a l i d i t y o f q u a l i t a t i v e r e s e a r c h ( M a l k i n & Howe, 1993, p . 2 8 7 ) . The use o f m u l t i p l e methods f o r o b t a i n i n g d a t a a s s i s t e d the r e s e a r c h e r i n c l a r i f y i n g t h e f i n d i n g s (Howe & K e l l e r , 1 9 8 8 ) . T h i s fo rm o f "methods 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 i n t h i s s p e c i f i c r e s e a r c h p r o j e c t . W h i l e t h e m a j o r i t y o f t he d a t a c o l l e c t e d was t h r o u g h q u a l i t a t i v e methods , t h e use o f q u a n t i t a t i v e measures was a l s o n e c e s s a r y and 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 and q u a l i t a t i v e methods has been f a v o u r a b l y v i e w e d by numerous r e s e a r c h e r s ( F l y n n , V o l p e , B o s c h e n , Lewko, S a l h a n i & Shea , 1993 ; P a t t o n , 1 9 8 0 ) . Howe and K e l l e r (1988) s t a t e d t h a t t h e r e has been c o n s i d e r a b l e deba te r e g a r d i n g the c o m p a t i b i l i t y o f t h e s e two a p p r o a c h e s . However , t he i n v e s t i g a t o r b e l i e v e d t h e r e was a need t o u t i l i z e a s p e c t s o f b o t h app roaches i n t h i s p a r t i c u l a r s t u d y . S o u r c e t r i a n g u l a t i o n r e f e r s t o c o m p a r i n g m u l t i p l e d a t a s o u r c e s ( M a l k i n & Howe, 1993, p . 2 8 8 ) . T h i s fo rm 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 , and o f c r o s s - c h e c k i n g the i n f o r m a t i o n c o n s i s t e n c y o b t a i n e d a t d i f f e r e n t t i m e s and by d i f f e r e n t methods o f d a t a c o l l e c t i o n 55 ( P a t t o n , 1 980, p. 3 3 1 ) . D a t a A n a l y s i s D a t a 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 was o b t a i n e d t h r o u g h T.R.O.P. s e s s i o n s , i n t e r v i e w s , a n d f i e l d n o t e s , a f o r m o f c o n s t a n t , c o m p a r i s o n was u t i l i z e d . The i n v e s t i g a t o r f r e q u e n t l y r e v i e w e d e a c h p i e c e o f i n f o r m a t i o n i n t h e p a r t i c i p a n t s ' f i l e s t o s t u d y t h e i r r e s p o n s e s . F o l l o w i n g t h e p a r t i c i p a n t s ' d i s c h a r g e f r o m t h e h o s p i t a l , t h e i n v e s t i g a t o r r e v i e w e d t h e i r m e d i c a l c h a r t s o n s e v e r a l a d d i t i o n a l o c c a s i o n s . T h i s a n a l y s i s o f s e c o n d a r y d a t a was d e s i g n e d t o b r i n g f u r t h e r m e a n i n g t o t h e e x i s t i n g i n f o r m a t i o n , a n d t o f i l l i n some o f t h e unknowns. The d a t a a n a l y s i s i n c l u d e d r e v i e w i n g t r a n s c r i p t s o f t h e p a r t i c i p a n t s ' i n t e r v i e w s a n d n o t i n g k e y p o i n t s w h i c h w e r e m e n t i o n e d b y t h e p a r t i c i p a n t s o r o b s e r v e d b y t h e i n v e s t i g a t o r . The i n v e s t i g a t o r l o o k e d f o r r e p e t i t i o u s w o r d s , p h r a s e s , a n d p h y s i c a l a c t i o n s t o a s s i s t h i m i n i s o l a t i n g a n d i d e n t i f y i n g s y m b o l i c l a n g u a g e . A u d i o t a p e s w e re r e v i e w e d t o e n s u r e t h a t t h e t r a n s c r i b e d r e s p o n s e s w e r e a c c u r a t e a n d t o a n a l y z e t h e p a r t i c i p a n t s ' r e s p o n s e s f o r a d d i t i o n a l d e t a i l s . C h a r a c t e r i s t i c s s u c h a s e n t h u s i a s m , s a d n e s s , l a u g h t e r , r e f l e c t i v e moments a n d o t h e r p r o p e r t i e s o f t h e i r v e r b a l r e s p o n s e s w h i c h m i g h t a d d f u r t h e r m e a n i n g t o t h e t r a n s c r i p t i o n s w e r e n o t e d . I n f o r m a t i o n o b t a i n e d f r o m t h e i n t e r v i e w s a n d t h e 56 completed worksheets was f r e q u e n t l y supported when the p a r t i c i p a n t s provided s i m i l a r or c o n s i s t e n t responses over a p e r i o d of time on s i m i l a r questions. Information was a l s o supported, on occasion, through r e p o r t s or feedback from other s t a f f i n v o l v e d i n the p a r t i c i p a n t s ' / p a t i e n t s ' treatment. The contents of the s o c i a l worker's notes on the medical chart were reviewed i n a l l cases, to confirm p a r t i c i p a n t responses and to seek a d d i t i o n a l information when p o s s i b l e . The p a r t i c i p a n t responses to questions regarding t h e i r l e i s u r e goals were a l s o accounted f o r i n the a n a l y s i s . E t h i c a l Review This study was submitted f o r approval to both the St. Paul's H o s p i t a l E t h i c s Committee f o r Human Experimentation and the U n i v e r s i t y of B r i t i s h Columbia Behavioural Sciences Screening Committee. The p r o j e c t was approved by both of these committees i n January, 1994 (see Appendix Four). Due to the apparent reluctance of some p a t i e n t s to provide w r i t t e n consent, who otherwise appeared t o v e r b a l l y agree and endorse T.R.O.P., the i n v e s t i g a t o r discussed p o t e n t i a l r e v i s i o n s to the consent process w i t h the St. Paul's H o s p i t a l E t h i c s Committee f o r Human Experimentation. Based on feedback r e c e i v e d from t h i s Committee, no changes were made to the i n i t i a l consent form or process. Confirming p o r t i o n s of the data and ensuring i t s a u t h e n t i c i t y through v e r i f i c a t i o n could have presented c e r t a i n 57 e t h i c a l i s s u e s . F o r example , c o n f i r m i n g some i n f o r m a t i o n may have " h u r t " t h e p a r t i c i p a n t s e m o t i o n a l l y . The i n v e s t i g a t o r had t o d e c i d e when i t was a p p r o p r i a t e t o seek c o n f i r m a t i o n f rom t h e p a r t i c i p a n t and when i t was n o t . I t was n o t a p p r o p r i a t e f o r t h e i n v e s t i g a t o r 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 t h e r a t h e r n e g a t i v e 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 c l o s e f a m i l y member a f t e r t h e i n t e r v i e w , as t h i s i n f o r m a t i o n r e l a t e d t o s p e c i f i c r e l a t i o n s h i p p r o b l e m s beyond t h e scope o f t h i s s t u d y . 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 w i t h o u t " h a r m i n g " t h e p a r t i c i p a n t 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 d i s c u s s i o n s w i t h o t h e r members o f t h e p a t i e n t s ' c a r e team. 58 CHAPTER FOUR R e s u l t s and D i s c u s s i o n O v e r v i e w The r e s u l t s s e c t i o n b e g i n s w i t h a b r i e f summary o f f i n d i n g s f rom t h e two p i l o t s t u d y p a r t i c i p a n t s . A p r o f i l e o f e a c h o f t h e e i g h t p a r t i c i p a n t s o f t h e ma in s t u d y f o l l o w s . These p r o f i l e s i n c l u d e s e l e c t e d demograph ic d a t a c o l l e c t e d f rom t h e i n t e r v i e w s , m e d i c a l r e c o r d s , and f i e l d n o t e s . Summaries o f t h e l e i s u r e i n t e r e s t s , c h a l l e n g e s and g o a l s w o r k s h e e t s a r e p r e s e n t e d n e x t . The r e s u l t s w h i c h a r e r e l e v a n t t o t h e s p e c i f i c r e s e a r c h q u e s t i o n s and i n t e r v i e w q u e s t i o n s c o m p l e t e s t h i s c h a p t e r . Any r e f e r e n c e t o a s p e c i f i c p a r t i c i p a n t i s d e n o t e d by t h e i r code l e t t e r s , e i t h e r a t t h e b e g i n n i n g o f t h e s e n t e n c e o r f o l l o w i n g t h e s t a t e m e n t s made by t h e p a r t i c i p a n t . S i x ou t o f t h e e i g h t p a r t i c i p a n t s i n t h e m a i n s t u d y c o m p l e t e d the e n t i r e c o u r s e o f t h e p r o g r a m . Two p a r t i c i p a n t s became i n e l i g i b l e t o c o n t i n u e as t h e y b o t h r e q u i r e d e x t e n d e d r e - h o s p i t a l i z a t i o n . However , t h e i r i n c o m p l e t e r e s u l t s have been i n c l u d e d . P i l o t S t u d y The r e s u l t s o f t he p i l o t s t u d y r e v e a l e d t h a t T . R . O . P . 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 f o r two r e c e n t l y h o s p i t a l i z e d o l d e r a d u l t s who were e x p e r i e n c i n g a m u l t i t u d e o f m e d i c a l p r o b l e m s . "MA" was a 58 y e a r o l d woman who was i n r e n a l f a i l u r e and a w a i t i n g a k i d n e y t r a n s p l a n t . 59 She has a l s o had 14 o p e r a t i o n s i n l e s s t h a n two y e a r s due t o a s p i n a l c u r v a t u r e , and she was a l l e r g i c t o a v a r i e t y o f common s u b s t a n c e s . 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 dependent d i a b e t i c , w i t h a b e l o w - t h e - k n e e a m p u t a t i o n o f h i s r i g h t l e g . A l s o , he had 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 . I n r e s p o n s e t o q u e s t i o n s r e l a t e d t o what had h e l p e d h e r e n j o y h e r l e i s u r e , t he f i r s t p a r t i c i p a n t s t a t e d t h a t " h a v i n g r e a l l y good f r i e n d s " was a f a c i l i t a t i n g f a c t o r ( G a l l a n t , 1994, p . 3 0 ) . I n r e s p o n s e t o the same q u e s t i o n , t h e s e c o n d p a r t i c i p a n t s t a t e d , " I guess sometimes the company y o u ' r e w i t h " ( G a l l a n t , 1994, p . 4 5 ) . O t h e r r e s u l t s o f t he p i l o t s t u d y i n d i c a t e d t h a t b o t h p a r t i c i p a n t s 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 l i f e s a t i s f a c t i o n as b e i n g i n t e r r e l a t e d . The f i r s t i n t e r v i e w e e s t a t e d : "They go t o g e t h e r . T h a t ' s l a r g e l y where I w o u l d improve my l i f e by i m p r o v i n g the l e i s u r e t h i n g s I do" ( G a l l a n t , 1994, p . 3 1 ) . The o t h e r i n t e r v i e w e e s t a t e d : " I t h i n k t h e y go hand i n h a n d . . . W e l l I w o u l d s a y i f y o u ' r e n o t happy w i t h y o u r l i f e i n g e n e r a l i t ' s g o i n g t o be v e r y h a r d t o be happy w i t h i n d i v i d u a l t h i n g s ( such as l e i s u r e ) " ( G a l l a n t , 1994, p . 4 6 ) . B o t h p a r t i c i p a n t s i n the p i l o t s t u d y d e s c r i b e d t h e f o l l o w i n g b e n e f i t s r e l a t e d t o T . R . O . P . MA s t a t e d " i t has f o c u s e d my i n t e r e s t s a b i t b e t t e r " . She was r e f e r r i n g t o 60 l e i s u r e education h e l p i n g her to c l a r i f y her i n t e r e s t s and make d e c i s i o n s . TU s t a t e d , " I enjoyed 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 This s e c t i o n provides a p r o f i l e on each of the ei 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 the main T.R.O.P. study. Each p r o f i l e presents informa t i o n r e l a t e d 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, e a r l y background and s o c i a l support, work and l e i s u r e h i s t o r y , involvement i n T.R.O.P., c o n s t r a i n t s to l e i s u r e , and perceptions of leisure.. 61 TG H e a l t h and P h y s i c a l Appea rance T . G . 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 w i t h a f r a c t u r e d l e f t l e g due t o a f a l l . There was no o t h e r h i s t o r y o f m e d i c a l p r o b l e m s . The m a j o r i t y o f h e r h o s p i t a l a d m i s s i o n .and t r e a t m e n t was on the R e h a b i l i t a t i o n U n i t . She s h a r e d h e r s e m i - p r i v a t e room w i t h one o t h e r woman. T . G . was e x p e c t e d t o r e t u r n t o h e r p r e v i o u s l e v e l o f f u n c t i o n i n g . T . G . was a t a l l i n s t a t u r e and had a medium b u i l d . W h i l e i n t h e h o s p i t a l and d u r i n g the o u t r e a c h s e s s i o n s , she u s u a l l y a p p e a r e d c a s u a l l y d r e s s e d i n sweat p a n t s and a t - s h i r t . E a r l y B a c k g r o u n d and S o c i a l Suppor t T . G . , who had been d i v o r c e d , l i v e d a l o n e i n h e r K i t s i l a n o house , where she had r e s i d e d f o r 30 y e a r s . She had two s o n s , who l i v e d i n B r i t i s h C o l u m b i a w i t h whom she s t a t e d t h a t she was v e r y c l o s e . She s a i d t h a t she had some d i f f i c u l t y f i n d i n g f r i e n d s a v a i l a b l e d u r i n g the d a y t i m e as many o f h e r f r i e n d s were s t i l l w o r k i n g and she was n o t . She had numerous v i s i t o r s and a v a r i e t y o f c a r d s and f l o w e r s were d i s p l a y e d on h e r b e d s i d e t a b l e . Work and 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 i n a d m i n i s t r a t i o n w i t h a l o c a l u t i l i t y company. She c o n t i n u e d t o be h i g h l y a c t i v e i n a v a r i e t y o f community s e r v i c e o r g a n i z a t i o n s and r e c r e a t i o n p u r s u i t s i n c l u d i n g : a t t e n d i n g 6 2 b a s e b a l l games, swimming, s o c i a l i z i n g w i t h numerous f r i e n d s , and h o l d i n g t h r e e v o l u n t e e r p o s i t i o n s . There was no i n i t i a l i n d i c a t i o n o f a p a r t i c u l a r r e l i g i o u s a f f i l i a t i o n on h e r m e d i c a l r e c o r d . However , l a t e r on h e r m e d i c a l r e c o r d t h e r e was some m e n t i o n o f h e r r e c e i v i n g some a s s i s t a n c e w i t h h e r mea l s on a s h o r t - t e r m b a s i s f rom a c h u r c h . I n v o l v e m e n t i n T . R . O . P . D u r i n g h e r p a r t i c i p a t i o n i n the T . R . 0 . P . s e s s i o n s she was c o n s i s t e n t l y c h e e r f u l , g r a t e f u l , and i n t e r a c t i v e . She was a v e r y o u t g o i n g , m o t i v a t e d and r e s o u r c e f u l i n d i v i d u a l b o t h i n the h o s p i t a l and communi ty . I n t h e h o s p i t a l she c o u l d o f t e n be found r e a d i n g n o v e l s and magaz ines o r 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 . TG s t a t e d t h a t b e i n g h o s p i t a l i z e d made h e r aware o f how l u c k y she has been i n l i f e so f a r and how t h a n k f u l she was t o be a l i v e . The i n v e s t i g a t o r f e l t she d e m o n s t r a t e d e x c e l l e n t i n s i g h t i n t o 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 c o n s t r a i n t s . I n t h i s r e g a r d , 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 the same as 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 because I w i l l be a s t r o n g e r p e r s o n . W i l f u l l y s t r o n g e r . D u r i n g 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 i n a s p e c i a l i z e d swimming p o o l p r o g r a m , o f w h i c h she was p r e v i o u s l y unaware . We i n i t i a t e d an a p p l i c a t i o n t o a t t e n d t h i s swimming p r o g r a m . She a l s o i n q u i r e d about a v a i l a b l e programs f o r an i s o l a t e d d i s a b l e d f r i e n d o f h e r s . T . G . 6 3 a c h i e v e d h e r a d d i t i o n a l g o a l s w h i c h c o n s i s t e d o f g o i n g t o Gambie r I s l a n d and r e s u m i n g d r i v i n g . C o n s t r a i n t s t o L e i s u r e W h i l e h e r knowledge o f n o n - s p e c i a l i z e d ' communi ty f a c i l i t i e s and s e r v i c e s was i m p r e s s i v e , she was somet imes unaware o f s p e c i f i c programs o f f e r e d a t t h e s e f a c i l i t i e s . She a l s o a p p e a r e d t o have a good u n d e r s t a n d i n g o f h e r l e i s u r e c o n s t r a i n t s . She i n d i c a t e d , " I j u s t n e v e r have enough f r e e t i m e . I t h i n k I may change 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 " . She was a l s o aware o f a n o t h e r c o n s t r a i n t , as she s t a t e d : 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 have anybody i n my own age g roup 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 w i t h o u t o t h e r incumbersomes l i k e husbands t o (be a b l e t o ) t r a v e l w i t h me". The re was no i n d i c a t i o n o f any e m o t i o n a l , s p i r i t u a l , c u l t u r a l , o r f i n a n c i a l b a r r i e r s w h i c h a f f e c t e d T G ' s l e i s u r e i n v o l v e m e n t . P e r c e p t i o n o f L e i s u r e T . G . appea red t o v a l u e b e i n g a c t i v e , b u t she a l s o p e r c e i v e d t h e need t o s l o w down and e n j o y h e r l e i s u r e e v e n more . She r e c o g n i z e d t h a t l e i s u r e c o u l d be "so many d i f f e r e n t t h i n g s " . She appeared t o be happy w i t h h e r l i f e s t y l e p r i o r t o the a c c i d e n t and she was h i g h l y m o t i v a t e d t o r e t u r n t o h e r p r e v i o u s l e v e l o f l e i s u r e i n v o l v e m e n t . 64 FB H e a l t h and P h y s i c a l Appearance F . B . was a 58 y e a r o l d r e t i r e d man, most r e c e n t l y a d m i t t e d 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 l e f t l e g . He had been p r e v i o u s l y a d m i t t e d , i n O c t o b e r o f 1992 due t o a r i g h t s t r o k e . T h i s was f o l l o w e d by a n o t h e r a d m i s s i o n i n J a n u a r y o f 1993 due t o a l e f t s t r o k e . He c o n t i n u e d t o have some d i f f i c u l t y w i t h h i s speech c l a r i t y as a r e s u l t o f t h e s e s t r o k e s . F . B . was w e l l - d r e s s e d , w e l l - g r o o m e d , and he u s u a l l y wore g l a s s e s . He was o v e r w e i g h t and s l i g h t l y l e a n e d t o w a r d s one s i d e , when he s t o o d . E a r l y B a c k g r o u n d and S o c i a l Suppor t F . B . was b o r n i n I t a l y and he c o n t i n u e d t o m a i n t a i n c l o s e . c o n n e c t i o n s t o t h e I t a l i a n community i n V a n c o u v e r , where he had l i v e d f o r a p p r o x i m a t e l y 30 y e a r s . He r e c e n t l y moved t o an apa r tmen t a t a s e n i o r s complex , where he l i v e d a l o n e . F . B . was d i v o r c e d and had two sons w i t h whom he was i n c o n t a c t w i t h on a w e e k l y b a s i s . One son l i v e d i n t h e V a n c o u v e r a r e a and t h e o t h e r l i v e d i n M a n i t o b a . F . B . l i v e d w i t h one o f h i s s o n s , i n a Burnaby a p a r t m e n t , f o r a p p r o x i m a t e l y one y e a r . F . B . r e c e n t l y moved t o an I t a l i a n a p a r t m e n t c o m p l e x , where he l i v e s a l o n e . He r e g u l a r l y a t t e n d e d a s t r o k e s o c i a l c l u b and s e v e r a l e v e n t s a t t h e I t a l i a n Community C e n t r e . He s t a t e d he was happy i n t h e 65 c o m f o r t o f t h e h o s p i t a l w i t h company a round h i m . He was e x t r e m e l y w e l l l i k e d by t h e h o s p i t a l ' s s t a f f and w e l l - k n o w n t o them due t o h i s p r e v i o u s a d m i s s i o n s . A l t h o u g h he seemed t o make f r i e n d s e a s i l y i n t h e h o s p i t a l , he d i d n o t a p p e a r t o have anyone w i t h whom he r e g u l a r l y spen t h i s l e i s u r e t i m e . F . B . ' s one bedroom apar tmen t appea red n e a t , c o z y , b r i g h t , and c l e a n . S e v e r a l r e l i g i o u s p i c t u r e s and s t a t u e s c o u l d be seen i n the a p a r t m e n t . There was a l s o a g a r d e n o u t s i d e t h e l i v i n g room w h i c h seemed w e l l l o o k e d a f t e r . The re were s e v e r a l t y p e s o f v e g e t a b l e s and f l o w e r s g r o w i n g i n t h i s g a r d e n a r e a . Work and 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 d r i v e r f o r a l o g g i n g camp and a l s o as a p l a n t fo reman . He s t a t e d t h a t he had a marked r e d u c t i o n i n h i s p a r t i c i p a t i o n i n l e i s u r e p u r s u i t s w h i c h u s e d t o i n c l u d e : o p e r a s i n g i n g , c o o k i n g , w r i t i n g p o e t r y , p a i n t i n g , w a l k i n g w i t h h i s s o n s , and a v a r i e t y o f o t h e r i n t e r e s t s . I n v o l v e m e n t i n T . R . O . P . F . B . 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 t h e p rog ram because he l e a r n e d t o "become i n t e r e s t e d i n t h i n g s and i n l i f e a g a i n " . The i n v e s t i g a t o r found 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 had e n c o u n t e r e d a number o f r e c e n t , r a t h e r s u b s t a n t i a l m e d i c a l s e t b a c k s , y e t he r e t a i n e d a good sense o f humour and s p i r i t . F . B . appea red g e n e r a l l y p o s i t i v e r e g a r d i n g h i s f u t u r e . He was i n s i g h t f u l i n t o h i s c o n d i t i o n 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 , c o n s i d e r i n g 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 s t a t e d : " I had i t i n my mind 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 and m a r r i e d and n o w . . . a l l hope i s gone . I w o u l d l i k e i t t o happen , bu t I d o n ' t see i t h a p p e n i n g " . F . B . s t a t e d t h a t t he i n v e s t i g a t o r had p r o v i d e d o p p o r t u n i t i e s 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 -p rob lems , and " b r i n g i n g i d e a s t o my m i n d " . A t t i m e s d u r i n g t h e i n t e r v i e w s , FB became t i r e d and h i s speech c o h e r e n c e d e c r e a s e d . T h i s seemed t o f r u s t r a t e h im d u r i n g p o r t i o n s o f t h e i n t e r v i e w s and e d u c a t i o n s e s s i o n s . F . B . ' s 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 s t r o k e c l u b and t o improve h i s p h y s i c a l s k i l l s enough t o r e t u r n t o w a l k i n g o u t d o o r s . He was a b l e t o meet h i s f i r s t g o a l however h i s m e d i c a l p r o b l e m s d i d no t t o t a l l y r e s o l v e p r i o r t o t h e c o m p l e t i o n o f T . R . O . P . C o n s t r a i n t s t o L e i s u r e F . B . r e q u i r e d an a s s i s t i v e a i d t o become m o b i l e , t h u s 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 cane t o commute s h o r t d i s t a n c e s a r o u n d h i s apar tment complex and n e i g h b o u r h o o d . He a l s o s t a t e d t h a t f i n a n c i a l and p h y s i c a l c o n c e r n s r e s t r i c t e d h i s l e i s u r e . P e r c e p t i o n o f L e i s u r e I t a p p e a r e d t h a t F . B . f e l t l e i s u r e p l a y e d an i m p o r t a n t r o l e i n h i s l i f e . H i s i n t e r e s t s i n o p e r a and m u s i c were v e r y i m p o r t a n t t o h i m . More r e c e n t l y he r e f l e c t e d on l e i s u r e and 67 s t a t e d : " c e r t a i n t h i n g s a r e good . They keep me i n t e r e s t e d i n l i f e , and i n the w o r l d . " He seemed t o be a d j u s t i n g e m o t i o n a l l y t o h i s d e c l i n i n g h e a l t h s t a t u s , y e t s t i l l hoped f o r p h y s i c a l improvements i n the f u t u r e w h i c h w o u l d p e r m i t h im t o e n j o y w a l k i n g o u t d o o r s once a g a i n . T h i s now seemed t o be an u n l i k e l y g o a l t o a c h i e v e , bu t c e r t a i n l y n o t an i m p o s s i b l e g o a l . 68 VB H e a l t h and P h y s i c a l Appea rance V . B . was a 70 y e a r o l d woman who was a d m i t t e d t o S t . P a u l ' s H o s p i t a l G e r i a t r i c Asses smen t and Trea tmen t U n i t due t o 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 a s s o c i a t e d w i t h i n t e r n a l b l e e d i n g , f o r w h i c h she r e c e i v e d t r e a t m e n t and from w h i c h she r e c o v e r e d . A c c o r d i n g t o V . B . ' s m e d i c a l r e c o r d , she was a l s o d i a g n o s e d as h a v i n g ma jo 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 t o t h e a g i n g p r o c e s s . 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 t r e a t m e n t . V . B . ' s m e d i c a l r e c o r d i n d i c a t e d t h a t she had become i n c r e a s i n g l y i s o l a t e d r e c e n t l y . V . B . f r e q u e n t l y seemed c o n c e r n e d about how she l o o k e d . She a l w a y s appea red n e a t , w e l l - d r e s s e d , and she u s u a l l y wore a s m a l l amount o f make-up. E a r l y Backg round and S o c i a l S u p p o r t She has been widowed f o r s even y e a r s and s i n c e t h e n she has l i v e d a l o n e i n he r Bu rnaby a p a r t m e n t . The i n v e s t i g a t o r o b s e r v e d h e r apar tment t o be d a r k and c l u t t e r e d . She a p p e a r e d t o s e c l u d e h e r s e l f f rom o t h e r s , y e t i n p r a c t i c e she f r e q u e n t l y spoke o f t h e need t o be a r o u n d o t h e r s . V . B . opened h e r c u r t a i n s a l i t t l e when t h e i n v e s t i g a t o r v i s i t e d and was a n x i o u s d u r i n g t h e i n i t i a l p o r t i o n s o f many o f t h e i n p a t i e n t and o u t r e a c h s e s s i o n s . . She has two d a u g h t e r s who l i v e i n t h e Lower M a i n l a n d , w i t h whom she has been i n c o n t a c t on a r e g u l a r b a s i s . V B ' s 6 9 m e d i c a l r e c o r d a l s o i n d i c a t e d t h a t " v e r y l i t t l e has e v e r s a t i s f i e d her," . F a m i l y v i s i t o r s r emarked t h a t VB " i s h a p p i e r and more p o s i t i v e now ( i n the h o s p i t a l ) " t h a n t h e y have s een h e r i n a l o n g t i m e . D u r i n g c o n v e r s a t i o n s w i t h t h e i n v e s t i g a t o r , VB f r e q u e n t l y spoke about h e r s i s t e r , who l i v e s i n Edmonton . Work and L e i s u r e H i s t o r y VB s t a t e d she had worked s i n c e she was i n h e r e a r l y t e e n s . B e f o r e r e t i r i n g she worked a t a s m a l l c a r e home f o r o l d e r a d u l t s . VB was h i g h l y i ndependen t w h i l e i n t h e h o s p i t a l . She o f t e n spen t a p a r t o f h e r day o f f t h e h o s p i t a l u n i t , o r t a l k i n g w i t h one o f t he t h r e e women, w i t h whom she s h a r e d h e r h o s p i t a l room. She w o u l d f r e q u e n t l y go o u t s i d e t h e h o s p i t a l f o r a w a l k and 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 r e c r e a t i o n p rog rams w h i l e i n t h e h o s p i t a l . These i n c l u d e d : c r a f t s , g a r d e n i n g , o b s e r v i n g l i v e mus ic e n t e r t a i n m e n t and a t t e n d i n g d i s c u s s i o n g r o u p s . . V . B . a l s o e n j o y e d r e a d i n g and l i s t e n i n g t o m u s i c w h i l e i n h e r h o s p i t a l b e d . Her r e c e n t l e i s u r e i n t e r e s t s and a c t i v i t i e s c o n s i s t e d o f g o i n g o u t d o o r s f o r w a l k s , o c c a s i o n a l l y a t t e n d i n g h e r l o c a l communi ty c e n t r e t o have a c o f f e e w i t h a few women f r i e n d s , and p l a n n i n g a t r i p t o Edmonton . Upon t h e c o m p l e t i o n o f t h i s s t u d y , V . B . t r a v e l l e d t o Edmonton t o accompany h e r s i s t e r t o e a s t e r n Canada on a one month d r i v i n g v a c a t i o n . 70 I n v o l v e m e n t i n T . R . O . P . V . B . was an e n e r g e t i c , s t i m u l u s s e e k i n g women who was a l s o f r e q u e n t l y a n x i o u s and l a c k i n g i n s e l f - c o n f i d e n c e d u r i n g many o f t h e T . R . O . P . s e s s i o n s . She was f r e q u e n t l y b u s y d o i n g c r o s s w o r d p u z z l e s , l i s t e n i n g t o m u s i c , and a t t e n d i n g s o c i a l r e c r e a t i o n programs w h i l e she was h o s p i t a l i z e d . V . B . d e s c r i b e d h e r s e l f as r e s t l e s s and was n o t u s e d t o b e i n g a l o n e . She had no p h y s i c a l l i m i t a t i o n s and she seemed t o b e n e f i t p r i m a r i l y from t h e s o c i a l c o n t a c t t h r o u g h t h e i n p a t i e n t T . R . O . P . s e s s i o n s . Home v i s i t s c o n f i r m e d t h e i n v e s t i g a t o r ' s b e l i e f s r e g a r d i n g V . B . ' s a n x i o u s n e s s and l o w s e l f - c o n f i d e n c e . Her l e i s u r e g o a l s i n c l u d e d t o f i n d ou t more about v o l u n t e e r o p p o r t u n i t i e s w i t h s e n i o r s , t o s t a r t t r a v e l l i n g , and t o f i n d ou t what p rog rams and 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 c o m p l e t i o n o f T . R . O . P . she met a l l t h r e e g o a l s w i t h some deg ree o f s u c c e s s . She t r a v e l l e d t o Edmonton t o accompany h e r s i s t e r on a one month d r i v e t owards e a s t e r n Canada and a l s o o b t a i n e d i n f o r m a t i o n on v o l u n t e e r i n g and communi ty r e c r e a t i o n p r o g r a m s . She was u n c e r t a i n o f when she w o u l d be 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 pu r sue any v o l u n t e e r w o r k . C o n s t r a i n t s t o L e i s u r e D u r i n g t h e 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 any c u l t u r a l , f i n a n c i a l , o r s p i r i t u a l c o n c e r n s w h i c h a f f e c t e d h e r . However , she d i d i n d i c a t e t h a t money was a c o n s t r a i n t when r e s p o n d i n g t o t h e l e i s u r e w o r k s h e e t s y e t h e r c h o i c e o f 71 g o a l s and h e r l i s t o f s t e p s t o o v e r c o m i n g b a r r i e r s d i d n o t i n d i c a t e t h a t money was a b a r r i e r . V . B . f o c u s e d on h e r l a c k o f c o m p a n i o n s h i p towards the end o f t h i s s t u d y . A t h e r home, she c o m p l a i n e d t h a t she l a c k e d the s o c i a l s t i m u l a t i o n w h i c h she was e x p o s e d t o i n the h o s p i t a l . P e r c e p t i o n o f L e i s u r e V . B . i n d i c a t e d t h a t l e i s u r e was i m p o r t a n t t o h e r . She a p p e a r e d t o have a good u n d e r s t a n d i n g o f t he r o l e i t p l a y s i n h e r l i f e . 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 was 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 l e i s u r e 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 t h e s t r u c t u r e o f t h e 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 p r o g r a m s . She seemed much more a n x i o u s , somewhat ove rwhe lmed , and d i s o r g a n i z e d once she was d i s c h a r g e d back t o h e r a p a r t m e n t . She e m p h a s i z e d h e r enjoyment i n h a v i n g o t h e r p e o p l e a r o u n d a l l t h e t i m e and seemed t o p r e f e r s o c i a l forms o f l e i s u r e , e s p e c i a l l y i n t h e h o s p i t a l . She s t a t e d , I ' m no t u s e d t o b e i n g a l o n e . I ' v e been 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 and p e o p l e a round me. 72 JN H e a l t h and P h y s i c a l Appea rance J . N . was a 71 y e a r o l d male who was a d m i t t e d t o S t . P a u l ' s f o r a r i g h t b e l o w - t h e - k n e e a m p u t a t i o n . He was on t h e R e h a b i l i t a t i o n U n i t , i n a room w i t h t h r e e o t h e r men. P r e v i o u s l y J . N . had a l e f t b e l o w - t h e - k n e e a m p u t a t i o n . He a l s o had a h i s t o r y o f a n g i n a , and a c c o r d i n g t o h i s w i f e , he has been " s i c k " f o r 12 y e a r s . J . N . d r e s s e d i n worn , s l i g h t l y t o r n c l o t h e s . He was s m a l l i n s t a t u r e and had a r o u g h l y shaven f a c e . E a r l y B a c k g r o u n d and S o c i a l Suppor t J . N . was b o r n i n F i n l a n d bu t grew up i n a M o n t r e a l orphanage and has l i v e d i n V a n c o u v e r f o r 25 y e a r s . He l i v e d w i t h h i s w i f e i n a West End apar tment b u i l d i n g , w h i c h t h e y were r e s p o n s i b l e f o r manag ing . J . N . was d i v o r c e d f rom t h i s same, w i f e f o r 22 y e a r s , bu t r e m a r r i e d h e r f i v e y e a r s ago . They have f i v e c h i l d r e n , a l l l i v i n g i n W i n n i p e g , M a n i t o b a . The re a p p e a r e d 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 . T h i s was documented i n t h e m e d i c a l c h a r t and o b s e r v e d by t h e i n v e s t i g a t o r . The apar tment was c l u t t e r e d , d u s t y , and had a s t a l e smoky s m e l l . The re was a s m a l l , o l d dog p r e s e n t and a p e t b i r d l i v e d i n a cage i n the l i v i n g room. D u r i n g t h e f i r s t o u t r e a c h s e s s i o n t h e i r i n v e s t i g a t o r a s k e d i f t h e t e l e v i s i o n vo lume c o u l d be t u r n e d down, as i t was t o o l o u d t o c o n v e r s e . 73 Work and L e i s u r e H i s t o r y E a r l i e r i n h i s l i f e he worked as a l a b o u r e r i n t h e c o p p e r m i n e s . H i s p r e v i o u s l e i s u r e i n t e r e s t s i n c l u d e d : r e p a i r i n g e l e c t r o n i c equ ipmen t , h u n t i n g , f i s h i n g , r e l a x i n g , g o i n g t o t h e h o r s e r a c e s , a t t e n d i n g a n e i g h b o u r h o o d communi ty c e n t r e w i t h h i s w i f e , p l a y i n g ches s and w a t c h i n g t e l e v i s i o n . He has no t p a r t i c i p a t e d i n most o f t h e s e f o r a l o n g p e r i o d o f t i m e . I n v o l v e m e n t i n T . R . O . P . J . N . was r e l u c t a n t t o i n i t i a t e c o n v e r s a t i o n w i t h t h e i n v e s t i g a t o r o r o t h e r p a t i e n t s i n the h o s p i t a l . A l t h o u g h he s t a t e d he d i d no t l i k e t o s o c i a l i z e , he s t a t e d t h a t he d i d e n j o y the v i s i t s by t h e i n v e s t i g a t o r and the t h e r a p e u t i c r e c r e a t i o n p r o g r a m . He a p p e a r e d t o o v e r s t a t e h i s d e s i r e t o become i n v o l v e d i n s p e c i f i c l e i s u r e i n t e r e s t s , c i t i n g he w o u l d l i k e t o s t a r t g o i n g ou t more w i t h h i s s c o o t e r , b e g i n w a t e r - c o l o u r p a i n t i n g , resume h i s e l e c t r o n i c s hobby , and f i n d a c h e s s p a r t n e r . He a c h i e v e d one o f t h e s e l e i s u r e g o a l s by f i n d i n g a chess compan ion . T h i s was a c h i e v e d t h r o u g h the a s s i s t a n c e o f t he i n v e s t i g a t o r , who s u g g e s t e d t h a t J N c o n t a c t two community c e n t r e s . The i n v e s t i g a t o r c o n t a c t e d t h e s e c e n t r e s as JN a p p e a r e d r e l u c t a n t t o t a k e t h e i n i t i a t i v e t o make the phone c a l l s . A n o t h e r g o a l was t o o b t a i n i n f o r m a t i o n on West End p r o g r a m s . The i n v e s t i g a t o r b e l i e v e d J . N . was s i n c e r e i n h i s e x p r e s s i o n o f t h i s i n t e r e s t , y e t he was u n m o t i v a t e d t o f o l l o w - t h r o u g h w i t h any 74 s p e c i f i c a c t i o n r e l a t e d t o p u r s u i n g o t h e r i n t e r e s t s . He seemed t o l a c k p r o b l e m - s o l v i n g a b i l i t i e s r e l a t e d t o r e a c h i n g h i s g o a l s and he appea red t o e x p e c t o t h e r s ( such as h e a l t h p r o v i d e r s and h i s w i f e ) t o s o l v e p r o b l e m s f o r h i m . I n r e t r o s p e c t , t h e i n v e s t i g a t o r b e l i e v e d t h a t J . N . o v e r s t a t e d 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 have 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 t o t h e i n v e s t i g a t o r . C o n s t r a i n t s t o L e i s u r e J . N . seemed t o have p o o r i n s i g h t i n t o h i s own d a i l y n e e d s . He had r e f u s e d home-making s e r v i c e s , w h i c h were recommended by b o t h h i s s o c i a l w o r k e r and h i s w i f e , t h u s p l a c i n g i n c r e a s e d r e s p o n s i b i l i t i e s and demands upon h i s w i f e . J . N . u s e d a s c o o t e r t o move about t h e West End a r e a . J . N . had l i m i t e d f i n a n c i a l r e s o u r c e s and t h e r e was no i n d i c a t i o n t h a t he had any f r i e n d s . P e r c e p t i o n o f L e i s u r e I t was d i f f i c u l t t o a s c e r t a i n how J . N . p e r c e i v e d l e i s u r e as he seemed t o have some d i f f i c u l t y a r t i c u l a t i n g h i s r e s p o n s e s . H i s p a s t and more c u r r e n t l e i s u r e b e h a v i o u r s s u g g e s t e d he d i d e n j o y d o i n g s e v e r a l a c t i v i t i e s , b u t h i s l e v e l o f p a r t i c i p a t i o n appea red t o be d e c l i n i n g . J N d i d n o t , however , 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 r e v e a l h i s l e i s u r e p e r c e p t i o n s . 75 JR H e a l t h and P h y s i c a l Appearance J . R . was a 71 y e a r o l d woman, a d m i t t e d t o S t . P a u l ' s H o s p i t a l as t h e r e s u l t o f a f a l l and a f r a c t u r e d l e f t h i p . He r 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 l e f t t o t a l h i p r e p l a c e m e n t 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 , a c o n g e n i t a l d i s l o c a t e d l e f t h ip , - n a r c o l e p s y s i n c e c h i l d h o o d , and s e v e r e a r t h r i t i s o f the s p i n e w i t h s c o l i o s i s . She was a n e a t , p e t i t e , f r a i l woman. D u r i n g t h e i n v e s t i g a t o r ' s f i r s t v i s i t w i t h J . R . she was i n , b e d w i t h t h e c u r t a i n s f u l l y drawn a round he r b e d . There were a number o f n o v e l s and c r o s s w o r d p u z z l e books a t h e r b e d s i d e , a l o n g w i t h s e v e r a l "ge t w e l l " c a r d s and an ar rangement o f f l o w e r s . E a r l y B a c k g r o u n d and S o c i a l Suppor t J . R . was b o r n i n Moosejaw, S a s k a t c h e w a n . She was n e v e r 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 apa r tmen t c o m p l e x i n t h e K i t s i l a n o a r e a o f Vancouver f o r 10 y e a r s . He r s m a l l one bedroom apar tmen t was c o z y , d e c o r a t e d w i t h a number o f hand-made r u g s , macrame, and p a i n t i n g s . The re were a l s o many books and p u z z l e s i n t h e l i v i n g room a r e a where t h e o u t r e a c h s e s s i o n s t o o k p l a c e . J . R . s t a t e d t h a t she had one s i s t e r who l i v e d i n S e a t t l e , W a s h i n g t o n and a s i s t e r - i n - l a w who l i v e d i n V a n c o u v e r , B r i t i s h C o l u m b i a . Work and L e i s u r e H i s t o r y J . R . c o n t i n u e d t o v o l u n t e e r as t he s e c r e t a r y - t r e a s u r e r f o r h e r s e n i o r ' s c o m p l e x . There was no h i s t o r y o f any p a i d 76 employment d u r i n g h e r l i f e t i m e . Her l e i s u r e i n t e r e s t s i n c l u d e d : b i n g o , k n i t t i n g , v o l u n t e e r i n g , a t t e n d i n g c h u r c h , r e a d i n g , and g o i n g on s h o r t t r i p s w i t h h e r b r o t h e r , who i s now d e c e a s e d . She s t a t e d on s e v e r a l o c c a s i o n s , t h a t she now has t o o much t i m e on h e r hands . P a r t i c i p a t i o n i n T . R . O . P . JR appea red v e r y r e s e r v e d i n he r r e s p o n s e s and i n t e r a c t i o n s w i t h t h e 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 . She r e s p o n d e d o n l y b r i e f l y t o each q u e s t i o n d u r i n g t h e i n t e r v i e w , and r a r e l y made eye c o n t a c t w i t h t h e i n v e s t i g a t o r . She was somewhat r e l u c t a n t t o a c c e p t i n f o r m a t i o n . T h i s l e a d t o some degree o f d i s a p p o i n t m e n t f o r t h e i n v e s t i g a t o r who was i n t e r e s t e d i n p r o v i d i n g J . R . w i t h some communi ty r e c r e a t i o n i n f o r m a t i o n bu t found i t d i f f i c u l t t o " r e a c h " h e r . J . R . i n d i c a t e d t h r e e g o a l s w h i c h w e r e : t o o b t a i n a means o f t r a n s p o r t a t i o n , ge t i n f o r m a t i o n on p r o g r a m s , and i n i t i a t e a swimming program a p p l i c a t i o n . 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 , however she d i d n o t appea r i n t e r e s t e d i n p u r s u i n g swimming once h e r a p p l i c a t i o n was a p p r o v e d . C o n s t r a i n t s t o L e i s u r e J . R . 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 h e r a p a r t m e n t , and 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 f o r h e r t o g e t a r o u n d . She r e q u i r e d a v a r i e t y o f a s s i s t i v e r e a c h i n g d e v i c e s f o r c o m p l e t i n g d a i l y t a s k s s u c h as d r e s s i n g . 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 h e r 77 l i f e , h e r r e s p o n s e s somet imes s u g g e s t e d t h a t she has had a d i f f i c u l t l i f e w i t h v e r y few c l o s e f r i e n d s . She a l s o s t a t e d t h a t most o f t h e f r i e n d s she d i d have were no l o n g e r a l i v e and t h a t she now had t o o much t i m e on h e r hands . The re d i d n o t appea r t o be any f i n a n c i a l c o n c e r n s . P e r c e p t i o n o f L e i s u r e J . R . i n d i c a t e d she o f t e n g e t s b o r e d bu t " u s u a l l y f i n d s s o m e t h i n g t o d o " . D u r i n g t h e same i n t e r v i e w she s t a t e d she had " t o o much l e i s u r e and no t enough t o do i n i t " . Thus , t h e r e was some u n c e r t a i n t y towards h e r a b i l i t y t o u t i l i z e h e r " l e i s u r e t i m e " . C e r t a i n l y , she appea red t o equa te l e i s u r e w i t h t i m e and she a l s o saw l e i s u r e as s o m e t h i n g w h i c h c o u l d h e l p p e o p l e f o r g e t t h e i r t r o u b l e s . 78 PP H e a l t h and P h y s i c a l A p p e a r a n c e P . P . was a 73 y e a r o l d f e m a l e , a d m i t t e d t o S t . P a u l ' s H o s p i t a l , G e r i a t r i c A s s e s s m e n t and Trea tment U n i t , due t o a f a l l and d e p r e s s i o n . He r o t h e r m e d i c a l p r o b l e m s i n c l u d e d : a dependency upon s l e e p i n g p i l l s , o s t e o a r t h r i t i s o f h e r r i g h t h i p and r i g h t knee , a l e f t w r i s t i n j u r y , d e g e n e r a t i v e d i s k d i s e a s e , b r e a t h l e s s n e s s and c o u g h i n g when a n x i o u s , and a p r e v i o u s h i s t o r y o f a l c o h o l abuse . P . P . s t a t e d t h a t she was no t s a t i s f i e d w i t h h e r l i f e , and t h a t she was happy t o be h o s p i t a l i z e d . She was s m a l l i n s t a t u r e , n e a t l y d r e s s e d , and had a s t r o n g S c o t t i s h a c c e n t . She w a l k e d s l o w l y and l a b o r i o u s l y and she f r e q u e n t l y coughed when she was c o n v e r s i n g . E a r l y B a c k g r o u n d and S o c i a l S u p p o r t P . P . was b o r n i n G l a s g o w , S c o t l a n d and has l i v e d i n V a n c o u v e r f o r 3 7 y e a r s . She was d i v o r c e d and l i v e d a l o n e i n a West End a p a r t m e n t . She d i d n o t have any c h i l d r e n bu t she had two s i s t e r s , one l i v i n g i n V a n c o u v e r and t h e o t h e r i n Edmonton. Her apa r tmen t was p a r t i c u l a r l y b r i g h t i n a p p e a r a n c e . I t was a l s o t i d y , c l e a n , w e l l o r g a n i z e d and s p a c i o u s . Work and L e i s u r e H i s t o r y She s t a t e d she has n o t seen much o f t h e c i t y due t o h e r busy work s c h e d u l e p r i o r t o h e r r e t i r e m e n t as a s e c u r i t y o f f i c e r . She a l s o s t a t e d t h a t she had a v e r y d i f f i c u l t t i m e 7 9 c o p i n g w i t h h e r r e t i r e m e n t . P r e v i o u s l y , she r e g u l a r l y s o c i a l i z e d , c o o k e d , and a t t e n d e d shows w i t h two c l o s e f r i e n d s who have s i n c e moved away. She u s e d t o b a l l r o o m 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 o r g a n i z a t i o n ( P e o p l e w i t h A I D S ) . She a l s o e n j o y e d r e a d i n g , swimming, and w a l k i n g . 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 ' awareness g r o u p i n h e r n e i g h b o u r h o o d , on a w e e k l y b a s i s . She w a t c h e d t e l e v i s i o n , e n j o y e d t a l k i n g " l e t t i n g them (people ) know someone c a r e s " . I n v o l v e m e n t i n T . R . O . P . P . P . was e x t r e m e l y r e c e p t i v e t o c o n v e r s a t i o n w i t h t h e i n v e s t i g a t o r and she r e v e a l e d p e r s o n a l i n f o r m a t i o n abou t h e r s e l f . She l a c k e d s e l f - c o n f i d e n c e and f r e q u e n t l y w o r r i e d abou t n o t b e i n g a b l e t o c o n t r i b u t e t o T . R . O . P . She a l s o seemed v e r y c o n c e r n e d o v e r phone c a l l s she r e c e i v e d e a r l y i n t h e m o r n i n g bu t d i d no t answer . PP i n d i c a t e d she was a f r a i d o f b e i n g h u r t a g a i n , as she was e m o t i o n a l l y and p h y s i c a l l y abused as a c h i l d . She was a l s o f r u s t r a t e d as she c o u l d n o t f o r e s e e any f u t u r e improvements t o h e r h e a l t h . The i n v e s t i g a t o r b e l i e v e d t h a t t h i s was a r e a s o n a b l e s e l f - p r o g n o s i s due t o the m u l t i t u d e o f m e d i c a l c o n d i t i o n s she e x p e r i e n c e d . She was a n x i o u s a t t i m e s , b u t she had made some p r o g r e s s t owards he r l e i s u r e g o a l s . One o f t h e s e g o a l s was 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 , who had moved away. She a c c o m p l i s h e d t h i s by p u r c h a s i n g an e l e c t r i c t y p e w r i t e r a t t h e s u g g e s t i o n o f t he i n v e s t i g a t o r . She was q u i t e p r o u d o f h e r a c c o m p l i s h m e n t . Her o t h e r g o a l s were t o f i n d o u t what 80 p r o g r a m s w e r e a v a i l a b l e a n d t o p u r s u e v o l u n t e e r w o r k a g a i n . She d i d r e v i e w i n f o r m a t i o n o n a v a i l a b l e r e c r e a t i o n p r o g r a m s a n d v o l u n t e e r o p p o r t u n i t i e s , b u t f e l t h e r h e a l t h was n o t s u i t a b l e t o c u r r e n t l y p u r s u e t h e s e i n t e r e s t s a n y f u r t h e r . The i n v e s t i g a t o r f e l t t h i s was a r e a l i s t i c o u t l o o k . I n r e s p o n s e t o t h e i n v e s t i g a t o r ' s q u e s t i o n "What i s t h e o u t c o m e o f y o u r h o s p i t a l i z a t i o n ? " , PP r e s p o n d e d : " I t h i n k a n a w f u l l o t b e t t e r t h a n I h a d b e e n b e f o r e g o i n g i n t o t h e h o s p i t a l . . . I f e e l l i k e a d i f f e r e n t p e r s o n g e t t i n g b a c k t o what I u s e d t o b e . " She r e f e r r e d t o h e r s u c c e s s i n no l o n g e r b e i n g a d d i c t e d t o p r e s c r i p t i o n d r u g s . C o n s t r a i n t s t o L e i s u r e P.P.'s m a j o r c o n s t r a i n t s seemed t o be h e r d e c l i n i n g p h y s i c a l a b i l i t y a n d h e r s o c i a l i s o l a t i o n . She d i d n o t i n d i c a t e a n y f i n a n c i a l c o n s t r a i n t s t o l e i s u r e w h i c h was e v i d e n t i n h e r r e c e n t r a t h e r s p o n t a n e o u s p u r c h a s e o f t h e e l e c t r i c t y p e w r i t e r . P e r c e p t i o n o f L e i s u r e P.P. a p p e a r e d t o p e r c e i v e l e i s u r e t o be somewhat n e g a t i v e . She o b v i o u s l y e n j o y e d many r e c r e a t i o n a l a c t i v i t i e s a number o f y e a r s ago. She s t a t e d " I u s e d t o l o v e b a l l r o o m d a n c i n g . . . g o t o t h e Queen E l i z a b e t h T h e a t r e f o r d i f f e r e n t s h o w s . . . 1 c a n ' t w a l k t h e way I u s e d t o . . . 1 u s e d t o r e a d a l o t " , b u t s h e f e l t most o f h e r e n j o y m e n t i n l i f e came f r o m b e i n g a t w o r k . " I was a t my h a p p i e s t when I was w o r k i n g . " 81 RC There was l i m i t e d d a t a c o l l e c t e d on R . C . because he became was r e - a d m i t t e d t o h o s p i t a l f o r an e x t e n d e d amount o f t i m e and c o u l d no t c o m p l e t e the p rog ram. He d i d a t t e n d two i n p a t i e n t e d u c a t i o n s e s s i o n s . H e a l t h and P h y s i c a l Appearance R . C . was a 75 y e a r o l d widowed m a l e . He was a d m i t t e d t o h o s p i t a l f o r . h i p r e p l a c e m e n t s u r g e r y and l a t e r r e - a d m i t t e d 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 he f e l l i n h i s bedroom. D u r i n g h i s i n i t i a l h o s p i t a l s t a y he was i n a f o u r p e r s o n room on t h e R e h a b i l i t a t i o n U n i t . He had a 15 y e a r h i s t o r y o f back p a i n r e s u l t i n g i n d e c r e a s e d m o b i l i t y and dependency on an e l e c t r i c s c o o t e r . R . C . was a t a l l and o v e r w e i g h t g e n t l e m a n . He f r e q u e n t l y s m i l e d and h i s appea rance g e n e r a t e d a sense o f warmth . He wore g l a s s e s and u s u a l l y c o u l d be found r e a d i n g i n t h e d i n i n g room on t h e h o s p i t a l u n i t o r i n h i s b e d . Due t o a r e - a d m i s s i o n t o S t . P a u l ' s H o s p i t a l as t h e r e s u l t o f a f a l l , t h e i n v e s t i g a t o r w i t h d r e w h im f rom t h e 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 l e a s t a n o t h e r t h r e e mon ths . E a r l y B a c k g r o u n d and S o c i a l Suppor t He had l i v e d a t h i s p r e s e n t Richmond apa r tmen t f o r s i x y e a r s . 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 e x c e p t i o n o f one n i e c e , who l i v e d i n t h e Vancouve r a r e a , t h e r e was no 82 o t h e r m e n t i o n o r d o c u m e n t a t i o n o f r e l a t i v e s . R . G . i n d i c a t e d he had s e v e r a l c l o s e f r i e n d s i n the Richmond a r e a . The w a l l b e h i n d t h e head o f h i s bed had s e v e r a l c a r d s f rom f r i e n d s and t h e r e were numerous f l o w e r a r rangements a t h i s b e d s i d e . Work and 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 worked a t p r i o r t o r e t i r e m e n t . H i s p r e v i o u s l y a c t i v e l i f e s t y l e i n c l u d e d s a i l i n g , swimming , f i s h i n g , h i k i n g , h u n t i n g and r e a d i n g . He u s e d t o a t t e n d c h u r c h on a r e g u l a r b a s i s bu t has n o t been t h e r e r e c e n t l y . He s t a t e d he was u n c e r t a i n as t o what r e c r e a t i o n p rograms were a v a i l a b l e f o r h im , a l t h o u g h he was aware o f many o f t h e n e a r b y f a c i l i t i e s . R . C . a p p e a r e d t o have a c c e p t e d h i s l e v e l o f d i s a b i l i t y , and he was s e e k i n g some d i r e c t i o n f o r t h e f u t u r e l e i s u r e - r e l a t e d r e s o u r c e s and p r o g r a m s , p r i o r t o b e i n g d i s c h a r g e d from the s t u d y . 83 MP There was a l s o l i m i t e d d a t a c o l l e c t e d on t h i s p a r t i c i p a n t due t o r e - a d m i s s i o n t o t h e h o s p i t a l . H e a l t h and P h y s i c a l A p p e a r a n c e M . P . was a 77 y e a r o l d widowed f e m a l e , a d m i t t e d t o h o s p i t a l due t o a f r a c t u r e o f h e r r i g h t femur . She was a d m i t t e d t o t h e i n t e n s i v e c a r e u n i t i n s e r i o u s c o n d i t i o n and l a t e r t r a n s f e r r e d t o t h e R e h a b i l i t a t i o n U n i t i n t o a s e m i - p r i v a t e room. Her o t h e r m e d i c a l h i s t o r y i n c l u d e d c a n c e r o f t h e c e r v i x , a r t h r i t i s i n h e r hands , and a l e f t b e l o w t h e knee a m p u t a t i o n . M . P . 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 . She moved about t he h o s p i t a l u n i t s l o w l y i n h e r w h e e l c h a i r and h e r f ace p r e s e n t e d t h e l o o k o f someone who was a l w a y s i n deep t h o u g h t . S h o r t l y a f t e r h e r d i s c h a r g e from S t . P a u l ' s H o s p i t a l , she d e v e l o p e d a s o r e on h e r r i g h t f o o t and was a d m i t t e d t o M t . S t . J o s e p h ' s H o s p i t a l . She was l a t e r a d m i t t e d t o a l o n g - t e r m c a r e f a c i l i t y and became i n e l i g i b l e t o c o n t i n u e p a r t i c i p a t i n g i n t h i s s t u d y . E a r l y B a c k g r o u n d and S o c i a l S u p p o r t M . P . was a widow who l i v e d a l o n e i n h e r E a s t V a n c o u v e r house . She had two c h i l d r e n and a s i s t e r . None o f t h e s e r e l a t i v e s l i v e d n e a r b y and she d i d no t appear t o be i n c l o s e c o n t a c t w i t h them. The i n v e s t i g a t o r d i d o b s e r v e a number o f "get w e l l " c a r d s and f l o w e r s a t h e r b e d s i d e i n t h e h o s p i t a l . 84 These were from her c h i l d r e n , grandchildren, and a next 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 outreach s e s s i o n p r i o r t o her re-admission to h o s p i t a l . During t h i s v i s i t , which took place 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 her obvious 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 t o move around the k i t c h e n and from one room to the next. She s t a t e d she now spent most of her time i n the k i t c h e n reading 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 strength to move about too much. She appeared to enjoy the s o c i a l nature of the f i r s t home v i s i t . She was unable to be contacted to schedule the second v i s i t due to her re-admission to h o s p i t a l . Work and Leisure 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 while at St. Paul's H o s p i t a l . These inclu d e d : bingo, pet v i s i t s , and attending l i v e entertainment programs. P r e v i o u s l y she enjoyed watching sports, reading, shopping, sewing, and used to go swimming. She a l s o enjoyed watching her husband gardening and the company of her 12 year o l d dog which had d i e d two years e a r l i e r . C o n s t r a i n t s to L e i s u r e M.P. was using a walker to m o b i l i z e i n s i d e her house, a f t e r being discharged from St. Paul's. She used a manual wheelchair when she l e f t her house. M.P. had no apparent 8 5 f i n a n c i a l c o n c e r n s . M . P . had l i t t l e knowledge o f a c c e s s i b l e f a c i l i t i e s s u c h as b i n g o h a l l s o r s p o r t s a r e n a s . T h i s was t o be one f o c u s a r e a o f T . R . O . P . R e s e a r c h Q u e s t i o n s One, Two, and Three The k e y p h r a s e s from p a r t i c i p a n t s ' r e s p o n s e s w h i c h were 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 t h r o u g h t h r e e a r e summar ized and p r e s e n t e d i n T a b l e s 1 and 2 . These s p e c i f i c r e s e a r c h q u e s t i o n s were : 1. How d i d o l d e r a d u l t s d e s c r i b e t h e b e n e f i t s o f l e i s u r e ? 2 . How d i d o l d e r a d u l t s f e e l t h a t t h e y b e n e f i t t e d / d i d n o t b e n e f i t f rom T . R . O . P . ? 3 . What were t h e s e l f - p e r c e i v e d f a c i l i t a t i n g f a c t o r s w h i c h c o n t r i b u t e d towards enjoyment o f l e i s u r e ? B e n e f i t s o f L e i s u r e The most common r e s p o n s e 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 t i m e t o t h i n k o r t o c o l l e c t t h e i r t h o u g h t s . T . R . O . P . gave p a r t i c i p a n t s a d d i t i o n a l o p p o r t u n i t i e s t o r e f l e c t upon t h e i r l i v e s 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 was r e l a t e d t o t h e e l emen t o f " f r eedom" . These b e n e f i t s , as d e s c r i b e d by t h e p a r t i c i p a n t s , a re c o n s i s t e n t w i t h t h e e l e m e n t s o f en joymen 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 a r e r e p o r t e d i n t h e l i t e r a t u r e (Lee e t a l . , 1994) and i n t h e d e f i n i t i o n o f l e i s u r e s e l e c t e d by the r e s e a r c h e r ( D a t i l l o & 86 Murphy, 1991) . TABLE 1: Key phrases 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 three P a r t i c i p a n t s Question TG FB VB Topic B e n e f i t s of -provides -enj oyment -you can Le i s u r e time to -made me r e l a x and thi n k r e a l i z e i t c o l l e c t -allows you might be your freedom to b e t t e r t o be thoughts t h i n k a l i v e c l e a r l y -keeps me i n t e r e s t e d i n l i f e , and the world B e n e f i t s of - i n s i g h t i n t o -enj oyed -enjoyed T.R.O.P. what i s being the a v a i l a b l e i n v o l v e d a c t i v i t i e s - s p e c i f i c -became resources i n t e r e s t e d f o r the i n c e r t a i n d i s a b l e d things -got me t h i n k i n g F a c i l i t a t i n g -aunt's -being w i t h -being Factors help my c h i l d r e n around -being at home -doing people -being able to p h y s i c a l - h e l p i n g d r i v e a c t i v i t i e s others - t h i n k i n g openly -enjoying people's company -not l i v i n g a hermit's l i f e 8 7 TABLE 2: Key p h r a s e s f rom 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 ( c o n t i n u e d ) P a r t i c i p a n t s Q u e s t i o n T o p i c JN JR PP B e n e f i t s o f L e i s u r e - t i m e t o t h i n k - g i v e s y o u a chance t o do what y o u want - f o r g e t y o u r t r o u b l e s - g i v e s y o u a s o c i a l a s p e c t - s e n s e o f s a t i s f a c t i o n B e n e f i t s o f T . R . O . P . - f o u n d a ches s p a r t n e r - l e a r n e d from t h e w o r k s h e e t s -made me i n t e r e s t e d i n c e r t a i n t h i n g s -made me more aware - g e t t i n g and h a v i n g i n f o r m a t i o n e x p l a i n e d - b r i g h t e n e d t h e h o r i z o n - n i c e h a v i n g a v i s i t o r F a c i l i t a t i n g F a c t o r s - b e i n g a b l e t o g e t a r o u n d - b e i n g a b l e t o w a t c h s p o r t s - a r g u i n g w i t h " the o l d l a d y " - b e i n g w i t h my r e l a t i v e s and f r i e n d s - w o r k i n g - b e i n g p h y s i c a l l y a c t i v e ( b a l l r o o m d a n c i n g ) P P ' s r e s p o n s e t o t h i s q u e s t i o n seemed i n c o n s i s t e n t w i t h p r e v i o u s d i s c u s s i o n s she had w i t h the i n v e s t i g a t o r . She r e f e r r e d t o o b t a i n i n g a "sense o f s a t i s f a c t i o n " as a b e n e f i t o f l e i s u r e . D u r i n g T . R . O . P . i n p a t i e n t and o u t r e a c h v i s i t s she m e n t i o n e d t h a t she e n j o y e d h e r s e l f most when she was a t w o r k . Now due t o h e r h e a l t h , she f e l t f r u s t r a t e d w i t h h e r r e c e n t 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 an example o f t h e i n c r e a s e d t r u s t t he p a r t i c i p a n t p l a c e d i n t h e 88 s o f i n v o l v e m e n t i n T . R . O . P . g P ^3 1 and 2, a l l t he p a r t i c i p a n t s c b e n e f i t o f t he T . R . O . P . p r o g r a m a t e d m u l t i p l e b e n e f i t s . These rom b r i e f comments t o more ^-^.-j.—-^erie'iTtrs-c7f T . R . O . P . , as d e s c r i b e d by- p a r t i c i p a n t s i n c l u d e d : " h a v i n g a v i s i t o r " o r i n c r e a s e d s o c i a l c o n t a c t , g a i n i n g i n s i g h t i n t o community r e c r e a t i o n o p p o r t u n i t i e s , h a v i n g an i n d i v i d u a l t o d i r e c t q u e s t i o n s t owards and answer q u e s t i o n s , l e a d i n g t o an i n t e r e s t i n p u r s u i n g c e r t a i n t h i n g s . 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 o f t he b e n e f i t s o f 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 he h o r i z o n . Because I ' m p r e t t y w e l l on 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 k i n d o f n i c e h a v i n g 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 . was a b l e t o p r o v i d e f o r a v a r i e t y o f p a r t i c i p a n t s ' s e l f - p e r c e i v e d needs and t h a t o u t r e a c h l e i s u r e e d u c a t i o n can a s s i s t o l d e r a d u l t s l i v i n g i n t h e communi ty . The l i t e r a t u r e on o t h e r a d u l t p o p u l a t i o n s has r e a c h e d a s i m i l a r c o n c l u s i o n ( C l a r k & C u r r a n , 1994; Lyons e t a l . , 1 9 9 3 ) . The i n v e s t i g a t o r d i d have some i n i t i a l c o n c e r n s 89 r e g a r d i n g t h e s p e c i f i c i n t e r v i e w q u e s t i o n "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 any way?" There was some f e a r , t h a t t h e p a r t i c i p a n t s 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 r e s p o n s e . I t i s d i f f i c u l t t o a s c e r t a i n whe the r s u c h a " h a l o " e f f e c t o c c u r r e d o r n o t . The i n v e s t i g a t o r c o u l d have assumed t h e p a r t i c i p a n t s ' r e s p o n s e s were more a u t h e n t i c i f some had s a i d "no" o r "not much" . F a c i l i t a t i n g - F a c t o r s What d i d p a r t i c i p a n t s p e r c e i v e as c o n t r i b u t i n g t o w a r d s t h e i r l e i s u r e en joyment? There was a s t r o n g emphas i s on t h e i m p o r t a n c e o f s o c i a l s u p p o r t as a f a c i l i t a t i n g f a c t o r . F i v e o f t h e s i x p a r t i c i p a n t s i n d i c a t e d t h e i r c h i l d r e n , s p o u s e , o r f r i e n d s were s o u r c e s f o r s o c i a l c o n t a c t and s u p p o r t and c o n t r i b u t e d t o t h e i r l e i s u r e en joyment . O n l y one p a r t i c i p a n t (PP) 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 n e a r b y , 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 the company o f h e r two f r i e n d s who r e c e n t l y moved away. T h i s f i n d i n g c o n t r a s t s t h e r e s e a r c h o f Ross (1991b.) who s t a t e d t h a t t h e r e has been a d e c l i n e i n t h e f a m i l i e s ' a b i l i t y t o s u p p o r t t h e i r " e l d e r l y " 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 g e o g r a p h i c d i s t a n c e and t h e 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 h o u s e h o l d s . I t w o u i d seem t h a t t h e m a j o r i t y o f t he p a r t i c i p a n t s s t i l l " f e l t " t h e i r r e l a t i v e s were s o c i a l s u p p o r t s , a l t h o u g h t h e s e r e l a t i v e s d i d no 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 same communi ty . The two younges t p a r t i c i p a n t s FB and TG were v e r y 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 i n d i c a t e d t h e y were i n v o l v e d i n s o c i a l g roups w i t h i n t h e i r communi ty . A l l s i x o f t h e p a r t i c i p a n t s e x p r e s s e d a d e s i r e f o r i n c r e a s e d s o c i a l c o n t a c t . T h i s need f o r i n c r e a s e d s o c i a l r e l a t i o n s i s c o n s i s t e n t w i t h t h e f i n d i n g s o f o t h e r r e s e a r c h e r s ( F r e i d l a n d & M c C o l l , 1992 ; R u b i n s t e i n , Lubben & M i n t z e r , 1994) and s u g g e s t s t h a t t h e i r f a m i l y s u p p o r t was i n a d e q u a t e . 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 by a number o f p a r t i c i p a n t s due i n p a r t , t o t h e i n c r e a s e d o p p o r t u n i t i e s f o r s o c i a l i z i n g . F o r example VB s t a t e d she was n o t happy b e i n g a l o n e a l l t he t i m e a t h e r home, " I was v e r y l o n e l y , I c r i e d a l o t . " C l o s e r e l a t i v e s a l s o d e s c r i b e d h e r as " s o c i a l l y i s o l a t e d " p r i o r t o he r h o s p i t a l i z a t i o n . However , 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 as "more p o s i t i v e , h a p p i e r , i n a b e t t e r mood" when she was h o s p i t a l i z e d . VB a l s o became h i g h l y a n x i o u s as she a p p r o a c h e d h e r d i s c h a r g e d a t e , s t a t i n g she was n o t c e r t a i n how she w o u l d manage when she r e t u r n e d t o h e r home a l o n e . She a l s o s a i d t h a t she w o u l d m i s s eve ryone she met i n t h e h o s p i t a l . I t seems a p p r o p r i a t e t o s t a t e t h a t t h e e n v i r o n m e n t w i t h i n S t . P a u l ' s H o s p i t a l p r o v i d e d t e m p o r a r y o p p o r t u n i t i e s f o r p a t i e n t s t o form s h o r t - t e r m " f r i e n d s h i p s " . I n t h e two s p e c i f i c h o s p i t a l u n i t s , where a l l the p a r t i c i p a n t s were p a t i e 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 and n o n - s t r u c t u r e d o p p o r t u n i t i e s t o engage i n some fo rm o f 91 s o c i a l i z a t i o n . P r i o r t o t h e i r a d m i s s i o n t o S t . P a u l ' s H o s p i t a l , many o f t h e p a r t i c i p a n t s l a c k e d s u c h a v a r i e t y o f o p p o r t u n i t i e s . A f t e r d i s c h a r g e from the h o s p i t a l o t h e r p a r t i c i p a n t s m e n t i o n e d t h e y were "happy i n t h e c o m f o r t o f t h e h o s p i t a l w i t h company" (FB) and t h a t t h e y f e l t t h e l o s s o f s o c i a l o p p o r t u n i t i e s . The e f f e c t s o f s h o r t - t e r m i n c r e a s e d s o c i a l o u t l e t s , s u c h as t h o s e p r o v i d e d i n the h o s p i t a l e n v i r o n m e n t , needs f u r t h e r i n v e s t i g a t i o n . The r e s e a r c h e r a l s o had some i n f l u e n c e o v e r t h e one p a r t i c i p a n t ' s s o c i a l i s o l a t i o n i n the community and may have been a " t e m p o r a r y " f a c i l i t a t o r towards en joymen t . F o r e x a m p l e , P . P . s t a t e d : L e t me p u t i t t h i s way P a u l , I n e v e r ge t any v i s i t o r s . I mean I d o n ' t see anybody e l s e . I t ' s k i n d o f n i c e t o have 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 found i t s u r p r i s i n g , t h a t t h e o n l y p a r t i c i p a n t (JN) . who l i v e d w i t h h i s spouse , a l s o i n d i c a t e d a need f o r e x t e r n a l 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 by h i s w i f e who r e q u e s t e d t h e same. I t t h i s s p e c i f i c c a s e i t w o u l d appea r a t t i m e s t h a t " s o c i a l r e l a t i o n s " were n o t n e c e s s a r i l y " b e n e f i c i a l o r s u p p o r t i v e " . I ndeed , Coleman (1993) has s t a t e d t h e y c o u l d be d e t r i m e n t a l i n some c a s e s . The c a s e o f JN,may w e l l r e p r e s e n t such a r e l a t i o n s h i p . 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 A summary o f t h e p a r t i c i p a n t s i n t e r e s t s i s p r e s e n t e d i n T a b l e 3 . These i n t e r e s t s were g rouped i n t o s e v e n c a t e g o r i e s 92 c o m p r i s e d o f s i x l e i s u r e e x p e r i e n c e domains and one a d d i t i o n a l c a t e g o r y , l a b e l l e d as " o t h e r " ( B a l l a n t y n e , 1987; BC R e h a b i l i t a t i o n S o c i e t y , 1 9 8 9 ) . The domains were h e l p f u l i n c a t e g o r i z i n g t h e v a r i o u s a r e a s o f i n t e r e s t . They were d e s i g n e d t o d e t e r m i n e t h e s p e c i f i c i n t e r e s t s o f t h e p a r t i c i p a n t s . The " o t h e r " c a t e g o r y was formed f rom r e s p o n s e s t h e p a r t i c i p a n t s p r o v i d e d i n a d d i t i o n t o t h e f o r c e d - c h o i c e i t e m s on the l e i s u r e i n t e r e s t w o r k s h e e t . The l e i s u r e i n t e r e s t s t a b l e c o n s i s t e d o f r e s p o n s e s t h e p a r t i c i p a n t s p r o v i d e d p r i m a r i l y t h r o u g h t h e i r c o m p l e t i o n o f t h e l e i s u r e i n t e r e s t w o r k s h e e t , and any o t h e r r e s p o n s e s w h i c h 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 t h r o u g h o u t t h e d u r a t i o n o f t he s t u d y . VB i d e n t i f i e d the most (22) l e i s u r e i n t e r e s t s . She was the o n l y p a r t i c i p a n t t o i n d i c a t e a l l t h e c h o i c e s i n b o t h the " s o c i a l " and " s o l i t a r y " c a t e g o r i e s . T h i s s u g g e s t s she en joys a v a r i e t y o f s o c i a l i n t e r e s t s b u t she a l s o a p p r e c i a t e s t h e o p p o r t u n i t y " t o r e l a x and c o l l e c t h e r t h o u g h t s " t h r o u g h t h e s e more s o l i t a r y i n t e r e s t s . The l o w e s t f r e q u e n c y o f t o t a l e x p r e s s e d i n t e r e s t s was i n d i c a t e d by J N . He s e l e c t e d o n l y s e v e n i n t e r e s t s and d i d n o t i n d i c a t e any i n t h e s o c i a l doma in . T h i s l a c k o f s o c i a l i n t e r e s t s and the i n v e s t i g a t o r ' s knowledge o f h i s l i v i n g s i t u a t i o n , s u g g e s t s t h a t JN p r o b a b l y r e l i e s h e a v i l y on h i s w i f e f o r s o c i a l s u p p o r t i n a d d i t i o n t o o t h e r a s s i s t a n c e he r e q u i r e s f rom h e r f o r h i s d a i l y c a r e . T h i s may a c c o u n t f o r some o f the m e d i c a l r e c o r d e n t r i e s w h i c h s u g g e s t e d JN was 93 u n w i l l i n g t o a c c e p t h e l p from a home-making s e r v i c e and r e l i e d on h i s w i f e f o r most f i n a n c i a l and c a r e - g i v i n g m a t t e r s . 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 PP d i d n o t i n d i c a t e any i n t e r e s t s i n the s o c i a l and c r e a t i v e d o m a i n s . T h i s f i n d i n g was i n c o n s i s t e n t w i t h d a t a o b t a i n e d d u r i n g t h e 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 . D u r i n g s e v e r a l o u t r e a c h s e s s i o n s PP s t a t e d she l i k e d t o w r i t e l e t t e r s , cook f o r o t h e r s , and t h a t she b e l o n g e d t o a l o c a l s e n i o r s ' c e n t r e . These i n t e r e s t s were l i s t e d as c h o i c e s on t h e w o r k s h e e t , however PP d i d no t s e l e c t them. B a l l a n t y n e (1987) s t a t e d t h a t i t was i m p o r t a n t f o r i n d i v i d u a l s t o m a i n t a i n a sense o f b a l a n c e w i t h i n t h e i r l e i s u r e . 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 i n a v a r i e t y o f i n t e r e s t s f rom each o f t he domains . V i e w i n g t h e r e s u l t s o f t h e 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 s , r e v e a l e d t h a t t h e r e were s e v e r a l p a r t i c i p a n t s i n a d d i t i o n t o PP, who d i d n o t i n d i c a t e i n t e r e s t s i n a t l e a s t one o f t he doma ins . FB d i d no t i n d i c a t e any i n t e l l e c t u a l i n t e r e s t s . J N d i d n o t i n d i c a t e any s o c i a l i n t e r e s t s a l t h o u g h he wanted t o f i n d a chess p a r t n e r and he r e c e n t l y had been t o a community c e n t r e w i t h h i s w i f e . JR d i d n o t i n d i c a t e any p h y s i c a l o r i n t e l l e c t u a l i n t e r e s t s , a l t h o u g h she l a t e r e x p r e s s e d a c u r i o s i t y about swimming. The d i s c r e p a n c i e s i n P P ' s , J N ' s , and 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 t h e i r i n c r e a s e d u n d e r s t a n d i n g o f what was b e i n g a s k e d o f them as 9 4 t h e p r o g r a m p r o g r e s s e d . 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 was a d m i n i s t e r e d i n t h e v e r y e a r l y s t a g e s o f t h e p r o g r a m , w h i l e 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 . As t h e p rogram 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 l e i s u r e i s s u e s . The re may have been an i n c r e a s e d u n d e r s t a n d i n g and awareness on t h e p a r t i c i p a n t s ' p a r t . T h i s s u g g e s t s t h a t u t i l i z i n g 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 t h e i n p a t i e n t and 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 and a c c u r a t e r e s u l t s . 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 P a r t i c i p a n t s Domains/Leisure Interests TG FB VB JN JR PP RC MP Social w r i t i n g l e t t e r s X X X 3 s o c i a l t e l e p h o n e c a l l s X X X 3 v i s i t i n g f r i e n d s / f a m i l y X X X X 4 j o i n i n g a g r o u p / c l u b X X X X 4 c a r i n g f o r p e t / a n i m a l X X X 3 TOTAL 4 3 5 0 1 0 1 3 17 Physical e x e r c i s e class/swimming X X X 3 go i n g f o r walks X X X X 4 ga r d e n i n g X X 2 p r a c t i s i n g r e l a x a t i o n X X 2 TOTAL 2 3 3 1 0 2 0 0 11 S o l i t a r y r e a d i n g X X X X X 5 l i s t e n i n g t o music X X X X 4 humming o r w h i s t l i n g X 1 b e i n g outdoors X X X X X X 6 daydreaming X X 2 TOTAL 3. 1 5 1 2 4 2 0 18 Creative mechanics X 1 c r a f t s X X X 3 p a i n t i n g / d o o d l i n g X X X 3 woodworking X X 2 c o o k i n g o r e a t i n g X X X 3 composing X X X 3 p l a n n i n g p a r t i e s X 1 TOTAL 2 4 3 1 3 0 1 2 16 I n t e l l e c t u a l v i s i t i n g l i b r a r y / g a l l e r y X 1 c u r r e n t events X X X X 4 d i s c u s s i o n s X 1 h o b b i e s / c o l l e c t i n g X X X 3 v o l u n t e e r i n g X X 2 TOTAL 3 0 3 2 0 1 1 1 11 Spectator w a t c h i n g TV o r movies X X X X X X X 7 b i r d w a t c h i n g X X 2 people w a t c h i n g x • X X X 4 c o n c e r t s / t h e a t r e X X X X X 5 . a t t e n d i n g l i v e s p o r t s X X X X X 5 TOTAL 4 1 3 1 3 4 3 3 22 Others Chess X 1 E n t e r i n g c o n t e s t s X 1 C r o s s w o r d s / p u z z l e s X 1 S i n g i n g X 1 T r a v e l l i n g X 1 Bingo X 1 K n i t t i n g X 1 B a k i n g X 1 S k a t i n g X 1 B o w l i n g X 1 TOTAL 2 1 0 1 2 4 0 0 10 GRAND TOTAL 20 13 22 7 11 15 8 9 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 C o n s t r a i n t s The f o l l o w i n g t a b l e (Tab le 4) p r e s e n t s t h e p a r t i c i p a n t s r e s p o n s e s t o t h e L e i s u r e C h a l l e n g e s w o r k s h e e t . The t o p i c o f " l e i s u r e c o n s t r a i n t s " has p r e v i o u s l y appea red i n t h e l i t e r a t u r e u n d e r t h e h e a d i n g s o f l e i s u r e b a r r i e r s and l e i s u r e c h a l l e n g e s ( B a l l a n t y n e , 1987; W i t t & E l l i s , 1989) . O n l y t h e p a r t i c i p a n t s s e l f - p e r c e i v e d c o n s t r a i n t s appea r i n t h i s t a b l e . A d d i t i o n a l c o n s t r a i n t s t o l e i s u r e , as p e r c e i v e d by t h e i n v e s t i g a t o r o r o t h e r s t a f f f a m i l i a r w i t h t h e p a r t i c i p a n t s a r e p r e s e n t e d i n the p a r t i c i p a n t s ' p r o f i l e s . 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 v a r i e d f rom a l o w o f two c o n s t r a i n t s (TG, RC) t o a h i g h o f 10 c o n s t r a i n t s ( V B ) . The two p a r t i c i p a n t s who were d i a g n o s e d w i t h d e p r e s s i o n (PP, VB) i n d i c a t e d t h e g r e a t e s t number o f p e r c e i v e d c o n s t r a i n t s . T h i s f i n d i n g p r o v i d e s s u p p o r t f o r t h e r o l e w h i c h p e r c e i v e d f reedom 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 . 353) s t a t e d , i n d i v i d u a l s who p e r c e i v e t h e m s e l v e s t o be c o n s t r a i n e d " w i l l f a i l t o e x e r c i s e s e l f - d e t e r m i n a t i o n " . F u r t h e r m o r e , p e r s o n s who have a s ense o f s e l f - d e t e r m i n a t i o n 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 an i n t e r n a l l o c u s o f c o n t r o l c an " b u f f e r " t h e i r h e a l t h a g a i n s t l i f e s t r e s s . I n the c a s e s o f PP and VB d e p r e s s i o n may have been a t l e a s t p a r t i a l l y r e l a t e d t o t h e i r p e r c e p t i o n o f a l a c k o f s e l f - d e t e r m i n a t i o n o r a l a c k o f p e r c e i v e d c o n t r o l . S i x ou t o f t h e e i g h t p a r t i c i p a n t s i n d i c a t e d f i v e o r l e s s c o n s t r a i n t s . These f r e q u e n c i e s may no t r e f l e c t t h e p o t e n t i a l i m p a c t t h e s e c o n s t r a i n t s had on the p a r t i c i p a n t s ' l e i s u r e e x p e r i e n c e s . 97 The most f r e q u e n t l y i n d i c a t e d p e r c e i v e d c o n s t r a i n t s a f f e c t e d f o u r ou t o f t h e e i g h t p a r t i c i p a n t s . These c o n s t r a i n t s w e r e : n o t h a v i n g t h e p h y s i c a l s k i l l s , n o t knowing what p rograms o r f a c i l i t i e s were a v a i l a b l e , p r o c r a s t i n a t i n g o r f i n d i n g i t d i f f i c u l t t o s t a r t p a r t i c i p a t i n g , and h a v i n g no one t o go w i t h . The l a c k o f knowledge c o n s t r a i n t has been f r e q u e n t l y r e p o r t e d i n t h e l i t e r a t u r e ( O ' N e i l l & R e i d , 1991 ; S e a r l e & Mahon, 1 9 9 3 ) . Two p a r t i c i p a n t s m e n t i o n e d t h e y " d i d no t have enough money t o do want t h e y w a n t e d " . The a n a l y s i s c o n d u c t e d by F o r b e s , Hayward and Agwani (1991) found " l o w income" t o be o f g r e a t e r i m p a c t on s e l f - r e p o r t e d i m p a i r m e n t s o f o l d e r a d u l t s . T h i s d i d n o t appear t o be the ca se i n t h e m a j o r i t y o f p a r t i c i p a n t s i n t h i s s t u d y . 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 a d d i t i o n a l f i n a n c e s and s e v e r a l o f t he p a r t i c i p a n t s who d i d have more " c o s t l y " g o a l s appea red t o have the a v a i l a b l e f i n a n c e s t o p u r s u e t h e s e g o a l s (TG, P P ) . 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 c o n s t r a i n t s were no t s e l e c t e d by any o f t he p a r t i c i p a n t s : " t o o many f a m i l y o b l i g a t i o n s " , "work i s t he main p r i o r i t y now", and "I d o n ' t have enough t i m e " . These c o u l d a l l be c a t e g o r i z e d as c o n s t r a i n t s r e l a t e d t o o t h e r o b l i g a t i o n s o r " l a c k o f t i m e " and sugges t t h a t p a r t i c i p a n t s were no 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 was 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 he p a r t i c i p a n t s were r e t i r e d and appea red t o have few o b l i g a t i o n s r e l a t e d t o t h e i r t i m e . 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 t o l e i s u r e 98 p a r t i c i p a t i o n and a i m i n g t owards o v e r c o m i n g t h e s e c o n s t r a i n t s s h o u l d be e m p h a s i z e d . However , t h e r e i s a need 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 d e c l i n i n g o r u n s t a b l e i n d i v i d u a l . P r o v i d i n g a form o f c o n t i n u e d f o l l o w - u p , s u c h as T . R . O . P . , a s s i s t e d p a r t i c i p a n t s i n t h e i r c l a r i f i c a t i o n o f l e i s u r e c o n s t r a i n t s and may l e a d t o i n c r e a s e f u t u r e s u c c e s s e s r e l a t e d t o t h e i r l e i s u r e e x p e r i e n c e s . " S t a y i n g c u r r e n t and a d d r e s s i n g p r o b l e m s o r b a r r i e r s 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 r a t e s o f o t h e r 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 due t o d i s a b i l i t y ( C l a r k and C u r r a n , 1994, p . 3 1 ) . 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 C o n s t r a i n t s P a r t i c i p a n t s C o n s t r a i n t s T G F B V B J N J R P P R C M P = I don't f e e l l i k e d o i n g a n y t h i n g X X 2 I r e l y on o t h e r s f o r t r a n s p o r t X X X 3 I overcommit myself X X X 3 I don't have enough money X X 2 I don't have the p h y s i c a l s k i l l s X X X X 4 I don't have the a r t i s t i c s k i l l s X X X 3 I am embarrassed about l e a r n i n g something new X 1 I don't know what programs o r f a c i l i t i e s are a v a i l a b l e X X X X 4 I p r o c r a s t i n a t e X X X X 4 s o c i a l s i t u a t i o n s are awkward X X X 3 I have no one t o go w i t h X X X X 4 making d e c i s i o n s i s d i f f i c u l t X X X 3 o t h e r s . . . - no b a t h i n g s u i t X 1 - no chess p a r t n e r X 1 - I don't t h i n k l e i s u r e i s i m p o r t a n t X 1 Total Indicated Challenges: 2 3 10 4 5 9 2 4 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 T h i s r e s e a r c h q u e s t i o n was a s k e d i n the c o n c l u d i n g i n t e r v i e w t o e s t a b l i s h t h e p a r t i c i p a n t s ' p e r c e p t i o n s o f t h e r e l a t i o n s h i p be tween l e i s u r e s a t i s f a c t i o n and l i f e s a t i s f a c t i o n . I t became appa ren t t h a t s e v e r a l p a r t i c i p a n t s 1 0 0 had d i f f i c u l t y u n d e r s t a n d i n g t h e i n t e r v i e w q u e s t i o n s . T h i s was n o t a p p a r e n t i n t h e p i l o t s t u d y as b o t h o f t h e p i l o t 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 h e s i t a t i o n . B o t h PP and FB r e q u i r e d t h i s i n t e r v i e w q u e s t i o n t o be r e w o r d e d b e f o r e t h e y r e s p o n d e d . The r e w o r d e d q u e s t i o n s i n c l u d e d s p e c i f i c examples o f t h e p a r t i c i p a n t s ' l e i s u r e i n t e r e s t s 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 l e i s u r e . The p a r t i c i p a n t s ' r e s p o n s e s d i d no t p r o v i d e a d e f i n i t i v e answer t o t h e i n t e r v i e w q u e s t i o n s , bu t t h e y s u g g e s t e d p o s i t i v e r e l a t i o n s h i p s be tween l e i s u r e s a t i s f a c t i o n and l i f e s a t i s f a c t i o n . F o r example , FB s t a t e d : I r e a l l y d o n ' t t h i n k s o . 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 ge 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 s t a t e d : g o i n g t o the 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 coming ou 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 igh 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 s t r o k e c l u b p r o v i d e d s o c i a l c o n t a c t s w i t h h i s p e e r s who had a l s o e x p e r i e n c e d a s t r o k e . A d d i t i o n a l s t a t e m e n t s f rom t h e s e two p a r t i c i p a n t s (PP, FB) were o b t a i n e d f rom o t h e r i n t e r v i e w q u e s t i o n s and t h e i n v e s t i g a t o r ' s f i e l d n o t e s . These s t a t e m e n t s s u g g e s t e d t h a t 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 be tween l e i s u r e s a t i s f a c t i o n and l i f e s a t i s f a c t i o n a l t h o u g h t h e y had d i f f i c u l t y f o r m u l a t i n g t h e i r r e s p o n s e s . VB s t a t e d 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 l i f e r i g h t now and a t t r i b u t e s t h i s t o "not b e i n g a b l e t o go o u t and 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 t h i n g s 101 I ' m u s e d t o " . T h i s l a s t s t a t emen t s u g g e s t s t h a t VB i s n o t s a t i s f i e d w i t h h e r l i f e a t l e a s t p a r t i a l l y due t o h e r d i s s a t i s f a c t i o n w i t h h e r l e i s u r e . 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 p e r c e i v e d a d e f i n i t e p o s i t i v e r e l a t i o n s h i p be tween l e i s u r e s a t i s f a c t i o n and l i f e s a t i s f a c t i o n . 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 a l s o been s u b s t a n t i a t e d by t h e l i t e r a t u r e ( R u s s e l l , 1987; B r o w n , F r a n k e l & F e n n e l 1 , 1 9 9 1 ) . A n o t h e r p a r t i c i p a n t s t a t e d h e r p e r c e p t i o n o f t h 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 s a t i s f a c t i o n , " T h e y ' r e a l m o s t one i n t h e same. Because I d o n ' t have t o w o r r y about work o r I c a n p l a y b a s i c a l l y 24 hou r s a d a y . T h a t ' s my l i f e and a l s o my l e i s u r e " (TG) . 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 i n d i c a t e d t h e i r en joyment o f s p e c i f i c l e i s u r e i n t e r e s t s f rom t h e i r p a s t and t h e i r f r u s t r a t i o n due t o no t b e i n g c a p a b l e o f c o n t i n u i n g t h e s e i n t e r e s t s due t o t h e i r change i n h e a l t h . However , S a i n s b u r y and B r u c e (1994, p . 35) have shown t h a t s e n i o r s l i f e s a t i s f a c t i o n c o u l d s t i l l be i m p r o v e d i n s p i t e o f p o o r o r f a i l i n g h e a l t h . A d d i t i o n a l F a c t o r s I n a d d i t i o n t o the r e s u l t s and d i s c u s s i o n s r e l a t e d t o t h e s p e c i f i c r e s e a r c h q u e s t i o n s , a d d i t i o n a l r e s u l t s emerged f rom t h e d a t a . T h i s s e c t i o n r e p o r t s and d i s c u s s e s t h e s e a d d i t i o n a l r e s u l t s . 102 M e a n i n g o f L e i s u r e The p a r t i c i p a n t s e ach v i e w e d l e i s u r e s l i g h t l y d i f f e r e n t l y . S e v e r a l p a r t i c i p a n t s d i s c u s s e d l e i s u r e as t hough i t c o n s i s t e d p r i m a r i l y o f a c t i v i t i e s . Y e t o t h e r s d w e l l e d more on l e i s u r e as a " t i m e t o t h i n k " o r t o " r e l a x and c o l l e c t y o u r t h o u g h t s " . T h i s c o n c e p t u a l i z a t i o n o f l e i s u r e was somewhat c o n s i s t e n t w i t h the i n v e s t i g a t o r ' 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 as "a 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 f reedom t o choose t o p a r t i c i p a t e i n m e a n i n g f u l , e n j o y a b l e , o r s a t i s f y i n g e x p e r i e n c e s " ( D a t t i l o & Murphy, 1991 , p . 3 ) . Pe rhaps an even more f l e x i b l e d e f i n i t i o n o f l e i s u r e i s needed . Lee e t a l . (1994) sugges t t h a t l e i s u r e i s composed o f many c h a r a c t e r i s t i c s . There i s no one concep t w h i c h c l e a r l y d e f i n e s l e i s u r e and o n e ' s i n t e r p r e t a t i o n o f l e i s u r e e x p e r i e n c e s changes o v e r t i m e (Lee e t a l . , 1994, p . 200) . One p a r t i c i p a n t (PP) f r e q u e n t l y men t ioned h e r d i f f i c u l t y a d j u s t i n g t o r e t i r e m e n t . S p e c i f i c a l l y she d e s c r i b e d p r o b l e m s r e l a t i n g t o f e e l i n g n o n - p r o d u c t i v e because she was i n a c t i v e and no l o n g e r w o r k i n g . These may be i n d i c a t i v e o f s t r o n g b e l i e f s i n t h e "work e t h i c " and h e r d i f f i c u l t y i n a c c e p t i n g the a g i n g p r o c e s s . The r e s e a r c h f i n d i n g s o f Lee e t a l . (1994) r e p o r t an appa ren t a s s o c i a t i o n o f t he work e t h i c and f e e l i n g s o f g u i l t . I n d i v i d u a l s who have m e n t i o n e d the e n j o y a b l e t i m e s i n t h e i r l i v e s , as b e i n g t h e i r t i m e a t work , may have d i f f i c u l t y i n e n j o y i n g t h e m s e l v e s away from 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 t o be w o r k . 103 L e i s u r e G o a l s The i n i t i a l 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 r e v e a l e d , a c r o s s a l l p a r t i c i p a n t s , t h e i r need t o be m o b i l e . " B e i n g 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 c i t e d g o a l o f many p a r t i c i p a n t s and i s c o n s i s t e n t w i t h the l i t e r a t u r e on o l d e r a d u l t s ( O ' N e i l l & R e i d , 1991 ; P a t t e r s o n & C a r p e n t e r , 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 f r e q u e n t l y r e a l i s t i c , g i v e n t h e p a r t i c i p a n t s ' p r o g n o s e s , and t h a t t h e y were 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 t h i s . A l s o , b e i n g a b l e t o e i t h e r b e t t e r use t h e e x i s t i n g t r a n s i t s e r v i c e s s u c h as the buses and a c c e s s i b l e t a x i s o r i n one p a r t i c i p a n t ' s c a s e , t h e i r own v e h i c l e were seen 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 format o f T . R . O . P . d i r e c t e d t h e 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 t owards r e a c h i n g m u t u a l l y e s t a b l i s h e d g o a l s , and when n e c e s s a r y r e v i s i n g t h e s e g o a l s . F r e q u e n t l y the g o a l s w h i c h p a r t i c i p a n t s 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 c o n s t r a i n t s . F o r example t h r e e p a r t i c i p a n t s i n d i c a t e d g o a l s r e l a t e d t o f i n d i n g ou t what p rograms a r e a v a i l a b l e (VB, J R , PP) and t h e s e same p a r t i c i p a n t s i d e n t i f i e d "not knowing what p rogram o r f a c i l i t i e s a r e a v a i l a b l e " as a c o n s t r a i n t . The s u c c e s s i n a t t a i n i n g t h e s e g o a l s o r o v e r c o m i n g t h e s e c o n s t r a i n t s v a r i e d among p a r t i c i p a n t s , as was e x p e c t e d . S e v e r a l o f t he p a r t i c i p a n t s i n t h i s s t u d y had d e g e n e r a t i v e c o n d i t i o n s . F o r p a r t i c i p a n t s w i t h d e g e n e r a t i v e c o n d i t i o n s s u c c e s s i n a c h i e v i n g l e i s u r e g o a l s s h o u l d be r e l a t e d t o t h e ach ievemen t o f s l o w e r r a t e s o f d e c l i n e i n 104 h e a l t h ( F l y n n e t a l . , 1993, p . 2 6 8 ) . I n d i v i d u a l s d i f f e r i n t h e i r ad jus tmen t p r o c e s s t o i l l n e s s and d i s a b i l i t y (Lyons e t a l . , 1993) . The d i f f e r e n t c o p i n g s t y l e s o f t h e p a r t i c i p a n t s may have 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 and t h e i r s u c c e s s i n a t t a i n i n g t h e s e g o a l s . A l t h o u g h t h e m u l t i d i s c i p l i n a r y a p p r o a c h u s e d i n t h e c a s e s t u d y s e t t i n g was no t a f o c u s o f t h i s s t u d y , e v i d e n c e o f t h e e f f e c t i v e n e s s o f t h i s a p p r o a c h emerged. The team 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 c o n c e r n s t o be examined a t t he same t i m e . W h i l e t h e 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 , i t has 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 the o f t e n c o m p l i c a t e d h e a l t h i s s u e s o f o l d e r a d u l t s . A "team" a p p r o a c h c a n a l s o i n c r e a s e t h e c o o r d i n a t i o n o f e f f o r t s by e n s u r i n g t h a t many o f t h o s e i n v o l v e d i n t h e p a t i e n t s ' c a r e a r e w o r k i n g t o g e t h e r t owards d e s i r e d g o a l s . I n many o f t h e p a r t i c i p a n t s c a s e s t h e s e g o a l s a r e r e l a t e d t o a d j u s t m e n t s i n l e i s u r e b e h a v i o u r . O t h e r r e s e a r c h e r s have a l s o found s i m i l a r s u c c e s s e s u t i l i z i n g the m u l t i d i s c i p l i n a r y a p p r o a c h (McLennan, 1 9 9 2 ) . L e i s u r e Ad jus tmen t Lyons e t a l . (1993, p . 254) d e f i n e d l e i s u r e a d j u s t m e n t as " the m o d i f i c a t i o n o f e n j o y a b l e , v a l u e d a c t i v i t i e s i n r e s p o n s e s t o i n d i v i d u a l , s o c i a l a n d / o r e c o n o m i c a l c h a n g e s " . The p a r t i c i p a n t s ' d e s i r e t o change t h e i r b e h a v i o u r v a r i e d f rom l i t t l e o r no e x p r e s s e d d e s i r e (JR, TG) t o a h i g h d e s i r e t o change t h e i r l e i s u r e b e h a v i o u r (PP, V B ) . The two male 105 p a r t i c i p a n t s (FB, 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 t o change t h e i r b e h a v i o u r . JN e x p r e s s e d s e v e r a l l e i s u r e p u r s u i t s 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 , however he was n o t i n t e r e s t e d i n c h a n g i n g h i s b e h a v i o u r a t t h e p r e s e n t . JN s t a t e d when h i s l e g g e t s b e t t e r and he f e e l s b e t t e r , he w i l l t h e n c o n s i d e r t h e s e a d d i t i o n a l i n t e r e s t s . T h i s p a r t i c u l a r f a c t o r ( l e i s u r e a d a p t a t i o n ) seemed t o be t h e cause o f g r e a t f r u s t r a t i o n f o r two o f t h e p a r t i c i p a n t s (FB, P P ) . B o t h FB and PP d i s c u s s e d an i n t e r e s t i n 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 t o r e t u r n t o a p r e v i o u s l e i s u r e p u r s u i t . F . B . wanted t o r e t u r n t o o p e r a s i n g i n g and p a i n t i n g . He had become i n v o l v e d i n a s t r o k e c l u b a f t e r h i s s econd s t r o k e w h i c h o c c u r r e d c l o s e t o two y e a r s ago . 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 ou t t o some shows. B o t h p a r t i c i p a n t s p e r c e i v e d t h e y 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 t h e s e i n t e r e s t s due t o 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 w i t h s p e e c h and m o b i l i t y , due t o h i s s t r o k e and P . P . ' s p e r s i s t e n t c o u g h , d e c r e a s e d e n e r g y and d e c r e a s e d m o b i l i t y made i t d i f f i c u l t f o r h e r t o p u r s u e he r i n t e r e s t s . The i n v e s t i g a t o r b e l i e v e d t h a t . F B ' s and P P ' s p e r c e p t i o n s were r e a l i s t i c . H e a l t h S t a t u s I t was a p p a r e n t f rom t h e d a t a , 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 i n t h i s s t u d y were a t a s i g n i f i c a n t l y h i g h l e v e l 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 and 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 i n d i v i d u a l 106 who had l e s s c o m p l i c a t e d p rob l ems was TG. She had s u s t a i n e d a f r a c t u r e d l e g due t o a f a l l and had no o t h e r s i g n i f i c a n t m e d i c a l h i s t o r y o r m e d i c a l i s s u e s . Two p a r t i c i p a n t s i n p a r t i c u l a r , PP and FB had complex m e d i c a l c o n d i t i o n s . A c c o r d i n g t o t h e s e p a r t i c i p a n t s ' m e d i c a l r e c o r d s 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 o t h e r s t a f f i n v o l v e d i n t h e s e p a r t i c i p a n t s ' c a r e , FB had 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 and PP was l i k e l y t o c o n t i n u e d e c l i n i n g i n h e r h e a l t h . J N ' s h e a l t h a p p e a r e d t o be s l o w l y d e c l i n i n g o v e r the p a s t 12 y e a r s . He r e q u i r e d some a s s i s t a n c e i n managing t h e stump o f h i s r e c e n t l y amputa t ed l e g and seemed dependant on h i s w i f e f o r a s s i s t a n c e w i t h d r e s s i n g and w i t h meal p r e p a r a t i o n . I n v e s t i g a t o r - P a r t i c i p a n t R e l a t i o n s h i p The r e l a t i o n s h i p be tween the 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 s changed as t h e s t u d y e v o l v e d . Many o f t h e p a r t i c i p a n t s were i n i t i a l l y r e l u c t a n t t o p r o v i d e d e t a i l e d r e s p o n s e s t o q u e s t i o n s b e i n g a s k e d by the i n v e s t i g a t o r who was a t l e a s t 25 y e a r s younge r and r e l a t i v e l y u n f a m i l i a r t o them. The p a r t i c i p a n t s ' e x p e r i e n c e d v a r y i n g d e g r e e s o f c o m f o r t w i t h t h e i n v e s t i g a t o r o v e r the t o t a l c o u r s e o f T . R . O . P . F o r example V B , PP, and FB appea red t o be s i n c e r e i n t h e i r r e s p o n s e s and t r u s t i n the i n v e s t i g a t o r t o w a r d s t h e c o m p l e t i o n o f t he i n i t i a l o u t r e a c h s e s s i o n . TG was c o n s i s t e n t l y s i n c e r e and t r u s t i n g from the f i r s t i n p a t i e n t s e s s i o n t o t h e c o m p l e t i o n o f t he p rog ram. She (TG) was a l s o t h e y o u n g e s t p a r t i c i p a n t w i t h the l o w e s t number o f h e a l t h 107 p r o b l e m s . 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 l e t t h e i n v e s t i g a t o r e n t e r t h e i r w o r l d . B o t h JN and JR c o n s i s t e n t l y p r o v i d e d b r i e f , r a t h e r vague r e s p o n s e s and d i d n o t appear g e n u i n e l y i n t e r e s t e d i n t h e T . R . O . P . p r o c e s s . The d i s t a n t age gap be tween t h e r e s e a r c h e r and the p a r t i c i p a n t s may have been a c o n s t r a i n i n g f a c t o r i n the e v o l u t i o n o f t h e i n v e s t i g a t o r - t h e r a p i s t 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 n o t appear t o be an i s s u e w i t h the o t h e r 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 i n f o r m a t i o n t o the i n v e s t i g a t o r as t h e y became more f a m i l i a r w i t h h i m . T h i s may have been a t l e a s t p a r t i a l l y i n d i c a t i v e o f t h e i r i n c r e a s e d t r u s t i n t h e i n v e s t i g a t o r and t h e i r i n c r e a s e d need f o r s o c i a l o p p o r t u n i t i e s as t h e i r t i m e away f rom t h e h o s p i t a l i n c r e a s e d . 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 and t r u s t i n g o f 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 r e s p o n s e s (PP, V B , F B , TG) as t i m e e l a p s e d . He f e l t the o u t r e a c h s e s s i o n s p r o v i d e d h im w i t h a c e r t a i n sense o f p r i v i l e g e t o be p e r m i t t e d t o e n t e r the p e r s o n a l l i v i n g space o f t h e p a r t i c i p a n t s . 108 CHAPTER F I V E C o n c l u s i o n s and Recommendat ions C o n c l u s i o n s 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 has f o c u s e d on a c t i v i t y 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 t o p a r t i c i p a t i o n . Over a decade ago i t was r e a l i z e d t h a t t he f o c u s needed t o be r e d i r e c t e d t owards t h e i n d i v i d u a l and n o t t he a c t i v i t y ( T i n s l e y & T i n s l e y , 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 and t h e p e r s o n a l 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 t h a n the a c t i v i t i e s p e r s e . F o r example , what appea red t o m a t t e r t h e most t o p a r t i c i p a n t s i n t h i s s t u d y was no t a s p e c i f i c 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 need f o r s o c i a l c o n t a c t and s u p p o r t f o c u s e d a r o u n d f r i e n d s and f a m i l y w h i c h was most i m p o r t a n t . . F u l f i l l i n g s o c i a l s u p p o r t needs i s more d i f f i c u l t t o a c h i e v e f o r some o l d e r a d u l t s who a re now l i v i n g a l o n e and away f rom t h e i r f r i e n d s o r c h i l d r e n . S i g n i f i c a n t l i f e e v e n t s s u c h as t h e d e a t h o f a spouse , r e t i r e m e n t , and i l l n e s s o r d e c l i n i n g h e a l t h o f t e n p r e s e n t o l d e r a d u l t s w i t h s u c c e s s i v e 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 l i f e s a t i s f a c t i o n . As some p a r t i c i p a n t s have s u g g e s t e d (TG, V B , PP , and MP) t h e i m p a c t o f s u c h e v e n t s a r e l i k e l y t o be r e d u c e d , when t h e r e a r e f r i e n d s 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 p r o v i d i n g s o c i a l s u p p o r t . I t appea r s t h a t l e i s u r e r e s e a r c h has l a r g e l y e x c l u d e d t h e s t u d y o f o l d e r , c o m m u n i t y - d w e l l i n g a d u l t s , who have e x p e r i e n c e d r e c e n t 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 s t a t i s t i c s p r e d i c t a c o n t i n u i n g t r e n d t owards an i n c r e a s e d number o f 109 o l d e r a d u l t s , s p e c i f i c a l l y t o t h e V a n c o u v e r and S u r r e y c o m m u n i t i e s (GVRD). These p r e d i c t i o n s s u g g e s t t h e r e w i l l be an even g r e a t e r need f o r c o m m u n i t y - b a s e d r e s o u r c e s . R e c r e a t i o n p r a c t i t i o n e r s need 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 t h e y s h o u l d be p r o a c t i v e and i n v o l v e d w i t h c l i e n t s i n t h e change p r o c e s s . C l o s e r w o r k i n g r e l a t i o n s and c o o r d i n a t i o n o f e f f o r t s a r e needed between t h e communi ty and i n s t i t u t i o n a l s e t t i n g s i n 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 as c o n t r i b u t i n g towards l i f e s a t i s f a c t i o n and as h a v i n g h e a l t h b e n e f i t s . I t w o u l d seem, t h a t a more e f f e c t i v e s h a r i n g o f r e s o u r c e s be tween h e a l t h and l e i s u r e s e r v i c e s i s needed t o b e t t e r p r o v i d e f o r an 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 e x p e c t a n c y . " O l d e r a d u l t s have l i v e d l o n g l i v e s w i t h a r i c h n e s s i n e x p e r i e n c e t h a t c o n t r i b u t e s t o a h i g h degree o f i n d i v i d u a l i s m " (Hawkins & M c l e a n , 1993, p . 3 1 ) . Such a s t a t e m e n t s h o u l d s e r v e as a g u i d e l i n e t o r e s e a r c h e r s and p r a c t i t i o n e r s i n v o l v e d i n t h e u n d e r s t a n d i n g o f l e i s u r e e x p e r i e n c e s . The r e s u l t s o f T . R . O . P . have i n d i c a t e d , t h e s e p a r t i c i p a n t s , who were a l l r e c e n t l y h o s p i t a l i z e d o l d e r a d u l t s , were n o t a homogeneous g r o u p . F o r example , t h e s e o l d e r a d u l t s were d i v e r s e i n t h e i r h e a l t h , l e i s u r e i n t e r e s t s , s a t i s f a c t i o n s , c o n s t r a i n t s and g o a l s . I t i s p r o b a b l e t h a t t h e y a l s o d i f f e r e d on many c h a r a c t e r i s t i c s w h i c h were n o t f o c u s e d upon i n t h i s r e s e a r c h s t u d y . F o r example , more p r e c i s e q u e s t i o n s and o b s e r v a t i o n s m i g h t a l s o be a b l e t o f u r t h e r e x p l o r e a r e a s s u c h a s : s o c i a l c l a s s , e d u c a t i o n , gende r , and c u l t u r e . F l e x i b l e a p p r o a c h e s , s u c h as t h o s e u t i l i z e d i n t h i s 110 p e r s o n - c e n t r e d r e s e a r c h p rogram a p p e a r e d t o be e f f e c t i v e i n r e v i e w i n g some o f the r i c h e x p e r i e n c e s o f t h e s e e i g h t o l d e r a d u l t s . These e x p e r i e n c e s i n c l u d e d t h e i r p e r c e i v e d b e n e f i t s o f l e i s u r e ' and T . R . O . P . , f a c i l i t a t o r s o f l e i s u r e , l e i s u r e i n t e r e s t s , c o n s t r a i n t s t o l e i s u r e , and t h e i r b e l i e f s abou t t h e r e l a t i o n s h i p between l e i s u r e and l i f e s a t i s f a c t i o n . The r e l a t i o n s h i p be tween l e i s u r e and l i f e s a t i s f a c t i o n has been p r e d o m i n a t e l y d e s c r i b e d i n t h e l i t e r a t u r e as a p o s i t i v e one ( E d g i n t o n , J o r d a n , D e G r a a f , & E d g i n t o n , 1 9 9 4 ) . Some o f the p a r t i c i p a n t s i n t h i s s t u d y a l s o d e s c r i b e d t h e c o n v e r s e (VB, PP, FB) and v i e w e d t h e i r d i s s a t i s f a c t i o n w i t h t h e i r l e i s u r e as a c o n t r i b u t i n g f a c t o r t o a r e a s o f d i s s a t i s f a c t i o n i n t h e i r l i f e . T h e r e f o r e l e i s u r e s h o u l d n o t be 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 e x p e r i e n c e . T . R . O . P . and s i m i l a r programs may n o t o n l y have t h e p o t e n t i a l t o f a c i l i t a t e l e i s u r e en joyment , b u t t h e y may a l s o have the p o t e n t i a l t o d e c r e a s e l e i s u r e d i s s a t i s f a c t i o n and pe rhaps 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 ' l i f e d i s s a t i s f a c t i o n . There i s a need f o r f u t u r e s t u d i e s t o examine t h i s new o u t l o o k on 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 s a t i s f a c t i o n r e l a t i o n s h i p . Recommendat ions f o r F u t u r e R e s e a r c h L e i s u r e i s a c o n t i n u o u s l y e v o l v i n g c o n c e p t . T h i s c a s e - s t u d y a p p r o a c h a s s i s t e d the r e s e a r c h e r i n c o n c e p t u a l i z i n g " l e i s u r e " as i t r e l a t e s t o e i g h t r e c e n t l y h o s p i t a l i z e d o l d e r a d u l t s . I n i t i a l l y , t he i n v e s t i g a t o r a c c e p t e d D a t t i l o and M u r p h y ' s (1991) d e f i n i t i o n o f l e i s u r e w i t h a b e l i e f t h a t s u c h I l l a b r o a d and s u b j e c t i v e 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 a l l p o p u l a t i o n s . Now the i n v e s t i g a t o r q u e s t i o n s t h i s c h o i c e o f a d e f i n i t i o n . Such a d e f i n i t i o n meant t h a t " l e i s u r e " was h i g h l y - l i m i t e d f o r many o f t h e s e p a r t i c i p a n t s d u r i n g t h e c o u r s e o f T . R . O . P . 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 p h y s i c a l s t a t u s and l a c k o f ad ju s tmen t t o t h e s e p h y s i c a l c h a n g e s . "Freedom t o choose t o p a r t i c i p a t e i n m e a n i n g f u l , e n j o y a b l e , o r s a t i s f y i n g e x p e r i e n c e s " becomes a v e r y c o m p l i c a t e d c o n c e p t . Most o f t h e p a r t i c i p a n t s i n t h i s s t u d y were r e s t r i c t e d by t h e i r m u l t i p l e m e d i c a l c o n d i t i o n s . These " r e s t r i c t i o n s " i m p l y a l o s s o f f reedom and t h e r e f o r e , 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 , a l o s s o f l e i s u r e o p p o r t u n i t i e s . I t appea r s t h a t r e s e a r c h e r s need t o c o n t i n u o u s l y r e c o n s i d e r t h e i r v i e w s towards l e i s u r e and t h e i r d e f i n i t i o n s o f 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 s u b j e c t s . L e i s u r e r e s e a r c h 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 f o r t h e e x p e r i e n c e s o f o l d e r a d u l t s w i t h d e c l i n i n g h e a l t h and who a r e s u s c e p t i b l e t o d e c r e a s e d l e i s u r e p a r t i c i p a t i o n and t o i n c r e a s e d s o c i a l i s o l a t i o n . F u r t h e r i n v e s t i g a t i o n o f t h e s o c i a l b e n e f i t s w h i c h o u t r e a c h t h e r a p e u t i c r e c r e a t i o n can p r o v i d e i s n e c e s s a r y . There i s a l s o a need t o r e s e a r c h t h e i m p a c t o f s o c i a l c o n t a c t and s o c i a l s u p p o r t s on o l d e r r e c e n t l y h o s p i t a l i z e d a d u l t s f u r t h e r . 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 on t h e l e i s u r e e x p e r i e n c e s o f c o m m u n i t y - d w e l l i n g o l d e r a d u l t s , who have e x p e r i e n c e d r e c e n t i l l n e s s o r d e c l i n i n g h e a l t h . A t p r e s e n t t h e r e i s l i t t l e l i t e r a t u r e i n t h i s a r e a , e s p e c i a l l y w i t h i n t h e t h e r a p e u t i c r e c r e a t i o n f i e l d . The l i t e r a t u r e w h i c h does e x i s t 112 on o l d e r a d u l t s and l e i s u r e , f r e q u e n t l y f o c u s e s on t h e h e a l t h y o l d e r a d u l t s i n the communi ty , o r on t h o s e who a r e i n s t i t u t i o n a l i z e d . T h i s i s n o t s u r p r i s i n g because r e c r e a t i o n t h e r a p i s t s have h i s t o r i c a l l y been employed by i n s t i t u t i o n s s u c h as l o n g - t e r m c a r e f a c i l i t i e s and h o s p i t a l s . H o p e f u l l y , t h e r e s e a r c h w i t h i n t h e l e i s u r e and t h e r a p e u t i c r e c r e a t i o n f i e l d s w i l l be i n f l u e n c e d by t h e c h a n g i n g d i r e c t i o n o f h e a l t h c a r e . The r e s u l t s o f t h i s s t u d y have o t h e r i m p l i c a t i o n s f o r improvements i n f u t u r e r e s e a r c h . A d d i t i o n a l m e a n i n g f u l d a t a 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 i n t h e age c a t e g o r y o f 59-69 y e a r s o f age . T h i s p a r t i c u l a r s t u d y had an u n i n t e n t i o n a l absence o f p a r t i c i p a n t s i n t h i s s p e c i f i c age r a n g e . An a d d i t i o n a l r ecommenda t ion i n v o l v e s t h e i n c r e a s e d u t i l i z a t i o n o f a m u l t i d i s c i p l i n a r y team as an i n t e g r a l p a r t o f t h e 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 the members o f t h e m u l t i d i s c i p l i n a r y team may have 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 i n f o r m a t i o n t o t h e r e s e a r c h e r . A d d i t i o n a l i n f o r m a t i o n on 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 t h e c o o r d i n a t i o n o f i n p a t i e n t and o u t r e a c h h e a l t h s e r v i c e s . The re a l s o r e m a i n s a need f o r l o n g i t u d i n a l s t u d i e s w h i c h examine t h e s u b j e c t i v e l e i s u r e e x p e r i e n c e s o f o l d e r a d u l t s who have been r e c e n t l y i l l . Such s t u d i e s w o u l d p r o v i d e d a t a on the l o n g t e r m e f f e c t s 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 s e r v i c e s c a n have on o l d e r a d u l t s a f t e r t he passage o f t i m e . 113 Recommendat ions f o r P r a c t i t i o n e r s H e a l t h Sys tem 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 o f h e a l t h - c a r e s e r v i c e s . T h i s need has been c o n s i s t e n t l y r e p o r t e d i n t h e l i t e r a t u r e (Peat & B o y c e , 1993, p . 282) and has a l s o become e v i d e n t t h r o u g h t h e r e s u l t s o f t h i s s t u d y . 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 rom t h e 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 h e a l t h - c a r e (VB, J N , MP & FB) and on o c c a s i o n s d i d n o t know how t o a c c e s s s p e c i f i c r e s o u r c e s . R e l a t e d t o t h i s 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 w o u l d be t h e e s t a b l i s h m e n t o f a more e f f e c t i v e sy s t em f o r c o m m u n i c a t i n g t h e c o n c e r n s o f t h e o l d e r a d u l t s t o t h e a p p r o p r i a t e s e r v i c e , o r t o the i n d i v i d u a l i n v o l v e d i n t h e i r c a r e . The p l a n n i n g f o r t h e f u t u r e c a r e o f a l l B r i t i s h C o l u m b i a n s ' h e a l t h i s p r e s e n t l y unde r major r e v i s i o n . Many o f t he i n i t i a l s t r a t e g i e s o u t l i n e d i n t h i s h e a l t h r e f o r m s h o u l d r e s u l t 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 h e a l t h (BCRCHCC, 1991) . The t o t a l h e a l t h needs o f r e c e n t l y h o s p i t a l i z e d o l d e r a d u l t s s h o u l d be g i v e n t h e p r i o r i t y and a t t e n t i o n t h e y appear t o r e q u i r e . These i n c l u d e e x p r e s s e d 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 s u p p o r t . H e a l t h c a r e b o a r d s w i l l a l l o c a t e r e s o u r c e s t o a r e a s where t h e y see t h e communi ty need and t h e demand f o r r e s o u r c e s . T h e r e f o r e h e a l t h and l e i s u r e p r a c t i t i o n e r s s h o u l d e n s u r e t h a t t h e needs o f r e c e n t l y h o s p i t a l i z e d o l d e r a d u l t s , who have n o t been aware o f r e s o u r c e s and o p p o r t u n i t i e s a v a i l a b l e t o them i n t h e p a s t , have t h e o p p o r t u n i t y and t h e c h o i c e t o e x p r e s s t h e i r needs t o 114 h e a l t h c a r e d e c i s i o n - m a k e r s . These needs i n c l u d e t h e i m p o r t a n c e o f p r o v i d i n g o u t r e a c h s e r v i c e s f o r o l d e r a d u l t s . S o c i a l R e s o u r c e s 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 s o c i a l r e s o u r c e s f o r o l d e r a d u l t s i n o u r l o c a l p o p u l a t i o n . The s o c i a l needs o f some o l d e r a d u l t s , e s p e c i a l l y t h o s e who a r e l i v i n g a l o n e , may r e q u i r e an i n c r e a s i n g emphas i s t o be p l a c e d on i m p r o v i n g t h e i r p e r c e p t i o n s o f l e i s u r e c o n t r o l , l e i s u r e competence , 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 w i l l be r e q u i r e d f rom t h e t r a d i t i o n a l t h e r a p e u t i c r e c r e a t i o n r o l e s i n h o s p i t a l and i n s t i t u t i o n a l - b a s e d s e r v i c e s t o more o f a f o c u s on d e v e l o p i n g communi ty -based s e r v i c e s w h i c h may need t o a d d r e s s t h e i s s u e s o f s o c i a l n e t w o r k s and s o c i a l s u p p o r t s . The re w i l l be a move away from h o s p i t a l - b a s e d a c t i v i t y p rog rams t o meet t h e s o c i a l needs o f o l d e r a d u l t s w i t h d e c l i n i n g h e a l t h l i k e t h o s e d e s c r i b e d i n t h i s s t u d y . T h i s t r a n s i t i o n w i l l r e q u i r e t h e c a r e f u l c l a r i f i c a t i o n o f f u t u r e r o l e s f o r r e c r e a t i o n t h e r a p i s t s 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 p rograms and p r a c t i t i o n e r s . A d e q u a t e l y a d d r e s s i n g t h e s o c i a l s u p p o r t c o n c e r n s o f o l d e r c o m m u n i t y - d w e l l i n g a d u l t s , w i l l be dependent p a r t i a l l y on t h e 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 and commun i ty -based r e c r e a t i o n p r a c t i t i o n e r s . However , t h e s e r e s o u r c e s may no t be enough t o e s t a b l i s h what t h e o l d e r a d u l t p e r c e i v e s t o be " s o c i a l s u p p o r t " . The r e s o u r c e s may a c t o n l y t o i n c r e a s e s h o r t - t e r m s o c i a l c o n t a c t s u c h as t h a t w h i c h 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 were i n the h o s p i t a l . B e i n g h o s p i t a l i z e d was no t n e c e s s a r i l y a " n e g a t i v e " 115 e x p e r i e n c e . T h i s f i n d i n g emerged from t h e comments g i v e n by- s e v e r a l p a r t i c i p a n t s s u g g e s t i n g t h a t r e s e a r c h e r s s h o u l d n o t u n d e r e s t i m a t e the s o c i a l i m p a c t o f h o s p i t a l i z a t i o n . Pe rhaps p a r t i c i p a t i o n i n T . R . O . P . p r o v i d e d an o p p o r t u n i t y f o r r e f l e c t i o n s on t h e i r p a s t , p r e s e n t , and f u t u r e s o c i a l e x p e r i e n c e s . O l d e r a d u l t s l i v i n g a l o n e may have r e c o g n i z e d t h e enjoyment t h e y o b t a i n e d f rom b e i n g s u r r o u n d e d by o t h e r s , many o f who were i n a s i m i l a r s i t u a t i o n . 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 R e s o u r c e s F a c i l i t a t i n g the i n v o l v e m e n t o f o l d e r a d u l t s i n t o f u t u r e o u t r e a c h programs w i l l r e q u i r e a r e s t r u c t u r i n g o f e x i s t i n g h e a l t h c a r e s e r v i c e s t o s u p p o r t a d d i t i o n a l s t a f f i n g i n t h e communi ty . A s h i f t i n g from h o s p i t a l ba sed i n p a t i e n t p rograms t o community based o u t r e a c h programs i s c o n s i s t e n t w i t h t h e c u r r e n t h e a l t h c a r e p l a n and may be a r e a l i t y i n t h e n e a r f u t u r e (Core S e r v i c e s R e p o r t , 1 9 9 4 ) . O t h e r r e s e a r c h e r s and p r a c t i t i o n e r s i n the t h e r a p e u t i c r e c r e a t i o n f i e l d w o u l d l i k e t o see an emphas is f rom h o s p i t a l t o commun i ty -based t h e r a p y and r e h a b i l i t a t i o n ( C o n d i e , 1992, p . 1 1 ; MacDona ld & G a l l a n t , 1 9 9 4 ) . H e a l t h c a r e s e r v i c e d e l i v e r y i s c h a n g i n g i t s f o c u s from i n t e r n a l o r i n p a t i e n t forms o f t r e a t i n g i l l n e s s t o more communi ty -based s e r v i c e s a imed a t h e a l t h p r o m o t i o n , w e l l n e s s , and empowerment ( C l a r k and C u r r a n , 1993, p . 2 8 ) . " P r e v e n t i o n and P u b l i c H e a l t h S e r v i c e s " a r e r e c o g n i z e d as r e q u i r e d s e r v i c e s unde r the r e f o r m e d p r o v i n c i a l h e a l t h c a r e p l a n (Core S e r v i c e s R e p o r t , 1 9 9 4 ) . The t a r g e t i n g o f s p e c i f i c s e r v i c e s t owards s e n i o r s ' w e l l n e s s and t h e r e c o g n i t i o n o f t h e s e 116 s e r v i c e s w h i c h need t o be d e l i v e r e d from a v a r i e t y o f s e t t i n g s , i n c l u d i n g t h e home and r e c r e a t i o n c e n t r e s , i s e m p h a s i z e d i n t h e l a t e s t r e p o r t from the B r i t i s h C o l u m b i a M i n i s t r y o f H e a l t h ( C o r e . S e r v i c e s R e p o r t , 1 9 9 4 ) . T h i s s t u d y v e r i f i e s t he i n v e s t i g a t o r ' s p e r c e p t i o n o f t h e need f o r i n c r e a s e d s e r v i c e s t o r e c e n t l y h o s p i t a l i z e d e l d e r l y i n d i v i d u a l s r e s i d i n g i n t h e communi ty . The l i t e r a t u r e and d i r e c t i o n o f h e a l t h c a r e f u r t h e r s u p p o r t s t h i s n e e d . F u r t h e r m o r e , Lyons (1993, p . 257) a d v o c a t e s t h a t r e c r e a t i o n o u t r e a c h s e r v i c e s a r e a n e c e s s a r y f u n c t i o n o f r e h a b i l i t a t i o n s e r v i c e s . As t h e need f o r t h e s e s e r v i c e s f r e q u e n t l y e x i s t e d , a l m o s t w i t h o u t e x c e p t i o n , p r i o r t o the i n d i v i d u a l ' s h o s p i t a l i z a t i o n , t h e r e a r e l i k e l y l a r g e numbers o f e l d e r l y i n d i v i d u a l s i n the community who c o u l d p o t e n t i a l l y b e n e f i t f rom s i m i l a r o u t r e a c h s e r v i c e s . I n t h e V a n c o u v e r a r e a t h e r e a r e numerous r e c r e a t i o n and s o c i a l p rograms a v a i l a b l e f o r t h e o l d e r a d u l t . U n f o r t u n a t e l y t h e r e i s f r e q u e n t l y l i t t l e awareness o f s u c h p rog rams by t h e o l d e r a d u l t , and t h e r e i s p o o r commun ica t i on be tween v a r i o u s a g e n c i e s i n v o l v e d i n t h e d e l i v e r y o f t h e s e s e r v i c e s (Core S e r v i c e s R e p o r t , 1 9 9 4 ) . 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 s h o u l d be an e s s e n t i a l component o f a comprehens ive t h e r a p e u t i c r e c r e a t i o n s e r v i c e ( R i d d i c k & K e l l e r , 1991 , p . 1 7 0 ) . The r e s u l t s and l i t e r a t u r e s u p p o r t t h e need f o r l e i s u r e e d u c a t i o n t o f o c u s on more p e r s o n - c e n t r e d a p p r o a c h e s . 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The e f f e c t s o f a l e i s u r e e d u c a t i o n p rogram on s e l e c t e d s o c i a l - p s y c h o l o g i c a l v a r i a b l e s : a t h r e e month f o l l o w - u p i n v e s t i g a t i o n . T h e r a p e u t i c R e c r e a t i o n J o u r n a l , 2 7 ( 1 ) , 9 - 2 1 . Sneegas , J . J . (1989) . S o c i a l s k i l l s : an i n t e g r a l component o f l e i s u r e p a r t i c i p a t i o n and t h e t h e r a p e u t i c r e c r e a t i o n s e r v i c e s . T h e r a p e u t i c R e c r e a t i o n J o u r n a l , 24 (2) , 3 0 - 4 0 . S t a t i s t i c s Canada (1989) . 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 : s u b p r o v i n c i a l d a t a f o r B r i t i s h C o l u m b i a . C a t a l o g u e No . 8 2 - 6 1 2 . O t t a w a : M i n i s t e r o f R e g i o n a l I n d u s t r i a l E x p a n s i o n and t h e M i n i s t e r o f S t a t e f o r S c i e n c e and T e c h n o l o g y . S t a t i s t i c s Canada (1988) . 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 : S e l e c t e d D a t a f o r Canada , P r o v i n c e s and T e r r i t o r i e s . O t t a w a : M i n i s t e r o f R e g i o n a l I n d u s t r i a l E x p a n s i o n and t h e M i n i s t e r o f S t a t e f o r S c i e n c e and T e c h n o l o g y . S t e i n k a m p , M.W. and K e l l y , J . R . ( 1987 ) . 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 o l d e r a d u l t s : a c t i v i t y t h e o r y r e v i s i t e d . I n t e r n a t i o n a l J o u r n a l A g i n g and Human Deve lopmen t , 25 ( 4 ) : 2 9 3 - 3 0 7 . T i n s l e y , H . E . A . and T i n s l e y , D . J . ( 1982 ) . A h o l i s t i c mode l o f l e i s u r e c o u n s e l i n g . J o u r n a l o f L e i s u r e R e s e a r c h , 1 4 ( 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. ( 1 9 8 7 ) . 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 R e f e r e n c e f o r L e i s u r e E d u c a t i o n - 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 . Hampstead, New H a m p s h i r e : S t e r l i n g P r e s s . W i l h i t e , B . (1992) . In-home a l t e r n a t i v e s f o r communi ty 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 o f 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 . and K e l l e r , M . J . (1992) . 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 o f o l d e r a d u l t s w i t h d e v e l o p m e n t a l d i s a b i l i t i e s . A n n u a l 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 . and E l l i s , G . D . (1989) . 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 u s e r s m a n u a l . S t a t e C o l l e g e , V e n t u r e 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 well- balanced leisure lifestyle and, these components are frequently met in ways 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 do. . . SOCIAL . CREATIVE. . . writing letters making social telephone calls ' visiting friends, family joining a social group or interest club caring for a pet or animal doing crafts, woodworking or mechanics doodling cooking or eating fancy food composing poetry,stories or music planning parties PHYSICAL . . INTELLECTUAL. joining an exercise class going for walks gardening refinishing furniture practising relaxation techniques visiting libraries, museums or galleries ~ keeping up on current events discussing controversial subjects hobby collecting volunteering SOLITARY. S P E C T A T O R . . . reading listening to music humming or whistling sitting outdoors daydreaming watching T V or movies bird watching people watching attending concerts/theatre attending live sporting events OTHER. . . Adapted by BC 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 your leisure experience? Instructions: Read the following list and check off the items most important to you. to do something meaningful to contribute to my community to feel peace to continue learning to b e physically active to be creative/expressive to relax or take it easy to b e entertained to b e able to do what I want to b e spontaneous to laugh and enjoy to help others to improve my self-esteem Others to challenge myself to spend time with friends/family to participate in a variety of activities to have support from others to feel committed to something to use, improve or develop my skills to have something to show for my efforts to keep busy to organize and get things going to learn more about myself to develop friendships to be competitive to improve my health Adapted by BC Rehabilitation Society, from Ballantyne 1987, "Leisure Lifestyles... C H A L L E N G E S 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 O V E R C O M I N G C H A L L E N G E S 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, from Ballantyne 1987, "Leisure Lifestyles..." Appendix 2 I n i t i a l I n t e r v i e w Q u e s t i o n s 1. How has y o u r h o s p i t a l s t a y been so f a r ? 2 . Where do y o u l i v e ? How l o n g have y o u l i v e d t h e r e ? Does anyone e l s e l i v e w i t h you? Where were y o u bo rn? 3 . Do y o u have any f a m i l y ? Where do t h e y l i v e ? 4 . T e l l me some o f the t h i n g s y o u l i k e d t o do b e f o r e e n t e r i n g t h e 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 a rea ) n e a r where y o u l i v e ? 6. Were y o u happy w i t h y o u r l i f e s t y l e and f r e e - t i m e b e f o r e y o u came i n t o h o s p i t a l ? 7 . I s t h e r e s o m e t h i n g y o u have n o t done, bu t w o u l d l i k e t o t r y / o r f i n d out more about ? I s there , 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 and w o u l d l i k e t o do a g a i n ? 8. What a r e y o u d o i n g f o r y o u r enjoyment w h i l e i n t h e h o s p i t a l ? 9. What i s (or what do y o u t h i n k w i l l b e . . . ) t h 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 ? 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 months f rom now? What w i l l y o u be d o i n g f o r y o u r en joyment t h e n ? 1 1 . I s t h e r e a n y t h i n g y o u ' d l i k e t o ask q u e s t i o n s abou t o r f i n d ou t more about ? 132 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 1. a) Has t h i s p rogram b e n e f i t t e d y o u i n any way? Have , y o u 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 the b e n e f i t s o f l e i s u r e ? 2 . a) 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 has changed y o u r awareness o f t h e i m p o r t a n c e o f l e i s u r e ? b) Has y o u r a t t i t u d e towards 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 ? ( I f s o , how w o u l d y o u s ay i t has changed?) 3 . How s a t i s f i e d a r e you w i t h y o u r l e i s u r e ? Has t h i s changed r e c e n t l y ? 4 . Has y o u r awareness 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 changed? I f so how has i t changed? 5 . Has y o u r community 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 o r 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 see y o u r s e l f d o i n g f o r e n j o y m e n t / s a t i s f a c t i o n ? 7. What has h e l p e d you t o e n j o y y o u r r e c r e a t i o n / l e i s u r e ? What has h e l p e d you t o e n j o y y o u r l i f e ? 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 what w o u l d y o u l i k e t o see changed? 9. Would y o u say y o u a r e g e n e r a l l y v e r y s a t i s f i e d w i t h y o u r l i f e ? 1 0 . 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 t h e moment, y o u a r e s a t i s f i e d w i t h y o u r l i f e ? b) Do y o u t h i n k t h e r e i s any r e l a t i o n s h i p be tween 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 w i t h y o u r l e i s u r e ? 1 1 . How d i d t h e p rogram make y o u f e e l t o w a r d s y o u r s e l f , y o u r own l e i s u r e , and o t h e r p e o p l e ? 1 2 . Were t h e r e any n e g a t i v e a s p e c t s t o t h e p rogram? Was t h e r e a n y t h i n g you w o u l d l i k e t o see done d i f f e r e n t l y o r improved? 134 R i s k s / S i d e E f f e c t s 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 t o p a r t i c i p a t i n g i n t h e s e s e s s i o n s . B e n e f i t s T h r o u g h p a r t i c i p a t i n g i n t h i s s t u d y , 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 awareness 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 s u p p o r t i n a c c e s s i n g t h o s e r e s o u r c e s you c h o o s e . You w i l l a l s o have 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 use y o u r f r e e t i m e . P a r t i c i p a t i o n i n s u c h a p rogram may l e a d t o an i n c r e a s e d l e v e l o f i ndependence and 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 t h e communi ty . M o n e t a r y C o m p e n s a t i o n T h e r e w i l l be no mone ta ry c o m p e n s a t i o n . However , s e r v i c e s 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 . 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 beyond 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 . C o n f i d e n t i a l i t y Any 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 k e p t s t r i c t l y c o n f i d e n t i a l . I n f o r m a t i o n r e p o r t e d 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 by 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 and 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 you have any q u e s t i o n s o r c o n c e r n s a t any 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 he numbers l i s t e d on page o n e . * * * * * * * * * * * * * * * * * * * * * * I have r e a d t h e above i n f o r m a t i o n and I have had an o p p o r t u n i t y t o ask 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 what my p a r t i c i p a t i o n w o u l d i n v o l v e . I f r e e l y c o n s e n t 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 c o n s e n t f o r m . S i g n a t u r e o f P a r t i c i p a n t Date S i g n a t u r e o f W i t n e s s Page 2 o f 2

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