Leisure Activity Engagement Among the Oldest Old in China, 1998–2018

Abstract

Objectives. To examine the trends of leisure activity engagement among the oldest old in China for the past 2 decades.

Methods. Our panel data came from the Chinese Longitudinal Healthy Longevity Survey, which systematically asked respondents about their current participation in leisure activities over a 20-year period. The final sample contained 66 789 interviews from 1998 to 2018. We applied generalized estimating equations regression models in our analysis.

Results. Compared with 1998, odds ratios of television watching among Chinese oldest old individuals increased by about 2 to 3 times in 2018. Meanwhile, the odds ratio of exercise declined by 24%, mostly in men; playing cards and mah-jongg declined by about 30% for men. Results also showed that reading became less popular in the oldest old, and Chinese women tended to do more housework than before.

Conclusions. Our findings indicated that Chinese oldest old persons have become more sedentary and solitary in the past 2 decades. The negative trend in leisure activity engagement among the elderly Chinese population warrants policy attention, and the urgent development of public health interventions is required to reverse such trends.

Leisure time makes up a major part of one’s later life. Engagement in leisure activities, defined as preferred and enjoyable activities that an individual participates in during his or her free time,¹ has long been considered an important aspect of healthy and active aging. Meaningful and purposeful leisure activities are often found to be associated with a wide range of positive outcomes for older adults, including physical, mental, and social well-being, as well as reduced risks of mortality.²

Surveillance of the trends of leisure activities, especially leisure-time physical activity, has made substantial progress in the last 2 decades because of the importance of physical activity for preventive medicine.³ Yet existing studies have focused mostly on children and adolescents. With the world’s population aging at a rapid pace, monitoring the level and trend of leisure activity engagement among older adults is increasingly becoming an urgent priority.

Previous studies have mostly documented positive leisure-time physical activity trends among older adults in Western countries. For example, the proportion of older Americans reporting no leisure-time physical activity engagement declined gradually from the 1990s to the 2010s.⁴ Similar findings were reported in other Western societies.⁵ By contrast, studies conducted among elderly populations in Asia suggested that older adults are becoming increasingly more sedentary over time.⁶ To the best of our knowledge, no studies have specifically examined leisure activity engagement in the oldest old (80 years or older), the fastest-growing segment within the population of older adults. This is unfortunate because the association of leisure activities with quality of life tends to increase with age, and the oldest old are likely to have the greatest potential to benefit from leisure-targeted interventions.⁷ Our study fills the literature gap by examining the trends in leisure activity engagement among the oldest old in China over a 20-year period.

METHODS

Our data were from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which contains one of the largest data sets of oldest old cohorts in the world; a complete description of the CLHLS is given elsewhere.⁸ CLHLS features a panel design, and surviving respondents are reinterviewed each wave. Accordingly, we pooled observations across all 8 survey waves—namely, 1998, 2000, 2002, 2005, 2008, 2011, 2014, and 2018—and the final sample included 66 789 interviews.

The CLHLS systematically asked respondents about their current participation in 11 leisure activities: watching television, reading, exercising, engaging in outdoor activity, taking part in tourism, playing cards or mah-jongg, raising flowers or birds, gardening, doing housework, engaging in social activity, and participating in religious activity. A 5-level response category was used (almost every day, at least once a week, at least once a month, less than once a month, and never), except for “exercising,” which was coded as a yes-or-no variable. We collapsed the first 4 responses into the “yes” category and contrasted it with the “no” category.

We applied generalized estimating equations regression models to examine each leisure activity, with year as the key independent variable (1998 as reference), controlling for gender, age, rural or urban residence, activities of daily living, cognitive impairment, education, number of children alive, marital status, and region (for more details, see Table A, available as a supplement to the online version of this article at http://www.ajph.org). The generalized estimating equations models also accounted for repeated measures of the same individuals across waves through the exchangeable correlation structure.

RESULTS

Among the 11 leisure activities, we observed consistent temporal trends over 5 major activities—namely, watching television, reading, exercising, playing cards or mah-jongg, and doing housework (Table 1). Overall, the results suggested that the Chinese oldest old have become more sedentary and solitary over the past 2 decades.

TABLE 1—

Temporal Trends of Leisure Activity Engagement Among the Oldest Old: China, 1998–2018

	1998, No. (%) or OR (95% CI)	2000, No. (%) or OR (95% CI)	2002, No. (%) or OR (95% CI)	2005, No. (%) or OR (95% CI)	2008, No. (%) or OR (95% CI)	2011, No. (%) or OR (95% CI)	2014, No. (%) or OR (95% CI)	2018, No. (%) or OR (95% CI)
Sample size	8235	10 179	10 069	9551	10 882	5177	3681	9015
Watching television
No. (%)	2075 (34.8)	3227 (32.9)	3219 (39.5)	3267 (46.5)	4035 (51.5)	2222 (54.4)	1721 (57.0)	3996 (56.7)
All	1 (Ref)	1.25 (1.17, 1.33)	1.56 (1.46, 1.67)	1.74 (1.62, 1.86)	2.14 (2.00, 2.29)	2.32 (2.14, 2.52)	2.55 (2.33, 2.79)	2.40 (2.23, 2.59)
Urban, male	1 (Ref)	1.27 (1.12, 1.45)	1.50 (1.30, 1.73)	1.53 (1.32, 1.78)	1.70 (1.46, 1.98)	2.04 (1.72, 2.42)	2.16 (1.79, 2.62)	1.92 (1.65, 2.24)
Urban, female	1 (Ref)	1.28 (1.12, 1.48)	1.91 (1.65, 2.20)	2.21 (1.91, 2.56)	2.51 (2.18, 2.89)	3.30 (2.79, 3.90)	3.80 (3.18, 4.55)	3.70 (3.14, 4.37)
Rural, male	1 (Ref)	1.10 (0.97, 1.25)	1.33 (1.16, 1.52)	1.45 (1.26, 1.66)	1.74 (1.51, 2.00)	1.73 (1.47, 2.03)	1.84 (1.54, 2.20)	1.77 (1.54, 2.03)
Rural, female	1 (Ref)	1.21 (1.05, 1.41)	1.65 (1.43, 1.92)	1.90 (1.65, 2.20)	2.75 (2.39, 3.16)	2.76 (2.34, 3.24)	3.06 (2.58, 3.64)	3.24 (2.78, 3.78)
Reading
No. (%)	1394 (22.2)	1832 (16.3)	1546 (17.6)	1413 (18.9)	1292 (16.2)	798 (19.5)	582 (18.2)	1420 (20.7)
All	1 (Ref)	0.97 (0.89, 1.05)	0.95 (0.87, 1.04)	0.91 (0.82, 1.00)	0.69 (0.62, 0.76)	0.83 (0.74, 0.93)	0.79 (0.69, 0.90)	0.68 (0.60, 0.75)
Urban, male	1 (Ref)	0.98 (0.86, 1.11)	0.96 (0.83, 1.11)	0.88 (0.75, 1.03)	0.63 (0.54, 0.75)	0.68 (0.57, 0.82)	0.65 (0.54, 0.79)	0.58 (0.49, 0.69)
Urban, female	1 (Ref)	1.07 (0.93, 1.24)	1.06 (0.90, 1.24)	0.97 (0.82, 1.14)	0.68 (0.57, 0.81)	0.99 (0.81, 1.21)	0.89 (0.70, 1.12)	0.82 (0.66, 1.01)
Rural, male	1 (Ref)	0.84 (0.69, 1.03)	0.79 (0.63, 0.99)	0.92 (0.72, 1.17)	0.74 (0.57, 0.97)	0.91 (0.68, 1.21)	1.00 (0.73, 1.36)	0.75 (0.59, 0.96)
Rural, female	1 (Ref)	0.82 (0.58, 1.16)	1.02 (0.70, 1.46)	1.00 (0.69, 1.43)	1.00 (0.70, 1.42)	1.01 (0.65, 1.57)	1.18 (0.74, 1.88)	0.73 (0.46, 1.14)
Exercising
No. (%)	2256 (34.6)	3409 (35.2)	2845 (31.6)	2508 (34.1)	2520 (31.9)	1512 (38.0)	850 (27.5)	2141 (33.1)
All	1 (Ref)	1.24 (1.16, 1.32)	1.13 (1.05, 1.21)	0.96 (0.90, 1.03)	0.81 (0.75, 0.87)	1.07 (0.99, 1.17)	0.71 (0.65, 0.78)	0.76 (0.70, 0.82)
Urban, male	1 (Ref)	1.02 (0.89, 1.18)	1.11 (0.96, 1.28)	0.91 (0.78, 1.06)	0.80 (0.68, 0.93)	0.84 (0.71, 0.99)	0.57 (0.47, 0.69)	0.60 (0.52, 0.70)
Urban, female	1 (Ref)	1.42 (1.25, 1.62)	1.14 (1.00, 1.31)	0.88 (0.76, 1.01)	0.69 (0.60, 0.80)	0.99 (0.83, 1.17)	0.75 (0.62, 0.91)	0.90 (0.76, 1.06)
Rural, male	1 (Ref)	1.11 (0.97, 1.27)	1.17 (1.01, 1.35)	0.97 (0.83, 1.12)	0.94 (0.81, 1.10)	1.14 (0.96, 1.36)	0.86 (0.70, 1.05)	0.73 (0.62, 0.84)
Rural, female	1 (Ref)	1.46 (1.28, 1.68)	1.12 (0.97, 1.29)	1.17 (1.01, 1.34)	0.87 (0.75, 1.00)	1.33 (1.13, 1.57)	0.66 (0.54, 0.81)	0.98 (0.84, 1.16)
Playing cards or mah-jongg
No. (%)	1051 (18.9)	1385 (17.0)	1207 (17.0)	1190 (19.3)	1109 (17.7)	602 (15.6)	470 (16.4)	973 (14.7)
All	1 (Ref)	0.95 (0.88, 1.03)	0.97 (0.89, 1.06)	1.00 (0.92, 1.09)	0.77 (0.71, 0.85)	0.79 (0.71, 0.88)	0.81 (0.72, 0.91)	0.79 (0.71, 0.87)
Urban, male	1 (Ref)	0.89 (0.77, 1.03)	0.87 (0.74, 1.02)	0.93 (0.78, 1.11)	0.70 (0.58, 0.84)	0.69 (0.57, 0.84)	0.72 (0.58, 0.90)	0.68 (0.57, 0.82)
Urban, female	1 (Ref)	1.16 (0.99, 1.36)	1.21 (1.02, 1.43)	1.18 (1.00, 1.40)	0.92 (0.77, 1.09)	1.18 (0.96, 1.45)	1.05 (0.83, 1.32)	0.84 (0.67, 1.05)
Rural, male	1 (Ref)	0.81 (0.69, 0.95)	0.92 (0.78, 1.09)	0.89 (0.74, 1.07)	0.68 (0.56, 0.83)	0.57 (0.44, 0.72)	0.59 (0.45, 0.78)	0.67 (0.55, 0.81)
Rural, female	1 (Ref)	0.90 (0.75, 1.07)	0.87 (0.72, 1.05)	1.00 (0.82, 1.21)	0.84 (0.69, 1.03)	0.90 (0.71, 1.15)	1.01 (0.78, 1.29)	0.99 (0.79, 1.25)
Housework
No. (%)	2027 (40.5)	2674 (41.4)	2534 (44.0)	2413 (45.1)	3031 (49.3)	1748 (51.5)	1417 (53.5)	2630 (47.0)
All	1 (Ref)	0.99 (0.92, 1.07)	1.12 (1.04, 1.21)	1.03 (0.95, 1.11)	1.02 (0.95, 1.11)	1.34 (1.22, 1.46)	1.43 (1.30, 1.58)	1.14 (1.05, 1.24)
Urban, male	1 (Ref)	0.88 (0.75, 1.04)	1.02 (0.85, 1.22)	0.85 (0.70, 1.02)	0.91 (0.76, 1.09)	1.26 (1.04, 1.54)	1.22 (0.98, 1.52)	0.98 (0.82, 1.18)
Urban, female	1 (Ref)	1.17 (1.01, 1.36)	1.42 (1.22, 1.66)	1.32 (1.13, 1.54)	1.14 (0.98, 1.33)	1.53 (1.27, 1.84)	1.82 (1.50, 2.21)	1.41 (1.18, 1.69)
Rural, male	1 (Ref)	0.88 (0.76, 1.02)	0.97 (0.83, 1.13)	0.83 (0.70, 0.99)	0.91 (0.77, 1.07)	1.19 (0.98, 1.44)	1.57 (1.27, 1.94)	1.02 (0.86, 1.20)
Rural, female	1 (Ref)	1.00 (0.88, 1.14)	1.10 (0.96, 1.26)	1.09 (0.95, 1.25)	1.10 (0.97, 1.26)	1.42 (1.21, 1.67)	1.23 (1.03, 1.47)	1.15 (0.99, 1.35)

Note. CI = confidence interval; OR = odds ratio. All percentages are weighted to indicate the national prevalence rates. All ORs are adjusted by gender (when appropriate), age, rural or urban residence (when appropriate), activities of daily living, cognitive impairment, education, number of children alive, marital status, and region. For detailed information on covariates, please refer to Table A, available as a supplement to the online version of this article at http://www.ajph.org.

Of most interest is the rising popularity of watching television, odds ratios of which increased by about 2 to 3 times over the past 2 decades. Meanwhile, the Chinese oldest old exercised less: the odds ratio declined by 24% from 1998 to 2018, mostly in men. Similarly, playing cards or mah-jongg declined by about 30% for men in both rural and urban areas. Results also showed that reading became less popular in the oldest old, and Chinese women tended to do more housework than before.

DISCUSSION

Leisure-time physical and social activities are effective in promoting health, well-being, and life satisfaction of Chinese older adults⁹; however, our study found that the oldest old in China have become more sedentary and solitary over the past 20 years. Although our measurements of these leisure activities were limited without detailed information on their frequency, intensity, and duration, the patterns as shown are evidently worrisome and alarming.

Prolonged television watching not only is a low-demand cognitive activity but also leads to physical inactivity and thus increases the risk for type 2 diabetes, cardiovascular disease, and all-cause mortality.¹⁰ The uprising trend of television watching as observed also should be partially responsible for the declines in reading and exercising among the Chinese oldest old, both of which promote mental and physical health in old age. We speculate that this negative trend was embedded in the larger social transformations of China taking place in recent decades. As a marker of modernization, television ownership increased significantly in China with economic development since the 1980s. More Chinese people chose to spend leisure time watching television, especially older persons. Interventions toward better health behaviors in later life were not prioritized in the public agenda until the 2010s, when a national system of social security was finally completed to cover all older people for basic medical insurance and pensions. Additionally, the lack of age-friendly public space and the ambient air pollution, caused by the rapid urbanization during this period, also helped trap many seniors indoors.

The decline of social gaming and the increase in doing housework also mirror social transformations in China. The market reform in the 1980s individualized the social life of Chinese adults, and now it is quite common that many Chinese are not familiar with their next-door neighbors. For older adults, this may lead to a higher risk for social isolation and depression. A recent meta-analysis showed that the loneliness of Chinese older adults increased significantly from 1995 to 2011.¹¹ The rising trend of housework among elderly Chinese women may be attributable to grandparenting responsibilities even though they do not live with their adult children, particularly so for rural elderly whose adult children have migrated to cities.

PUBLIC HEALTH IMPLICATIONS

Western societies have made good progress in helping adults meet the national recommendations for leisure-time physical activity.¹² We advocate to strengthen the monitoring of leisure activity engagement of older adults, the oldest old in particular, and call for more research in developing countries such as China, where the negative trends of leisure activities could be worrisome, as shown in this study.

Our study suggests that after the completion of the national social security system for older adults, the Chinese government needs to shift focus to develop effective lifestyle interventions for the oldest old, especially to promote their engagement in leisure-time physical and social activities. In the rapidly aging China, reversing the trend toward a more sedentary and solitary lifestyle among the oldest old could be a cost-effective way to promote their healthy aging and quality of life.