Older people’s views on loneliness during COVID-19 lockdowns

Abstract

Background and Objectives

There have been growing concerns that social distancing and stay-at-home mandates have exacerbated loneliness for older people. Empirical evidence about older people’s experiences of loneliness and COVID-19 have quantified this phenomena without considering how older people themselves define and understand loneliness. This paper explores how older New Zealanders conceptualized and experienced loneliness under ‘lockdown’ stay-at-home measures.

Methods

This multi-methods qualitative study combines data from letters (n = 870) and interviews (n = 44) collected from 914 people aged over 60 and living in Aotearoa, New Zealand during the COVID-19 pandemic. We conducted a reflexive thematic analysis to conceptualise this data.

Findings

We identify three interconnected ways in which older people conceptualised and experienced loneliness: (1) feeling disconnected relating to lack of emotional closeness to another often resulting from being physically separated from others and not being able to touch; (2) feeling imprisoned relating to separation from preferred identities and activities and was frequently associated with boredom and frustration; and (3) feeling neglected which often related to feeling let down by generalised and idealised forms of support, such as one’s neighbourhood and health care system.

Discussion

Older New Zealanders experienced lockdown loneliness in three interconnected ways rather than as a stable and homogenous experience. Māori, Pacific, Asian and New Zealand European older people often discussed loneliness in different ways; attesting to loneliness being a culturally-mediated concept shaped by expectations around desirable social interaction. We conclude the paper with implications for research and policy.

Keywords:

• Adaptation
• engagement
• loneliness
• older people
• social connection
• social distancing
• social isolation

Introduction

Initial public health responses to COVID-19 have centred on protecting older people from the virus due to their disproportionate risk of morbidity and mortality. Many countries developed various forms of stay at home ‘lockdown’ measures and social distancing requirements in public settings. With the closures of day care venues, community centres and places of worship as well as cessation of home-help and other voluntary services, there has been sustained concern across the pandemic as to older people’s increased risk of social isolation and loneliness (Armitage & Nellums, 2020; Steinman et al., 2020). Loneliness is broadly understood as a negative feeling arising from a perceived discrepancy between a person’s desired and achieved social relations (Perlman & Peplau, 1981). While used interchangeably, social isolation by contrast is an objective measure relating to lack of social interaction and lower number of social contacts (Perlman & Peplau, 1981). Loneliness has already been identified as a major public health concern facing older people, particularly because they are exposed to risk factors such as living alone, being widowed and experiencing chronic illness (Holt-Lunstad, 2017). Strong evidence has linked loneliness with increased rates of mental health and cardiovascular issues, strokes (Leigh-Hunt et al., 2017) and mortality (Holt-Lunstad et al., 2015). The potential negative health implications of pandemic-related social restrictions, such as prolonged loneliness, may therefore long outlast the pandemic (Morrow-Howell et al., 2020).

The current evidence basis, drawing primarily from survey studies with online convenience samples, presents an unclear relationship between older people’s experiences of loneliness and the pandemic. Studies from Europe and the United States have identified increased loneliness (Atzendorf & Gruber, 2022;; Kotwal et al., 2021), with factors cited such as fear associated with high death rates and/or a greater number of days with stringent isolation measures (Cohn-Schwartz et al., 2022;; Peng & Roth, 2021). Other studies have reported lower rates of loneliness among older people than younger generations, owing to the former’s resilience and lower social expectations (Birditt et al., 2021; Carney et al., 2021; Nelson & Bergeman, 2021). The few qualitative studies published to date have emphasized older people’s ability to mitigate feelings of loneliness through a range of coping and adapting strategies under lockdown conditions (Bundy et al., 2021; Kremers et al., 2022;; Lofgren et al., 2022;; Portacolone et al., 2021). For example, a qualitative interview study conducted with 12 already-lonely Americans found that participants reinterpreted their pre-existing feelings of loneliness into a ‘matter of conscientious self-isolation’ through which they were positively assisting with the national public health response by observing social distancing restrictions (Bundy et al., 2021). Much of this research has been based on small sample sizes (Lofgren et al., 2022) and certain groups of structurally vulnerable older people, such as cultural minorities and those living in rest homes, remain underrepresented (Morrow-Howell et al., 2020; Portacolone et al., 2021). There has been no research to date specifically on how older people have conceptualized loneliness during this period (Falvo et al., 2021) despite calls for further qualitative research to deepen our understandings about the psychological and social toll of the pandemic on older people (Whitehead & Torossian, 2021).

Research in the COVID-19 context feeds into wider discussions around how older people conceptualise loneliness more broadly (Tesch-Roemer & Huxhold, 2019). The dominant view in the gerontological literature remains the cognitive approach that views loneliness as resulting ‘from unfavourable comparisons between social relations and social standards’(Perlman & Peplau, 1981). This approach usefully recognises the role cultural expectations, at both individual and collective level, play in shaping older people’s such social standards and views on socially desirable interactions (de Jong Gierveld & Tesch-Römer, 2012; Ng & Northcott, 2015;; Victor & Bowling, 2012; Wright et al., 2017). Emphasising the material aspects of loneliness, scholars have more recently theorised loneliness through the resource model. This approach holds that such adverse feelings arise from missing resources and lacking competencies (Burholt et al., 2017; de Jong Gierveld & Tesch-Römer, 2012). There is evidence from the current pandemic that older people with less economic resources and poorer physical health are at greater risk of loneliness (McCallum et al., 2021; O’Sullivan et al., 2021), something that might be connected to their ability to usher resources when managing pandemic restrictions (Dahlberg, 2021). Given both subjective and contextual nature of loneliness, further research is required to understand how older people themselves have conceptualised loneliness under pandemic regulations in order to adequately address their needs and concerns (Dahlberg, 2021).

Drawing on a large, multi-method qualitative study, this paper attends to this research gap by exploring how older New Zealanders (NZers) conceptualized and experienced loneliness under ‘lockdown’ stay-at-home measures. Aotearoa, NZ presents an important case study as it had a particularly stringent set of lockdown measures. A four-level COVID-19 alert system (Table 1) involved strict social distancing and stay-at-home measures requiring all citizens to keep in their ‘bubble’, typically a household unit (Kearns et al., 2021). Everyone, including older people, could leave their homes for safe recreational activity in their local area and for supermarket shopping (Ministry of Health, 2021). Visiting policies for residential aged care facilities, hospices, hospitals initially prohibited all family visits (Ministry of Health New Zealand, 2022). Home visiting services, including hospice nursing, were radically reduced (Frey & Balmer, 2022). Additionally NZ had comparable pre-existing rates of loneliness to other high income countries prior to the COVID-19 pandemic (Chawla et al., 2021). NZ is composed of a large multi-cultural ageing population, which enables us to consider the culturally mediated experiences of loneliness, which have currently been under-explored in current evidence (Falvo et al., 2021; Morrow-Howell et al., 2020).

Table 1. Characteristics of letter writers.

Characteristics of letter writers	Number of participants or %
Number of Letter writers	870
Number of Letters	760
Email	289 (38%)
Qualtrics	367 (48%)
Post	104 (14%)
Age (range)	60-94
Age (mean)	77
Ethnicity
New Zealand European	395 (51%)
Not assigned	341 (45%)
Māori	8
Asian	4
Pacific	1
Other	21 (3%)
Gender
Female	67%
Male	29%
Not provided	3%

Methods

This study draws from a larger multi-method qualitative study centred on enabling older New Zealanders to have their say about the COVID-19 and lockdown (Morgan et al., 2021). Drawing on Letherby and Zdrodowski (1995) approach, our data collection combined letter writing and interviews to maximise participation in our study. Letters were practical data-collection method during COVID-19 lockdowns and meant that older people across the country could take part. Letters offer distanced rapport which allows a greater degree of confidentiality as participants are less exposed through their written contributions (Letherby & Zdrodowski, 1995). It is an empowering method as it enables participants to decide when, where and how they share their experiences (Stamper, 2020). We combined this approach with semi-structured interviews as our previous research identified this as the preferred method for older people from diverse ethnic backgrounds (Morgan et al., 2020). Semi-structured interviews have the benefit of enhancing rapport and familiarity between interviewee and interviewer as they provide space and time for in-depth discussions (Devault, 2002). Interviews open up space for participants to reflect on and provide accounts rooted in the realities of their lives (Devault, 2002). To support rapport-building, our interviewing team was ethnically and linguistically diverse as described below. This study received ethical approval from the University of Auckland Human Participants Ethics Committee (reference number 024568).

Data for both letters and interviews were collected between 30th April 2020–8th June 2021. A more extensive discussion of the data collection methods are reported elsewhere for the letter writing study (Prigent et al., 2022) and interview study (Morgan et al., 2022). Invitations to contribute a letter were sent out via local media, organisations representing the interests of older people, and through the study investigators’ networks. This nationwide recruitment strategy was designed to promote participation from a range of older New Zealanders, including those living in residential care and the community. Participants were invited to send open-ended, unstructured letters about their lockdown experiences. Participants could send letters via post, email, or via an online Qualtrics survey designed with a free-text dialogue box. All participants submitted a consent form along with their letter. Participants who included contact details received a thank you letter.

For the semi-structured interviews, participants were recruited via a snowballing method through the support of two Age Concern NZ sites (one large urban, one small rural) who called potential participants on our behalf to ask if they would be happy for a researcher to contact them. This recruitment approach was complemented with a community word-of-mouth approach, for participants whose first language was not English. Participants sent us their participant information sheet (PIS) and consent form (CF) prior to the interview. Taped oral consent was also taken at the beginning of every interview. All the NZE interviews were conducted over the telephone and all Māori, Pacific, and Asian interviews were conducted face-to-face when lockdown levels had eased.

To maximize the cultural inclusivity of our study our interview team is made of up experienced researchers including two Māori, one Samoan/Tongan, one Korean, one Chinese and three NZE interviewers, all identify as female and range from mid-20s to 60 years old. Participants were offered the option of interviewing in their preferred language. All Chinese interviews were conducted in Mandarin, two out of three Korean interviews were conducted in Korean. All Māori and Pacific interviews were conducted in English but included culturally-specific terminologies and phrases. Interviews were audio recorded and transcribed in full by a professional transcriber, if in English. For other languages, the interviewer transcribed and checked-over transcripts themselves. All interview participants received a $30 koha (gift) for participating.

Questions guiding both the interviews and letter writing prompts were developed through discussions with Age Concern, an older people’s charity, around what they saw as important to their clients in the early stages of the pandemic. Loneliness was not prompted in data collection explicitly; though the related question ‘how did you stay socially connected with family during lockdown conditions’ was prompted for both letter writers and interviewees (Appendices). The decision to frame questions around connection rather than loneliness explicitly was informed by our strengths-based approach to the research, and to recognise that loneliness is often associated with ageism and stigma (Morgan et al., 2019). When loneliness was discussed explicitly or implicitly discussed in interviews, interviewers were able to probe further. This was not the case for letters as they were produced independently.

Our total sample comprises experiences of 914 people aged 60 and over. This sample includes letters received from 870 participants (including 40 joint or group letters) and interviews (including three group interviews) with an additional 44 people. Letters ranged from a short paragraph to five detailed diaries with the longest spanning six months. Interviews lasted typically an hour. Characteristics of letter writers and interview participants are provided in Tables 1 and 2.

Table 2. Characteristics of interview participants.

Characteristics of interview participants	Number of participants or %
Number of interview participants	44
Interview format
Individual	25
Group	19 participants across 3 groups
Age
Age (range)	64-91
Age (mean)	77
Ethnicity
New Zealand European	16
Māori	15
Asian	8
Pacific	5
Gender
Female	31
Male	13

Analysis

This analysis is guided by a reflexive thematic analysis that emphases the researcher’s active role in knowledge production (Braun & Clarke, 2019). Braun and Clarke (2019) suggest that reflexivity occurs at the intersection of (1) the dataset; (2) the theoretical assumptions of the analysis; and (3) the analytical skills/resources of the researcher (Braun & Clarke, 2019). We reflect on each of these below.

Due to the large volume of letters and interviews, analysis was conducted in phases. Letters and interview transcripts were all databased and scanned by a research assistant. Two researchers, one experienced (TM), once novice (KM) then worked together to read data as it was received and deposit it into the data management software NVivo-12. Combining our different skill levels resulted in a productive mentoring dynamic that meant were in constant conversation about how to handle and characterise the data. Once data collection was complete, the full research team familiarised ourselves with the data by reading through and open coding the first twenty letters. This process supported our reflexive and thoughtful engagement with the analytic process as it allowed us to ask questions of each other’s interpretations which helped clarify meanings. Codes were understood as ‘central organising concepts’ that reflected the researcher’s interpretations of patterns of meaning across the dataset (Braun & Clarke, 2019). Each interviewer also selected a transcript for the whole team to read, with this process designed to embed cultural diversity into the coding framework. These conversations were particularly centred around cultural understandings of pre-existing expectations around socialising in terms of where, when and with whom (especially around the role of family, friends and community).

Through this iterative process we identified eighteen broad categories with loneliness being one of them. Other initial categories included topics such as adjustment, views on government response, and living arrangements. An analyst (KM) working closely with a second analyst (TM) then read through and coded every letter and interview using NVivo12 data management software according to these initial categories. KM and TM subsequently data cleaned each category of the letters and interview data, respectively, for quality assurance. We identified 336 explicit mentions of loneliness across 131 letters and 91 references across 26 interviews (including the 3 group interviews).

This paper presents a reflexive thematic analysis of all excerpts in the category ‘loneliness’. Two analysts (both of NZE ethnicity) read all excerpts relating to loneliness. Informed by our earlier work on social connectedness and loneliness among older people in the NZ context, we looked closely at how participants framed emotional closeness and their satisfaction with social interactions within wider cultural and gendered scripts (Morgan et al., 2019; 2020;). In this analysis we considered how participants and ourselves as researchers were positioned within wider cultural discourses, one of which was that lockdowns were lonely experiences (Byrne, 2022). Importantly, we operated from the assumption that older people experienced a range of emotional responses to the lockdown and therefore did not assume that loneliness was a natural or universally experienced phenomena. To promote rigour and reflexivity, initial themes about loneliness were discussed directly with each interviewer to ensure that interpretations of loneliness were culturally-situated and reflective of participants intended meaning. We consolidated themes by meeting together to discuss and interrogate categories and considered outliers. The final themes are supported with quotations. Letters are marked as E = Email, P = Post, or Q = Qualtrics and their unique identifier. Quotes from both letter writers and interview participants include their age, ethnicity, and gender where known.

Findings

We identified three connected, albeit distinct, ways that loneliness was experienced by older people during lockdown: (1) feeling disconnected relating to lack of emotional closeness to another; (2) feeling imprisoned relating to separation from preferred identities and activities; and (3) feeling neglected by those from whom they expected to receive help. Most participants directly related loneliness to stay-at-home measures and physical distancing regulations. Participants described loneliness as a painful emotion that was difficult to talk or write about, though many spoke more openly when referring to loneliness observed in others.

Feeling disconnected

Participants most commonly experienced and discussed loneliness as a feeling of disconnection. Many highlighted a lack of emotional closeness, particularly when they were separated from others. Some, most notably widows, saw loneliness as resulting from perceptions that they were less connected than other older people. For example, a participant living in a rest home described feeling:

Very envious of others who have their husband or wife to spend each day with. My husband passed away 4 years ago, and I miss him so much. I wish he was here to be part of my bubble (P0027, 84, female).

A widower who lived rurally described how regulations restricting his ability to see friends meant he spent most of his time reminiscing about his late wife. He continued that ‘I am usually fairly self-sufficient but during lockdown the loneliness really increased’ (E0166, 85, European, male). Descriptions of feeling disconnected were typically combined with strategies participants were using to see others. Community-dwelling participants described seeking out social company by walking around the neighbourhood and going to the supermarket:

I was very lonely with no-one to talk to face to face. I went grocery shopping and skipped the big queues at the supermarket by flashing my Gold Card [card identifying senior citizens for discounts and transport fares]. The shopping was my lifesaver because I saw other people (Q0031, 87, European, female).

Disconnection could also occur when physically near others. For example, while many community-dwelling participants turned their daily exercise outside of the house into a social opportunity, social distancing regulations were viewed as restricting their ‘friendly’ interaction:

Living as we do so close to the sea made it easy in most cases to get out and about for exercise but what I found hardest was not being able to communicate with people as before – I love to engage with others in very friendly ways and to have to keep so far away from others was heart breaking for me (Q0061, 76, European, female).

This sentiment was echoed in concerns about lack of touch, which participants described as dehumanising. As one participant put it: ‘we need human contact to remind us who we are!’ (E0186, 85, female). Another explained how she lack of physical intimacy impacted her:

Not having human touch was dehumanising. I have lived on my own for many years so was not unduly worried about lockdown but I had underestimated my need for hugs and touch. (Q0226, 72, European, Female)

Disconnection was also a culturally mediated experience for Māori and Pacific participants. They described communicating kanohi-ki-te-kanohi (face-to-face) as both culturally-appropriate and emotionally satisfying, as a Samoan participant expressed: ‘I’d rather do it [socialise] face-to-face’ (Interview, Samoan, female, over 70). A Tuvaluan participant directly related his disconnection to the ‘bubble’ system. Whilst being in what he described as a ‘small family bubble… 12 of us’ he was distressed by being separated from his extended family and church community: ‘the bubble disconnects you with everybody by means of organising where to go and especially level 4 lockdown’ (Interview, Tuvaluan, male, mid-60s). Owing to the preference for face-to-face interaction there was far less enthusiasm among Māori and Pacific older people for using digital forms of connecting with others, though the notable exception was attending church and tangihanga (funeral) online.

Technology could also form a disconnect within households. A participant whose granddaughter moved in during the lockdown was upset with the lack of emotional support from her granddaughter who she felt ‘spent so much time on her devices it felt as though she was trying not to settle in with us’ (P0069, 80, Female). Another participant described how his grandchildren used their phones and computers as a ‘drawbridge’ protecting them ‘against having to relate too closely with those they are stuck with’ (E0158, Male).

Disconnection was also experienced because some found it difficult to share how they were feeling due to their perceptions that they must manage their emotions. Participants described muting their distress and keeping a brave face on for other family members but struggled with the consequences. A participant shared how she ‘felt suicidal very frequently’, something she had not experienced before, and her loneliness was compounded as she felt ‘unable to share my lonely experience with friends as they didn’t seem to mind lockdown’ (Q0354, 70, European, female). Another participant described that after six weeks of lockdown, she had ‘hit the wall’ with an empty ‘family tank’. After reluctantly sharing her feelings of loneliness with a family member ‘they responded and we began Zoom games [and] meetings, bringing 3 families together…It was great’ (P0019, 75, female).

Some participants also expressed loneliness as a sense of disconnection from wider society due to disempowering, discriminatory narratives about people over 70 and COVID-19. Echoing a sentiment expressed by many, one letter writer typed: ‘in the end I hated Level 4. It was so lonely and the way older people were demonised in the Press did not help’ (Q0031, 71, European, female). Another shared that, by the end of the first lockdown she felt socially ostracised, describing herself as ‘a cross between a cot case and a leper’ (E0217, female).

Feeling imprisoned

Many participants associated loneliness with a sense of imprisonment. Participants described the lockdown as feeling like being in ‘prison’ (Q0564, 73, NZ/European, female); ‘solitary confinement’ (E0086, female) and involving ‘austere solitude and tears’ (E0118, male) while one said she was ‘grieving the loss of my freedom’ (E0064, female).

Visiting policies adopted by hospitals and retirement villages made some participants feel as though they had lost their right to mobility and their ability to receive guests. Residents were restricted from visiting each other, which in one case meant two partners were confined to their separate rooms: ‘I was locked up for weeks! I couldn’t even go out to see my partner, and she couldn’t get out either’ (Q0441, 76, European, male). Older residents with serious health conditions were subject to the strictest isolation measures to safeguard against the virus, which increased their fear during times of medical distress:

My worst time was after I went for a regular treatment to the hospital. The manager took me in the back of the 10 seat van – he was masked and gloved as was I. When I got home 4 hrs later I was in full isolation for 2 weeks. I didn’t get to talk to anyone and I could see people walking on the drive but they didn’t see me on the 4th floor (Q0218, 72, European, female).

Another resident who was also restricted to her room for the whole lockdown penned this poem at ‘one stage in desperation’ as a means of capturing her interconnected feelings of imprisonment, loneliness and boredom:

THE PRISONER

From the depths of this prison I pour out my heart How can this virus Tear us apart?

A lonely six weeks Without kith or kin An insidious battle

I wonder who’ll win. Within these walls

No games are allowed

All of the inmates are under a cloud In our bubbles we stay Bored out of our brain

Will we ever see the real world again? ….(E0030, 82, female).

Community-dwelling participants also associated loneliness with monotony and disempowerment. One connected loneliness with her inability to be herself by challenging ageist representations of older women as passive and conventionally feminine:

Loneliness is awful. I am sick of doing crosswords. I want to be a social being not an isolate. People in quarantine get let out….not me ….no freedom for me. And I hate to see pictures of little old ladies smelling roses….what a laugh….what have roses got to do with growing old. Give me a ride on a Harley Davidson (E0144, 82, female).

Fear of contracting COVID-19, and uncertainty around how to follow the rules, resulted in a sense of self-imprisonment that exacerbated loneliness. A handful of participants were so fearful that they cut off all social contact and thus essentially imprisoning themselves. A couple coined the acronym ‘F.O.G.O. (Fear of going out)’ (E0222, 82 &77, male & female) to justify staying at home as a form of self-protection. They only ‘escaped from [residence] just twice’ during lockdown ‘once to visit the Pharmacy for Flu Jabs and once to the Hospital for a Heart Scan. Both these journeys were quite stressful’ (E0222, 82 &77, male & female). Another participant described how her 92-year-old mother, who was ‘in a state of panic about catching Covid-19…cancel[ed] the Nurse Maude home help and her meals on wheels as she felt they were a source of bacteria outside her control’ (Q0418, 70, European, female). Chinese and Korean participants’ fear arose from linguistic barriers that limited their ability to access information about the pandemic rules. In some cases this meant they did not join bubbles with other family members despite feeling acutely distressed.

Not all participants experienced COVID-19 lockdowns as a change. Some participants with mobility issues and/or limited social lives prior to lockdown described lockdown measures as a continuity of daily life than a novel imprisonment. As one participant put it: ‘I have little social life, so no difference’ (E0252, male). Some participants had already chosen to live more isolated lives, clearly articulated by a couple who had lived on a yacht for the five years prior to lockdown who felt ‘Lockdown wasn’t nearly as hard for us because our experience and expectations were different from those of many others’ (E0223, 78, female). Some participants with limited mobility, visual and hearing impairments and/or terminal illness described how they had come to terms with their loss of independence already. Some participants expressed that they were better off than other generations due to their life experiences: ‘I found the lockdown to be little different from normal living, and often thought that I was certainly better off than younger people’ (E0128, 81, male). For others lockdown removed the last vestiges of independence. As one woman shared: ‘I am 82 and in permanent lockdown, I am losing my sight and cannot drive. I am deaf. I live alone. I was able to access groceries. I hated losing my limited independence’ (E0144, 82, female).

Feeling neglected

Another way participants described loneliness was feeling neglected by individuals and groups from whom they had expected to receive help or acknowledgement. Participants described feeling let down by generalised and idealised forms of support, such as one’s neighbourhood and health care system. As one starkly put it: ‘Live alone, no supporting cast, not one “neighbour” even spoke [to me]’ (E0040, 71, female). Another participant felt surprised that no one called on her, highlighting the affective role people expect their neighbours to play in times of crisis:

Very surprised that in my own street not one person, not even next door neighbours, contacted me to see if I was ok or needed anything. (Not that I did, but they didn’t know that.) (Q0581, 76, European, female)

A handful of NZE participants lamented the wider decline of neighbourliness in urban cities, with one participant sharing: ‘My theory is: the closer we are crammed into smaller properties, the more emotionally distant people become’ (E0040, 71, female).

Participants expressed desires for support that promoted their independence. Some participants were therefore offended when younger neighbours identified them as dependent and requiring assistance. Some felt abandoned when their attempts to help others were unreciprocated. One couple described putting a lot of effort into supporting ‘fragile’ people in their network, but also reported feeling ‘deserted’ when no one checked in on them:

Survival was maintained by social group emails, phone calls to friends and relatives, to folks we knew to be fragile and/or living on their own. It became interesting that with a few exceptions the vast majority of our friends did not see it necessary to contact us. Loneliness and depressions cannot be taken for granted. Not everyone presents with obvious needs. Many days we felt deserted. (E0243, 76, female).

On the other hand, some rurally based kaumātua (older male Māori) described their connection to their wider community as being strengthened through a localised rāhui (restriction or prohibited activity). This prohibition on interaction was established by Māori community leaders to protect vulnerable members of the community from the virus being spread by tourists and other tauiwi (non-indigenous people). Some Māori interview participants felt that their sense of connection with their local community was enhanced through the manaakitanga (hosting responsibilities and reciprocal care), in terms of food, general groceries and emotional support they received from their community during the lockdown period. As one 80 year old kuia (older female Māori) exclaimed:

Stores and stores on my table out there. They were dropping off kai. And the domestic cleaning and all that. We had pork. Where did it come from? Ours is [from local incorporated iwi organisations], the marae. They just knew who to give it to (Interview Māori, kuia/female, 80).

Some participants felt neglected when formal health and social care providers and voluntary organisations did not check in on them around whether they had adequate medication or food supplies. They felt they fell through the cracks of these services:

I was living alone and did not get contacted by any of the organisations that stated they were contacting elderly. I had a landline and mobile computer, but those that do not must have struggled with a lack of people interaction. It was frightening, and you are so conscious of how much more vulnerable you are (E0093, female).

Neglect from services was particularly poignant in the accounts of recently bereaved participants who directly linked their lack of support with accentuated feelings of loneliness:

I had a phone call to check that I was managing OK but this was at the point when we had moved to level 1 and I could not understand why they bothered. Some supportive contact during level 4 or 3 would have helped me feel less isolated and alone. I am still grieving the death of my husband and this was an additional unpleasant experience (E0165, female).

Some participants did describe increased attention and support from formal care professionals, most mentioned by participants living in residential care who felt ‘very lucky’ for their supportive rest home staff. One participant observed: ‘I could imagine that things would have been a lot lonelier if we had still been in our house in a suburb’ (E0126, European, 78, Male).

Discussion

This analysis highlights that from the perspective of older people there was not one but three ways to experience loneliness under lockdown conditions during the COVID-19 pandemic. This findings offers an important reflection point for the current evidence base which predominantly focused on reporting rates of loneliness amongst older people, as if it were one stable and homogenous experience (Atzendorf & Gruber, 2022;; Birditt et al., 2021). We contend that feelings of disconnection, imprisonment and neglect ought to be distinguished in future survey-studies to support greater understanding around prevalence and intensity of loneliness in this period. This analysis highlights how older people experienced loneliness differently depending on their ethnicity, building on prior insights that loneliness is shaped by cultural expectations, at both individual and collective level, which inform what desirable social interactions are (de Jong Gierveld & Tesch-Römer, 2012). We identified features of the public health response that exacerbated loneliness amongst Māori, Pacific and Asian older people, such as the restriction of face-to-face socialising and the initial lack of translation of public health messaging beyond English (particularly in relation to disconnection and neglect). This finding is novel as culturally minoritized people have thus far been left out of COVID-19 research about older people (Falvo et al., 2021; Morrow-Howell et al., 2020). From a policy perspective, these findings highlight the need to balance physical restrictions with the emotional and mental health of older people and to think intersectionality when considering how policies might impact different groups of older people.

Participants most frequently experienced loneliness as a form of disconnection from others. This aligns with Perlman and Peplau (1981) description of loneliness as a discrepancy between a person’s desired and achieved social relations. This disconnect resulted from social distancing measures which limited physical touch and impeded face-to-face communication. Loneliness arose from missing resources and lacking competencies that made it difficult, if not illegal, to connect in preferred ways (Tesch-Roemer & Huxhold, 2019). Our analysis highlights how older people also centred the resources and competencies that remained, such as the ability to walk around the neighbourhood and drive to the supermarket, when describing how they attempted to counter loneliness. Our findings align with other research emphasising that older people creatively strategized to establish and maintain connection in this period (Falvo et al., 2021). Interestingly, we identified an ambivalence around older people’s use of technology in their strategies to connect. In emphasising the importance of touch and face-to-face contact many older people rejected digital technology as being a panacea for their loneliness, as it has so often been described in research (Morrow-Howell et al., 2020). Alternative measures that balance the physical and social implications of the virus are necessary, especially given evidence about the long-term impacts of social disconnection on older people’s health (Paananen et al., 2021).

Older people also linked loneliness with imprisonment, which combined aspects of restriction on movement but also boredom and limited personal expression. While the physical restrictions in rest homes were in place to mitigate the very real threat of virus transmission, the feelings of imprisonment they engendered also had deleterious impacts. A review of loneliness interventions indicates that focusing on activities that are fun and engaging are effective for attending to older people’s loneliness (Masi et al., 2011). We suggest such interventions would be useful when loneliness is experienced as imprisonment, particularly where in-person socialising is deemed risky to physical health such as in some residential care facilities during the pandemic.

We also found that feelings of imprisonment were entrenched through ageist media framings of older people as ‘vulnerable’. Such framings without adequate explanations left older people acutely nervous of virus transmission, leading some to refuse formal service support, something observed in previous research (Brown & Reid, 2021). This dealt older people a double blow as interactions with health care professionals offer important social opportunities as well as being essential for physical health (Armitage & Nellums, 2020; Steinman et al., 2020). Providing clearer public health information relating to risk and social interaction in this period, presented in a range of languages, would help to mitigate fear (Morgan et al., 2022). This is especially important for older migrants for whom English is not their first language.

Thinking about loneliness as imprisonment also draws attention to the diversity of older people’s pre-pandemic experiences, where some were already in a permanent state of lockdown due to physical impairment. For these people, being used to less social interaction already could sometimes be seen as a strength, similar to qualitative findings that already lonely individuals reframed their isolation as conscientious observation of lockdown restrictions (Bundy et al., 2021). However, for others, lockdown was a unique and decisive challenge to their sense of independence. Future research should do more to include older people with mobility and/or health issues and how they conceive of their social lives under pandemic conditions.

When framing loneliness as neglect, older people drew on imaginaries of idealised forms of support from neighbourhoods, communities, and health and social care systems. Loneliness was experienced in this way when older people perceived that they were unable to draw on these forms of social capital in times of crisis (Koh et al., 2023). Loneliness as neglect seems to be tied into older people’s wider sense of belongingness in society, something loneliness scholars are beginning to consider in their definitions (O’Rourke & Sidani, 2017). Our analysis emphasises the important role community members and organisations can play in buffering older people’s loneliness, via informal interactions such as acknowledging older people in public spaces (Prigent et al., 2022) and through the formal provision of health and social care. So as not to be patronising, such community support ought to be provided in a way that treats older people as independent and promotes their ability to reciprocate care and support (Brownlie & Spandler, 2018). Alongside this, targeted, proactive support is necessary for particular groups such as the recently bereaved, whose loneliness was intensified by lack of service provision.

Strengths and limitations

Letter writing is a familiar means of communication for older people and allowed participants to share what they wanted. Participation was invited via a range of methods, which enabled people without internet access to take part. The large number of letters received encompassed a diverse range of living situations, including those living in rest homes and the community, and responses from across the country. A limitation of the letter-writing study is that participants were mostly older NZE. We think the study would have benefited from active recruitment of non-English speaking older people in particular, which we unfortunately did not have resource for on such a large scale. In-depth interviews, on the other hand, enabled more in-depth exploration of older people’s experiences and working with ethnicity and language-matched interviewers and appropriate cultural protocols supported the involvement of Māori, Pacific, Korean and Chinese older people. This addressed the under-representation of minoritized ethnic groups in our letter writing study, which has also been reported in other general population studies (Sin et al., 2021). Limitations to the study include that questions were not specifically asked of participants related to loneliness; nevertheless we identified this as a significant point of discussion. We cannot make any claims about the representativeness of our sample though we note that 914 participants makes for an uncharacteristically large sample size for a qualitative study, thus enhancing our information power (Malterud et al., 2016).

Conclusion

Older New Zealanders experienced lockdown loneliness in three interconnected ways: disconnection, imprisonment and neglect. Māori, Pacific, Asian and New Zealand European older people often discussed loneliness in different ways; attesting to loneliness being a culturally-mediated concept shaped by expectations around desirable social interaction.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by Auckland Medical Research Foundation;Woolf Fisher Trust.

Appendix 1.

Interview schedule

1. How have you found the experience of lockdown? Was it different for you at the different alert levels?

2. Can you compare this to any other major events you have experienced in your lifetime?

3. What was a typical day like for you in lockdown? [Prompts: how was that different than before the lockdown? And from now? Positive/negative experiences of lockdown?]

4. During isolation, how did you stay connected with family/whanau/friends who were not in your bubble? [Eg. Technology usage.] Did you feel like you were connected enough? Did this change as the national Levels changed?

5. Could you describe for me your bubble? [Prompts: who was in your bubble during Level 4, and how about now?]

6. What helped you the most get through the lockdown period, especially at level 4?

7. What help did you get from paid workers (eg. home-help) pre-lockdown, during lockdown and now? Was their other/additional support you would have liked to receive from them?

8. If you did have a paid worker come into the home, such as home help, what was this like for you?’ prompt if uncertain: was it a good experience? Did you have any concerns about them coming in? Did you feel they had enough personal protective gear to keep you and them safe?

9. What support did you get from family/whanau/friends/community organisations (like church, clubs, local organisations) during lockdown and now? [Eg. meal delivery, online communications, visits and standing at the gate, moved in and shared the same bubble.] Was their other/additional support you would have liked to receive from them?

10. What suggestions do you have for helping people in your age group stay connected during times of isolation such as this? [And/or how did you contribute to others’ connection/wellbeing]

11. Do you have any thoughts or comments about the ways that various media talked about people over 70 in relationship to the pandemic?

12. Is there anything you would like to tell the Prime Minister about what people in your age group need at this time?

13. Anything we haven’t asked that you’d like to say?

Appendix 2.

Instructions to letter writers for the qualtrics online survey

Your letter

Please tell us what it has been like for you to be in lockdown during the COVID-19 pandemic. Below are some questions to give you ideas about what to write about, though you are free to write about anything you choose.

• How have you found the experience of lockdown? Was it different for you at the different alert levels?

• Did the lockdown remind you of any other significant events in your life?

• How did you stay socially connected with family/whānau/friends who were not in your bubble?

• What helped you the most get through the lockdown period, especially at Level 4?

• How did you help others during the lockdown?

• What did you learn during lockdown that is of value to you?

• Do you have any thoughts or comments about the ways that various media talked about people over 70 in relationship to the pandemic?

• Is there anything you would like to tell the Prime Minister about what people in your age group needed during the lockdown or more generally about the pandemic?