H Minhat, R Amin
elderly, leisure participation, malaysia, social support
H Minhat, R Amin. Social Support And Leisure Participation Of Elderly In Malaysia. The Internet Journal of Geriatrics and Gerontology. 2012 Volume 7 Number 1.
Population ageing is a global phenomenon. It refers to the increasing proportion of elderly compared to the total population in a country, contributed by declining fertility and mortality rate, improved health and life expectancy. It is not a conscious move, but rather an impact of improved health status and a better lifestyle and quality of life that enhances longevity . The total number of elderly worldwide is expected to triple from 259 million in 1980 to 761 million in 2025, with 72% (236.9 million) will be expected in the developing countries .
Malaysia is one of the developing countries moving towards an ageing country. According to Balasundram , Malaysia is reaching the status of an ageing country and is expected to become one in 2035, of which 14% of the population are elderly aged 60 years and above. A medium projection by the United Nations reported that, the proportion of older Malaysian will rise to 22% or 8.7 million older persons in 2050 . The added years to life contributed by the increase in life expectancy presented numerous challenges and implications to the society and nation especially related to the healthcare cost involve in treating various health problems which become more apparent with increasing age. Therefore various measures and efforts have been identified and undertaken to develop a healthier and active ageing society.
The social support received by the senior citizens play an important role in ensuring the well being and quality of life of the elderly. The existence of strong social support network contributes to the motivational element to encourage them to involve in certain type of activities.
Ageing Society and Social Support
Social support is an important aspect in the daily activities of the elderly . It incorporates several important concepts including emotional concern, instrumental aid, access to information, and appraisal , which can be obtained through formal (e.g. public institutions) or informal (e.g. family, friends and neighbors) sources.
Definitions of social support fall into two categories which are the objective and subjective perception of social support. Objective social support indicates what people have actually received or report to have received . While, subjective perception refers to individual’s beliefs about the available support, and is more persistently and powerfully related to health and well being .
A study conducted by Baltes and colleagues in 2001 showed that social interactions decrease with aging , which frequently related to critical events and loss of opportunities commonly take place during ageing process, such as retirement and loss of loved ones. The social support, either perceived or received by the elderly is playing an important role in the everyday life of the elderly, including influencing their leisure participation. A good social support and relationship is an important element in leisure experience .
Since this aspect has never been explored among the increasing Malaysian elderly, such study is a necessity. The results obtained should be utilized in the development and planning of elderly related programs. This paper aims to report part of the findings from a study on factors influencing leisure participation among elderly in Selangor, Malaysia and the association between their participation and quality of life.
Data for this cross-sectional study was collected in eight health clinics in 4 districts in Selangor, namely Petaling, Klang, Hulu Langat and Kuala Langat. The districts were purposively selected based on the highest proportion of older people from the urban and rural localities in Selangor for the year 2009.
Elderly population aged 60 years and above who came to the designated health clinics was selected purposively. Only elderly with normal score for cognitive function and depression were included. These were measured using the Elderly Cognitive Assessment Questionnaire (ECAQ) and the Geriatric Depression Scale (GDS). A total of 335 elderly people were screened initially. But only 268 people were found to have normal cognitive function and depression scale.
A standardized pre-tested questionnaire was used to identify the sociodemographic factors of respondents. Two mainly involved questionnaires were the Leisure Participation Questionnaire (LPQ) and the Perceived Social Support Questionnaire by Prociano and Heller (1983), which consist of 2 scales, Family Scale (PSS-Fa) and Friend Scale (PSS-Fr). The LPQ, which is a 6-point Likert-scale questionnaire containing 25 activities to measure leisure participation was specifically developed for the purpose of this study. The standardized Cronbach’s alpha reliability coefficient values obtained were ranging between 0.504 and 0.609 for each category of leisure activities. Activities were categorized into four categories, namely recreational (physical), cognitive, social and productive activity. Most of the definitions used for each category are based from a study done by Cheung et al. . Recreational activity refers to physical form of recreational activity such as walking, running, cycling and any form of sports. Meanwhile, cognitive activity refers to activity that involves active information processing as a central component. Social activity refers to activity that promotes interpersonal interactions, developed social identity and regulated emotions. Productive activity involves organizing and performing the required tasks, providing services, or generating products. The scale of frequency used for each activity were everyday (5), almost everyday (4), once a week (3), once a month (2), once in few month (1) and never (0). Perceived social support was measured using the Perceived Social Support-Family Scale (PSS-Fa)” and Friend Scale (PSS-Fr) by Prociano and Heller , which has been translated into Malay by Norhafiza .
Descriptive statistics were performed on all variables. Pearson’s correlation and linear regression analyses were performed to assess the association between different categories of leisure activities and perceived social support. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 19.0. Data for perceived social support was presented as continuous data for correlation analysis and categorical data for regression analysis. The level of significance was set at 0.05.
The sociodemographic characteristics of the 268 elderly who agreed to participate and eligible for this study are shown in Table 1. The mean age of this sample was 67.65 years (range, 61-73 years). Majority of the respondents were in the young-old (84.7%) group, slightly more female (51.5%) compared to male (48.5%), were Malays (71.6%), living with others (91.4%), were married (67.9%) and only received primary education (60.8%). Half of them have no fixed income and lives in rural or urban area.
The distribution of leisure activity carried out by the elderly is reported in Table 2. Among the recreational physical activities, exercising was found to have the highest participation rate, while playing golf gives the lowest level of involvement. While, watching television and reading which are both sedentary activities, were found to dominate other cognitive activities. On the other hand, having conversations while relaxing and spending time with grandchildren were the two most common social activities performed by the elderly during leisure. Whereas, gardening was found to be the most frequently done productive activity.
Overall, the most frequently done daily activities were having conversations while relaxing (78.7%), watching television (74.6%), and reading (63.4%). While the least common activities were playing golf (99.6%), performing musical instruments (98.9%), playing sports (98.1%) and playing cards, mahjong and others (96.6%) which are mainly from recreational and cognitive activity.
The findings also reflect a poor involvement of the Malaysian elderly towards constructive and stimulating activities such as playing musical instruments, playing cards, chess or mah-jong, using computer or browsing the internet, writing or drawing for fun and also teaching, which is likely more often done by higher educated elderly. Elderly were more likely to involve in passive and sedentary activities compared to physical activities. Although having conversations while relaxing was the most common activity done, but watching television noted to have higher overall mean score for overall frequency.
Table 3 shows the pattern of perceived social support received by respondents from family members and friends. Majority of the respondents perceived that they receive high level of social support from the family members (85.4%), with score of between 12 and 17. Meanwhile, there was a minimal difference between those who perceived they receive low (50.4%) and high (49.6%) social support from friends.
The correlation analysis between the different categories of leisure activities and perceived social support was shown in Table 4. All categories of leisure activities were significantly correlated with perceived social support from friends. Meanwhile, only social activity was found to have significant correlation with both social supports received from family members and friend. Cognitive activity was shown to have a negative correlation with perceived social support from family members. However, the association was not significant. Most of the correlations shown were weak, except for between recreational activity and social support from friends showing moderate correlation (r=0.308, p<0.05).
Table 5 shows the regression analysis between the leisure activities as dependent variable and perceived social support received from family members and friends as independent variables. Elderly who perceived they received higher social support received from friends was found to be the main predictor for leisure participation involving all four categories of activities. However, the models involved only explained a small variation in each category of leisure activities with 12.7% for recreational (physical) activity, 7.1% for cognitive activity, 18% for social activity and 5.4% for productive activity. Whereas, a high perceived social support from family members was shown to only predicting involvement of elderly into social activities.
Leisure Participation of Elderly
This study showed that social activity was the most frequently done leisure activities among the elderly. Having conversations while relaxing which was done with family members or friends had the highest daily percentage compared to other activities. A similar form of activity which involves social interaction among elderly was also studied by Silverstein and Parker  and Triado et al. . Triado et al.  reported that 43.5% of the rural elderly in Spain spent time talking with others in an ideal day. The elderly also allocated less time to passive activities such as watching TV or resting in the ideal day, and spent more time socializing .
Social interaction with friends was also the most common activity performed by the very old elderly in Sweden . Although it is passive and sedentary in nature, various benefits can be gained from social activities, even if only involves a simple informal social interactions or conversations. A critical review by Adams et al.  had suggested that an informal social interaction was the most evident activities affecting the well-being of an individual.
This study also showed that watching television (TV) was the second most common leisure activity among elderly. Similarly, a study by Cheung et al.  also found watching TV was the most prevalent leisure activity among community-dwelling elders in Hong Kong. Furthermore, it was reported as a major sedentary behavior in the United States . The high level of involvement in watching TV among elderly is likely due to the availability of television in most households nowadays. Despite the benefits gained from this activity in stimulating the cognitive function and social interaction involve if it is done in a group, the sedentary nature of watching TV has been reported to link with several health risks. There is no doubt that different activities provide different benefits to the elderly . However, they should be encouraged to adopt a more active and diverse leisure participation. Those who participated in various and more physical activities reported a better physical well-being .
Meanwhile, the high percentage of elderly spending time with their grandchildren is likely related to the rising of child care costs and increasing number of working parents. This situation indirectly increases the burden of the elders as well as preventing them from participating in certain type of leisure activities.
The low involvement in using computer is probably related to the low educational level among most of the respondents. A study done by Hisham  found that there is a correlation between education level and computer usage and also between the level of confidence and computer performance among elderly people in Malaysia. She also suggested that, the use of internet among senior elderly users (65 and older) is likely to increase in next decade.
Other than that, their involvement into activities that provide source of income, such as gardening and perception that productive activities such as gardening or domestic work which is also physical in nature and is comparable to exercise may also contribute to the low participation level in physical activities during leisure among the respondents. However, the cultural lifestyle of the multi-racial communities in Malaysia may have also significantly influenced the pattern of leisure activity among them.
Social Support and Leisure Participation among Elderly
The findings of this study also highlight the importance of social support received by the elderly, especially from friends in shaping their leisure activities. Elderly who perceived that they received higher social support from friends were more likely to involve in all four different categories of leisure activities. The higher social support received from family members by most respondents in this study was only significantly influenced their participation into social activities, which was reflected by the highest participation level into having conversations while relaxing activity. However, in view of the possibility of the existence of a two-way relationship between social support and leisure, a longitudinal study may be beneficial to demonstrate the causal relationship between them.
A study done in the United States also reported that support from friends was an important factor that influenced leisure participation . However, in contrast they found social support received from family members play a more important role than those received from friends .
The association between social support and physical activity has been reported in several studies. A study by Kuhiranyaratn et al.  among elderly in Thailand suggested that, there is a significant association between social supports and exercising among the elderly population living in the rural area, with social support received from friends was a stronger predictor. Exercise level among the rural elderly was increased with increasing social support received from friends.
A study done among elderly in Brazil also demonstrated a strong relationship between social interaction and physical activity . In contrast they also found that majority of the elderly received higher social support from friends compared to from family members . The frequency and types of physical activities performed were also linked with social support. According to Saint Onge , both the amount of exercise and the types of physical activities are likely to be associated with social support and social network.
The significant association between social support and physical activity may explain the low participation level of respondents in this study in recreational (physical) activity since less than half of the respondents reported they received high social support from friends. Whereas, the higher social support received from the family members will only influence their participation into social activities.
This study also found that social support received from friends was also a significant predictor for cognitive activity. A similar finding was reported by Yeh and Liu  among Taiwanese elderly. They found that elderly who obtained higher score for cognitive function from doing cognitive activities received strong social support, as measured by marital status and positive social support from friends.
Limitation And Suggestion
The main limitation of this study is the selection of sample from the health clinics who may have better physical function and are more likely to be healthier than some patients who are bed ridden, contributes to the information and selection bias in the study. This factor will affect the pattern of their leisure participation compared to those who are bed-ridden and immobilized.
Moreover, since social support received by the elderly may vary according to their health status and physical function, these factors should also be measured or controlled in order to obtain a better view on the association between social support and leisure participation among the senior citizens. A qualitative study should also be considered to assess individual perception, acceptance, barriers and values placed on leisure participation.
Additionally, the small sample size and is dominated by Malay respondents may also influence the outcome of the study. Further studies with a larger sample are recommended for future consideration to refine and consolidate our findings. On the other hand, in view of the possibility of the two-way association between leisure and social support, a longitudinal study is recommended to explain the causal relationship between them.
Majority of the Malaysian elderly perceived that they receive higher social support from family members compared to from friends. However, social support received from friends was found to be a more important predictor of leisure participation for all four different categories of leisure activities. The association between social support received from family members and social activity was reflected by the highest level of involvement into having conversations while relaxing activity among respondents.
The low level of leisure participation in recreational physical activity may be related to the low social support received from friends by almost half of the elderly involved in this study. The findings of this study indicate the needs for emphasizing and focusing on social interactions between the senior citizens in order for them to develop a more active and healthier lifestyle. Health promotion programmes for the elderly should integrate social interaction elements which may act as a catalyst and encourage them to participate in various types of activities. Additionally, the higher social support received from family members should also be channeled into doing a more active and physical activities which were proven to have numerous health benefits and not only into doing social activities which can be sedentary and passive in nature.
To certain extend the findings from this study provide a new lens on the association between social support and leisure participation among Malaysian elderly. The role and importance of social support received by the elderly from friends may become more important in the coming years with the reducing size of household and increasing number of elderly living in formal institutions.