Leisure activities and attitude of institutionalized elderly people: a basis for nursing practice

Aim: to identify the leisure activities performed in Long-Stay Institutions for the Elderly (LSIEs), registered in the city of Maringá-PR, Brazil, and to analyze the attitude of the elderly people toward leisure promoted by the institutions. METHOD: this was a descriptive and transversal study with a quantitative approach, carried out with 97 elderly people, through the establishment of the socio-demographic profile and the application of the Leisure Attitude Scale. The data was subjected to descriptive statistical analysis, association tests (chi-square or Fisher's) and Spearman's correlation. RESULTS: males, aged 80 or over, widowed, with one to eight years of study, who had a monthly income were predominant. Age group and income were significantly associated with the performance of leisure activities. The results reflected the positive attitude of the elderly people in relation to leisure activities, except in the behavioral component. CONCLUSION: the findings of this study indicate the need for further investigation into the difficulties linked to the attitude toward leisure in the behavioral component, considering aspects such as individual concepts of leisure and the health status of the elderly people.

by dependency, limited physical space and a determined time for daily activities, with it being vital to adapt to the rules and routines of the new environment, which does not always provide adequate living conditions, in this case, with an emphasis on non-regimented leisure as a way to exercise autonomy.
Although the classical theoretical concepts (2) related to the theme have been marked by the Work-Leisure dichotomy, the current concepts reflect on the complementarity between one and the other.
This interpretation is in agreement with the Theory of Communicative Action (6) , in which leisure is essentially a social relationship that is expressed in the "world of life", i.e., not directly related to the "world of work", through the integration between people, the pursuit of fun and the desire to feel pleasure (7) . This perspective highlights leisure activities in certain populations, in which time is not linked to labor activities, as in the case of institutionalized elderly people, who no longer perform work functions.
Given the above, this study aimed to identify the leisure activities performed in Long-Stay Institutions for the Elderly (LSIEs), registered in the municipality of Maringá-Paraná, Brazil, and to analyze the attitude of the elderly people toward leisure promoted by the LSIEs.

Methodology
The population of this cross-sectional descriptive The data for the characterization of the subjects concerning institutionalization and leisure, as well as the measurement of positive and negative attitudes toward leisure, were analyzed descriptively. Leisure activities mentioned by the elderly people were classified according to the following categories: physical, manual, artistic, intellectual, associative and touristic (10)
Regarding the institutions, four were private and three philanthropic and/or governmental, however, 64% of the study sample were living in the latter type. The length of residence in the LSIE was one to five years for 49.5% of the elderly people. The main reason to seek accommodation in these places was due to difficulty in maintaining the family relationship (66%), followed by self-care difficulties (16.5%), financial deficit (12.4%) and due to their own desire (5.1%).
Concerning leisure activities, 69% of the elderly people reported performing them, while the remaining 31% reported that their respective LSIEs did not offer leisure activities, or that they were not suitable for their health conditions, or even that they did not felt the desire to perform them. The classification of the activities performed by the elderly people, as well as their frequency and duration, are listed in Table 1. physical activities were the subject of the greatest number of suggestions to complement the leisure in the LSIEs, especially with regard to the practice of sports (football, swimming and table tennis), dance and hydrogymnastics. In addition to these, the possibility of living with pets and children was also suggested.
When associating the performance of leisure activities with the sociodemographic and institutionalization characteristics, statistically significant differences were observed regarding age group (p <0.010) and income (p <0.04), as shown in Table 2. It was found that 40.3% of the subjects who performed leisure activities were in the 60 to 69 years age group, while among those who did not perform leisure activities, 63.3% were 80 years  Table 3).
The correlations obtained between the cognitive, affective and behavioral subscales, as well as the total scale are presented in Table 4.

Discussion
Being female, of advanced age, widowed, with lower levels of education and income are predictors for institutionalization (11) . This draws attention to the predominance of women in the characterization of the institutionalized community, as demonstrated by a study conducted in Korea (12) . The results of the present study regarding gender, however, differ from those highlighted, since 56.7% of the elderly participants were male. It should be noted that, despite female longevity, living longer means greater exposure to adversitydiscrimination in access to education, income, food, meaningful work and politics -which, taken together, lead to greater frailty in older age (13) .
Leisure activities contribute to the biopsychosocial balance of the elderly person (14) . Regarding leisure activities performed by elderly people, the findings of this study confirm those of a study conducted in a LSIE in Curitiba (15) , in which the most frequent activities were those of the intellectual, associative and manual types.
These activities seem to have a protective effect on functional loss in elderly people, through mechanisms similar to the work activity, which involves cognitive stimulation and compensatory mechanisms of the social support network (14) . Simultaneously, given the importance of physical activity in preventing falls and functional disability in elderly people, especially with strength training, muscular endurance, flexibility and balance exercises (16) , the need to implement physical activity during the leisure time of institutionalized elderly people is stressed, as the elderly people themselves suggested.
The participation of the elderly people in leisure activities decreased significantly with respect to age, this reduction may be related to functional limitations, since functional performance tends to decrease with increasing age (17) . which corroborates the findings of the validation study of the Portuguese version (3) , however, diverges from the results of the original version study (9) , in which the highest mean was obtained in the affective subscale and the lowest in the cognitive subscale.
In the area of social psychology, contrary to what would be considered common sense, the attitude is not constituted by the action itself, but developed according to the object in question and the position of the individual regarding this, based on his/her life experiences (18) .  (19) , can influence transformations in knowledge and beliefs, as well as in behavior with respect to an object, in this case leisure. Furthermore, behavior can be influenced by the circumstances experienced and, when considering an institutional context to which the elderly people had or have to adapt, the sudden emergence of rigid routines, the reduced privacy and the imposition of roles characterized by dependence must be considered (20) .
Regarding the correlations obtained between the subscales and the total scale, as in the original scale and the Portuguese version, the affective and behavioral subscales presented coefficients greater than those obtained in the cognitive and behavioral subscales. The discussion, in this sense, is centered on the hypothesis that behavioral intentions are determined more by what is felt than by what is known about leisure activities (3) .
The satisfaction of the basic needs of the elderly people depends on the professionals of the LSIE, especially the nursing staff, directly responsible for the provision of care. Accordingly, it should be mentioned that the nurse, as well as the team, must view the human being from the perspective of integrality, offering personalized and humanized care (4) , which includes greater attention to leisure activities.
The institutional context is subject to social interaction and empowerment of the person (6) , provided Castro VC, Carreira L.
that the interventions performed consider people's choices about their lives, especially regarding leisure, which has proved relevant for the development of health promotion strategies that favor quality of life (21) .

Conclusion
The leisure activities performed by the elderly people were mostly intellectual, followed by associative and manual. There was a statistically significant association between the performance of leisure activities and the age group and income variables. In general, the results