Eff ect of Recreational Activity Program on Older Peoples Quality of Life and Activities Daily Living at Helwan District

Background : Recreational activities enrich life and provide to have a pleasant time as well as increase older people life quality. Aim : The current study aimed to assess Effect of recreational activity program on older people quality of life, and activities daily living at geriatric home Helwan District. Method : A quasi-experimental design was used in this study. The study was piloted at Huda Tallat Harp, Omklsom and El Saida Nafisa geriatric home Helwan District. A purposive sample was used to choice a total number of 80 participants, representative the attendant's pre mentioned setting. Tools : one tool was used as structured interview that covers five parts as Part I: demographic characteristic, part II: older peoples' knowledge, part III: World Health Organization Quality of Life (WHOQOL), part IV: Elderly mobility scale (EMS) and part VI: Barthel Index of activities of daily living (pre and post). Results : This study displayed statistically significant enhancement in older peoples' knowledge, quality of life, mobility and activity of daily living (72% poor and 27 % fair to 2.5% poor,22.5% fair and 75% good) ( 32.33 ± 15.47 to 51.08±14.17 ) ( 11.46±6.75 to 15.74±5.32 ) ( 14.41±6.66 to 19.57±5.27 ), respectively pre vs. post program with (p<0.05). Conclusion : The current study exposed importance of recreational program for older people to enrich their knowledge, mobility level, activity of daily living and quality of life. Recommendation : Adapting and continues application of recreational activity program in geriatric home and clubs to improve older knowledge and quality of life.


Introduction
Aging populations have become a major global societal issue.In order to address the health-related concerns that older people confront, there is a need for more prevention, treatment, and rehabilitation programs.This demographic transition poses numerous challenges to community health, caregiving for older people, and the load on society.Health care providers frequently deal with chronic illnesses, cognitive decline, and social integration issues, all of which have the potential to cause major societal issues.To address the aforementioned issues and obstacles, it is therefore imperative to promote a healthy lifestyle, raise their level of health, and recognize that aging in a healthy manner is a necessary part of life (Han et al. 2022).Additionally, aging is a natural part of growing up and experiencing old age, and it is often viewed as a curse that accompanies a decline in many aspects of life, including social, psychological, physical, and economic.Elderly quality of life (QoL) is predicted to be affected by most of these changes, thus it's critical to evaluate older people's QoL and educate them about agingrelated changes (Breytspraak and Badura, 2020).Recreational activities are a major factor in lowering loneliness.Older people's physical and mental health issues, which impact their level of daily activity and mobility, may be exacerbated by loneliness.Since the majority of these changes are anticipated to have an impact on older people's quality of life, recreation is crucial to enhancing their quality of life (Bakar and Aşılar, 2021).Older people are rejuvenated, their confidence grows, and they are given a socializing environment by the activities that are conducted in the nursing home (Esentaş et al., 2018).
The quality of life (QoL) of older people refers to how older individuals assess their lives, including their level of depression, their perceived health, and their level of satisfaction with various aspects of their lives, including their relationship with family members, their financial situation, and their sexual activity.Conditions, decisions, and events made during infancy and adulthood, including lifestyle and environmental factors, greatly influence the quality of life (QoL) of older adults (Cole et al., 2020).In addition to providing information about the value of recreation in helping older people deal with challenges and identify personal coping mechanisms, nurses can push for improvements in the health care that older people receive.By actively involving older people in decisions about their care and enhancing their quality of life, nurses can also help older people feel more in control of their conditions.Finally, nurses should be interested in offering recreational activities to older people in order to improve their psychosocial well-being and quality of life (Rondón García et al., 2021).Significance of the study: Globally, the average lifespan of individuals has been rising for a number of reasons, such as genetics, lifestyle choices, eating a nutritious diet, quitting smoking, and engaging in physical activity.The continuous rise in the number of older people in Egypt over the past few decades has been one of the primary demographic trends.Egypt is predicted to have the highest proportion of older people in the region-3.1 million-and the highest number of old people overall-23.7 million-by 2050.In the future, this group will be referred to as older people if this scenario persists.Older people sometimes lack understanding about recreational activities, which can lead to a decrease in their daily activity levels and mobility issues (Sweed, 2019) (World Health Organization, 2020).

Aim of the study:
The study aimed to evaluate the effect of recreational activity program on older people quality of life and activity daily level at geriatric home, Helwan District.

Research hypothesis:
The recreational activity program will improve older people knowledge, activity daily level, mobility level and their quality of life.

Design:
A Quasi-experimental study was used in this study

Setting:
The study was conducted at the Huda Tallat Harp, Omklsom and El Saida Nafisa geriatric home Helwan District where the elderly people resident in it.

Subjects:
A purposive sample was utilized to choose 80 participants, representing those attending the specified setting during the years 2022-2023.Participants were selected based on the following inclusion criteria: they were aged 60 years or older, free from mental illnesses and willing to participate in the study.  (11.With the help of this tool, the degree of mobility in older adults can be evaluated using a standard mean.The evaluation of seven dimensions of functional performance comprised seven multiplechoice questions, lying to sitting, sitting to lying, sitting to standing, standing process, gait, timed walk, and functional reach.All seven dimensions pertain to abilities that facilitate the execution of daily living activities.

Scoring system:
There are seven different response possibilities, each worth 0-4 points.These points are added together in the final result to provide a total point total of up to 20.Based on the three total score ranges listed below, there are three categories of interpretations: 14-20: Older people are usually safe at home and self-sufficient in their everyday activities, but may need some assistance.13-10: Older adults have a borderline degree of independence in everyday activities and need assistance with some mobility tasks.0-9: older people depend on long-term care and need assistance with everyday tasks Part V: Barthel Index of Activities of Daily life: Adapted from Collins et al. (1988) to evaluate older people activities of daily life.There were ten multiple-choice questions in all: three about bowels, three about bladder, two about grooming, three about toilet usage, three about feeding, four about transfer, four about mobility, three about dressing, and three about stairs.Two objects for bathing.

Scoring system:
Add up the senior points for every question.There is a total possible score between 0 and 20, with lower scores denoting more disability.It fell into two groups.
-10-20: Older people consider independent.Validity: A jury comprised of five Community Health Nursing specialists evaluated the tools' content validity in order to validate their significance and thoroughness.Reliability: Reliability coefficients were calculated for the questionnaires of: people knowledge, Cronbach's Alpha was 0.84.Standardized quality of life tool, Cronbach's Alpha = 0.82.Elderly mobility scale (EMS), Cronbach's Alpha =0.86.Barthel Index of Activities of Daily Living, Cronbach's Alpha =0.88.Pilot Study: To determine how long it would take to complete the questionnaire, a pilot study was conducted on eight participants, or 10% of the total sample.The pilot research indicates that no changes were made to the tools under investigation; yet, the pilot study sample was not included in the larger sample under investigation.Ethical considerations: Before beginning data collection, the researchers received oral agreement from the study sample after explaining the purpose and advantages of the research to those who consented to participate.Throughout the whole study process, the studied sample's privacy was guaranteed.Participants were given the assurance by the researchers that all information gathered would be kept private and utilized exclusively for study.The study sample was informed by the researchers that participation in the study is voluntary and that they are free to leave the study at any time, for any reason, without having to give a reason.Elderly mobility scale (EMS) to assess degree of mobility consisted of: lying to sitting, sitting to lying …etc.Barthel Index of Activities of Daily Living used to assess daily living activities of older People.Implementation phase: five sessions over the course of six months made up the recreational activity program.Twenty to twenty-five minutes was the average length of each session.Beginning each session with an overview of the previous one, the researchers determined the goals of the current one while making sure to use language that was both clear and simple enough to be appropriate for all educational levels of the investigated sample.Various instructional techniques, such as brain storming, small group discussions, demonstration, and re-demonstration, were employed.For data visualization, the researchers used laptop screens, colorful posters, and pamphlets.Every sample under study received a guidebook.The content and time of the following session were decided by the researchers and the researched samples at the conclusion of each session.Evaluation phase: Two weeks after the program's introduction, an evaluation of the recreational activity was conducted using the identical preprogramming instruments.Statistical Design: SPSS, version 22, developed by SPSS Inc. in Chicago, IL, USA, was used to gather, tabulate, and statistically analyze the data.For numerical information, the standard deviation, mean, and range were computed.It offers a frequency, percentage, or proportion of each category for a categorical set of data in qualitative data.A Chi-square test ( 2 ) was used to compare two groups and more.Using Pearson's correlation coefficient (r), the relationship between the variables was assessed.When interpreting the findings of tests of significance, significance was defined as p<0.05 (Dawson & Trapp, 2001).

Results
Socio-demographic characteristics of the studied sample revealed that 61.3% of them aged 60<70years old with mean and SD 68.00 ± 6.2399 , female and 31.3% of them has University education &more, while 38.8 % had primary education and less.51.3% of them retired.65% had enough income and 70% widow and 58.8 from urban residence.One of the most urgent worldwide issues is the aging population.A predicted 2.1 billion people over 60 will make up half of the world's population by 2050, up from over 1 billion currently.Age-related health problems include chronic illnesses, impairment, and dependency is linked to a number of bad outcomes, which raises the financial burden and expense of health care.For as long as feasible, older persons should maintain their functional independence in order to reduce the negative consequences of aging.Given this, an increased emphasis should be placed on enhancing older adults' quality of life and encouraging healthy aging (Bowling et al., 2021).Regard socio-demographic characteristic of the studied sample.The current study illustrated that 61.3% of them aged 60<70years old, female and 38% had primary education and lower although 31.3% of them has University education &more, while 51.3% of them retired.70% of widows and 65% of those with sufficient money agree with findings from ÇİYAN et al. (2021) at Darulaceze Institution, Istanbul, who examined the "effect of recreational activities on life quality of elders" and who found that the participant group was between the ages of 50 and 69.In terms of educational background, the percentage of literate people is 40%, whilst the percentage of high school graduates is 26.7%.A bachelor's degree is held by just 1 individual (3.4%).Also this finding goes on the same line as Seo et al 2023.who study "Effect of Physical Activity on Health-Related Quality of Life of Older people " Using Newly Developed Health-Related Quality of Life Tool for the Korean Population and reported that individuals >65 years of age, (56.7% women and 43.3% men) .The proportions of participants based on the level of education that less than elementary school represent 54.6%, regarding marital status; widowed represent 67.1%.Concern the effect of the program of the studied sample knowledge, mobility level, activity of daily living and quality of life.The current study clear that improvement in total knowledge score, quality of life, mobility limitation, and Barthel of activities daily living of the studied sample regarding recreational activity in the post -program than pre -program and these results was accordance with Sala, etal 2019 who study "The impact of leisure activities on older people cognitive function, physical function, and mental health" and reported that engaging in leisure activities was positively associated with all the three successful aging indicators.Moreover, kim, etal.2020 who study "A Meta-Analysis on the Effects of Therapeutic Recreation Programs for the Elderly", the results of this study prove that therapeutic recreation programs for the elderly can be an effective way to bring along a positive change .From researchers point of view it may be related to the effect of the program.The researchers' point of view was supported by Kordi, et al 2019 who study "The Effect of Recreation Therapy on Selfesteem and Quality of life in elderly people Referred to a Daycare Center "and reported that According to the results of ANOVA, repeated measures, inter-group variations in self-esteem (p = 0.003) and quality of life (p = 0.007) show a significant difference between intervention and control groups.In the subscales of quality of life, intergroup variations in the field of intrusion (p = 0.004) and success (p = 0.006) show a significant difference between intervention and control groups.
In the same line the study finding was consistent with Cai et al. 2023 who study "Effects of leisure activities and general health on the survival of older people: a cohort study" in China also stated that the older population's survival was significantly predicted by their leisure time and self-rated general health, with general health acting as both a mediator and moderator in the relationship between the two.Older people who took part in PLA & CLA had the longest survival duration (mean = 50.31months), whereas the in neither group had the shortest (mean = 29.60 months).When it came to participating in various leisure activities, there were significant disparities in survival status (Log-rank test, Chi-square = 576.80,p >> 0.001).In the current study, which examined the impact of recreational activities on older people's quality of life, a rise in mean ± SD in the physical health area total score pretest/posttest data was also noted (4.91 ± 1.90/6.47± 2.23).When comparing the psychological total scores with the pretest/posttest data, a statistically significant change was also discovered (5.13 ± 2.43/ 9.12 ± 2.37) statistical significant improvement in mean and standard deviation of studied sample independence differed from ( 5

Figure ( 1 )
: clear that improvement in total knowledge score of the studied sample regarding recreational activity and quality of life in the post -program than pre -program.

Figure ( 1
Figure (1): Total Knowledge Score and level among the studied sample regarding quality of life and activity daily living pre and post recreational activity program, (N =80).

, Hu, T., Zhou, L ., Jiang, H., and Gao
Barthel index score (F = 19.68,p < 0.001) and Lawton's IADL scale results (F = 17.59, p < 0.001).All four domains of life quality were strongly improved.The present study clear that improvement in total knowledge score of the studied sample regarding recreational activity and quality of life in the post -program than pre -program.And these results agree with Provencher et al. 2018 who study "Activities, Adaptation & Aging Exploring the Impact of a New Intervention to Increase Participation of Frail Older Adults in Meaningful Leisure Activities" Canada and reported that intervention improved their knowledge regarding the compensatory strategies learned and their participation in meaningful leisure activities.Conclusion Based on the results of the study results and research hypothesis, the present study concluded that after implementation of the program, it was founded that there was a statistically significant positive effects on improving the studied sample knowledge, mobility level, activity of daily living, and quality of life.Recommendations On the light of the current study finding the following recommendation suggested: 1. Continuity of adapting and application of recreational activity program in geriatric home and clubs to improve older people knowledge and quality of life.2. Applying other program as an educational program, instructional leisure activity program for older people.3. Further researches are needed for older people in different community setting.
, Y. (2023): Effects of leisure activities and general health on the survival of older people: a cohort study in China Aging and Public Health Volume 11 -2023, available