Physical Leisure Activities and the Risk of Dementia in the Elderly

This paper is a literature review on the leisure activities of dementia among the elderly and the suggestion for further studies. It aims at identifying whether physical leisure activity participation in old age reduces the risks of moderate dementia. The paper discusses the importance of leisure activity engagement, cognitive reserve hypothesis, physical activity on risk dementia, and the impact of physical and mental activities on cognitive function.

Running head: LEISURE ACTIVITY AND DEMENTIA
Physical Leisure Activities and the Risk of Dementia in the Elderly
Name:
Institutional Affiliation:

LEISURE ACTIVITY AND DEMENTIA 2
Physical Leisure activities and the risk of moderate dementia in the elderly
The risk of dementia has been associated with old age. The older one gets the higher the
chances of dementia. A lot of attention has been provided to dementia and researches on possible
ways to prevention strategies. Identification of protective factors is important to the development
of effective modes of management of dementia. Several studies link dementia to less
participation in leisure activities during the middle adulthood. The leisure activities also play a
role in cognitive status in old age. According to Genoe (2010), individuals with a higher level of
education are less likely to be exposed to dementia due to the great capacity of cognitive reserve.
This paper is a literature review on the leisure activities of dementia among the orderly and the
suggestion for further studies.
Objectives
The previous studies suggest that engagement in leisure activities such as physical, social
and mental activities are associated to lower risk of dementia. Engagement in leisure activities is
associated with successful aging and those above the age of 85 years receive a lot of cognitive
impairments that affects their daily activities functioning satisfaction. Few studies have evaluated
the link between leisure activities and dementia. Chang, Wray and Lin (2014) also link a
person’s engagement in leisure activities to improve the cognitive reserve resulting in lower risk
of dementia. Therefore, this paper aims at identifying whether physical leisure activity
participation in old age reduces the risks of moderate dementia. In this case, physical leisure
activities would include; hiking, swimming, dancing and planned exercise.
Statement of the problem
Improved health care services have increased the life expectancy among the older adult in
their mid-60s. An increase in the population of older adults in the world today has seen an

LEISURE ACTIVITY AND DEMENTIA 3
increase in cognitive impairment disorders such as dementia. According to the world health
organization report (2015), by 2030, 75.6 million of older adults have been diagnosed with
dementia. The risk of diagnosis of dementia is seen to increase with age such that 5-8% between
the ages of 65-74years and 25-50% for those above the age of 85 is affected with cognitive
impairment (American Psychological Association, 2012). The increased prevalence of diagnosis
of cognitive impairments disorders such as dementia at an older age has led to research on the
link between leisure activities and old age and the possible interventions to manage the disorder.
Dementia
Dementia affects an individuals’ short-term memory and the ability to reason. An
individual diagnosed with dementia loses their ability to perform daily activities. They are unable
to conduct social, physical and cultural activities as they were able to practice before. According
to Fernández et al. (2015), dementia is common among patients in the special care unit as they
find difficulty in handling the burden they put on family and friends. The progressive decline in
daily functioning due to dementia leads to decline in verbal communication skills. These
difficulties lead to decrease engagement in activities (Mesman, Buchanan, & Berg, 2011).
Importance of leisure activity engagement
According to Heo, Stebbins, and Lee (2013), leisure time is defined as one’s free or spare
time, where they do not take part in any form of work or studying. It is the time one engages in
activities that interests them without obligation. It is time one relaxes and enjoys doing what they
desire. Leisure is characterised with participation in different activities. According to past
studies, a positive relationship exist between leisure activities engagement and increased health
benefits. Involvement in leisure activities is associated with reduced risk of chronical illnesses
and diseases. Physical leisure activities lead to improved functions and physical strength leading

LEISURE ACTIVITY AND DEMENTIA 4
to flexibility in joints and muscle strengths. Heo and Lee (2010) denote that, when older adults
practice leisure physical activities, they experience positive mental and psychological health
aspects. These include self-enjoyment, happiness, positive emotions and feelings. An attachment
to certain activities maintains an involvement and creation of emotional and social connection
among the participants with the same interests.
Leading lifestyle activities is critical in maintaining high levels of cognitive functioning
in old age. Stern (2017) denotes that cognitive decline can be prevented through the lifestyle
activities that stimulate the cognitive reserve in an individual. There are beneficial roles of
intellectual leisure activities as learning a new language or engaging in learning activities that
leads to the development of the cognitive level of an individual. This explains the inter-
individual differences in cognitive functioning which is visible in old age. Increased leisure
activities lead to improved cognitive functioning in old age. Leisure activities such as doing
sports, attending theatres, participation in clubs and playing games are important for the
development of cognitive activities (Wang et al., 2013).
According to Horowitz and Vanner, (2010), active engagement in leisure activities is
essential to the cognitive development and physical health. Dementia has been a major health
problem, and its prevention is important. Studies have reported that, those engaged in leisure
activities during young adulthood are less likely to contract dementia in older adulthood. Also
though engaged in leisure activities in older adult hood are at low risk of dementia. According to
Jonaitis et al. (2013) higher education level is linked to reduced risks of dementia due to
development of greater cognitive reserves as a result of increased neural synapses. Education
develops the cognitive ability of an individual. Those with lower level of education are at higher
risk of contracting dementia at old age when different changes occurs to the brain. Participation

LEISURE ACTIVITY AND DEMENTIA 5
in leisure activities reduces the risks of dementia as it improves the cognitive reserves making it
easy for adjustments when the changes occur in the brain. A study conducted by Garcia,
Feliciano & Ilem, (2018) showed that older adults who participated in leisure activities had lower
risks of dementia compared to those who did not participate in leisure activities.
Genoe, (2010), acknowledges that despite the results of their study linking leisure
activities to having a protective role in dementia, other alternatives can address the issue in
depth. Dementia is characterized by a long period of decline in cognitive functioning. Reduced
activities in the preclinical phase of dementia may be as a result of cognitive decline and not the
cause. Depression is associated with cognitive issues and a decline in cognitive functioning and
may result in dementia. Cognitive status, level of depression, and educational level may
confound the relationship between dementia and leisure activities (Adams, Leibbrandt, & Moon,
2011)
Leisure activities represent an individuals social capital from where emotional and support
are drawn by the elderly. The individuals who participate in leisure activities are found to have
high social networks that prevent loneliness (Sauter, Widmer, & Kliegel, 2018). Loneliness is
associated with depression leading to a decline in cognitive functioning. More research has
shown evidence that participation and engagement in leisure activities among the elderly people
results in considerable health benefits such as social benefits, psychological, physical and
cognitive. Psychological and cognitive mental health can lead to serious health issues in the older
adults. Leisure activities is linked to happiness and enjoyment that results in healthy mental state.
The physical perspective shows that there is a strong link between the physical wellbeing and
leisure activities. Reduced leisure activities are linked to slower rate of motor function that
results in a decline in chronic diseases in old age (Heo et al., 2013).

LEISURE ACTIVITY AND DEMENTIA 6
Chang, Yu, and Jeng, (2015) argue that the link between leisure activities and cognition
depends on the significant extent on leisure activities in young adulthood. Gates & Valenzuela
(2010) analyzed the association of reduced cognitive leisure activities with the reduced global
functioning of cognition. The decline is evident in the speed of cognition functioning but not in
the memory. According to Chang, Yu and Jeng, (2015) several factors have linked to causes and
prevent dementia. They affirm that frequent engagement of leisure activities results in reduction
of risk of contracting dementia. Social and mentally stimulating activities lessen the risk of
dementia. They increase the functioning of the brain and association with positive reinforcement
that leads to good health status and general wellbeing.
Cognitive reserve hypothesis
The cognitive reserve hypothesis provides a potential account of the findings of the
relationship between leisure activities and dementia. Two related models have been used to
illustrate the concept; the active and passive model. The passive model describes that the reserve
capacity of each person differs due to the structural neural substrates that are different in
different individuals, for instance, the brain weight. The increased number of neurons and
synapses in the cortex leads to greater brain reserve which is associated with larger brain weight.
The larger brain weight compensates the brain when there is a decline and pathological changes
due to increase in age which may lead to dementia disease. When a critical threshold reserve has
been achieved in the brain, dementia occurs (Wang et al., 2013).
On the other hand, the active model of cognitive reserve hypothesis focuses on the
capability of an individual to compensate the degradation of the brain in old age. Engagement in
leisure activities and positive environmental aspects can lead to an individual gaining a larger
cognitive reserve. This leads to more efficient and effective cognitive network. The cognitive

LEISURE ACTIVITY AND DEMENTIA 7
networks enable one to compensate for the cognitive decline caused by pathological changes and
use the alternative networks in cases of dementia. Physical activities are linked to neural
beneficial effects that have also been proposed to prevent dementia, and this is supported by
several other studies that linked the physical activities and dementia (Wang et al., 2013).
Physical activity on risk dementia
According to Sofi et al. (2011), there are benefits associated with physical activities such
as playing games to the reduction in risk of dementia. The increased physical activities prevent
the onset of dementia. However, no evidence presented have confirmed that physical activities
prevent dementia (Cohen et al. 2010).
Impact of physical and mental activities on cognitive function
Leisure activities involve a variety of various activities such as reading, playing games
that associated with thinking and reasoning. Research shows that cognitive exercise has an
impact on the performance of the neuropsychology. The literature above summarizes some of the
evidence on leisure activities, cognitive decline and the risk of dementia. They show that
physical and mental leisure activities may protect against cognitive decline and dementia. It is
also clear that the beneficial impacts of physical activity on the risk of dementia need to be
researched further. Cognitive training has an impact on improving the cognitive functions in the
older adults which leads to the development of the cognitive reserves that reduces the risk of
dementia (Gates &Valenzuela, 2010). Therefore, leisure activities that involve mental actions are
critical.
However, according to a study conducted by Wang et al. (2012), certain leisure activities
do not show any connection with dementia. There are no relationships between the increased
leisure activities and risk of dementia. Therefore there is a need for further studies and evidence

LEISURE ACTIVITY AND DEMENTIA 8
to conclude the relationship between engaging in leisure activity and dementia (Horowitz &
Vanner, 2010).
The various methods and study populations explain the differences in the previous
studies. There are other factors such as physical well-being and health-related behaviors that are
related to physical activities. For instance, depression can affect ones’ ability to participate in
leisure activities. Therefore the need to control these factors when researching the impact of
leisure activities engagement and risk factors of dementia (Chang et al., 2010). (Stern, 2017) also
contributes to the need to control other factors when conducting research.
Methodology
The paper will use the quantitative research method. The method involves converting
data into a numerical form to enable statistical calculations and conclusions to be drawn. The
research will have two hypotheses;
 Null hypothesis: there is no significant relationship between physical leisure activities
and risk of moderate dementia in older adults.
 Alternative hypothesis: there is a significant relationship between physical leisure
activities and the risk of moderate dementia in older adults.
The study will also adopt the use of music therapy with the aim of monitoring its direct
and indirect effect in the treatment of dementia. This is because music has been identified as
a good therapeutic strategy for many health complications it is has some effects on the
patient.
Data collection method
The data collected will be critically examined in order to conclude. Also, other variables
such as the physical and social wellbeing will be controlled in order to achieve accurate

LEISURE ACTIVITY AND DEMENTIA 9
information and for the conclusion not to be biased. The data will be collected through the
means of interviews and questionnaires. The interviews will be informal in order to encourage
elderly people to share information. The interviews will obtain data on any history of the
diseases and for the participants in the health care facilities; the records will be obtained from the
medical history that is the secondary data available in the facilities. The data on leisure activities
will be collected using questionnaires with structured questions on how frequent they participate
in physical leisure activities such as hiking, swimming, dancing and planned exercise in a three
months period. The above mentioned physical leisure activities will be included where they will
select the type of activities they participated in and how frequent. The participants will be older
adults from the age of 65 and above. The questionnaires will be sent to the participants in their
homes and also those at the health centers.
Geriatrics and aging recreational activities will also be used with the aim of reducing
behavioral symptoms in dementia. Random sampling will be used to collect data and the selected
participants will be taken and will be presented with the questionnaires. A list of different
physical activities will be provided on the questionnaires, and the participants asked on how
frequently they participate in the physical activities. They will also indicate if they never
participate in physical activities. Different physical activities will also be included where the
participant will be required to select the type of activities they participate in.
Report on findings
The findings will be reported using descriptive statistics to illustrate the characteristics of
the sample tested. The statistical results will be presented using the American psychological
association format. Each of the statistical tests will end with one or two sentences that the results
explain about the hypothesis. That is it will indicate whether the hypothesis was supported by the

LEISURE ACTIVITY AND DEMENTIA 10
data collected. The figures and tables will be used to assist in visualizing the significance of the
results. They will also be used to summarize the results of the data collected. The findings will
be made simple in order to allow easy interpretations of results and a clear response to the
hypothesis.
Suggestions for the future
The studies have focused on moderate stage of dementia. There is a need to identify the
different types of dementia and determine the effects of different leisure activities of them. The
results from the prior studies conducted are inconsistent; some identified the significant effect of
leisure activities on cognitive functions while others did not note the difference. These indicate
the limited studies on the topic. Therefore there is a need for further studies to identify the
potential link between dementia and different leisure activities. There is also the need for specific
research on the specific type of dementia in respect to leisure activities.
Budget and Gantt chart
Budget
An estimated budget for the proposed project will be $ 4500. The money will be used as
follows:
Research from online resources, peer reviewed journal and textbooks for the literature review
will cost and estimate of $ 1000
Data collection is estimated at $ 2000
Data analysis at $1000
And miscellaneous at $ 500
The table below shows a summary of the activities;

LEISURE ACTIVITY AND DEMENTIA 11
Appendix
Table 1.1 Budget
Use Amount
Literature Review $1000
Data Collection $2000
Data Analysis $1000
Others $ 500
Estimated Total Budget $4500
Gantt chart
The activities will be undertaken as summarized below;
Table 1.2 Gantt chart
Task Week 1 Week 2 Week 3-12 Week 13 Week 14
Problem
identification
Literature review
Data collection
Data analysis
Discussions,
report and
findings

LEISURE ACTIVITY AND DEMENTIA 12
Matrix
Author Purpose EBP Level
and
Research
Design
Outcome
Measure
Results Conclusion
and Method
Concerns
Adams, K.
B.,
Leibbrandt,
S., and
Moon, H
The study
measures the
activity
among older
adults and
reported
literature on
specific
dimensions
of activity
and
wellbeing
Data was
collected
from
secondary
sources;
PsycInfo,
AgeLine,
Medline,
Academic
Search
Premiere and
CINHAL,
and peer-
reviewed
journals or
leisure
activity
among non-
institutionally
resident older
adults
published
from 1995 to
2009.
Of the
42 studies, 24
were cross-
sectional and 18
longitudinal.
The longitudinal
studies spanned
from four to 20
years
Most of the
reviewed
studies
showed
positive
associations
between
activity
participation
and
psychosocial
wellbeing,
survival or
health.
Social,
productive
and leisure
activities
have
significant
associations
and
predictive
relationships
with aspects
of wellbeing
for older
adults.
The activities
need to have
specific
measures.
Brajsa-
Zganec, A.,
Merkas, M.,
and Sverko,
Shows how
leisure
activity
involvement
4,000
participants
recruited
through large
Different
subsamples and
show moderate,
but substantial
The pattern of
important
leisure
activities
study findings
show that
participation
in various

LEISURE ACTIVITY AND DEMENTIA 13
I contributes
to subjective
wellbeing
scale public
opinion and
representative
of adult
population.
contribution of
leisure activities
to social
wellbeing.
somewhat
varies in
different
samples
leisure
activities
significantly
contributes to
SWB of
Croatian
citizens,
and this
confirms the
general
hypothesis
about positive
relationship
between
participation
in leisure and
social
wellbeing.
Cardenas,
D.,
Henderson,
K. A., and
Wilson, B
Examines
how Senior
adult
participate
and are
involved in
games and
their
perceived
impact on
health
The study
used random
sample of
1000
Participants
from the local
community
from local
events.
The intrinsic
factors for
participation
included; fun
and competition
was the highest
rated. Doctors’
recommendation
was the lowest
rated factor.
The results
showed how
positive
participation
into
community
leisure
activities has
an impact on
older adults.
The
community
based
physical and
social leisure
activities
motivates
individual to
participate in
them and it
contributes to
the health of
the older
population.
Chang, P.-J.,
Wray, L., &
Lin, Y.
Purpose is to
examined
how leisure
Core
interviews
were
Physical and
psychological
well-being were
The results of
this study
confirmed the
An improved
understanding

LEISURE ACTIVITY AND DEMENTIA 14
(2014) influences
the link
between
social
relationships
and health in
older age
conducted in
participants’
homes in
1992; follow-
up interviews
were
conducted by
phone every
two years
thereafter.
The HRS
surveys a
representative
sample of
26,000
Americans
every two
years
coded so that
the larger the
value, the lower
the level of
physical health
and
psychological
well-being.
hypothesis
that the links
between
social
relationships
and physical
health or
psychological
well-being
were
enhanced in
the presence
of leisure
activities.
of the
mediating
effect of
leisure
activities in
such a link is
important for
improvement
and
maintenance
of health
among the
older
population,
which can be
applied to
effective
intervention
development
to help older
adults during
the aging
process
Heo, J.,
Stebbins, R.
A., Kim, J.,
& Lee, I
examines the
relationships
among
serious
leisure, life
satisfaction,
and health
of older
adults
there were
564 older
adults who
participated
in the Indiana
Senior
Games. They
were asked to
complete a
survey linked
to online
registration.
There were
benefits
associated with
serious leisure
participation.
The findings
have
expanded the
body of
knowledge,
demonstrating
that leisure
involvement
in the context
of serious
leisure is
positively
associated
with life
Confirms the
relationship
among
leisure, life
satisfaction
and health
makes it
important to
Increase
efforts in the
involvement
of older

LEISURE ACTIVITY AND DEMENTIA 15
satisfaction,
physical
health and
mental health
adults in
Serious
leisure
activities.

LEISURE ACTIVITY AND DEMENTIA 16
References
Adams, K. B., Leibbrandt, S., & Moon, H. (2011). A critical review of the literature on social
and leisure activity and wellbeing in later life. Ageing & Society, 31, 683–712.
American Psychological Association. (2012). Guidelines for the evaluation of dementia and
agerelated cognitive change. American Psychologist, 67, 1–9.
http://dx.doi.org/10.1037/a0024643
Brajsa-Zganec, A., Merkas, M., & Sverko, I. (2011). Quality of life and leisure activities: How
do leisure activities contribute to subjective well-being? Social Indicators Research,
102(1), 81–91
Cardenas, D., Henderson, K. A., & Wilson, B. (2009). Experiences of participation in Senior
Games among older adults. Journal of Leisure Research, 41(1), 41–56
Chang, Y., Nien, Y., Tsai, C., & Etnier, J. L. (2010). Physical activity and cognition in older
adults: The potential of Tai Chi Chuan. Journal of Aging & Physical Activity, 18(4), 451–
472.
Chang, P.-J., Wray, L., & Lin, Y. (2014). Social relationships, leisure activity, and health in
older adults. Health Psychology, 33(6), 516–523. https://doi.org/10.1037/hea0000051
Chang, L.-C., Yu, P., & Jeng, M.-Y. (2015). Effects of leisure education on self-rated health
among older adults. Psychology, Health & Medicine, 20(1), 34–40.
https://doi.org/10.1080/13548506.2014.897914
Cohen-Mansfield, J., Marx, M. S., Thein, K., & Dakheel-Ali, M. (2010). The impact of past and
present preferences on stimulus engagement in nursing home residents with dementia.
Aging & Mental Health, 14, 67–73.

LEISURE ACTIVITY AND DEMENTIA 17
Fernández-Mayoralas, G., Rojo-Pérez, F., Martínez-Martín, P., Prieto-Flores, M.-E., Rodríguez-
Blázquez, C., Martín-García, S., … Forjaz, M.-J. (2015). Active ageing and quality of
life: factors associated with participation in leisure activities among institutionalized
older adults, with and without dementia. Aging & Mental Health, 19(11), 1031–1041.
https://doi.org/10.1080/13607863.2014.996734
Garcia, S., Feliciano, L., & Ilem, A. A. (2018). Preference assessments in older adults with
dementia. Behavior Analysis: Research and Practice, 18(1), 78–91.
https://doi.org/10.1037/bar0000045
Gates, M. Valenzuela (2010). Cognitive exercise and its role in cognitive function in older adults
Curr. Psychiatry Rep., 12 (6), 12-34
Genoe, M. R. (2010). Leisure as resistance within the context of dementia. Leisure Studies,
29(3), 303–320.
Heo, J., Stebbins, R. A., Kim, J., & Lee, I. (2013). Serious Leisure, Life Satisfaction, and Health
of Older Adults. Leisure Sciences, 35(1), 16–32.
https://doi.org/10.1080/01490400.2013.739871
Heo J, Lee Y. (2010) Serious leisure, heath perception, dispositional optimism, and life
satisfaction of Senior Games participants. Educational Gerontology, 36(2):112–126.
Horowitz, B., & Vanner, E. (2010). Relationships among active engagement in life activities and
quality of life for assisted-living residents. Journal of Housing for the Elderly, 24, 130 –
150
Jonaitis, E., La Rue, A., Mueller, K. D., Koscik, R. L., Hermann, B., & Sager, M. A. (2013).
Cognitive activities and cognitive performance in middle-aged adults at risk for

LEISURE ACTIVITY AND DEMENTIA 18
Alzheimer’s disease. Psychology and Aging, 28(4), 1004–1014.
https://doi.org/10.1037/a0034838
Mesman, G. R., Buchanan, J. A., Husfeldt, J. D., & Berg, T. M. (2011). Identifying preferences
in persons with dementia: Systematic preference testing vs. caregiver and family member
report. Clinical Gerontologist: The Journal of Aging and Mental Health, 34, 154 –159.
http://dx.doi.org/10.1080/ 07317115.2011.539516
Sauter, J., Widmer, E., Ihle, A., & Kliegel, M. (2018). The association of leisure activities in
middle adulthood with cognitive performance in old age: Social capital mediates
cognitive reserve effects. Psychology & Neuroscience.
https://doi.org/10.1037/pne0000146
Sofi, D. Valecchi, D. Bacci, R. Abbate, G.F. Gensini, A. Casini, C. Macchi. (2011). Physical
activity and risk of cognitive decline: a meta-analysis of prospective studies J. Intern.
Med., (269),107-117.
Stern, Y. (2017). An approach to studying the neural correlates of reserve. Brain Imaging and
Behavior, 11, 410–416. http://dx.doi.org/10.1007/s11682- 016-9566-x
Wang, H.-X., Jin, Y., Hendrie, H. C., Liang, C., Yang, L., Cheng, Y.,... Gao, S. (2013). Late life
leisure activities and risk of cognitive decline. The Journals of Gerontology: Series A, 68,
205–213. http://dx.doi.org/10.1093/gerona/gls153
World Health Organization. (2015). Governments commit to advancements in dementia research
and care [News release]. Geneva, Switzerland. Retrieved from
http://www.who.int/mediacentre/ news/releases/2015/action-on-dementia/en/