Introduction
An engaged lifestyle is widely regarded as an important component of successful ageing. Many older adults with active participation in social and leisure activities report positive wellbeing, a fact which stimulated the original activity theory of ageing and continues to influence contemporary researchers and practitioners. Numerous studies examining associations between social or leisure activity participation and aspects of wellbeing are represented in the ageing literature. In this article, we undertake a critical review of the literature, examine the conceptualisation and measurement of activity among older adults and consider the implications and prospects for a more comprehensive activity theory.
Activity and wellbeing in gerontology
The activity theory of ageing began with the simple propositions that wellbeing in older adults is promoted by (a) higher levels of participation in social and leisure activities, and (b) role replacement when roles must be relinquished (Havighurst Reference Havighurst1961). As one of the first and most influential theories of adjustment to ageing, activity theory caught the collective imagination of gerontological practitioners and researchers alike, appealing in its optimism about the possibilities for later life. Further development of the theory occurred during the early 1970s as investigators distinguished three broad types of social and leisure activity participation: informal, interacting socially with familiar people such as relatives, friends or neighbours; formal, participation in formal groups and organisations; and solitary, activities one does alone like reading, television viewing and many hobbies. Findings suggested that activity theory might be revised to emphasise informal social activity, which was shown to influence wellbeing more than formal or solitary activity (Lemon, Bengtson and Peterson Reference Lemon, Bengtson and Peterson1972; Longino and Kart Reference Longino and Kart1982).
Increased longevity means that many more individuals now reach advanced old age than ever before. Retirement pensions and insurance that have improved the economic standing of many older adults, along with better health care and nutrition, offer present cohorts of middle-aged and older adults greater opportunities for prolonged health and wellbeing, and cast late life in a new light. Furthermore, since the 1970s social roles have become more fluid among middle-aged and older adults, also casting activity theory in a new light. As we face the increasing demographic imperative of an ageing population, activity theory seems at once outdated and yet very relevant. Its influence continues today in the ‘successful ageing’ paradigm. Rowe and Kahn's (Reference Rowe and Kahn1998) report of the McArthur Foundation's research posed a definition of successful ageing that featured social engagement as one of three major elements. They defined social engagement in two ways: ‘remaining involved in activities that are meaningful and purposeful’ and ‘maintaining close relationships’, therefore emphasising productive and social aspects of activity for successful ageing.
Gerontology scholars propose a number of means by which social and leisure participation may maintain or promote wellbeing in older adults. These include the obvious physical benefits from any activity that involves movement – the stimulation of bodily systems promotes a greater range of motion and muscle tone, and internal benefits to digestion and cardiovascular health. Extensive documentation of the health benefits of physical activity for older adults is found in the medical, nursing, physical therapy and occupational therapy literatures (e.g. Hogan Reference Hogan2005; Lim and Taylor Reference Lim and Taylor2004). Social support pathways – both emotional closeness and instrumental assistance – offer another important means through which social and leisure participation enhances wellbeing (Aquino et al. Reference Aquino, Russell, Cutrona and Altmaier1996). Social support may also reduce stress by promoting cognitive reappraisals that make stressful situations less stressful (Lazarus and Folkman Reference Lazarus and Folkman1984). Social interactions with family, groups or community may lead to social integration that promotes a sense of belonging and establishes or maintains positive interpersonal attachments (Hagrety et al. Reference Hagrety, Williams, Coyne and Early1996). Related to this is the manner in which social interaction and integration promotes the exchange of health information, persuasion and support that may directly persuade individuals to change health-related behaviours (Berkman et al. Reference Berkman, Glass, Brissette and Seeman2000).
On an individual level, role continuity or role replacement through appropriate activity participation and with familiar, supportive others may contribute to the individual's sense of meaning or purpose and to maintenance of a sense of identity (Atchley Reference Atchley1989; Lemon, Bengtson and Peterson Reference Lemon, Bengtson and Peterson1972). And finally, activity participation frequently involves the pursuit or achievement of personal goals, thus adding to a sense of personal mastery or accomplishment (Holahan Reference Holahan1988; Lawton Reference Lawton and Kelly1993; Lawton et al. Reference Lawton, Moss, Winter and Hoffman2002; Warr, Butcher and Robertson Reference Warr, Butcher and Robertson2004). These potential benefits of social and leisure activity in later life are intuitively appealing, yet it is unclear whether different types of activity are equally important for the wellbeing of older adults, or for all groups of older adults.
Defining wellbeing among older adults has received its own due attention (cf. Hilleras, Aguero-Torres and Winblad Reference Hilleras, Aguero-Torres and Winblad2001; Stanley and Cheek Reference Stanley and Cheek2003). Outside of gerontology, research on subjective wellbeing has expanded into positive psychology and tends to emphasise happiness, contentment, and satisfaction with the past, current life, and future (Diener et al. Reference Diener, Suh, Lucas and Smith1999). In gerontology, wellbeing has been said to be the subjective counterpart of a more public evaluation of ‘successful ageing’ (Stanley and Cheek Reference Stanley and Cheek2003). Because of the variety of definitions and measures used by researchers in the gerontology literature, this review has necessarily taken an inclusive approach to the definition of ‘wellbeing’, with constructs such as life satisfaction, happiness, positive affect, or quality of life. In later life, physical health and the nearness to death become more important than they may be in earlier life. Thus, global health measures such as self-rated health frequently appear in studies of activity and wellbeing relationships, and several longitudinal studies have used time till death as the ultimate objective measure of the effects of activity participation in later life. Although strictly speaking, survival or longevity goes beyond the scope of subjective wellbeing, these studies reflect a closely related way of capturing information on the potentially ameliorative effects of activity participation and are particularly relevant to gerontology research.
The current review focuses on the conceptualisation and measurement of the activities that comprise social and leisure participation among older adults, on the associations of these activities with subjective wellbeing, health and survival, and on the implications for theory and research in gerontology. Researchers have attempted to find universals as well as mediating and moderating factors in the activity/wellbeing paradigm. Furthermore, studies on activity and wellbeing among older adults present numerous ways of defining and measuring social and leisure activity and numerous wellbeing outcomes. The variety of different activity dimensions generates a confusing array of outcomes, which suggests the need to summarise and synthesise this literature. Hence, in this critical review of the recent literature on activity and health or wellbeing outcomes in later life, our aims are to identify domains of social and leisure activity participation, the methods used in measures of activity in later life, and extant evidence on the relationship of social and leisure activity participation to subjective wellbeing, health and survival in later life.
Methods
We searched five databases, PsycInfo, AgeLine, Medline, Academic Search Premiere and CINHAL, as well as article reference lists for original research articles published in English in peer-reviewed journals that described naturalistic (non-intervention) studies with a focus on social or leisure activity among non-institutionally resident older adults published from 1995 to 2009. We targeted recent research to find studies using rigorous methods that have become more common since the early 1990s and to update the knowledge base in this area for relevance to current and coming cohorts. We used the following search terms:
• Activity, social activity, leisure activity, recreation, or activity theory.
• Older adult, age, ageing, seniors, or elder.
• Wellbeing, health, or mental health.
Other criteria for inclusion in this review were: the study had to use a measure of social and/or leisure activity among older adults, and model the relationship of activities to other variables with a focus on subjective wellbeing (e.g. self-reports of life satisfaction, happiness, positive affect, freedom from depression, general health or functioning measures), or survival. Health was not the major focus but seen as a component of wellbeing; other studies focused on length of survival as an ultimate measure of wellbeing. We included cross-sectional and longitudinal studies, but chose only studies in which statistical covariates and/or grouping variables were used to control for effects of socio-demographic attributes or other variables that might associate with wellbeing, health or survival. In the spirit of activity theory and given the theoretical importance of social and leisure activity, we omitted studies that examined only physical activity or productive activity, such as volunteer or paid employment, without considering them within the larger context of social or leisure participation. Finally, we did not include the growing literature on the effects of activity participation on cognitive functioning (or conversely, dementia), because we see measures of cognitive abilities as quite distinct from subjective wellbeing or survival. Furthermore, studies focusing on cognitive outcomes often retrospectively examine years of occupational and leisure activity from younger and middle adulthood to identify effects in later life, which clearly takes these studies outside the realm of the activity theory of ageing.
After the database search and selection process, we read completely all the selected studies and coded them for several key methodological characteristics: sample size and composition; study design (cross-sectional or longitudinal and length of time for the latter); domains of activity/social participation and individual activities measured, if given; measures of wellbeing, health or survival; moderating variables examined in the study; outcome variables related to wellbeing, health, or survival; relevant findings regarding the relationship of social and leisure participation to wellbeing, health or survival.
The results
The final database includes 42 studies reported in 44 peer-reviewed journal articles that modelled the relationship of activity participation among older adults to some form of wellbeing, general health or survival. Of the 42 studies, 24 were cross-sectional and 18 longitudinal. The longitudinal studies spanned from four to 20 years (mean 8.6). All of these studies included both male and female participants, and all were published in English in peer-reviewed journals. They represented Spain, Germany, The Netherlands, Finland, Sweden, Japan, China, Taiwan, Israel, Great Britain and the United States of America. Primary or secondary analyses of large datasets were tapped for several of these studies, including the Berlin Study of Ageing, the Baltimore Longitudinal Study of Ageing, and the Americans Changing Lives study. A small minority of the studies presented data from samples of less than 100, which may suggest there was insufficient power for some statistical tests, but most had well over 200 participants, and 13 of the studies included over 1,000. Table 1 is a list of the studies with selected information about key variables and outcomes.
Table 1. Study designs, sample sizes, activity domains, outcomes and key findings
Notes: ADL: activity of daily living. IADL: instrumental activity of daily living. 1. Focusing on activity domains related to wellbeing, moderators or mediators. Design: LS: longitudinal study. CS: cross-sectional study. 2. Sample sizes for individual countries from 1,854 to 2,417. 3. One wave from Terman LS. 4. Satisfaction with health, functional limitation, depressive symptoms, and life satisfaction. 5. Disability, cognitive impairment, functional limitations, depressive symptoms. 6. Defined by lack of disability, cognitively intact, non-depressed mood, independence in ADLs.
Activity classification
We defined activity domains as the categories used in measures of activity in later life. For instance, social, leisure or productive each represent domains which encompass a number of individual activities. Not all studies identified distinct domains; those that appear with only one domain in Table 1 grouped all activities measured under the label ‘leisure’ or ‘social’ and did not categorise them. Among the 42 individual studies, the number of identified domains ranged from one to 13 (mean 3.8). Investigators sometimes used different names to represent the same constructs. For instance, leisure activities were called ‘consumptive’ by some. ‘Regenerative’ activities were those that were necessary to everyday life, which also were termed ‘obligatory’ by some. We grouped similar domains with unique names to arrive at seven general activity domains, as follows: Social (in some studies, further specified as Informal or Formal), Leisure, Productive, Physical, Intellectual/Cultural, Solitary, Spiritual/Serving Others. In addition to these, several of the studies included some sort of evaluation of quality or satisfaction with activity participation, Quality/Satisfaction.
Various domain sets group these categories in ways that represent different perspectives on activity participation, dividing up the universe of possible activities according to certain criteria. Each domain set distinguishes different characteristics of social and leisure activity. For instance, the domain set social and solitary divides activity according to the social context. Theoretically, any activity could be classified as either social or solitary, although many aspects of the activities would not be captured. Among the domain sets reported were formal, informal and solitary; intellectual, physical, and social; productive and leisure; formal, informal and physical; in-home and out-of-home; and regenerative, productive and consumptive.
Whereas the domain sets describe groups of individual categories, we define dimensions as the overarching aspects of activity participation that are represented in the classification. For instance, the domain set formal, informal and solitary highlights two dimensions of the social context, tapping into both the solitary–social dimension and the formal–informal social dimension. In contrast, the domain set of productive and leisure highlights the activity's purpose along the dimension of productivity, i.e. the practical or instrumental functions of the activity, possibly including economic value, as distinct from a recreational or enjoyment purpose or function. Leisure activity may serve several purposes, but at its most basic definition, is done solely for the enjoyment of the actor. Also, leisure activity implies something done by choice. An activity measurement scheme highlighting the two domains productive and leisure therefore encompasses both purpose and choice. (The dimension of discretionary versus obligatory is a more formal way of expressing this aspect of activity, namely how much it is freely chosen.) Productivity versus leisure would not capture the social dimension, however, since both productive and leisure activities may be either social or solitary. A number of other overarching dimensions are reflected by activity domains and domain sets, such as spatial context, in the domains travel or fishing and hunting, creativity in domains such as music making, and arts and crafts, or self- versus other-directedness in diverse domains such as volunteer work, community service, or solitary hobbies.
Activity domains may also reflect other demands upon the participant, sometimes unintentionally. For instance, physical demand or mobility issues are reflected in the physical or fitness activity domains. It is also possible that physical mobility demand is reflected in measures of formal versus informal social activities, as it is more difficult to participate in formal social activities such as attending clubs without physical mobility and good functioning. Likewise, intellectual demand is reflected in a number of activities such as reading, games of skill, hobbies or attending cultural activities.
The reviewed studies fell into two major categories with regard to how activity domains were derived. Domains could be created a priori, or activity lists could be subjected to factor analytic techniques to enable categories to emerge empirically. Both methods have their merits and limitations. The straightforward a priori method uses background knowledge about the lifestyles of older adults from a given perspective about which properties of activity are important for older adults, and applies the face validity criterion to place activities in the categories. These decisions, however, may be biased by the researchers' presumptions that may be inappropriate for the sample. On the other hand, empirical methods such as factor analysis that categorise activities together according to their endorsement by the same individuals may result in groupings of relatively unrelated activities that nevertheless tend to co-vary in certain types of individuals. For example, people who like reading may also like gardening, both of which are usually solitary activities, yet differ in terms of the level of demand and the possible benefits to mind and body. Activities may not be correlated in consistent ways. Because the choice to participate in a given activity means there is less time for another activity to be done, to some extent, the choice of activities in which to participate is a zero-sum situation. In the phrase of Marottoli et al., ‘an aggregated summation of discrete (in some cases unrelated) activities constitutes a reasonable index of the amount of activity in which a participant engages’ (2000: S336). This argues against the need for factor analytic techniques in activity measurement.
Variability in the ways activity and ‘engagement in life’ are operationalised and measured makes interpretation of the literature problematic (Mendes de Leon Reference Mendes de Leon2005; Parslow et al. Reference Parslow, Jorm, Christensen and Mackinnon2006; Ritchey, Ritchey and Diaz Reference Ritchey, Ritchey and Dietz2001). According to Kerby and Ragan, ‘despite the widespread study of activities and ageing, little attention has been given to classifying activities. Most studies simply classify with an ad hoc approach. Comparisons across studies are difficult. … In addition, a weakness of this literature is the absence of an empirical basis for the classification’ (2002: 118). Possible criteria for ‘successful’ measurement of social and leisure activity in older adults might include the exhaustiveness of the domains in covering the range of social and leisure activities, clarity and exclusivity of categories used, as well as how theoretically relevant and meaningful the distinctions or dimensions are. Do they distinguish the aspects that are important in terms of activity content, social context, demand on the individual, and personal choice or meaning?
Among the best-conceptualised models of activity classification were several that combined two or more dimensions of the activity in their measurement scheme. For instance, the functional domains of social, leisure and productive were overlaid with the dimension of demand upon the participant (Everard et al. Reference Everard, Lach, Fisher and Baum2000), producing four final categories: instrumental, social, high-demand leisure and low-demand leisure. Through principal component analysis, Lennartsson and Silverstein (Reference Lennartsson and Silverstein2001) derived four underlying factors along two dimensions: solitary–social and sedentary–active. The resulting categories were as follows: social/friendship, social/cultural, solitary/sedentary and solitary/active. Both of these studies parsimoniously differentiated the content, function and demand aspects, as well as the social–solitary dimension, with dual categorisation.
Another exemplary activity classification system distinguished regenerative activities (those that have to be carried out to survive; self-maintenance) from discretionary activities (done by choice) (Maier and Klumb Reference Maier and Klumb2005). The discretionary category was further subdivided by the ‘third-party criterion’ that asks, ‘Could someone else do this on behalf of the person (productive activity), or is the purpose for the person to do this him or herself (consumptive activity)’? The resultant activity domains in this study are named regenerative, productive and consumptive, taking into account dimensions of choice and function. To address the social dimension, Maier and Klumb further subdivided the consumptive category into social and solitary activity, and then disaggregated the social into several of the most common specific activities among older adults – face-to-face talks, phone calls, making visits, other social interaction. This study presents one of the most complete categorisation schemes among those reviewed.
Findings on activity and subjective wellbeing, health or survival
The majority of studies reviewed showed positive associations between activity participation and psychosocial wellbeing, health or survival. Most of the studies reported differential associations by type of activity or by personal characteristics such as gender of participants. Some of the studies teased out associations with specific domains or even specific activities, while others used summary measures of activity participation, such as a general ‘leisure’ category. In studies that examined specific activity types, various domains were reported to positively relate to at least one measure of wellbeing, health or survival. The outcomes noted in Table 1 were those reported as statistically significant in the study. From these outcomes, we created a summary table of findings regarding the major categories of activity that were associated with wellbeing, health or survival, in cross-sectional or longitudinal studies (see Table 2). Taking all the studies into account, the summary domain of social activities (all social activities, including unspecified and specified, a mix of both informal and formal), followed by physical and unspecified leisure activities had the most associations with wellbeing, health or survival (in 26, 15 and 14 studies, respectively). Intellectual/cultural and solitary activities had significant associations in eight studies. Productive/instrumental and spiritual/service activities each accumulated evidence for associations in fewer studies. Among the longitudinal studies, social, physical and leisure activities predicted positive outcomes in the most studies: eight, seven and six, respectively.
Table 2. Activity summary domains associated with wellbeing, health or survival in 42 studies
The differential effects of activity on specific types of wellbeing or health variables were the focus of several studies. For instance, Ritchey, Ritchey and Dietz (Reference Ritchey, Ritchey and Dietz2001) used nine separate measures for different aspects of wellbeing to show that informal social activities positively influenced the greatest number of wellbeing measures. Warr, Butcher and Robertson (Reference Warr, Butcher and Robertson2004) found that family/social, home/garden and church/charity activities were most highly associated with affective wellbeing and life satisfaction. Werngren-Elgstrom, Brandt and Iwarsson (Reference Werngren-Elgstrom, Brandt and Iwarsson2006) found that productive activities were associated with better health and fewer depressive symptoms, but total activities related to subjective wellbeing.
More complex research designs tested questions beyond the straightforward activity–wellbeing relationship. Silverstein and Parker (Reference Silverstein and Parker2002) reported on ten-year longitudinal data that allowed them to follow increases or decreases in activity participation for various activities. They found that older Swedes withdrew from leisure activities over time, but many of the lost activities were replaced by alternatives, and some respondents actually increased the number of activity domains in which they participated. Cultural-entertainment, outdoor-physical, and formal group activities showed significant reductions, while friendship activities and reading were among those maintained at a similar level. In addition, they found that maintaining or increasing one's range of activities was a buffer against the detrimental effects of functional impairments, widowhood or lack of family support, pointing to the complexity of the relationship between activity participation and types of wellbeing. Strain et al. (Reference Strain, Grabusic, Searle and Dunn2002) also reported positive effects of continuing activities, while Nimrod (Reference Nimrod2008) focused solely on newly added activities – innovation – which was shown to be associated with greater life satisfaction. Another longitudinal study identified three patterns of activity participation among older adults and that those who fit the pattern with the most informal social activity had less initial depression and decreasing depression over time (Hong, Hasche and Bowland Reference Hong, Hasche and Bowland2009).
Causal inferences
Cross-sectional studies comprise the bulk of the evidence base for the association between activity participation and wellbeing or health. These studies demonstrate associations while controlling for other potential predictors of wellbeing, but cannot establish temporal order. Eighteen longitudinal studies were identified that tested relationships between social and leisure activity participation and wellbeing, health or survival among older adults. Longitudinal research is a superior vehicle for studying relationships with long-term effects, and is particularly germane to research on ageing that seeks to examine ‘determinants of intra-individual change over time’ (Schaie and Hofer Reference Schaie, Hofer, Birren and Schaie2001: 55). However, in naturalistic research on the effects of activity, drawing causal inferences from longitudinal studies may be limited by variations in starting points with regard to activity, health or wellbeing levels, and resultant measured or unmeasured moderation effects, or floor or ceiling effects on the potential for activities to influence wellbeing. Thus, although as Menec stated, ‘implicit in this discussion is that activity promotes health and wellbeing rather than vice versa’ (2003: S75), selection effects regarding health or socio-economic status may mean that those with poorer health or fewer resources cannot participate in as many activities, rather than that fewer activities actually makes for worse health or wellbeing (Agahi and Parker Reference Agahi and Parker2008). Janke, Nimrod and Kleiber (Reference Janke, Nimrod and Kleiber2008b) noted that their study offered more support for wellbeing influencing activity than activity influencing wellbeing.
As a number of these authors have noted, it is likely that there are reciprocal effects between social participation and health or wellbeing that cannot be easily untangled, whether the study is longitudinal or cross-sectional. Interpretations of any of these studies can only address the research questions answered by the design, measures and analytical methods, which vary considerably among the studies reviewed. Even though the studies controlled for many factors that might influence wellbeing, they cannot completely control for the interactive and reciprocal nature of health status, personality factors, activity opportunities, activity preferences and wellbeing measures. Even longitudinal studies using death as the ultimate outcome measure may not tell an easily interpretable story. According to Mendes de Leon, ‘[death is] the end result of often multiple disease processes that have evolved over years, if not decades, and interact with each other in complex ways. So, if we find measures of social engagement to be predictive of survival, what does this really mean? How did social engagement affect this process?’ (2005: 65).
Moderating factors
Understanding the influence of personal characteristics upon the activity/wellbeing relationship is an important goal that some recent studies have addressed by examining interaction or moderating effects of descriptive variables. Gender was the most commonly tested participant characteristic, appearing in about one-quarter of the studies, with enough evidence to suggest that there are distinct activity and wellbeing or survival relationships for males and females. For example, Lennartsson and Silverstein (Reference Lennartsson and Silverstein2001) found that solitary–active activities reduced mortality risk for males but not for females, while Warr, Butcher and Robertson (Reference Warr, Butcher and Robertson2004) found that women's family and social domains influenced their wellbeing more than men's. Agahi and Parker (Reference Agahi and Parker2008) likewise found that women's mortality risk decreased with more informal and formal social activity, whereas men's survival was helped more by solitary hobbies and gardening. In a more complex conceptualisation, Harlow and Cantor (Reference Harlow and Cantor1996) found that being retired raised the importance of activity for wellbeing more among men than women. In one of the only studies that examined a single activity, reading, Jacobs et al. (Reference Jacobs, Hammerman-Rozenberg, Cohen and Stessman2008) found that daily reading at baseline reduced mortality risk for men, but not women, after controlling for other factors. Walter-Ginzburg et al. (Reference Walter-Ginsburg, Shmotkin, Blumstein and Shorek2005) found very different results for old-old men and women in Israel; men fared better who participated in more solitary leisure activities and women fared better who reported more physical activity and attendance at religious services. In a similar finding for Taiwanese elders, Zimmer and Lin (Reference Zimmer and Lin1996) found that women's wellbeing was negatively influenced by greater contemplative activity.
In the Silverstein and Parker (Reference Silverstein and Parker2002) study discussed earlier, widowhood, higher functional limitations, and lower family support each moderated the longitudinal effect of activity participation on wellbeing. Age, being in the ‘old-old’ category, was found to positively moderate satisfaction with home-based activities (Fortuijn et al. Reference Fortuijn, van der Meer, Burhold, Ferring, Quattrini, Hallberg, Weber and Wenger2006) and negatively moderate degree of leisure activity (Lampinen et al. Reference Lampinen, Heikkinen, Kauppinen and Heikkinen2006), partly through its association with lower mobility and chronic illness. Klumb (Reference Klumb2004) found that the influence of social context on positive affect was moderated by proportion of time individuals spent alone, i.e. those who were alone less often were more positively influenced by being in the company of others. She also found that neuroticism moderated the relationship of social participation on positive affect, reducing this relationship. Depression status at baseline was another moderating variable in a longitudinal study by Glass et al. (Reference Glass, Mendes de Leon, Bassuk and Berkman2006). They found that fewer depressive symptoms at baseline resulted in less of an impact of activity on depressive symptoms at subsequent waves.
Mediating factors
The influence of intervening variables or mediating effects was examined in only a few studies. The purpose or motivation for engaging in social and leisure activities was shown to have an influence on the activity/wellbeing relationship. Six reason domains developed by Everard (Reference Everard1999) were quite exhaustive and clear, and results determined that ‘social’ reasons predicted the highest level of wellbeing. Herzog et al. (Reference Herzog, Franks, Markus and Holmberg1998) looked at a quality they called ‘agentic self-concept’ similar to personal mastery, which they found to mediate positively the activity/wellbeing relationship, along with a social self-concept, which had less of a mediating effect. Mobility status reportedly mediated the effects of activity on wellbeing or health in at least one study (Lampinen et al. Reference Lampinen, Heikkinen, Kauppinen and Heikkinen2006).
Evaluations or appraisals of social activity were included as mediators in the conceptual frameworks of several studies. Social relationship quality and supportiveness were found to be important mediators in the two studies by Litwin (Reference Litwin2000, Reference Litwin2006). Perception of one's activity level as ‘enough’ (Hong, Hasche and Bowland Reference Hong, Hasche and Bowland2009), satisfaction with leisure activities (Nimrod and Adoni Reference Nimrod and Adoni2006), the perceived value of activities (Katz and Yelin Reference Katz and Yelin2001; Neugebauer, Katz and Pasch Reference Neugebauer, Katz and Pasch2003), or ‘activity self-evaluation’ (Mullee et al. Reference Mullee, Coleman, Briggs, Stevenson and Turnbull2008) were all found to be influential variables in the activity/wellbeing relationship.
Discussion and theoretical implications
This review of recent studies from a number of countries and cultures demonstrates that social, leisure and productive activities each have significant associations and predictive relationships with aspects of wellbeing for older adults. Although differences in definition and measurement make it difficult to draw inferences about this body of evidence, methodologically rigorous studies generally find positive associations between activity and wellbeing. Arriving at a more comprehensive framework to describe the mechanisms of the effects of social and activity participation on wellbeing will require measures of activity to be better standardised and to take into account the dimensions of purpose, context and demand on the individual. Optimal measures of social and leisure activity should clearly specify the ‘active ingredients’ that the researcher wishes to examine and identify categories that are mutually exclusive. As noted in this review, a promising method for achieving this may involve classifying each activity by two or more dimensions, such as social/active, social/passive, and so on (e.g. Lennartsson and Silverstein Reference Lennartsson and Silverstein2001).
The reviewed studies in the aggregate provide support for a central aspect of the activity theory of ageing – that informal social participation, through activities such as visiting with friends, has a consistently positive relationship with wellbeing in later life. In their seminal 1972 article, Lemon, Bengtson and Peterson described the theory as the ‘social activity theory’ and emphasised social intimacy and role supports as the major processes to be understood. Although many of the recent articles reviewed have strayed from this central idea of activity theory in order to examine and compare more types of activity, it is still social activity that has the most evidence in support of its association with positive wellbeing. In several of the studies, informal social activity or social intimacy was shown to be the variable with the greatest independent effect upon wellbeing outcomes (cf. Everard Reference Everard1999; Litwin and Shiovitz-Ezra Reference Litwin and Shiovitz-Ezra2006; Maier and Klumb Reference Maier and Klumb2005; Ritchey, Ritchey and Dietz Reference Ritchey, Ritchey and Dietz2001; Warr, Butcher and Robertson Reference Warr, Butcher and Robertson2004). The social intimacy inherent in certain activities appears to be a very important, if not the most important, aspect of engagement that influences wellbeing.
In addition to informal social activity, several other types of activity are found to be related to wellbeing, health or survival, which suggests that activity's influence on wellbeing takes multiple pathways. We may surmise that social activity affects wellbeing or survival by reducing the risks of social isolation and by supplying emotional intimacy, socio-emotional support, reinforcement for one's self-concept and social roles, and the sense of being valued. On the other hand, productive activity may influence health and wellbeing through satisfaction with outcomes, economic gains, mental stimulation, comforting personal routines, sense of purpose, and increased self-efficacy or self-esteem (Wahrendorf et al. Reference Wahrendorf, Ribet, Zins and Siegrist2008). Recreational or leisure activities may affect wellbeing through their intellectual or physical demands (e.g. challenging crossword puzzles), through enjoyment and pleasure in the company or the surroundings, and through the reinforcement, again, of one's self-concept, as with ‘I am a good golfer; I can still bake a nice homemade pie’. Activity theory, while a reasonable shorthand, may be inadequate to explain these subtle relationships.
In refining theories of ageing, critical gerontology examines existing research through a lens informed by previous theories and research, as well as the contemporary social and policy context (e.g. Martinson and Minkler Reference Martinson and Minkler2006). Amidst improvements in quality of life and the ‘compression of morbidity’ in old age, there has also been some controversy about the universal prescription of activity in late life or, as coined by Ekerdt (Reference Ekerdt1986), ‘the busy ethic’, which holds older people to a standard of keeping busy, or risk being less valuable members of society. In the recent discourse on productive ageing and civic engagement, social gerontologists have critically examined the expectation that older adults be productive citizens, raising the possibility that these goals for older adults may do more to serve society than to enhance the good of the older person (Holstein Reference Holstein2006; Martinson and Minkler Reference Martinson and Minkler2006). This suggests that sweeping generalisations about the relationship of activity to wellbeing and health may not be appropriate, with implications for both policy and psycho-social practice (Adams Reference Adams2004; Katz Reference Katz2000).
Newer activity-related theories such as socio-emotional selectivity (SES; Carstensen Reference Carstensen1992; Frederickson and Carstensen Reference Frederickson and Carstensen1990), and Selection, Optimization and Compensation (SOC; Baltes and Baltes Reference Baltes, Baltes, Baltes and Baltes1990; Freund and Baltes Reference Freund and Baltes1998) espouse successful ageing through adaptation, focusing particularly on selection of appropriate social and leisure activities (Adams Reference Adams2004). SES suggests that these changes occur through the selection of social partners to provide the greatest level of comfort and reliability, supporting the importance of informal, reliable, intimate social context, whereas SOC focuses on maintaining everyday competence in activities – selecting and optimising activity choices, while compensating for areas that are less strong. Studies specifically designed to test the SOC model (Janke and Davey Reference Janke and Davey2006; Lang, Rieckmann and Baltes Reference Lang, Rieckmann and Baltes2002) have reported indications of selectivity of leisure pursuits, narrowing the range of activities, and substituting (compensating) by replacing an effortful activity with something more manageable. While each of these theories explains certain aspects of the how and why of changes in activity participation, neither precisely addresses the kernel of activity theory, that maintenance of activity and social engagement enhances wellbeing.
With all of the factors that have been found to influence the relationship of social and leisure activity to health or wellbeing, an updated comprehensive model of activity theory would necessarily be complex. From this current review of relatively recent empirical literature on activity and wellbeing in later life, we can envision some of the important elements of a conceptual model of an extended activity theory of ageing. For example, this literature review suggests that the activity/wellbeing relationship must take into account background variables or moderators, the type of activity, including its content and context, and potential mediators in the form of cognitive appraisals of the activity's benefits to the individual. Among descriptive variables that have been tested as moderators so far in the studies reviewed, we have noted gender, age, physical functioning, depression status at baseline, retirement status, and time spent alone. Certainly others may be relevant. The evidence for these findings is at an early stage of development, as gender is the only moderating factor with more than one or two assessment reports.
Our review has suggested that the content and context of activities are key elements when distinguishing various types. The content includes the mental and physical demand or challenge, and the behavioural aspects of the activity. Context is usually operationalised as social context (rather than environmental context, for example). Social context might encompass the simple dichotomy of being alone or with someone else, or being with one or more family members, friends, neighbours or care-givers, and such qualitative factors as the level of warmth or intimacy in the relationship.
Three broadly defined potential mediating constructs representing cognitive appraisals of the activity belong in this comprehensive model, coming between activity content and social context and the wellbeing outcomes: first, degree of choice or discretion of the individual regarding participation in the activity may be important to gauge. The ‘agentic self-concept’ noted by one study (Herzog et al. Reference Herzog, Franks, Markus and Holmberg1998) pertains to this important notion of choice and control. This volitional aspect is found in the distinction between regenerative, or obligatory, and discretionary activities (Maier and Klumb Reference Maier and Klumb2005), and in the more basic idea of leisure activity: something done by choice. Further, the newer activity-related theories described above, SES and SOC, clearly embrace the choice element in the emphasis on selection by the individual. Unfortunately, many of the domain sets were not able to tease out the issue of choice, by grouping leisure and social activities into larger categories that mixed those that might be freely chosen from those that might be more obligatory. A second mediating factor, again broadly defined, was the value ascribed to or satisfaction found in activity or social participation, measured and noted for its role in several studies (Katz and Yelin Reference Katz and Yelin2001; Mullee et al. Reference Mullee, Coleman, Briggs, Stevenson and Turnbull2008; Neugebauer, Katz and Pasch Reference Neugebauer, Katz and Pasch2003; Nimrod and Adoni Reference Nimrod and Adoni2006). A third set of related mediating factors might be the purpose (Everard Reference Everard1999) or meaning of the activity, shown to be relevant in the activity/wellbeing relationship in fewer studies (Lawton Reference Lawton and Kelly1993; Lawton et al. Reference Lawton, Moss, Winter and Hoffman2002). The purpose or meaning of the activity also figures into the constructs of productivity, creativity, self-expression and altruism, among others. Very few of the studies in this review explicitly considered an activity's purpose or meaning. Meaning may be one of the more difficult constructs to measure, but it may be crucial in making sense of the activity/wellbeing equation and developing a more comprehensive activity theory of ageing.
Many of the studies reviewed did not include these moderating or mediating factors – no one study could include all – but this critical review found rigorous studies that begin to validate and refine the activity theory of ageing. The evidence suggests there are positive effects of informal social context, productive activity, intellectual and cultural activity, and physical activity, but that these effects depend in part on individual characteristics, such as gender, age, life situation, and on cognitive appraisals about the activity. As noted by pioneers in this field over 40 years ago, perhaps the most evident limitation of activity theory is that it does not deal with individual differences and values (Havighurst, Neugarten and Tobin Reference Havighurst, Neugarten, Tobin and Neugarten1968). We can now be quite certain that individual characteristics, such as personality or gender, and intervening variables such as choice, meaning, or perceived quality of the activity, play an important role in fostering wellbeing, above and beyond the type of activity or participation frequency. Both the activity and successful ageing paradigms will be strengthened by consideration of the individual older adult, for example by recognising that all activities are not equally valued by all older adults for disparate psychological, developmental and pragmatic reasons. Research endeavours in social gerontology can begin to incorporate these individualising concepts into the design of future studies on activity and wellbeing. With carefully defined measures and more inclusive, well-crafted conceptual models that allow tests of mediating or moderating effects, whether cross-sectional or longitudinal, research on activity and wellbeing should be able to answer questions more definitively and further develop and refine the activity theory of ageing.
