1. Background

The aging of the South Korean society is progressing at an unprecedentedly rapid rate compared to the other countries in the world, including advanced countries like the United States and France. In 2026, South Korea is expected to become a post-aged society, with the elderly population estimated to reach 20.8% of the total population, and elderly people living alone are estimated to account for three-fifths of the total elderly population [1]. The rapid increase of the elderly population in South Korea has caused many changes in the status and role of the elderly in the South Korean society due to the changes in the socioeconomic structure resulting from modernization, urbanization, and industrialization, and it is emerging as a serious social problem.

As South Korea has become an aging society, the number of elderly people living alone reached 987,000 at the end of 2009, and the average age of the elderly women living alone is 75.1 years, which is expected to be higher than that of the elderly men living alone. The proportion of elderly women living alone is 84% of the total elderly people living alone. As the social interest in the elderly women living alone is increasing, the elderly women living alone themselves need to change their attitudes and become more active and optimistic [2]. As the economic wealth of the overall society has increased, and as the people's economic status has generally been improved, there is an increasing interest in pursuing the meaning of life. The elderly women living alone, however, are more exposed to economic and physical health problems than the other generations, and are faced with increasingly difficult problems due to a lack of family and social support [3]. In particular, they mostly live in seclusion due to isolation and alienation, do not associate with the people around them, and are weakened by disease. In addition, they exhibit psychological weakness and dependency, experience loneliness, and exert effort only to fill their daily lives. Therefore, there is a need for them to cope with the loss of their social status or role, loneliness, and feelings of alienation accompanying the physical, psychological, and social problems that they face. It is possible that the role loss of elderly women living alone not only reduces their self-esteem in social and mental terms [3] but also exacerbates their poor health status, psychological depression, and loneliness. Therefore, it can be said that a healthy old-age life is a requirement for giving a new meaning to the lives of elderly women living alone, and finding independent work for them to maintain their good health and regain their life may be achieved through their participation in leisure activities designed for them [4].

On the other hand, for elderly women living alone, leisure activities have different meanings from general leisure activities. Havighurst [5] stated that engaging in a leisure activity means taking a break from the stress of human relationships and restoring balance in one's life; in addition, it is an attempt to embrace new challenges and experiences as well as the pursuit of enjoyment. Therefore, the leisure activities of elderly women living alone are a crucial determinant of a successful life in old age [6, 7], and living a more meaningful and satisfying life may increase the morale and satisfaction of elderly women living alone and may improve their insights on life.

As a result of the extension of the average lifespan in today's aging society, the problem of leisure activities of elderly women living alone is thought to boil down to how to utilize their free time, which has been lengthened without pastimes compared to the other age groups. Therefore, how to spend one's abundant free time is a challenge for elderly women living alone [8]. Their participation in leisure activities leads to the improvement of their physical and mental confidence, contributes to their psychological well-being, and improves their health. It also drives them to pursue a pleasant life and self-worth, and enhances their self-reliance [9]. Therefore, health is very important to elderly women living alone, and their participation in leisure activities is related to the quality of their lives [10]. If their leisure activities become insufficient or if their social activities are decreased, they eventually become self-centered and isolated. Therefore, their depression and loneliness, which are associated with a person's psychological health, also become more pronounced.

On the other hand, the previous domestic and foreign studies on participation in leisure activities were mostly limited to the investigation of the level of health status of elderly people, and only presented the correlations among health status, depression, solitude, successful aging, and quality of life [4, 10, 13]. In relation to the difference in the health status of elderly people, each type of leisure activity was reported to maintain elderly people's physical health and was found to promote the good health of elderly people who are psychologically confused [11, 12]. Moreover, it was found that participation in leisure activities reduces depression and loneliness in elderly people and is thus correlated with elderly people's health status [13]. In addition, it was suggested that because the quality of life of elderly people who actively participate in leisure activities is improved, participation in leisure activities is a major predictor of successful aging [4, 10]. The previous studies described above, however, used the variables related to the health status of the general elderly population to investigate their participation in leisure activities, and there have been few studies of elderly women living alone that investigated the factors affecting their participation in leisure activities, which are overall positive activities that help elderly women living alone cope with the loss of their social roles.

Therefore, it is believed that the development and utilization of nursing intervention programs that promote elderly women living alone's participation leisure activities and help them lead a more stable and meaningful life in old age are crucially required. Thus, this study aimed to provide a basis for the development of such nursing intervention programs.

2. Purpose

The purpose of this study was to identify the factors influencing the participation in leisure activities of elderly women living alone. Below are the specific goals of this study.

1. Study Design

This study was a survey research that was conducted to determine the level of participation in leisure activities of elderly women living alone, and to investigate their levels of perceived health status, psychological well-being, depression, and loneliness, which are known to be the variables affecting the participation in leisure activities of elderly women living alone.

2. Data Collection and Participants

The subjects of this study were 150 elderly women aged 65 or older residing in Seoul or Gyeonggi Province, South Korea and who were able to communicate. The number of study subjects was calculated at the significance level of .05 and the medium effect size of .15 to secure 95% statistical power for the multiple regression analysis using the G*Power 3.1.2 program. The adequate sample size was determined to be 138 persons. The survey questionnaires were administered to 155 participants, considering the dropout rate. The number of samples in this study was 150 persons, excluding five subjects who did not complete the questionnaire or whose questionnaire contained missing data. The study subjects were elderly women to whom the purpose of the study was first explained, and who thereafter voluntarily agreed to participate in the study. In relation to the specific criteria for selecting the study subjects, elderly women aged 65 or older who were clearly conscious, could communicate verbally and non-verbally, and could understand the purpose of the study were finally selected as the study subjects. For the reliability of the data collection, two research assistants were trained to understand each questionnaire item, and in the case of the questionnaire items that the survey participants might have difficulty understanding, or the ambiguous items, an additional explanation was added to help the participants understand them. Approximately 70 people from two senior citizen centers and 1 church located in Seoul, and approximately 85 people from 1 senior citizen center, 3 churches, and 1 elderly welfare center located in Gyeonggi Province, were selected as the survey participants. The purpose of the study was explained to the head of each facility and the people in charge, and the survey participants' consent was obtained before data collection was conducted. The survey was conducted by visiting the facilities after making an appointment to visit them at the time when the survey participants were to get together.

3. Measures

4. Procedures

To select the measurement tools to be used, a preliminary survey was conducted among 50 persons who were randomly selected on September 10~20, 2012 after receiving IRB approval for this study. In the second survey for the main study, after the contents and purpose of the study were explained to the subjects, questionnaires were administered only to the subjects who voluntarily agreed to participate in the study. Such subjects were asked to complete the questionnaire through the self-reporting method. The accomplished questionnaires were collected from October 2 to November 19, 2012. It took about more than 30 minutes for each subject to complete the questionnaire. Excluding five subjects who did not complete the questionnaire or had missing data, the data of the selected 150 survey participants were used for the final statistical analysis.

5. Data Analysis

The collected data were analyzed using the SPSS/WIN 21.0 program, according to the purpose of the study and the characteristics of the variables.

6. Ethical Considerations

In this study, after the receipt of IRB approval (Kyung Hee University IRB No. 2012-S26), the purpose and procedure of the study were explained to the study subjects. Their cooperation in collecting the data was then implored, and they were informed the data to be collected from them would not be used for any purpose other than research, and that they could withdraw from the study at any time, without any disadvantage. Copies of the questionnaire were distributed to those who agreed to participate in the study, and the latter were asked to accomplish these.

7. Limitations of the Study

The subjects of this study were elderly women living alone who participated in the activities of a senior citizen center, a church, or an elderly welfare center located in Seoul and Gyeonggi Province. There are limitations in explaining the participation in leisure activities of elderly women living alone in general, due to the limitation of the sampling of the study participants. Therefore, it is necessary to conduct an expanded study considering the sampling of research participants in the future.

1. General Characteristics of the Study Subjects

With regard to the average age of the elderly women who participated in this study, 70.7% of them were in the 65~69 age group. As for the education level, 57.4% were elementary school graduates or lower, and 34.0% were middle or high school graduates. The proportion of the subjects with a religion was as high as 74.0%, and the proportion of the subjects who were unemployed was as high as 81.3%. With respect to the economic status of the study subjects, 70.7% rated their economic status as medium. As for the average monthly allowance, the proportion of the subjects with a monthly allowance of 200,000~290,000 won was the largest (36.0%), followed by the subjects with a monthly allowance of 300,000~390,000 won (30.7%) (Table 1).

Table 1 General Characteristics of the Study Subjects (N=150) Click for larger image

2. Levels of Participation in Leisure Activities, Perceived Health Status, Psychological Well-being, Depression, and Loneliness of the Study Subjects

For the scores for participation in leisure activities, perceived health status, psychological well-being, depression, and loneliness of the study subjects, the score for participation in leisure activities was found to be 60.00 points, with a median of 60 points. The score for perceived health status was 10.20 points, with a median of 9 points, the score for psychological well-being was 67.57 points, with a median of 54 points, the score for depression was 46.17 points, with a median of 45 points, and the score for loneliness was 79.03 points, which was higher than the median (78 points) (Table 2).

Table 2 Levels of Participation in Leisure Activities, Perceived Health Status, Psychological Well-being, Depression, and Loneliness of the Study Subjects (N=150) Click for larger image

3. Participation in Leisure Activities according to the General Characteristics of the Study Subjects

The analysis results of the degree of participation in leisure activities according to the general characteristics of the study subjects showed that there were statistically significant differences in the level of participation in leisure activities according to the presence of religion (F=3.60, p=.035), economic status (F=25.11, p=.004), family structure (F=4.68, p=.042), and average monthly allowance (F=5.86, p=.002). In other words, the study subjects with a religion had a higher level of participation in leisure activities than those without a religion. As for the economic status and average monthly allowance, as these became higher, the level of participation in leisure activities increased (Table 3).

Table 3 Participation in Leisure Activities according to the General Characteristics of the Study Subjects (N=150) Click for larger image

4. Correlations between Participation in Leisure Activities and the Main Variables

As a result of the analysis of the correlation between leisure activity participation and each of the main variables, perceived health status (r=.61, p<.01) and psychological well-being (r=.59, p<.01) showed a positive correlation with participation in leisure activities while depression (r=−.48, p<.01) and loneliness (r=−.35, p<.01) showed a negative correlation with it. In other words, as the level of perceived health status and psychological well-being became higher, the level of participation in leisure activities increased. On the other hand, as the levels of depression and loneliness became lower, the level of participation in leisure activities increased (Table 4).

Table 4 Correlations between Participation in Leisure Activities and the Main Variables (N=150) Click for larger image

5. Factors Influencing Participation in Leisure Activities

The tests for the assumptions of the regression analysis showed that the assumptions were satisfied. First, using the Durbin-Watson test, the autocorrelation of errors was independently tested. As a result, the statistic was 1.81, which is larger than the test statistic of 1.76, indicating that there was no autocorrelation. In addition, the tolerance as an indicator of multicollinearity was 0.24~5.12, larger than .10. The VIF was 1.32~3.07, not higher than 10, indicating that all the variables did not have any problem of multicollinearity. Finally, the correlation coefficient between the independent variables influencing the participation in leisure activities of the elderly women living alone was −0.48~0.61, lower than 0.80, indicating that all the variables were independent of one another.

The factors affecting the participation in leisure activities of the subject elderly women living alone were analyzed using stepwise multiple regression analysis. As a result, perceived health status, average monthly allowance, psychological well-being, economic status, religion, depression, family structure, and loneliness (in descending order of significance) were found to affect the subjects' participation in leisure activities, and their explanatory power was 55.4% (Table 5).

Table 5 Factors Influencing Participation in Leisure Activities (N=150) Click for larger image