This study examined data from the Swedish Panel Study of Living Conditions of the Oldest Old from 1992, which had approached 537 participants who had exceeded the upper age limit of the Swedish Survey of Living Conditions (used in the studies by Bygren et al), to ask them about their leisure activities. This included scope for reporting on attendance at the cinema and cultural venues including theatres, concerts and museums (reported as a combined category), reading books or newspapers (two separate categories) and participating in study groups across the frequency levels of not at all, sometimes or often. In 1996, 463 non-institutionalised respondents were followed up for survival. Mortality between 1992 and 1996 was taken as the main outcome measure, and a Cox proportional hazard regression model was used to estimate the relative effects of independent variables (including age, gender and educational level) on the logged hazard rate of mortality. Additional controls were made for factors observed to increase mortality risk, including functional impairment, the presence of heart or circulatory problems and tobacco use.
The focus of this study – looking at the relationship between engagement in life and successful ageing – was on the extent to which those leisure-time activities found to influence mortality were sedentary or active, solitary or social. Within this, socio-cultural attendance was taken to fall into the latter category on each axis, i.e. active and social, which contradicted studies suggesting that non-participatory attendance is more passive than active. When adjusting for age and education, socio-cultural activities showed a negligible association with mortality in either gender. The same pattern was observed when adjusting for age, education, functional health, circulatory/heart problems and current smoking. The only association that was observed to have a positive effect on mortality was engagement in solitary–active activities, such as gardening and engaging in hobbies (including carpentry), and this association was only observed in men.
In interpreting these results, the researchers offered a cautionary note that reverse causation might exist between the choice of activities and health condition. An effort was made to compensate for this by including the multi-dimensional confounder of functional ability, which was arrived at through the physical testing of participants. Further, the relatively small sample size and the observational nature of this study precluded any causal claims while admitting the possibility of residual confounding.
The relevance of this study to the present analysis lies in its rejection of socially orientated leisure-time events (including cultural and religious attendance) as a significant factor in mortality in older people. It also considered the subjective nature of participation, observing that ‘It is likely that activities are consequential when they are experienced as significant ways to engage one’s free time’ (p. S340).
Carin Lennartsson and Merril Silverstein, ‘Does Engagement With Life Enhance Survival of Elderly People in Sweden? The Role of Social and Leisure Activities’, Journal of Gerontology 56B, no. 6, 2001, pp. S335–S342.