TOURISM IMPACT ON ACTIVE AND HEALTHY … › eip › ageing › sites › eipaha › files › ...Subjective Well-Being (SWB), as Lindert et al. (2015, p. 731) recalled, “contributes

Mario Castellanos-Verdugo; M. Ángeles Oviedo-García;

Araceli Picón-Berjoyo; Carolina Ruiz-Moreno;

Manuela Vega-Vázquez

Contributor: M. Ángeles Rodríguez-Serrano

T o u r i s m & H e a l t h y a n d A c t i v e A g e i n g – I C T ( S E J - 5 7 7 )

TOURISM IMPACT ON ACTIVE AND HEALTHY AGEING - SUBJECTIVE MEASUREMENTS

https://ec.europa.eu/eip/ageing/commitments-tracker/d4/tourism-impact-active-and-healthy-ageing-subjective-measurements_en

https://ec.europa.eu/eip/ageing/commitments-tracker/d4/tourism-impact-active-and-healthy-ageing-subjective-measurements_en

CONTENTS

Page

1. INTRODUCTION 5

2. THEORETICAL FOUNDATIONS 7

2.1. Populational ageing and Active and Healthy ageing (AHA) 7

2.2. Subjective wellbeing 8

2.3. Tourism and AHA 9

3. INVESTIGATION METHODOLOGY 11

3.1. Objective and planning of the investigation 11

3.2. Nature of the Investigation 11

3.3. Scenario of the Investigation 11

3.4. Data-analysis procedure and techniques 13

4. DATA ANALYSIS AND RESULTS 15

4.1. Socio-demographic characteristics 15

4.2. Health and wellbeing 15

4.3. Travel data 20

4.4. Tourism, health and wellbeing 22

4.5. Importance of gender 25

5. CONCLUSIONS 27

REFERENCES 29

ANNEX 1. Descriptive statistics 31

ANNEX 2. Descriptive statistics: mean - gender 35

ANNEX 3. T test of independent samples 37


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Facultad de Turismo y Finanzas. Av. San Francisco Javier s/n. 41018 Sevilla (España) +34 954 556 845 - [email protected] - @turensalus – in/turensalus

Universidad de Sevilla

1. INTRODUCTION Investigations have demonstrated, in the framework of the social-mental-physical paradigm of active ageing, that leisure activities (whether in solitary or in group) contribute to both the physical and the psychological well-being of older people regardless of the functional level of the individuals (Simone and Haas, 2013). The physical activities of leisure directly bring about a better physical state in old people, as they positively influence the psychological sphere and improve the satisfaction of old people with life, reducing the probability of depression and delaying both physical and cognitive decline (López et al., 2011). In contrast, the strategies of active ageing that are simultaneously centred on physical, mental, and nutritional aspects have shown themselves to be more effective than strategies that centre on only one of those domains (Schneider and Yvon, 2013). Tourism is an irregular leisure activity that takes place away from the habitual local place of residence and that has no contra-indications for older people (Forest et al., 2013). Tourism even has the potential to connect various domains of ageing as they entail the completion of a physical and cognitive activity that is frequently developed in a context of social relations. In this report, the results of an investigation will be presented that test the relation between tourism and Active and Healthy Ageing (AHA), in terms of subjective wellbeing, which is relevant given the paucity of previous research results. The report will start with a review of the literature on the concepts of ageing, active and healthy ageing, subjective wellbeing and tourism, and their interrelations. It will then explain the methodology used in the investigation and present the most relevant results in order, finally, to argue the main conclusions of the investigation.


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2. THEORETICAL FOUNDATIONS

2.1. Populational ageing and Active and Healthy ageing (AHA) Over recent years, the tendency of the population to age has been clearly observed, both (figure 1) at a global and a European level (figure 2), due to the joint action of lower mortality rates and lower birth rates. It raises concerning issues for challenges in social, economic, health-related and political fields, in such a way that age is quite often seen as a threat (Sanchis Sánchez et al., 2014).

Figure 1. Population aged 60-79 years and aged 80 years or over by development group, 2000, 2015, 2030 and 2050

Data source. United Nations (2015). World Population Prospects: The 2015 Revision.

Figure 2. Population structure by major age groups, EU-28, 2016-80 (% of total population)

Data source. Eurostat (online data codes: demo_pjangroupand proj_15ndbims), 2015.


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However, the effects of illnesses associated with the ageing process in itself (Fuchs et al., 2013) must be seen separately, given that although ageing is linked to mortality, morbidity, and disability, through the lens of AHA, ageing also represents an opportunity to improve the wellbeing and the quality of life of older people. AHA promotes a positive image of older people, broadens their active role and the distribution of their value to other generations, so that it would be a stage of personal growth, adding “life to the years and not only adding years to your life " (WHO, 2002). So, AHA is a life-long process that fine-tunes the opportunities to improve and to maintain health and physical, social, and mental wellbeing, independence, and quality of life (Peel et al., 2004). Given that the form of ageing depends on 75% environmental and behavioural factors (and only on 25% due to genetic factors) (Sanchis Sánchez et al., 2014) and that, from an individual perspective, the person is the agent and the product of the ageing process (Ramiro Fariñas et al., 2012), older people have a broad set of possibilities available to them, between which they can choose and with which they age in active and healthy ways. Six key groups of decisive factors in active ageing have been established, moderated by gender and by culture: environmental (rural/urban context, helpful atmosphere); economics (salaries, pensions, work, protection); health and social services (health promotion and prevention of illness, first aid, long-term care); social (education, social support, prevention of violence, and abuse); behavioural (active physical diet, use of medication, alcohol rationing, no tobacco) and personal (biological and psychological) (WHO, 2002). The definitions of healthy ageing include survival beyond a certain age, living without chronic illnesses, independence in daily-life activities, wellbeing, quality of life, high social participation, level of cognitive or functional deterioration, and little or no disability/disablement (Fuchs et al., 2013). It brings to light the multidimensionality of the concept that extends across and goes further than good health and is composed of a wide set of bio-psycho-social factors (Petretto et al.,2016). Factors that mean older people can face up to this vital stage and maintain control over their lives in keeping with their values and their culture (Hung et al., 2010).

2.2. Subjective wellbeing Both at an individual and a social level, the importance of active and healthy ageing is undeniable. It is however difficult to measure given that it depends on the definition and the weight of its components (morbidity /multimorbidity, disability, frailty, quality of life, and social participation) (Fuchs et al., 2013). Life is lived as a subjective process over the course of time and through the diversity of contexts and relations (Dillaway and Byrnes, 2009). Taking that subjective process into account in the analysis of ageing, not only should objective perceptions of ageing be considered, but also the subjective ones, based on individual perceptions as “some people will have active ageing for both dimensions, for only one, or for none of them” (Petretto et al., 2016, p.239). Subjective Well-Being (SWB), as Lindert et al. (2015, p. 731) recalled, “contributes to lifelong health and healthy aging” given that the “lack of SWB or impaired SWB can contribute to disease and mental disorders”. In contrast, the subjective evaluation of wellbeing already includes the moderating nature of both gender and culture in the process of active and healthy ageing.


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SWB measures, due to the lack of a universally accepted definition, have been developed with a specific purpose (Pontin et al., 2013) on the basis of a hedonic tradition – with the aim in life of maximizing feelings of pleasure - as against a eudemonic one – a search for happiness in life- in which they were rooted and the theories on which they rest (Maslow’s hierarchy of needs, Sens’ capability approach, Ryff’s psychological well-being or spiritual well-being model and self-determination theory, among others), as well as the literature on the discipline that evaluates the SWB (clinical psychology, medical sociology, epidemiology, nursing, gerontology, primary care, public health, etc.) (Lindert et al., 2015; Linton et al., 2016). As a consequence, as many as 99 different measures of SWB in English have been found in which hundreds of dimensions of wellbeing are detailed. They are grouped around 6 key aspects (mental well-being, social well-being, physical well-being, spiritual well-being, personal circumstances and activities and functional life) as well as a global state of wellbeing (Linton et al., 2016).

2.3. Tourism and AHA The physical activities of leisure have demonstrated that not only do they have a logical impact on physical wellbeing, but, also, on the psychological context, improving satisfaction with life, which results in a lower probability of depression, as well delaying physical and cognitive decline (López et al., 2011). On the contrary, lack of social support, isolation and loneliness in old age are associated with a decline in physical and mental wellbeing. It is interesting to highlight that leisure activities, practiced in solitude as much as in a group, have significant effects on active and healthy ageing, regardless of the environment of individual functional capabilities (Simone and Haas, 2013). Recent investigations have shown that strategies that are simultaneously focused on different factors (for example, programmes that cover physical and mental activity together with nutritional aspects) tend to be more effective than those centring on a single domain (Schneider and Yvon, 2013). Tourism is not contra-indicated for older people (Forest et al., 2013), despite the inevitable increase in frailty and the reduction of functional capacity associated with the ageing process. Although the presence of comorbidities could imply a risk of medical complications during the trip, a geriatric consultation before travel will test the compatibility of the planned trip with the state of health of the individual. Altogether, the investigation has shown that: a) social activities by nature are more beneficial from the point of view of active and healthy ageing than activities that are done alone (Simone and Haas, 2013); b) physical leisure activities have demonstrated their positive impact, both on physical wellbeing and in the psychological life of older people, reducing the probability of depression and delay both physical and cognitive decline (López et al., 2011); c) the lack of social support, isolation and solitude in old age is associated with a decline in physical and mental wellbeing; and, d) strategies that simultaneously cover physical and mental activity with nutritional aspects tend to be of greater effect than those centring on only one domain (Schneider and Yvon, 2013).


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3. INVESTIGATION METHODOLOGY

3.1. Objective and planning of the investigation The main objective of this investigation in the preceding paragraphs has been to shed light on the empirical testing of the positive effect of tourism activities on the health and the wellbeing of older people, by means of an investigation developed through the following stages:

1. Identification of the variables: a phase in which the different variables and constructs are identified. 2. Identification of the instruments and scales of measurement. Having identified the variables, the

scales of measurement will be proposed. 3. Determination of the investigative scenario, so as to describe and to delimit the reality that only

the empirical approach can provide to the research: the determination of the objective population, the sampling unit, the selection of the sample and the definition of the sources and the methods for gathering and for storing information.

4. Definition of the techniques that should be used for data analysis; to identify and to justify the most appropriate techniques for the analysis of the data that have been gathered.

5. Analysis of the results through the application of the previously described techniques either lend empirical support or lend no support to the research proposal that is set out.

6. Conclusions. Finally, on the basis of the analysis of the results, conclusions may be extracted that can, on the one hand, constitute contributions to the scientific theory and literature, and, on the other, evidence-based recommendations to different sorts of public and private organisms.

3.2. Nature of the Investigation In the first place, it is important to highlight that in that investigation that is to be conducted, a field study will be adopted rather than an experimental design. This choice is because we expect that the variables contemplated in our model will exercise their influence in a natural way. In contrast with experimental methods, one field of study permits real (Kerlinger, 1992) and precise (Slater, 1995) information to be gathered in the field. Its use is commonly accepted in this area and is especially extensive in those investigations that are centred on the study of cultural and organizational variables. Furthermore, in relation to the temporal dimension, despite the convenience of contemplating a broad temporal horizon that permits measurement of the long-term effects on tourism in active and healthy ageing, the impossibility of finding enough time and necessary resources call for transversal-type investigations. Nevertheless, we consider that the possibility remains open that in the future, we might expand on the present work, giving it greater temporal continuity. Finally, taking into account the nature of the investigation, the objective that is pursued and the existing empirical background, a quantitative study was chosen. In summary, the investigation that is presented in this report was characterized by being a field study, of a quantitative nature, and with a transversal approach.

3.3. Scenario of the Investigation The population under study are older than 65 years of age and resident in Seville (Spain), have enjoyed a holiday period, both in the framework of social tourism and in the private sector, over the last 6 months. For the analysis of this population and for different (economic, access-related) reasons, probabilistic sampling, in which the selection of the sampling units is done in a random way with a known probability,


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was not used. Rather, the non-probabilistic sampling method was used, in which the selection of sampling units responds to subjective research criteria, such as quotas and convenience. In particular, the sample was constituted by those people who, forming part of the objective population, finally agreed to form part of the investigation. The method selected to obtain the necessary information in the investigation was the personal survey. The aim was to achieve a higher rate of response. The decision to select this type of survey was justified by the decisive role that the interviewer plays, whose professionality is what finally defines the quality of the results. The information obtained is as complete as possible and at the same time is able to capture the environment that encapsulates the survey. The questionnaire is the medium that includes the questions that are formulated for the survey. Due to the importance of relying on instruments in Spanish that are validated for the Spanish population, it was decided to make joint use of the SF-12v2 and the EQ5D-5L scales, following the recommendations in the literature (Lindert et al., 2015), under the modality of self-report, because of their psychometric validity (Linton et al., 2016), as well as their brevity, after the sublicense and the permits for their use have been obtained. The SF-12v2 Scale is composed of 12 items grouped into 8 dimensions: Physical Function (2 items), Social Function Social (1 item), Physical role (2 items), Emotional Role (2 items), Mental Health (2 items), Vitality (1 item), Bodily pain (1 item) and General Health (1 item). The response options evaluate the intensity or frequency of each one of the affirmations, using 5-point Likert-type scales. The SF-12 version of the questionnaire increases options for responses to some items and improves the wording of both the instructions and some items (Monteagudo-Piqueras et al., 2011). The EUROQOL-5D-5L scale, developed by EuroQOI Group, improves the psychometric properties of the previous EUROQOL-5D-3L version and is one of the most widely employed evaluation questionnaires on health-related quality of life (Health-related quality of life-HRQoL) (García-Gordillo et al., 2016). It consists of two sections; a) a descriptive 5-dimensional system (mobility, self-care, usual activities, pain-discomfort and anxiety/depression); and, b) a visual analogical scale, in which the individual self-evaluates his or her state of health on a scale of 0-100 (worse and better imaginable state of health). More specifically, these SWB measures were chosen for the following reasons:

1) These scales are short: 5 items EUROQUOL 5D-5L and 12 item scales SF-12v2. 2) Both scales are translated into Spanish and are validated for the Spanish population, because

among other psychometric factors, culture appears as a factor that can bias the results in the measurements of the SWB.

3) They include various aspects of well-being: the 5D-5L covers five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) and the SF-12 includes 8 dimensions (function physical, social function, physical role, emotional role, mental health, vitality, corporal pain, and general health).

4) These measures are internationally recognized. Additionally, data were collected relating to the profile of the interviewed people and some data referring to travel.


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The field work started on 22nd November 2017 and ended on 11th January 2018. Finally, 721 valid surveys were collected. It was conducted in the city of Seville (Spain) in different Old People’s Associations and Centres.

3.4. Data-analysis procedure and techniques The choice of these techniques was done taking into account the proposed objectives in the investigation, the variables, the measurement scales, and the nature of the investigation and the data. Finally, the chosen techniques were:

1. Descriptive techniques and univariant classification: Through these descriptive and classification techniques, we completed a preliminary analysis of the data with the purpose, on the one hand, of describing and summarizing the information that had been collected and of defining the sample characteristics. On the other hand, our purpose was to prepare this information for subsequent treatment with more complex techniques. IBM SPSS statistics 24 and Microsoft Excel 2010 were employed to perform these statistical techniques.

2. Bivariant causal analysis techniques: Test of differences of means. Different hypothesis tests were performed through means test comparisons: T-test for independent samples; ANOVA test; and non-parametric Kruskal Wallis test. They tested the influence of tourism activities on the health and the wellbeing of older people. They also analysed whether this influence was different according to the gender of the people under investigation.


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4. DATA ANALYSIS AND RESULTS

4.1. Socio-demographic characteristics As may be seen from the graphs (figure 3), the sample is very evenly distributed between men and women, the majority of the old people were married or widowed, with ages of between 70 and 80, and almost 60% of the sample only held primary studies.

Figure 3. Sample description

Data source. The authors.

The IMSERSO, Institute of Elderly People and Social Services, belonging to the Ministry of Health, Social Services and Equality of the Government of Spain, develops a Tourism Program “as a complementary service among those of the Spanish Social Security System, with the objective of providing older people with holidays in coastal areas and inland tourism, thereby contributing to improvements in their quality of life, their health, and the prevention of dependency”1 . The sample is evenly distributed in terms to belong to IMSERSO or not (non-IMSERSO 50.30% vs. IMSERSO 49.70%).

4.2. Health and wellbeing

• Questionnaire SF-12v2

47% of interviewees valued their health, in a general way, as good, and 46% as very good or as excellent. On average, between 1 and 5 of the interviewees assessed their health at 3.57 (table 1). 75% of the interviewees affirmed that their health presented no limits on making moderate efforts; and 60% thought that walking up various flights of stairs would be a definitive limit (figure 4).

1 http://www.imserso.es/imserso_01/envejecimiento_activo/vacaciones/objeto_programa/index.htm


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In general (figure 5), the interviewees affirmed that, over the past 4 weeks, their physical health had never limited them or almost never limited them from doing less than they had to do at work or in daily activities (78%), nor did they feel limited by the type of activity or other activities (68%). 86% of the sample considered that pain did not complicate their usual work or only complicated it a little (figure 5).

Figure 4. Health general assessment Valoración general de su salud


Figure 5. Phsysical health and social activities


Likewise, their emotional problems never, or almost never (86%) limited them from doing less than they do everyday or from doing activities less carefully (75%) (figure 5).


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Table 1. Descriptive statistics: indicate your state of health (SF-12v2) on a scale of 1 to 5

Mean Median Mode Variance Minimum Maximum

In general, you would say that your health is 3.57 3 3 0.721 1 5

Does your current health limit you to make efforts?

1.26 1 1 0.223 1 3

Does your current health limit you to go up several floors?

1.66 2 2 0.297 1 3

During the last 4 weeks in your daily life or in your work, did you do less than you would have liked to do because of your physical health?

1.88 2 2 0.68 1 5

During the last 4 weeks in your daily life or in your work, were you limited in the type of work or other activities because of physical health?

1.96 2 1 0.798 1 5

During the last 4 weeks in your daily life or in your work, did you do less than you would have liked to do because of some emotional problem?

1.72 2 2 0.537 1 5

During the last 4 weeks in your daily life or in your work, did you do your work or other daily activities less carefully than usual because of some emotional problem?

1.81 2 1 0.673 1 4

During the last 4 weeks, to what extent has the pain made your usual work difficult?

1.85 2 2 0.535 1 5

During the past 4 weeks, how often did you feel calm?

4.18 4 4 0.355 2 5

During the last 4 weeks, how often did you have a lot of energy?

3.83 4 3 0.764 1 5

During the past 4 weeks, how often did you feel discouraged and depressed?

1.68 2 2 0.48 1 5

During the past 4 weeks, how often have physical health or emotional problems hindered your social activities?

1.72 2 2 0.511 1 4

Of the following statements related to mobility, which one best describes your health today?

4.81 5 5 0.246 2 5

Of the following statements related to self-care, which one best describes your health today?

4.87 5 5 0.157 2 5

Of the following statements related to daily activities, which one best describes your health today?

4.59 5 5 0.362 2 5

Of the following statements related to pain or discomfort, which one best describes your health today?

4.37 4 4 0.357 2 5

Of the following statements related to anxiety or depression, which one best describes your health today?

4.73 5 5 0.244 2 5



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Figure 6. Emotional health


Over the past 4 weeks, as shown in figure 6, the interviewees have always or almost always felt calm and at ease (90.8%); with a lot of energy (60%); and never or almost never discouraged (89%).

• Questionnaire EQ-5D

Data about máximum, average, mode, and variance are shown in table 2. 85% of the interviewees had no serious problems when walking, 88% affirmed that they had problems washing and dressing themselves, and 64% of all interviewees had no problems carrying out daily activities and 30% affirmed that they had slight problems (figure 7).

Figure 7. Your health status today: mobility, self-care and daily activities



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Table 2. Descriptive statistics: indicate your state of health (EQ-5D)

Mean Median Mode Variance Minimum Maximum


4.81 5 5 0.246 2 5


4.87 5 5 0.157 2 5


4.59 5 5 0.362 2 5


4.37 4 4 0.357 2 5


4.73 5 5 0.244 2 5


With regard to pain and feeling discomfort, 42% responded that they felt no pain and 52 % reported discomfort or slight pain. And finally, 74% of the sample affirmed that they were neither anxious nor depressed (figure 8).

Figure 8. Your health status today: pain-discomfort and anxiety-depression.


Regarding a general assessment of the interviewees’ health status data are shown in table 3.


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Table 3. Visual analogue scale: indicate your state of health today on a scale of 0 to 100 (EQ-5D)

Mean 76.46

Median 75

Mode 70

Minimum 10

Maximum 100

Percentils

10 60

20 65

25 70

30 70

40 70

50 75

60 80

70 85

75 90

80 90

90 100


In general, the interviewees have a very good pereception about their health status.

4.3. Travel data As shown in figure 9, the majority of the interviewees stay on a trip 3 to 10 days and their last trip was three months ago.

Figure 9. Last trip


The next figure (figure 10) indicates the interviewees mostly preferred the coast as destination and went mainly by car or by bus.


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Figure 10. Destination and transportation


Figure 11. Trip purchase and loyalty


Figure 12. Type of accommodation and satisfaction



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In view of the graphs and tables presented above, we may say that the majority of the interviewees purchased the trip through Agencies, and selected hotel accommodation, preferably on the coast (figure 11), and they repeated the visit. Likewise, with regard to satisfaction with the visit and the accommodation, in both bases, the average scores were very high, at over 9.9 (Figure 12).

4.4. Tourism, health and wellbeing Having described the sociodemographic characteristics of the sample and having analysed the principal data on the trip, the main purpose of this investigation is approached; the analysis of the impact that tourism activities have had on the health and the wellbeing of the interviewees. In general, in view of the results and taking into account that the questionnaires were prepared after interviewee participation in a tourism activity, it appears logical to think that tourism had a favourable effect on both the physical and the emotional health of the interviewees. However, performing a hypothesis test with the comparison of means using an ANOVA test allows us to be more exhaustive with this affirmation. Thus, this test allows us to see whether the number of trips carried out in the last year by the interviewees affects their health and wellbeing, in other words, if those people who carry out tourism activities in a more frequent way present better health and wellbeing than those who go on tourist trips less frequently.

Figure 13. Number of trips during the last year


It is first necessary to test for homogeneity of variances in the different subgroups, before carrying out an ANOVA test. Otherwise, it would on the contrary be recommendable to use the non-parametric Kruskal Wallis test. The homogeneity of variances was evaluated with the Levene test (table 4).


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Table 4. Variance homogeneity test

Statistic of

Levene gl1 gl2 Sig.

1. In general, you would say that your health is 3.411 3 681 0.017

2. Does your current health limit you to make efforts? 10.244 3 681 0.000

3. Does your current health limit you to go up several floors? 25.897 3 681 0.000

4. During the last 4 weeks in your daily life or in your work, did you do less than you would have liked to do because of your physical health?

1.347 3 681 0.258

5. During the last 4 weeks in your daily life or in your work, were you limited in the type of work or other activities because of physical health?

2.679 3 681 0.046

6. During the last 4 weeks in your daily life or in your work, did you do less than you would have liked to do because of some emotional problem?

4.161 3 681 0.006

7. During the last 4 weeks in your daily life or in your work, did you do your work or other daily activities less carefully than usual because of some emotional problem?

2.489 3 681 0.059

8. During the last 4 weeks, to what extent has the pain made your usual work difficult?

9.845 3 681 0.000

9. During the past 4 weeks, how often did you feel calm and calm? 12.927 3 681 0.000

10. During the last 4 weeks, how often did you have a lot of energy? 5.438 3 681 0.001

11. During the past 4 weeks, how often did you feel discouraged and depressed?

5.362 3 681 0.001

12. During the past 4 weeks, how often have physical health or emotional problems hindered your social activities?

3.068 3 681 0.027

13. Of the following statements related to mobility, which one best describes your health today?

53.567 3 681 0.000

14. Of the following statements related to self-care, which one best describes your health today?

32.211 3 681 0.000

15. Of the following statements related to daily activities, which one best describes your health today?

11.329 3 681 0.000

16. Of the following statements related to pain or discomfort, which one best describes your health today?

2.504 3 681 0.058

17. Of the following statements related to anxiety or depression, which one best describes your health today?

9.863 3 681 0.000

18. Indicate your state of health today on a scale of 0 to 100 0.623 3 681 0.600


As may be seen in the table, questions 4, 7, 16, and 18 are the only ones that present equality of variances and were therefore interpreted on the basis of the ANOVA test (table 5). The other questions were interpreted through the Kruskal-Wallis test (table 6). Thus, in both cases, the results confirmed that those interviewees who travelled with more frequency presented better conditions of health and wellbeing in a statistically significant way (whether evaluated with the SF-12v2 scale or whether through the EQ-5D scale).


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Table 5. Anova

Sum of squares

gl. Half

quadratic F Sig.


Between groups

74.036 3 24.679 49.871 0.000

Within groups

336.992 681 0.495

Total 411.028 684


Between groups

58.043 3 19.348 33.28 0.000

Within groups

395.905 681 0.581

Total 453.947 684

Of the following statements related to pain or discomfort, which is the one that best describes your health today?

Between groups

26.158 3 8.719 30.629 0.000

Within groups

193.865 681 0.285

Total 220.023 684

Indicate your state of health today on a scale of 0 to 100

Between groups

14852.19 3 4950.729 28.073 0.000

Within groups

120096.2 681 176.353

Total 134948.4 684


Table 6. Kruskal-Wallis test

Chi

squared gl

Sig. asymptotic

In general, you would say that your health is 87.591 3 0.000

Does your current health limit you to make efforts? 17.911 3 0.000

Does your current health limit you to go up several floors? 31.800 3 0.000


102.328 3 0.000


96.160 3 0.000

During the last 4 weeks, to what extent has the pain made your usual work difficult?

82.823 3 0.000

During the past 4 weeks, how often did you feel calm and calm? 54.045 3 0.000

During the last 4 weeks, how often did you have a lot of energy? 100.287 3 0.000

During the past 4 weeks, how often did you feel discouraged and depressed? 69.516 3 0.000


90.185 3 0.000


54.501 3 0.000


30.874 3 0.000


33.229 3 0.000


19.503 3 0.000



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We may therefore affirm that the tourism activities have an impact on the subjective evaluation of the health and the wellbeing of older people favouring their quality of life in old age.

4.5. Importance of gender With respect to the incidence of gender on the first 12 questions linked to the questionnaire SF-12v2, the perceptions of men were that they were in a better state of health and they were in better condition to carry out their daily activities than women. In fact, in the majority of cases, the difference between men and women was statistically significant (see annex 2 and annex 3). With regard to questionnaire EQ-5D, we only found gender differences in the problems with carrying out daily activities, pain and discomfort, and in anxiety and depression, where in all cases, women presented worse emotional and health-related conditions than men (see annex 2 and annex 3).


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5. CONCLUSIONS Participation in tourism activities (in all their variety: urban tourism, active tourism, spa tourism, etc.) can promote the right of older people to active ageing. The results of our investigation have demonstrated that those people who travel more frequently, present better conditions of health and wellbeing and that tourism activities, therefore, impact favourably on the health and wellbeing of older people favouring their ageing and their quality of life. These results have significant implications for public bodies and for business organizations, which should promote and facilitate tourism activities for older people, in the interests of active and health ageing. Thus, as Sanchis Sáncez et al. (2014) highlighted, greater implication and intersectoral and institutional coordination is necessary to achieve ageing that is free from disability, that is independent and healthy, to which our older people have a right. Among the different activities that may be developed in the framework of active and healthy ageing, tourism may be highlighted from various reasons: as it is a social activity, it is more beneficial, from the point of view of health and wellbeing, than those practiced alone (Simone and Haas, 2013); it reduces the probability of depression and delays physical and cognitive decline (López et al., 2011); and, finally, by combining physical and mental activity with nutritional aspects, they are more effective than those that centre on a single domain (Schneider and Yvon, 2013). There is evidence of a relation between active ageing strategies and an increased quality of life among older people, although the empirical evidence in the field of tourism is scarce (Sanchis Sánchez et al., 2014). The results obtained in this study have shown that the health and the wellbeing of older people who travel more frequently and who involve themselves in tourism activities are in better condition than those older people who do not. Our investigation has shone light on this area, confirming the positive impact of tourism activities on the health and the wellbeing of older people, thereby favouring their active ageing. In this way, we have contributed to knowledge of active and healthy ageing, by showing the positive effect of tourism on the wellbeing of older people Although it is necessary to look in greater depth at this relationship in new investigations, as the influence of the determinants on the way both people and the population age has to be evaluated, as well as the perception and satisfaction of older people with regard to their quality of life (Sanchis Sánchez et al., 2014; Petretto et al.,2016) with a view to designing policies and strategies on active and healthy ageing.


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REFERENCES Dillaway, H. E., Byrnes, M. (2009). Reconsidering successful aging: A call for renewed and expanded academic critiques and conceptualizations. Journal of Applied Gerontology, 28(6), 702-722. Forest, A., Brihier, M., Verny, M. (2013). Personnes âgées en voyage. La Presse Médicale, 42(2), 209-216. Fuchs, J., Scheidt-Nave, C., Hinrichs, T., Mergenthaler, A., Stein, J., Riedel-Heller, S.G., Grill, E. (2013). Indicators for healthy ageing – A debate. International Journal of Environmental Research and Public Health, doi: 10.3390/ijerph10126630. García Gordillo, M.A., Adsuar, J.C., Olivares, P.R. (2016). Normative values of EQ-5D-5L: in a Spanish representative population sample from Spanish Health Survey, 2011. Quality of Life Research, 25, 1313-1321. Hung, L. W., Kempen, G. I. J. M., De Vries, N. K. (2010). Cross-cultural comparison between academic and lay views of healthy ageing: a literature review. Ageing Society, 30(8), 1373-1391. Kerlinger, F. N. (1992). Foundations of behavioral research (3rd ed.) Orlando, FL7 Harcourt, Brace. López, M.D., Zamarrón, M.D., Fernández-Ballesteros, R. (2011). Asociación entre la realización de ejercicio físico e indicadores de funcionamiento físico y cognitivo. Comparativa de resultados en función de la edad. Revista Española de Geriatría y Gerontología, 46(1), 15-20. Monteagudo-Piqueras, O., Hernando-Arizaleta, L., Palomar-Rodríguez, J.A. (2011). Normas poblacionales de referencia de la versión española del SF-12v2 para la región de Murcia. Gaceta Sanitaria, 25(1), 50-61. Peel, N., Bartlett, H., McClure, R. (2004). Healthy ageing: how is it defined and measured? Australasian Journal on Ageing, 23(3), 115-119. Petretto, D. R., Pili, R., Gaviano, L., López, C. M., Zuddas, C. (2016). Envejecimiento activo y de éxito o saludable: una breve historia de modelos conceptuales. Revista Española de Geriatría y Gerontología, 51(4), 229-241. Ramiro Fariñas, D. et al. (2012). Una vejez activa en España. Informe. Grupo de Población del CSIC, Available from: http://digital.csic.es/bitstream/10261/69327/1/2012VejezActiva.pdf (accessed 27 February 2017). Sanchis Sánchez, E., Igual Camacho, C., Sánchez Frutos, J., Blasco Igual, M.C. (2014). Estrategias de envejecimiento activo: revisión bibliográfica. Fisioterapia, 36(4), 177-186. Schneider, N., Yvon, C. (2013). A review of multidomain interventions to support healthy cognitive ageing. The Journal of Nutrition, Health and Aging, 17(3), 252-257. Simone, P.M., Haas, A.L. (2013). Frailty, leisure activity and functional status in older adults: relationship with subjective wellbeing. Clinical Gerontologist, 36(4), 275-293. Slater, S. F. (1995). Issues in conducting marketing strategy research. Journal of Strategic Marketing, 3(4), 257-270. WHO (2002). Active ageing. A policy framework. Available at http://apps.who.int/iris/bitstream/10665/67215/1/WHO_NMH_NPH_02.8.pdf (accessed 15 March 2018)

https://dx.doi.org/10.3390%2Fijerph10126630

http://digital.csic.es/bitstream/10261/69327/1/2012VejezActiva.pdf

http://apps.who.int/iris/bitstream/10665/67215/1/WHO_NMH_NPH_02.8.pdf


[31]



ANNEX 1

DESCRIPTIVE STATISTICS

N Mean

Standard deviation

95% confidence interval for the

mean Minimum Maximum

In general, you would say that your

health is

"1 time" 50 2.78 0.737 2.57 2.99 1 5

"2 times" 205 3.37 0.746 3.26 3.47 2 5

"3 times" 326 3.75 0.818 3.66 3.84 2 5

"More than 3 times"

104 3.93 0.792 3.78 4.09 3 5

Total 685 3.59 0.843 3.53 3.65 1 5

Does your current health limit you to

make efforts?

"1 time" 50 1.48 0.544 1.33 1.63 1 3

"2 times" 205 1.25 0.466 1.18 1.31 1 3

"3 times" 326 1.21 0.422 1.16 1.25 1 3

"More than 3 times"

104 1.18 0.388 1.11 1.26 1 2

Total 685 1.24 0.445 1.2 1.27 1 3

Does your current health limit you to

go up several floors?

"1 time" 50 2 0.495 1.86 2.14 1 3

"2 times" 205 1.71 0.507 1.64 1.78 1 3

"3 times" 326 1.6 0.51 1.54 1.65 1 3

"More than 3 times"

104 1.52 0.521 1.42 1.62 1 3

Total 685 1.65 0.522 1.61 1.69 1 3

During the last 4 weeks in your daily life or in your work, did you do less than

you would have liked to do because

of your physical health?

"1 time" 50 2.74 0.777 2.52 2.96 1 4

"2 times" 205 2.06 0.748 1.96 2.17 1 4

"3 times" 326 1.66 0.695 1.58 1.74 1 4

"More than 3 times"

104 1.49 0.591 1.38 1.61 1 3

Total 685 1.83 0.775 1.78 1.89 1 4

During the last 4 weeks in your daily life or in your work, were you limited in the type of work or

other activities because of physical

health?

"1 time" 50 2.76 0.744 2.55 2.97 1 4

"2 times" 205 2.21 0.806 2.1 2.33 1 4

"3 times" 326 1.74 0.785 1.66 1.83 1 3

"More than 3 times"

104 1.56 0.708 1.42 1.7 1 3

Total 685 1.93 0.845 1.87 1.99 1 4

During the last 4 weeks in your daily life or in your work, did you do less than

you would have liked to do because of some emotional

problem?

"1 time" 50 2.42 0.731 2.21 2.63 1 4

"2 times" 205 1.88 0.683 1.79 1.98 1 4

"3 times" 326 1.55 0.624 1.48 1.62 1 4

"More than 3 times"

104 1.38 0.508 1.29 1.48 1 3

Total 685 1.69 0.689 1.64 1.74 1 4

During the last 4 weeks in your daily life or in your work,

did you do your

"1 time" 50 2.46 0.762 2.24 2.68 1 4

"2 times" 205 2.08 0.827 1.97 2.2 1 4

"3 times" 326 1.65 0.753 1.57 1.73 1 3


[32]




N Mean

Standard deviation



work or other daily activities less

carefully than usual because of some

emotional problem?

"More than 3 times"

104 1.45 0.652 1.33 1.58 1 3

Total 685 1.81 0.815 1.75 1.87 1 4

During the last 4 weeks, to what

extent has the pain made your usual

work difficult?

"1 time" 50 2.54 0.788 2.32 2.76 1 4

"2 times" 205 1.98 0.645 1.89 2.06 1 4

"3 times" 326 1.72 0.608 1.65 1.78 1 4

"More than 3 times"

104 1.52 0.607 1.4 1.64 1 3

Total 685 1.82 0.681 1.77 1.88 1 4

During the past 4 weeks, how often did you feel calm?

"1 time" 50 3.72 0.607 3.55 3.89 3 5

"2 times" 205 4.13 0.499 4.06 4.2 3 5

"3 times" 326 4.28 0.526 4.22 4.34 3 5

"More than 3 times"

104 4.38 0.58 4.27 4.5 3 5

Total 685 4.21 0.556 4.17 4.25 3 5

During the last 4 weeks, how often did you have a lot

of energy?

"1 time" 50 3.02 0.714 2.82 3.22 2 5

"2 times" 205 3.59 0.815 3.48 3.7 2 5

"3 times" 326 4 0.828 3.91 4.09 1 5

"More than 3 times"

104 4.28 0.717 4.14 4.42 3 5

Total 685 3.85 0.864 3.78 3.91 1 5

During the past 4 weeks, how often

did you feel discouraged and

depressed?

"1 time" 50 2.16 0.618 1.98 2.34 1 3

"2 times" 205 1.81 0.592 1.73 1.89 1 3

"3 times" 326 1.55 0.615 1.48 1.61 1 3

"More than 3 times"

104 1.41 0.585 1.3 1.53 1 3

Total 685 1.65 0.635 1.6 1.7 1 3

During the past 4 weeks, how often

have physical health or emotional problems hindered

your social activities?

"1 time" 50 2.34 0.593 2.17 2.51 1 3

"2 times" 205 1.91 0.676 1.81 2 1 3

"3 times" 326 1.58 0.65 1.51 1.65 1 4

"More than 3 times"

104 1.4 0.566 1.29 1.51 1 3

Total 685 1.71 0.688 1.66 1.76 1 4


"1 time" 50 4.32 0.891 4.07 4.57 2 5

"2 times" 205 4.83 0.434 4.77 4.89 3 5

"3 times" 326 4.9 0.346 4.86 4.94 3 5

"More than 3 times"

104 4.9 0.296 4.85 4.96 4 5

Total 685 4.84 0.453 4.81 4.87 2 5

Of the following "1 time" 50 4.58 0.642 4.4 4.76 3 5


[33]




N Mean

Standard deviation



statements related to self-care, which is the one that best

describes your health today?

"2 times" 205 4.87 0.38 4.82 4.92 3 5

"3 times" 326 4.92 0.287 4.89 4.95 3 5

"More than 3 times"

104 4.89 0.339 4.83 4.96 3 5

Total 685 4.87 0.369 4.85 4.9 3 5

Of the following statements related to daily activities,

which one best describes your health today?

"1 time" 50 4.08 0.829 3.84 4.32 2 5

"2 times" 205 4.57 0.57 4.49 4.64 3 5

"3 times" 326 4.66 0.523 4.61 4.72 3 5

"More than 3 times"

104 4.7 0.5 4.6 4.8 3 5

Total 685 4.6 0.581 4.55 4.64 2 5

Of the following statements related

to pain or discomfort, which is

the one that best describes your health today?

"1 time" 50 3.78 0.616 3.6 3.96 2 5

"2 times" 205 4.31 0.532 4.23 4.38 3 5

"3 times" 326 4.45 0.534 4.4 4.51 3 5

"More than 3 times"

104 4.61 0.491 4.51 4.7 4 5

Total 685 4.38 0.567 4.34 4.43 2 5

Of the following statements related

to anxiety or depression, which one best describes your health today?

"1 time" 50 4.5 0.544 4.35 4.65 3 5

"2 times" 205 4.71 0.497 4.64 4.78 3 5

"3 times" 326 4.77 0.441 4.72 4.82 3 5

"More than 3 times"

104 4.81 0.442 4.72 4.89 3 5

Total 685 4.74 0.472 4.7 4.77 3 5

Indicate your state of health today on a

scale of 0 to 100

"1 time" 50 63 13.628 59.13 66.87 40 90

"2 times" 205 74.49 13.334 72.65 76.32 40 100

"3 times" 326 78.62 13.2 77.18 80.06 45 100

"More than 3 times"

104 82.31 13.255 79.73 84.89 60 100

Total 685 76.8 14.046 75.75 77.86 40 100


[35]



ANNEX 2

DESCRIPTIVE STATISTICS: MEAN - GENDER

Gender Mean

In general, you would say that your health is Man 3.67

Woman 3.45

Does your current health limit you to make efforts? Man 1.22

Woman 1.3

Does your current health limit you to go up several floors? Man 1.56

Woman 1.76


Man 1.83

Woman 1.93


Man 1.89

Woman 2.04


Man 1.67

Woman 1.77


Man 1.73

Woman 1.9

During the last 4 weeks, to what extent has the pain made your usual work difficult? Man 1.79

Woman 1.92

During the past 4 weeks, how often did you feel calm? Man 4.24

Woman 4.13

During the last 4 weeks, how often did you have a lot of energy? Man 3.91

Woman 3.75

During the past 4 weeks, how often did you feel discouraged and depressed? Man 1.61

Woman 1.76


Man 1.65

Woman 1.81

Of the following statements related to mobility, which one best describes your health today? Man 4.81

Woman 4.82

Of the following statements related to self-care, which one best describes your health today? Man 4.86

Woman 4.87


Man 4.6

Woman 4.58


Man 4.44

Woman 4.29


Man 4.78

Woman 4.66

Indicate your state of health today on a scale of 0 to 100 Man 78.79

Woman 73.91


[37]



ANNEX 3

T TEST OF INDEPENDENT SAMPLES

Levene's test of

equality of variances T test for equality of means

F Sig. t gl Sig. (bilateral) Difference of

means

Standard

error

difference

95% confidence interval of

the difference

Lower Higher

In general, you would say that

your health is

Equal

variances are

assumed

22.18 0.000 3.528 718 0.000 0.222 0.063 0.098 0.345

Equal

variances are

not assumed

3.559 712.401 0.000 0.222 0.062 0.099 0.344

Does your current health limit

you to make efforts?

Equal

variances are

assumed

17.55 0.000 -2.204 718 0.028 -0.077 0.035 -0.15 -0.008

Equal

variances are

not assumed

-2.191 684.596 0.029 -0.077 0.035 -0.15 -0.008

Does your current health limit

you to go up several floors?

Equal

variances are

assumed

35.52 0.000 -4.993 719 0.000 -0.2 0.04 -0.28 -0.121

Equal

variances are

not assumed

-5.012 718.959 0.000 -0.2 0.04 -0.28 -0.121

During the last 4 weeks in your

daily life or in your work, did you

do less than you would have

liked to do because of your

physical health?

Equal

variances are

assumed

6.875 0.009 -1.532 718 0.126 -0.094 0.061 -0.22 0.027

Equal

variances are

not assumed

-1.535 715.66 0.125 -0.094 0.061 -0.22 0.026


daily life or in your work, were

you limited in the type of work

or other activities because of

physical health?

Equal

variances are

assumed

1.063 0.303 -2.25 718 0.025 -0.15 0.066 -0.28 -0.019

Equal

variances are

not assumed

-2.251 713.389 0.025 -0.15 0.066 -0.28 -0.019



do less than you would have

liked to do because of some

emotional problem?

Equal

variances are

assumed

3.061 0.081 -1.869 719 0.062 -0.102 0.055 -0.21 0.005

Equal

variances are

not assumed

-1.871 715.677 0.062 -0.102 0.054 -0.21 0.005



do your work or other daily

activities less carefully than usual

because of some emotional

problem?

Equal

variances are

assumed

1.921 0.166 -2.729 719 0.007 -0.166 0.061 -0.29 -0.047

Equal

variances are

not assumed

-2.732 715.515 0.006 -0.166 0.061 -0.29 -0.047

During the last 4 weeks, to what

extent has the pain made your

usual work difficult?

Equal

variances are

assumed

16.48 0.000 -2.254 719 0.024 -0.123 0.054 -0.23 -0.016

Equal

variances are

not assumed

-2.264 718.995 0.024 -0.123 0.054 -0.23 -0.016

During the past 4 weeks, how

often did you feel calm and

calm?

Equal

variances are

assumed

16.4 0.000 2.508 719 0.012 0.111 0.044 0.024 0.198


[38]



Equal

variances are

not assumed

2.517 718.784 0.012 0.111 0.044 0.024 0.198

During the last 4 weeks, how

often did you have a lot of

energy?

Equal

variances are

assumed

3.799 0.052 2.547 719 0.011 0.165 0.065 0.038 0.293

Equal

variances are

not assumed

2.562 717.936 0.011 0.165 0.065 0.039 0.292


often did you feel discouraged

and depressed?

Equal

variances are

assumed

1.976 0.16 -2.896 719 0.004 -0.149 0.051 -0.25 -0.048

Equal

variances are

not assumed

-2.892 708.29 0.004 -0.149 0.051 -0.25 -0.048


often have physical health or

emotional problems hindered

your social activities?

Equal

variances are

assumed

3.825 0.051 -3.036 719 0.002 -0.161 0.053 -0.27 -0.057

Equal

variances are

not assumed

-3.036 713.019 0.002 -0.161 0.053 -0.27 -0.057

Of the following statements

related to mobility, which is the

one that best describes your

health today?

Equal

variances are

assumed

0.868 0.352 -0.29 719 0.772 -0.011 0.037 -0.08 0.062

Equal

variances are

not assumed

-0.293 713.464 0.77 -0.011 0.037 -0.08 0.061


related to self-care, which is the

one that best describes your

health today?

Equal

variances are

assumed

0.644 0.423 -0.339 719 0.735 -0.01 0.03 -0.07 0.048

Equal

variances are

not assumed

-0.341 717.555 0.733 -0.01 0.029 -0.07 0.048


related to daily activities, which

is the one that best describes

your health today?

Equal

variances are

assumed

1.053 0.305 0.408 719 0.683 0.018 0.045 -0.07 0.106

Equal

variances are

not assumed

0.41 718.704 0.682 0.018 0.045 -0.07 0.106


related to pain or discomfort,

which is the one that best


Equal

variances are

assumed

22.78 0.000 3.387 719 0.001 0.15 0.044 0.063 0.237

Equal

variances are

not assumed

3.409 716.828 0.001 0.15 0.044 0.064 0.236


related to anxiety or depression,

which is the one that best


Equal

variances are

assumed

25.53 0.000 3.141 718 0.002 0.115 0.037 0.043 0.187

Equal

variances are

not assumed

3.131 699.389 0.002 0.115 0.037 0.043 0.187

Indicate your state of health

today on a scale of 0 to 100

Equal

variances are

assumed

10.96 0.001 4.533 719 0.000 4.883 1.077 2.768 6.998

Equal

variances are

not assumed

4.56 717.791 0.000 4.883 1.071 2.781 6.985

TOURISM IMPACT ON ACTIVE AND HEALTHY AGEING - SUBJECTIVE MEASUREMENTS Action Group: D4 Age friendly environments

o Lead organisation name: Research Group Tourism, Healthy Ageing and ICT

o Organisation country: Spain

o Contact person: M. Ángeles Oviedo-García

o Contact person email: [email protected]

o Activity type: Commitment

Documents

TOURISM IMPACT ON ACTIVE AND HEALTHY … › eip › ageing › sites › eipaha › files › ...Subjective Well-Being (SWB), as Lindert et al. (2015, p. 731) recalled, “contributes