Changes in daily life and wellbeing in adults, 70 years and older, in the beginning of the COVID-19 pandemic

Abstract

Background

In the beginning of the COVID-19 pandemic, Swedish authorities enforced specific recommendations on social distancing for adults 70 years and older (70+). Day-to-day life changed for 15% of the Swedish population. The aim of the study was to explore how adults 70+ experienced and managed changes in everyday life due to the COVID-19 pandemic and how those changes affected wellbeing at the beginning of the virus outbreak.

Methods

Eleven women and six men, (mean age 76 years), living in ordinary housing, participated in remote semi-structured interviews in April 2020. The interviews were analysed with qualitative content analysis.

Findings

The theme Suddenly at risk – ‘…but it could have been worse’ included four categories My world closed down; Negotiations, adaptations and prioritizations to manage staying at home; Barriers and facilitators to sustain occupational participation; and Considerations of my own and other’s health and wellbeing emerged from the data analysis.

Conclusion

Everyday life changes had implications for health and well-being. The participants questioned previous conceptions of meaning in relation to habitual activities, likely leading to consistent occupational changes. However, these long-term effects remain to be explored, and considered to enable older adult’s health during the pandemic and beyond.

Keywords:

• Corona
• health
• later life
• occupational deprivation
• risk group
• social distancing
• social interaction
• Sweden

Introduction

The Coronavirus disease (COVID-19) reached Sweden in late January 2020, and March 10 the Public Health Agency of Sweden announced that the virus was spreading in the community. At the same time, the World Health Organisation (WHO) declared that COVID-19 had become a global pandemic. In the lack of pharmaceutical treatments (e.g. vaccines and antivirals), governments all over the world had to rely on public health measures [1] i.e. social distancing, quarantine, and border control, to control the spread of the virus. Extensive measures to slow down the spread of the virus were taken all over the world. Some countries enforced social distancing by imposing lockdowns (in certain regions or the country as a whole), while other countries took less stringent social distancing recommendations [2].

Worldwide, older adults were early on identified as being of higher risk to be severely ill or die from the virus. Medical conditions (e.g. asthma, diabetes, heart disease) that are more commonly occurring in later life were yet a risk factor. Compared to other Scandinavian countries, Sweden imposed less stringent social distancing measures. However, on March 16, the Public Health Agency of Sweden, declared that adults 70 years and older (70+) were recommended to limit all social contacts with family and friends to an absolute minimum, stop travelling by public transport and avoid shops and other public spaces [3]. People with good health and an active social life as well as more vulnerable people [4] had to adapt to the new situation. In a heartbeat, the conditions for day-to-day life changed for 15% (approximately 1.5 million) of the Swedish population. Beyond those recommendations, also general restrictions were implemented, e.g. as the Swedish Government declared that only 50 participants were allowed at public events from April 2.

Older adults constitute a heterogeneous group due to different life experiences, cultural backgrounds, genetics, health histories and contexts in which they are ageing. In Sweden, life expectancy is 81 years for men and 84 years for women, and the older population in Sweden is increasingly active and independent. Among people 80 years and older living in ordinary housing, about 29% receive home help services, and about 16% live in residential care facilities [5]. Retirement age in Sweden is currently 67 years but an increasing proportion beyond that age have a part-time or full-time employment. Few older adults live in poverty but the group having a pension below 60% of the Swedish median income has increased and is approximately 16% (12,550 SEK or 1200 EURO net income, 2020). Several health conditions have decreased among older adults in the last 20 years, while dementia and depression has increased. That is, older adults in Sweden show substantial heterogeneity regarding employment, income and health [6].

During the COVID-19 pandemic older adults’ health and wellbeing will be influenced not only by the risk of contracting the virus or becoming ill. The adverse effects that comes with social distancing recommendations or worry for relatives, economy etc. will also influence health and wellbeing [7]. Limiting out-of-home activities and social interaction might change older adults’ habits and daily activities in ways that beforehand can be hard to estimate.

Over all, sedentary behaviour is well known to have a negative impact on health and wellbeing in later life. A systematic review showed that for adults 60 years and older sedentary behaviour increased the risks for falls, metabolic syndrome, obesity and mortality [8]. Also, studies indicate that mental health is likely to be influenced, but more research to confirm such possible relations are needed [8]. Yet, feelings of loneliness and social isolation have repeatedly shown to have negative consequences on older adults’ physical, psychological and emotional health [9–11]. Moreover, the increased use of digital technologies during the pandemic bring marginalisation and further social exclusion for groups of older adults [12,13].

Quarantines during virus outbreak have shown to negatively impact psychological health on the general population. An early COVID-19 study from China showed that more than half of the respondents (N = 1, 210) experienced moderate to severe depressive symptoms, anxiety or increased stress levels [14]. During the quarantine in Toronto, Canada, caused by the SARS outbreak in 2003, posttraumatic stress syndrome (PTSD) or depressive symptoms were found in about a third of the respondents (N = 129) [15]. A recent review of the literature on the psychological effects of quarantine during past epidemics and pandemics highlighted that, when comparing the psychological outcomes of quarantined versus non-quarantined persons, the former are more likely to show psychological distress [16]. Although Sweden has not been subject to quarantine in the form of total lockdown, the pandemic and its implications per se could likely bring adverse mental health effects.

Social distancing enforced as a public health measure will likely affect individuals more who live alone, have no close family, or already feel lonely or isolated – these are situations common in later life. The health risks associated with loneliness and social isolation are particularly severe for older adults [17]. It is currently unclear whether less strict social distancing measures such as stay-at home (similar to the ones applied for adults 70+ in Sweden) recommendations that restricts social interaction and reduce the possibilities to do out-of-home activities also have similar negative impact on health and wellbeing.

Engaging in activities and independently managing everyday life and daily routines, promote health and wellbeing [18]. Ensuring active and healthy ageing is an important growth strategy for the EU – not only in economic terms, e.g. spending on pensions, health and long-term care, but equally so in terms of wider societal growth [19]. Being able to do tasks and activities found individually valuable and significant is the human way to engage with its social world, express identity and find meaning and purpose in life [20–22]. Sudden environmental restrictions (e.g. being limited to the home) constrains engagement in meaningful activities, limits the possibility to fulfil role engagements and restricts participation in society and social contexts with negative implications for health and wellbeing [23–25]. Being deprived of possibilities to do meaningful activities and tasks is defined as occupational deprivation or occupational alienation part of the occupational justice approach [26]. From an outside-view, adults 70+ in Sweden, became deprived of possibilities to engage in meaningful activities during the COVID-19 pandemic. However, since meaning is highly subjective, we need to listen to the voices and opinions of those who are experiencing the implications of the social distancing recommendations to really know.

The aim of the study was to explore how adults 70+ experienced and managed changes in everyday life due to the COVID-19 pandemic and how those changes affected wellbeing at the beginning of the virus outbreak.

Methods

The study has a qualitative, descriptive design including semi-structured interviews with older adults in Sweden at the time of the beginning of the COVID-19 pandemic (April, 2020).

Study context

The current study was a part of the ‘At Risk Study’, which is a qualitative longitudinal project with repeated in-depth interviews. The project explores how COVID-19 has impacted older adults’ health and daily life with a specific focus on how older adults cope and manage these changes over time. The Swedish Ethical Review Authority approved the study (Reg. No 2020-01493).

The participants

This study focussed on adults 70+, living in ordinary housing in Sweden. A pool of possible candidates was established including; older adults who previously had been part of two research studies at the Centre for Ageing and Supportive Environments (CASE) and willing to take part again as well as volunteers who had signed up on a community event where researchers at CASE presented ongoing studies (n = 23). The Ageing in The Right Place Study (n = 9) aimed to develop a housing counselling intervention by using research circles with community-living seniors in a medium-sized municipality in the north of Sweden [27]. The Planning Ahead Study (n = 17) explored housing decision-making among older adults in relative poverty with in-depth interviews with community-living seniors with a pension of 1200€ or less (Yadav et al. in manuscript). The pool of volunteers who had signed up included 31 adults being 70+. As we aimed to get a purposeful and heterogenic sample, selection was made in regards to variability in age, gender, living status and urban/rural location. The digital literacy and pension level of the participants had large variability due to inclusion criteria of original studies. We contacted 18 candidates, one declined and, 17 were included and signed informed consent prior to data collection. The final sample thus constituted of 11 women and six men being 71–87 years old (mean age = 76). See Table 1 for further details on participants. All names used are pseudonyms.

Table 1. Description of participants (N = 17).

Pseudonym	Gender	Age	Living status	Type of dwelling	Location	Education^a	Household pension level^b	Care^c	Additional risk factors^d	Working^e
Anna	♀	78	Alone	Apartment	Urban	USE	<12,500	Caregiver
Bjorn	♂	74	Co-residing	House	Urban	U	12,500–20,000		Yes
Cecilia	♀	74	Alone	Apartment	Rural	LSE	12,500–20,000
David	♂	86	Alone	Apartment	Urban	U	12,500–20,000	Safety alarm	Yes
Eric	♂	71	Co-residing	Apartment	Urban	USE	>20,000		Yes
Fred	♂	87	Co-residing	House	Rural	LSE	<12,500	Caregiver		Yes
Gunilla	♀	75	Alone	Apartment	Semi-urban	USE	<12,500	Caregiver
Helen	♀	75	Alone	House	Rural	U	<12,500
Ingrid	♀	75	Co-residing	Apartment	Urban	USE	>20,000		Yes
Jane	♀	75	Alone	House	Urban	U	<12,500			Yes
Kurt	♂	79	Co-residing	House	Semi-urban	U	>20,000	Caregiver
Lena	♀	77	Co-residing	House	Urban	U	>20,000
Marianne	♀	71	Alone	House	Urban	U	12,500–20,000
Nils	♂	73	Co-residing	Apartment	Urban	U	>20,000
Odette	♀	76	Alone	House	Semi-urban	U	>20,000		Yes	Yes
Patricia	♀	74	Co-residing	House	Semi-urban	PNU	12,500–20,000
Rita	♀	78	Co-residing	House	Rural	PNU	<12,500			Yes

^a LSE: Lower secondary education; USE: Upper secondary education; PNU: Post-secondary non-university education; U: University education.

^b Monthly net household pension income, in Swedish kronor (SEK).

^c Safety alarm = using municipal service with safety alarm; caregiver = informal caregiver to family member in the same household or outside of household.

^d Yes = Self-reported COVID-19 risk factors besides age, such as chronic pulmonary diseases, diabetes, immunosuppressive conditions and treatments, and/or cardiovascular disease.

^e Yes = Retired but currently employed/self-employed as w.

Data collection

We developed a thematic semi-structured interview guide based on the aim of the study, and conducted three pilot-interviews to test the interview guide and the recording equipment with satisfying result. All co-authors had previous experience from conducting in-depth interviews for research purposes and all co-authors were involved in the data collection. Due to the social distancing recommendations, all interviews were conducted remotely via video conferencing software (e.g. zoom, skype) (n = 12) or phone (n = 5). Audio was digitally recorded on an external device and transcribed verbatim. The interviews lasted in average 51 min (range 39–72 min).

Data analysis

All authors (team members) contributed to the data analysis using qualitative content analysis [28] and the NVivo 12 software [29] to organise the data and facilitate the analyses. First, each team member read one of the interviews they had conducted to grasp a sense of whole, as well as identified meaning units and coded it. These meaning units, codes and overall first impressions were discussed at a first analytic team meeting to align the coding procedure, and after that, the remaining interviews were coded. At a second analytic meeting preliminary categories were defined and then each team member applied the preliminary categories on the interviews assigned to them. A third analytic meeting was held where all interviews, codes and preliminary categories were discussed and then merged using NVivo. Finally, the first and last author conducted the remaining analysis. Through an iterative analytic process between meaning units, codes and categories the preliminary categories were developed considering homogeneity and heterogeneity. An overarching theme was developed. As a last step all authors read the preliminary findings and compared with the original transcripts of the interviews they had performed, to ensure trustworthiness.

Findings

The overarching theme of the findings revealed that even if everyday life of the participants dramatically changed in a heartbeat, they did not want to complain and acknowledged that the situation could have been a lot worse. Despite sacrifices, worry and social distancing they appreciated not to be in the situation of complete lockdown. They were grateful that the situation in Sweden seemed less serious than in Italy and Iran, repeatedly covered by the news. The participants described daily life full of changes, and feelings of uncertainty, they but also acknowledged that they had a lot to be thankful for. Having children close by, having a garden to be in, and having reasonable financial security made the Corona-pandemic bearable. The theme Suddenly at risk – ‘…but it could have been worse’ captured four categories. The participants described how they had to accept some changes due to COVID-19 and subsequent 70+ recommendations summarised in the first category; my world closed down. They made negotiations, adaptations and prioritizations to manage staying at home as described in the second category, but they also experienced contextual barriers and facilitators to sustain occupational participation as the third category elucidate. The experiences of health and wellbeing varied and are captured in the fourth category, considerations about my own and other’s health and wellbeing (Figure 1).

Figure 1. overview of the theme and the categories.

My world closed down

Before the pandemic most of the participants lived active lives, and the 70+ recommendations freed up much of their time. In this early phase of the COVID-19 pandemic, some of the participants struggled to handle the abrupt cancellations of health care (e.g. general practice visits, surgery) as well as cherished activities such as choir rehearsals, cooking groups, in- and outdoor exercises, social activities in 55+ communities and events organised by senior organisations. Cancelled visits to cinemas, concerts, restaurants and museums added adverse effects.

I feel a bit lonely, as sensory impressions has vanished, I can’t get stimulated by visiting a museum, an art gallery or going to the movies. I used to do that a lot… Now part of my life has disappeared, so I’m a bit lonely. (Marianne)

The more general restrictions allowing meetings with less than 50 people also affected the possibility to engage in valuable and productive activities (e.g. actor, politician, guardian, board member). Regular paid work within farming, education, social services and the cultural sector were also postponed, and some of the participants debated whether or not they would go back to these jobs after the pandemic. Participants’ serving as politicians could not fulfil their democratic assignments, but after a while, participation became possible through an online platform. Some had to pause voluntary work in non-profit help organisation, which had consequences beyond themselves. ‘I am responsible for five [older adults] that I should visit once a month, but that’s not possible now. Two of them live in nursing homes where visits aren’t allowed.’ (Rita)

Beyond the 70+ recommendations, the more general public-health recommendations of staying at home and avoiding social contact also affected the participants at the time of the interviews. Overall, the participants accepted and trusted the recommendations by the Public Health Agency, as they made them feel safe and secure. While most showed appreciation of specific shopping times assigned for older adults and other risk groups, one woman found the time of day (early or late hours) to be somewhat marginalising despite the good intention.

Most of the participants had no problems to occupy themselves but rather saw the benefits of a calmer, for some even less stressful everyday life, making way for reflection and things they had planned but never had time for; updating computers, decluttering of storage areas or learning a new instrument or language. For others, time passed by slowly, the day and the week lost structure, as they no longer had meaningful activities to engage in. For some this meant that they spent more time outdoors walking, while others watched TV more often than before.

Negotiations, adaptations and prioritizations to manage staying at home

Some participants stated that the life had changed a lot, whereas other stated that their life had not changed that much. One participant, a farmer continued to work on the farm with his son, and others were used to spending most of the time alone at home, in the garden or the summerhouse. ‘We weren’t so socially engaged before the pandemic either. So there is no dramatic change. We lived a quite calm life, and now it’s even more quiet. (Bjorn)

Participants appreciated the freedom to make individual but informed decisions and negotiations around activities – a freedom granted as the Swedish authorities did not apply a complete lockdown. Considering health care service appointments, some continued to visit the physicians, chiropractor etc. without much hesitation, trusting those services to take necessary precautions. Others were concerned and called the health care providers to discuss options and made a common agreement to postpone the visit, while others negotiated with themselves.

I’m supposed to do an X-ray tomorrow, so my last chance to cancel is today. But as they sent me a reminder yesterday they seem to want me to come, and I have no one to consult about doing this or not. There is a risk that I catch it (the virus) if I go to the hospital. I will follow, try to follow the 70+ recommendations so I’m hesitant about going tomorrow. (Anna)

The participants justified the decision to postpone health care visits with being afraid of getting the virus. In particular for those who had to use public transportation. However, participants who did choose to run errands in public environments, justified that with feeling safe as long as the places were not crowded and as long as they were able to take own precautions. While some received help to shop groceries by their children, others shopped online or through home delivery services to remain independent. Although that brought some limitations: ‘I don’t like it so much, as you can’t get it all, you can’t shop delicacies over the Web.’ (Rita). One participant tried to shop online, but failed as he lacked a mobile bank identification. Others preferred to shop on their own as before, but minimised time spent in the store, wore gloves or took other precautions.

I use my own bag, don’t touch the shopping cart and put the food in my own bag and pay at the cash desk…In my car I apply hand sanitizers, so I’m very careful. And I try not to meet anyone at the shop. I try to go when less people is shopping. (Patricia)

Pharmacy products were home-delivered utilising COVID-19 related pharmacy services provided, or bought by themselves or their children. Many pharmacies serviced their customers outside, so that the older adults did not have to enter the facility.

Participants also identified and suggested solutions for shopping independently; e.g. asking the plant nursery to deliver plants in the car park or deciding on what washing machine to buy over the Internet, while ordering and getting it home delivered free from a local retail store. Some took pleasure in shopping and missed this activity. Others did not mind or enjoyed that they did not have to shop for clothes or shoes. Some avoided going to the library or to the hairdresser while others made these visits on least busy hours or used a mask. Participants cancelled regular and irregular restaurant visits, or ordered home delivery. Shortly after the restrictions were implemented, one participant (and partner) made an overnight trip previously planned, thinking that a hotel room would support social distance – but got somewhat concerned when they realised that they had to sit quite close to others in the dining room.

Some participants held positions in boards in local senior citizen organisations, and they made sure to lead a good example, and initiated closedown of common activities. Participants engaged in non-profit organisations declined to participate in meetings at first, but soon transferred such meetings (e.g. guardian visits, steering board meetings) to online platforms or phone calls. For some, the use of digital technologies use turned into meaningful activities or supported occupational participation; ‘I’m not a pro on such technology, but today I performed a board meeting on the phone.’ (Kurt). Overall use of technology increased as they implemented new digital tools and services suggested by family members, organisations, employers or an inventive choir leader.

We sent audio files when singing [a traditional Swedish song to celebrate the spring]. We received music files to use as a help, and then we sent our own recordings and they put them together so that we [laughing] were singing the song together. (Helen)

Many participants continued to exercise. Most common was regular walks, and some participants changed their daily habit and took part in the 20 min exercise program on television initiated by National Swedish Television in the beginning of the pandemic. The participants avoided gyms and outdoor exercise classes were cancelled. Yet, although they considered physical activities important, their motivation for exercise was sometimes low due to the current circumstances, and largely their naturally occurring physical activities such as walking to the bus did not occur.

Social encounters with friends and families (ranging from birthday celebrations to casual everyday activities) decreased drastically; ‘and of course I can’t meet my grandchildren…and I guess they won’t come to celebrate my birthday either.’(Anna). Socialising with the neighbour across the hedgerow instead of on the porch, through the window or outdoors with children and grandchildren or with a friend on the opposite side of a bench were common solutions to keep and maintain social contact: ‘my neighbour and I, …we sit outdoors and drink a glass of whisky. We do that more or less every other day. But we don’t sit close to each other.’ (Fred). E-mails, social media posts, online video calls, phone calls or SMS: s became substitutes for regular lunches with a friend.

I even check Facebook now and then. I never did that before. I’m less digitally afraid now…Otherwise the isolation would have been complete. So, I nevertheless appreciate it, but I find it being a boring way of socializing compared to all other nicer ways there are. (Jane)

One of the participants in a living-apart-together relationship had not met her partner for over a month, as he had other health conditions putting him even more at risk, and they both lived beyond walking distance from each other. Another woman in such a relationship continued to meet her partner face to face although he followed recommendations less strict than she did. In conflict with the recommendations, one woman continued to meet a certain friend regularly to enable face-to-face talk. She argued that their encounters entailed low risk as they both kept themselves otherwise isolated. Others pursued caregiving as the person they helped lacked other to help, while one participant refrained from picking up her grandchildren from kindergarten. Overall, the participants found it necessary to cancel or postpone social activities, and accept that for a while.

Contextual barriers and facilitators to sustain occupational participation

Not all activities, habits or routines were restricted by the recommendations. Participants with homebound interests such as gardening, genealogy, playing cards or using the computer continued as usual, and some even spent more time on these activities than before. Pet owners appreciated the pets for enabling the maintenance of daily routines and social interactions.

Their home and housing situation had major implications on their possibilities to sustain a meaningful daily life while adhering to 70+ recommendations. Both co-habiting and single living participants reflected upon how much more challenging it was/would be to live alone during the pandemic.

If you live together with someone, you have someone to talk to. But you don’t have that if you are single living, and it’s not the same to make a phone call. You could say anything [anytime] when you are two. So that’s a major difference. (Gunilla)

Living at the countryside or in your own house, rather than in an apartment entailed less risk catching the virus according to participants. Such housing or an urban allotment garden made it easier to find things to do indoors and outdoors: ‘I don’t have time I need to kill, as I have a big house and garden to take care of.’ (Marianne). In fact, some of the participants chose to live in their summerhouses to obtain these advantages, arguing that confinement to an apartment was much more challenging, and overall access to the nature became a facilitator: ‘as I live so secluded, it’s, in a way, easier for me to continue my ordinary life.’ (Helen). Access to a car for private transportation was yet a facilitator, and participants used to travel with public transportation became restricted to walking or biking distances.

To several of the participants, the closedown of senior citizen organisations meant that their social contacts suddenly became reduced to a minimum, as they had few other friends or limited contact with people within these groups otherwise. Participants expressed how some friends were perhaps careless (e.g. planning to move from Stockholm to summerhouse in Southern Sweden), or too strict as they did not want to meet face to face. Participants’ possibilities for social interaction were largely influenced by others.

I had several things booked with people in my age. But I haven’t had to say no to those, as they are a lot more afraid than me. They don’t travel by bus or by train. And now I don’t do that either…as now I have also come to realize… but from the beginning, I thought that it wasn’t that dangerous. (Odette)

For one participant the housing situation changed dramatically, as her working grandson was forced by his father, to move out from her house, while another inherent, still in school and needing the participant’s support, could remain. Overall, children did not only help out with shopping but initiated constructive solutions for safe and social activities with family members and were often instrumental in helping the participants to see the value of complying to the 70+ recommendations: ‘our children are more worried than we are, saying you have to stay indoors. You can’t go shopping. You can’t go anywhere.’ (Patricia).

Several participants increased consumption of news to stay up to date on the developments of the pandemic. Newspapers, TV, radio, computers, or smart telephones were used to access the news. They regularly watched the Public Health Agency’s live TV broadcasts. However, 1 month into the pandemic, some participants felt they got too much information and they made sure to limit their news consumption: ‘There’s so much on the news about this, so there was a risk to go crazy. So I decided to listen to the news three times a day.’ (Nils).

Considerations about my own and other’s health and wellbeing

Many participants were worried about becoming ill with COVID-19, especially those experiencing additional risk factors. Most participants experienced health conditions (not related to COVID-19), but were used to their limitations and lived independently. Nevertheless, some health conditions became more challenging due to the pandemic. Participants with chronic obstructive pulmonary disease maintained extra precautions to reduce virus-related risks and one participants became more restricted due to an injured foot. Another participant were depressed and tired when the pandemic started, and became even more so;

I have been working too hard before the pandemic and got a bit chocked realizing that there is no need of me, even if there is a need of the job I have, but nevertheless I feel a bit insignificant. (Jane).

Participants were concerned about the reported dramatic course of the disease, tough treatments, the alleged prioritisation of younger patients and the scenario of having to die alone. However, several argued that the risk of spreading the virus by infecting others was more concerning than contracting the virus themselves. They were worried about the health and wellbeing of relatives and partners, especially the ones informally caring for loved ones or co-habiting with someone facing additional risk factors. How would they manage when the participants no longer could take care of them? ‘I do hope it won’t affect my relatives, my grandchildren and my daughter! That … worries me the most!’ (Anna).

Grieving a deceased dog also affected mood and motivation to get the day started, and for another participant an unruly cat had influenced daily habits more than the pandemic. Weather and time of year was a facilitator, making it easier to enjoy outdoor activities and life overall; ‘If this would have come in September, when it’s getting darker. Now it’s more and nice daylight, and beautiful in the nature, birds singing.’ (Cecilia). Yet others were concerned if people would still adhere to recommendations during the summer.

Some participants expressed how they missed people they could no longer meet face to face, family members (particularly grandchildren), friends, and partners. They were also longing for the parts of ordinary life that were missing and some even for luxury and flair. After all: ‘Everything that is fun in life has vanished with this epidemic’. (Jane).

They considered it a treat to get back to ordinary life and do ordinary things, and explained how they dreamt about getting on the local train or just to shop for themselves and see what unnecessary goodies that might end up in the shopping cart. They were frustrated from no longer being independent, but having to rely on support from others such as the children. Some expressed feelings of loneliness, isolation and being cut off from their own lives and the outside world; ‘Feeling a bit trapped, and locked up, can’t come around that’. (Nils). Some felt restless and that valuable time were wasted as they turned older; ‘You fall easily into depression when just waiting around… if it lasted a week, but it's been over a month now’. (Gunilla).

Some people expressed more strongly how wellbeing was affected; ‘It’s difficult, this uncertainty, and will it ever end?’. (Anna). It was not just longing or feelings of concern. One person expressed that life had become so limited that it was boring and meaningless. The feeling of no longer being valuable was destructive, and for a few, the fact that so many activities were shut down made them lose motivation for doing the few activities they could still do; ‘Can't say my inspiration is flowing to deal with things, wouldn’t say that exactly.’ (Odette).

However, not everyone felt that the pandemic and the 70+ recommendations affected their wellbeing. Further, some participants expressed how COVID-19 and the 70+ recommendations both affected their mood in a positive and a negative way. The participants who did not think that everyday life was particularly limited, did not either seem particularly worried. Their health and wellbeing was pretty much as usual, they said. Most participants also expressed how they were reluctant to complain because they considered themselves privileged, compared to people in more vulnerable or socioeconomically disadvantaged groups, or living in regions more affected by the spread of COVID-19, in Sweden (e.g. the capital city Stockholm) and abroad.

I am not very worried, really … Íve isolated myself, so to speak, don’t meet anyone, hardly even at a distance, and I take care of myself as one should. And I realize, after all, that I have a privileged situation because I have my own house, I have a big garden, I have a car, I can move around, and I live… .Well, no I'm not worried about the future. (Helen)

Some said they had a personality that helped them handle being alone or staying a lot at home; ‘I’m not bored, I don’t suffer from loneliness.’ (Helen). Moreover, some participants concluded that there was no need to worry all the time for everything, concluding that there were risks and that people died also under normal circumstances; ‘I'm not the worrying kind’. (Eric).

Some people also claimed that the 70+ recommendations actually fit well with how they thought they should live their lives. They had health problems to deal with from before, such as fatigue depression, and now they realised that a low-key life, such as the one following the recommendations, actually was positive for them as it helped them to be in the present and enjoy the moment.

Discussion

The present study explores how adults 70+ experience and manage changes in everyday life due to the COVID-19 pandemic, and how those changes affected health and wellbeing at the beginning of the virus outbreak. The findings reveal a unique situation, unlike anything the participants had experienced before. This unexpected situation caused the participants to question previous conceptions of what was meaningful which may lead to remaining changes of their priorities. Most (n = 11) interviews were conducted within a month from the announcement of 70+ recommendations, and all within 6 weeks. Consequently, the participants had not had much time to adapt to the new situation, and the experiences described were up-to-date rather than retrospective descriptions. Nevertheless, most participants were reluctant to complain as they considered themselves privileged, compared to others they had heard of in Sweden or abroad. The reluctance to complain, or rather the gratefulness coming from viewing one’s own situation as less burdensome than others resemble research on quality of life in older adults [30,31] and are likely to support the participants’ wellbeing despite these special circumstances.

On a similar note [30,31], our participants compared their situation to the situation in Stockholm that escalated at the time of the interviews. On the one hand, that comparison made them feel more safe and secure as they all lived far away from the capital city. On the other hand, the situation in Stockholm seemed to make them understand the necessity of taking recommendations seriously and maintain social distancing. They were overall positive to how the Swedish authorities dealt with the pandemic and trusted their recommendations.

Nevertheless, the participants were deprived to a varying extent of everyday life activities [32] which affected their occupational participation in several ways. Participants who made only minor changes in everyday life, who co-habited or had access to a car, garden or summerhouse, seemed to experience less occupational participation restrictions, and largely sustained their health and wellbeing. Other participants had both more occupational participation restrictions as well as negative impact on health and wellbeing as it was more challenging for them to solve practical matters, or because they had to quit their paid work, or pause voluntary commitments in organisations and politics. In line with Wilcock and Hocking [31] such occupational deprivation had a clear impact on the participants’ health and wellbeing.

To avoid COVID-19 and follow the 70+ recommendations the participants had to make rapid changes which affected roles and habits. This occupational adaptation was more or less challenging [23]. Some had previous challenges that intensified due to the COVID-19 pandemic, and given the novel situation, their usual strategies of dealing with challenges in everyday life did no longer apply. However, all made successful occupational adaptations of some sort and to some degree and seemed to be resilient [4]. They found new habits or had more time for old ones. They structured the day based on meals, walks and the daily press conference from the Public Health Agency of Sweden. They made sure to visit shops when few people visited or found other ways to buy necessities. Grandparent roles had largely to be reconsidered, and for most participants this was a significant loss, although some contact was maintained through phone or video calls. Moreover, digital technology was increasingly used on the initiative of the participants themselves or others. The 70+ recommendations supported advancing those skills, while previous knowledge or ability to acquire such knowledge also helped. However, not all participants had sufficient digital literacy to manage such necessities in everyday life and did not have access to user-friendly tools or services to make for example digital payments and experienced occupational alienation [31]. Marginalisation and social exclusion have been displayed as negative consequences from the increased digitalisation in the light of COVID-19 [7,13].

Even if, digital devices and services supported the execution of a certain task or activity, the value of that activity or task could be different compared to before [32]. For example, shopping for food online, brought them needed essentials but online shopping did not bring the possibility to choose what they wanted from the shelf or the fruit stand, or a manual counter the value of shopping changed and diminished. Similarly, the value of and motivation for physical activities changed, as they could no longer join such activities together with others (as the social component was omitted). While some spent more time outdoors walking, others decreased their physical activity. Given the health-related advantages of physical activity [33] the long-term implications/effects of the pandemic in this regard needs to be investigated.

Naturally, several participants described how their sense of belonging [31] and social interactions with friends, family and relatives decreased. Moreover, their pre-COVID-19 social activities seemed to build on weak ties, rather than strong ties, as the participants only interacted during these scheduled activities. As they had no previous habits of contacting each other between these activities, it was not natural to them to start such contact. Consequently, the social networks of all participants were clearly reduced, given the abrupt cancellations of social activities organised for and by older adults. However, many participants described how they increased their contact with their strong ties by calling or writing to them. The further health and wellbeing effects from this reduced or at least largely changed belonging [8,9,31] and social isolation remains to be seen.

Study limitations

The study participants ranged from being 71 years old to 86 years old, and reported several health conditions. However, no participants were dependent on help from others before the COVID-19 pandemic for basic ADLs or received home help services, which in terms of heterogeneity, was a limitation.

The participants originated from three different geographical areas in Sweden, which in the beginning of the COVID-19 pandemic represented areas with medium to large exposure of COVID-19. A limitation was that we did not have participants from Stockholm, the capital of Sweden, which later on showed to be the area with most burden from COVID-19 in the spring 2020.

We received rich and high-quality data from the sample of 17 participants. However, considering that 15% of the Swedish population is 70 years or older and the unique aspects of each individual’s experience of the COVID-19, we do not claim to have reached data saturation, nor was it an ambition.

We assumed beforehand that doing remote interviews instead of home-visit interviews would limit our possibilities to establish rapport, thus a limitation. Afterwards, we still consider it to be a limitation to some degree, but it showed to be easy to arrange, comparatively inexpensive and much less problematic than anticipated. Above all we avoided possible spread of COVID-19.

Conclusions

Early-on everyday life changes due to COVID-19 have implications for health and well-being. These changes need to be acknowledged by occupational therapists and other professionals as well as organisations when planning and providing interventions to sustain and enable older adults’ health during and beyond the current pandemic. The participants questioned previous conceptions of what activities is meaningful and meaningless, and that may lead to consisting occupational changes for both good and bad. However, the more long-term effects of these changes remain to be seen, but needs to be observed and considered in research, and not least practical settings.

Acknowledgements

We are most grateful to the older adults who willingly participated in our study in the midst of the COVID-19 pandemic. We also want to thank Filippa Axelsson for helping out with the tables and our colleagues at the department who gladly offered input and advice in hectic times.

Disclosure statement

All authors declare that they have no potential or competing conflicts of interest.

Additional information

Funding

This study was conducted within the context of the Centre for Ageing and Supportive Environments (CASE) at Lund University. It was supported by the Swedish Research Council FORMAS under Grant 942-2015-403; the Department of Health Sciences, Lund University, Sweden.