Yonago Acta medica 2003;46:17–24

Effects of Activity Participation of the Elderly on Qualityof Life
Miyoko Matsuo, Junko Nagasawa, Akiko Yoshino, Kimiko Hiramatsu and Keiko
Kurashiki
Department of Adult and Elderly Nursing, School of Health Sciences, Tottori University Faculty of
Medicine, Yonago 683-8503 Japan
Quality of life (QOL) and personality were examined in 2 groups of elderly subjects withand without activity participation (AP). A survey was conducted with 321 elderly subjects
over 65 years of age using a 24-item questionnaire regarding personality and depressive
inclination and the visual analogue scale-happiness to measure QOL. The AP group was
involved in 5 types of activity: community center activity course, learning and lecture
participation, club activity, elderly manpower service activity and other activities. The
QOL of the AP group was significantly higher than the non-AP group as expected. The
perceptual difference between the 2 groups obtained by the correspondence and cluster
analyses was that although the elderly of the AP group were satisfied and not bored with
their current life, this trend was not clear for the non-AP group. Among the 5 activity
types, other activities, characterized as activities adhered to by participants over a long
period, showed the highest QOL compared with the 4 other types. In conclusion, the AP ofthe elderly should be encouraged, and continuing AP might be an important factor in improving QOL of the elderly.
Key words: activity participation; elderly; quality of life; personality questionnaire; visual analogue
scale-happiness

The rate of aged persons in the Japanese population
is rapidly rising, and it is estimated that it will reach
27.4% in 2025. As the life span of the elderly islengthened, improvement in psychosocial satisfaction and quality of life (QOL) is becoming an important task as well as the maintenance of physicalhealth. However, because of the variety of valuelevels and life styles of the elderly, it seems to be
increasingly difficult to explain their psychosocial
satisfaction and QOL only in the fixed frame of“elderly.” This variability of elderly people is seenin their activity preference also. Therefore, the municipal office of each community in Japan offers

opportunities to participate in many activities. Recently, there has been an increase in research for theelderly regarding activity participation (AP) and
QOL, some focusing on factors for promoting AP(Sugai et al., 1996; Matsuda et al., 1998; Lindstrom
et al., 2002) and some on factors for improving
QOL such as health, family, personal relations, role
function and recreational activity (Matsubayashi etal., 1992; Shibata, 1996). However, little is known
about the association between the type of AP ofelderly people and their QOL. In this study, theelderly living in Yonago City were surveyed inorder to find out whether AP contributed to improv-

Abbreviations: AP, activity participation; C, Cramer association coefficient; GDS-15, 15 geriatric depression scale;
QOL, quality of life; VAS-H, visual analogue scale-happiness17

M. Masuo et al.

Table 1. Twenty-four question items regarding
the psychosocial condition of the elderly

carry out the survey because of his/her familiarity
with the elderly in his/her area. Because a lower
reply rate was anticipated when the questionnaire
was mailed, a home visit survey was used. A total
stranger visiting a home more or less makes people
take precaution against the visitor; thus, we thought
a better method was to use a home visit survey done
by a familiar person like a welfare commissioner
who periodically visited the residents of his/her
district. The questionnaire was delivered and collected by the welfare commissioner, and the elderly
subjects responded to the questionnaire anonymously. Before starting the survey, written informed consent for conducting the survey was obtained,
and the questionnaire was given only to the persons
who agreed to the study.
The questionnaire consisted of question items
on i) family make-up, that is, living with family oralone; ii) types of AP: community center activity,
learning and lecture participation (jinsei daigaku),
club activity, elderly manpower service activity(silver jinzai haken center) and other activities
which were not included in the other 4 types of activity; iii) psychosocial condition and iv) QOL. For
assessing the psychosocial condition of these elderly subjects, the 9 items of the ego-gram (Sugita,1985) and the 15 geriatric depression scale (GDS15) items (Yesavege et al., 1983) were used. Inorder to lighten the subjects’ burden of having toanswer so many questions, the 9 ego-gram items
were selected from a total of 50 original ego-gram
items by eliminating similar items. This item reduction was done with another 120 elderly whowere not subjects for the present study but performed the ego-gram test. The total of 24 items, a combination of the 9 ego-gram items plus the GDS-15
items (Table 1), were answered by choosing one of
3 possible answers: “yes,” “neither yes or no” and“no.” The QOL of our elderly subjects was examined with the visual analogue scale-happiness (VASH) developed by Matsubayashi et al. (1992) as a
QOL measure. The VAS-H is portrayed as a 100mm horizontal line with “lowest QOL” on the left
and “highest QOL” on the right. Elderly subjects
were asked to mark an X on the line in response toeach of the 7 VAS-H items: “Mark the degree you

1 Do you prefer to do things in an exact manner?
2 Do you push yourself to your idea withoutcompromising others?
3 Do you like taking care of others?
4 Do you look at the good point of the person rather
than the bad point?
5 Do you frequently suppress yourself without saying“no”?
6 Are you influenced by family members or others
rather than sticking at your idea?
7 Do you prefer social gatherings?
8 Do you frequently get upset over little things?
9 Do you ask or talk to someone when you are
puzzled?
10 Are you basically satisfied with your life?
11 Have you dropped many of your activities andinterests?
12 Do you feel that your life is empty?
13 Do you often get bored?
14 Are you in good spirits most of the time?
15 Are you afraid that something bad is going tohappen to you?
16 Do you feel happy most of the time?
17 Do you often feel helpless?
18 Do you prefer to stay at home, rather than goingout?
19 Do you feel you have more problems with memory
than most?
20 Do you think that it is wonderful to be alive now?
21 Do you feel pretty worthless the way you are now?
22 Do you feel full of energy?
23 Do you feel that your situation is hopeless?
24 Do you think that most people are better off than
you are?
Cited from Yesavage and Brink (1983) and Sugita (1985).

ing their QOL or psychosocial condition and whether the type of AP was associated with their QOL
or psychosocial condition.

Subjects and Methods
In Yonago City, a survey was conducted in all 26
districts on 321 elderly persons, over 65 years ofage and able to respond to a questionnaire. The
welfare commissioner of each district was asked to18

Activity participation in the elderly

Table 2. Subjects characteristics

feel i) you are healthy; ii) your feeling about life isgood; iii) your family relations are going on nicely;iv) your friendships are going on nicely, v) yourfinancial state is OK; vi) you are satisfied with yourlife and vii) you are happy. In the present study, AP
was defined as the activity in which the subject wasparticipating at the time of the survey.

AP group

Non-AP group

154
106
48
73 ± 5
63/91

146
85
61
76 ± 657/89

Number of subjects*
Living with family
Living alone
Age (mean ± SD)
Sex ratio (men/women)*Total, 300.
AP, activity participation.

Statistical analyses
Statistical analyses used were the Ward method ofcluster analysis, the correspondence analysis andthe Cramer association coefficient (C) for the 24
items from the ego-gram and depression scale, andthe Mann-Whitney U test for the VAS-H data. The
statistically significant difference was tested at alevel of P < 0.05.

participants and 146 non-activity participants.
Twenty-one of the 321 elderly subjects could not be
included in this study because some of them did not
answer to all the question items or answered themincorrectly. There was no significant difference
between the AP and non-AP groups for “living withfamily or alone” and “sex.” Results from the VASH data are shown in Fig. 1. For all 7 items, the APgroup placed the mark at a point closer to the rightend of the 100-mm line than the non-AP group,
showing a higher VAS-H score in the AP group(Fig. 1). Especially for the 5 items, “health consciousness,” “daily feeling,” “financial state,” “lifesatisfaction” and “feeling of happiness,”* each
VAS-H score was significantly higher in the APgroup than in the non-AP group (P < 0.01).

Results

Comparison of QOL between AP and non-APgroupsSubjects’ characteristics are shown in Table 2 interms of AP or non-AP, living with family or alone,
sex and age. Effective respondents were obtained
from a total of 300 elderly subjects, 154 activity

VAS-H score

100

*

*

80

*

*

*

AP
Non-AP

py
H

Li

fe

sa
t

ia
nc
Fi
na

ap

n
tio

ls

is
fa
c

ta

sh
nd
Fr
ie

la
t
re

te

ip

n
io

g
ily
Fa
m

D

ai

ly

H

fe
e

ea

lin

lth
y

60

Fig. 1. The visual analogue scale-happiness scores analyzed by group with or without activity paritipation (AP).
*P < 0.05.

19M. Masuo et al.

Q12 versus Q13
C = 0.218
P < 0.001

–1.5

–1

Q6 versus Q19
C = 0.274
P < 0.001

–0.5

0

NO

YES/NO

Q10 versus Q16
C = 0.294
P < 0.001

0.5

1

YES

Sum of squares
3000

2000

1500
1000
500
0

21 23 12 13 11 15 17 18 2 8 19 24 6 5 7 22 3 1 4 10 16 14 9 20

Question item
Fig. 2. Perceptual map and inter-item association for 24 items in the activity participation (AP) group. C, Cramer
association coefficient.

AP group items 10 and 16 were closer to “yes.”
The questions for items 10 and 16 were “Are you
basically satisfied with your life?” and “Do you feel
happy most of the time?”, respectively. And these2 items had a proximal distance to “yes.” This was
also supported with a higher Cramer association
coefficient between items 10 and 16 (C = 0.249, P <0.001). Similarly, the answer “no” was associatedwith items 12 and 13: “Do you feel that your life isempty?” and “Do you often get bored?”, respectively. And these 2 items had a proximal distance
to “no.” This answer pattern for items 12 and 13
was also supported with a significant association by
the Cramer coefficient (C = 0.218; P < 0.001) (Fig.
2). Figure 3 shows the perceptual association result
from the non-AP group. Item 14, “Are you in goodspirits most of the time?”, and item 20, “Do you
think it is wonderful to be alive now?”, were closer
to “yes,” and item 12, ”Do you feel that your life isempty?”, and item 23, “Do you often feel help-

Comparison of psychosocial condition between AP and non-AP groups
The 24 items were used to identify differences in
psychosocial condition between the AP and non-APgroups. The upper part of each Fig. 2 and 3 shows
the 24-item plotting of correspondence analysis forboth groups. On the horizontal axis, all 24 items
and the 3 answer types (“yes,” “neither yes or no”
and “no”) were plotted in order to map a perceptual
association between items and answer types. It wasvery revealing that the items closer to “yes” corresponded favorably with the “yes” answers, and theitems closer to “no” corresponded favorably “no”
answers. When 2 of the 24 items are closer to eitherof the 3 answer types, the Cramer association coefficient was calculated to confirm whether the 2 items
had a valid perceptual association. For example, as
shown on the correspondence analysis axis, for the20

Activity participation in the elderly

Q14 versus Q20
C = 0.299
P < 0.001–1

Q5 versus Q6
C = 0.285
P < 0.001

–0.5

0

NO

YES/NOQ12 versus Q23
C = 0.460
P < 0.001

0.5

1

YES

Sum of squares
200

150

100

50

0

21 23 12 13 11 15 17 18 2 8 19 24 6 5 7 22 3 1 4 10 16 14 9 20

Question item
Fig. 3. Perceptual map and inter-item association for 24 items in the non-activity participation (non-AP) group. C,
Cramer association coefficient.

less?”, were closer to “no.” The lower part of eachFig. 2 and 3 shows dendrograms illustrated byobtaining the degree of dispersion of the 24 items
by sums of squares (sum of squared deviations of
the values from their mean). This was done by theWard method. For the AP group, items 12 and 13
which were answered “yes” and items 10 and 16
which were answered “no” were located in thesame cluster of the dendrogram. The same is seenin the dendrogram of Fig. 3 for the non-AP group.
This answer pattern was finally validated by thefact that each of 3 statistical procedures (the Wardmethod, correspondence analysis and Cramer coefficient) led to the same results as described above.

VAS-H and activity types
In Fig. 4, the scores of the 7 VAS-H items are shownwith activity types: community center activity,
learning and lecture participation (jinsei daigaku),
club activity, elderly manpower service activity andother activities. Community center activity consisted of gatherings of the elderly who had a similar
taste to either of haiku, shogi and igo.* Learningand lecture participation was mainly participation in
lectures for the elderly, which were prepared by the
Yonago Municipal Office. The elderly in the club
activity participated in making handicrafts or playing musical instruments (mandolin, flute, etc.). The* haiku: a Japanese lyric verse form having 3 unrhyming lines of 5, 7 and 5 syllables, traditionally invoking an aspectof nature or the seasons.
shogi: a Japanese game similar to chess that is played on a board with 81 squares, each side having 20 pieces.
igo: a Japanese chess-like game played on a horizontally and vertically 19-lined board with 180 white and 181
black go stones.

21

M. Masuo et al.

100

VAS-H score

90

Other activities
80

Club activity
Community center activity

70

**

**

60

**

**

Elderly manpower
service activity

**
py
ap

tis

H

fa
c

tio

n

ls
ta
te
ia

sa

nc

Li

fe

na
Fi

Fr
ie

nd

sh
i

p

n
ily

Fa
m

ly
ai
D

re
l

fe
e

ea

lin

at
io

g

lth
y

50

H

Learning and lecture
participation

Fig. 4. The visual analogue scale-happiness scores analyzed for each activity. **P < 0.01: compared with all otheractivities.

al., 2002). Though it is believed that being healthy
is one of the conditions for participating in an activity, participation in the activity itself also helps
people to feel better and healthier. When the elderly stay at home with no daily routine, few of them
have a sense of being healthy; however, participation in daily activities may produce a sense ofhealth by the recognition of their ability to move oreven create something. The VAS score for daily
feeling was also higher for the AP group. There is
one report which showed that by making friends,
having conversation, going on hot spring tours andmaking handicrafts, stress was alleviated and depression lowered considerably (Shibata, 1996).
Thus, it can be inferred that stress divergence also isan effect of AP brought about by improving an elderly persons’ daily feeling. The VAS-H score onlife satisfaction of the elderly scored higher in the
AP group, indicating that AP works to make the elderly feel satisfied with their life. Some reports saythat AP sometimes brings the person to a new andimpressive discovery in daily life, and this helps
him/her to be interested in something and to avoid
isolation (Barkay et al., 2002; Holahan et al., 2002).
However, in the elderly subjects of this study, better financial condition of the AP group might haveelderly manpower service activity refers to the one
where the elderly register to obtain jobs. Activities
not included in these 4 types were dealt with separately as “other activities”.
The VAS-H score was higher for the club andother activities. Elderly subjects whose relation
with family went well and who were satisfied financially participated in these 2 types of activities. The
lowest VAS-H score was seen in elderly subjects
belonging to the elderly manpower service activity,
and the score was significantly lower comparedwith the other 4 types (P < 0.01) (Fig. 4).

Discussion

Comparison of VAS-H between AP and nonAP groups
The VAS-H score for health consciousness washigher in the AP group than in the non-AP group,suggesting that the elderly who participated in
activities had a better health status leading to ahigher QOL. This finding is supported by several
studies in which most elderly subjects were healthy
in the state of AP (Sugai et al.,1996; Lindstrom et

22Activity participation in the elderly

indicated that if one participates in an activity
which one can adhere to for a longer time, his/her
QOL improves when he/she gets older. Other activities and club activity occupied the highest andsecond highest scores in the QOL measure on the
VAS-H. Since the elderly persons participating inthe 2 activities had good family relations and financial state, these factors have to be considered as agreat influence on the higher QOL of the 2 activities.
The lowest QOL was found for elderly persons
who were members of the elderly manpower service activity, and interestingly, this was true for all
7 items of the QOL measure. Especially, the QOL
score for financial state and friendship was much
lower than the other 4 activities. The reason why
the elderly register in this service was to obtain a
job and income, and no subject registered for ahobby or an interest or to maintain their health. For
the elderly in a lower financial state, it was suggested that AP was still a means of earning income
and they could not afford to enjoy AP.
In conclusion, the AP group had a high QOL in
all items on the VAS-H QOL measure than the nonAP group as expected. For the items of health consciousness, life satisfaction, feeling in daily living
and happy feeling, these were shown to have significant differences. The 24 items for assessing psychosocial condition also resulted in the AP-group
being satisfied with their current life and living withless boredom; however, this trend was not clear in
the non-AP group. Among the activities of the APgroup, a longer-kept activity was shown as relevant
to a higher QOL. However, the elderly in a job activity had a lower QOL on financial condition, andseemed to have the disadvantage of not being able
to enjoy activities due to a lack of sufficient funds.

influenced their daily feeling or life satisfaction in apositive way.

Comparison of psychosocial condition between AP and non-AP groups
Between the 2 groups there was a different response
pattern for the 24 items from the personality anddepression scale. As seen in Figs. 2 and 3, for the
AP group, the “yes” and “no” items were clearly
separated with higher dispersions. However, forthe non-AP group, dispersions between the “yes”
and “no” items were lower than the AP group. Thisshows that the AP group distinctly responded tosome items by saying “yes” and some other items
by saying “no,” but for the non-AP group, a distinction between the “yes” and “no” answers was notwell clarified compared with the AP group. It
seems that the AP group clearly agreed that they felt
happy and satisfied with their life, and clearly disagreed that their interests in activities were fadingout or they often got bored. On the other hand, thenon-AP group showed a positive response to thequestion by a general expression like “being alive iswonderful” or “things should be done in an exact
manner.” However, their responses were vague tothe question of whether or not their life was goinghappily or satisfactorily.

QOL and AP
Among the 5 activities (community center activity,
learning and lecture participation, club activity, elderly manpower service activity and other activities), other activities had the highest QOL score on
the VAS-H. Also, other activities included elderly
persons who had been participating in an activity
for more than 3 years or even several elderly persons who had been adhering to one for more than 30
years. Some elderly who participated in other activities mentioned that their activities became a big
part of their life; therefore, it was easy for them tokeep going at it without any trouble. It is not easy
for one to find something like a hobby or an interest
at an older age. However, the result of this study

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Received December 24, 2002; accepted January 23, 2003
Corresponding author: Miyoko Matsuo

24