A hundred days in confinement: Doing, being, becoming, and belonging among older people in Sweden during the COVID-19 pandemic

ABSTRACT

Background: When and how people were able to engage in everyday occupations changed suddenly with the coronavirus pandemic. Defined as a risk group due to their age, people 70 years and older in Sweden experienced confinement, as did older adults globally. Aim: To explore how doing, being, becoming, and belonging as dimensions of occupation were manifested in the lives of Swedish people 70 years or older, 100 days into the coronavirus pandemic. Method: Data were elicited through semi-structured interviews with 17 participants (11 women, 6 six men, mean age 76 years), living in ordinary housing in Sweden. Interviews were conducted in June 2020 as part of a larger longitudinal research project. A directed content analysis approach was used to analyse the data based on the occupational dimensions of doing, being, becoming, and belonging. Results: After 100 days of confinement, daily occupations had been changed, and habits and routines disrupted. However, the need to engage in occupations was strong. Participants expressed how they adapted their occupations to the restrictions, but also how their doing affected their well-being, further development, and opportunities for social interactions. Conclusion: The participants, who were older people without any specific diagnosis, reflected upon their daily occupations during an unrehearsed natural experiment when, more than anything else, the social environmental circumstances changed. The analysis elucidates how doing, being, becoming, and belonging is embedded in people’s lives. The study can serve as a foundation to further research on understanding people’s individual needs as occupational beings.

背景：由于冠状病毒大流行的爆发，人们能够从事日常活动的时间和方式突然发生了变化。跟全球老年人一样，瑞典 70 岁及以上的人因年龄而被定义为风险群体，都经历了居家隔离。目的：探索在冠状病毒大流行 100 天后，70 岁或以上的瑞典人的生活中如何体现作为生活活动维度的做事、存在、成为和归属感。方法：通过对住在瑞典普通居所的 17 名参与者（11 名女性，6 名男性，平均年龄 76 岁）的半结构化访谈获得数据。采访于 2020 年 6 月进行，是一项更大的纵向研究项目的一部分。使用有向内容分析方法来分析基于做事、存在、成为和归属的生活活动维度的数据。结果：居家隔离100 天后，日常活动发生了变化，习惯和作息也被打乱了。然而，从事活动的需求非常强烈。参与者表达了他们如何使自己的生活活动适应这些限制，然而，也表达了他们的行为如何影响了他们的福祉、进一步发展以及社交互动的机会。结论：参与者是没有任何具体诊断的老年人，他们在未经演练的自然实验中，最重要的是社会环境状态发生了变化时，反思了自己的日常活动。该分析阐明了做事、存在、成为和归属感是如何嵌入人们生活中的。对于更深入了解生活活动个体的人们需求的研究，该论文可为之打下基础。

TITRE

Cent jours de confinement : Faire, être, devenir et appartenir chez les personnes âgées en Suède pendant la pandémie de COVID-19

RÉSUMÉ

Contexte : Le moment et la manière dont les gens pouvaient se livrer à leurs occupations quotidiennes ont changé brusquement avec la pandémie de coronavirus. Définies comme un groupe à risque en raison de leur âge, les personnes âgées de 70 ans et plus en Suède ont connu le confinement, tout comme les personnes âgées dans le monde. Objectif : Explorer les dimensions occupationnelles du faire, de l'être, du devenir et de l'appartenir dans la vie des Suédois de 70 ans ou plus, 100 jours après le début de la pandémie de coronavirus. Méthode : Les données ont été obtenues à partir d'entretiens semi-structurés avec 17 participants (11 femmes, 6 six hommes, âge moyen 76 ans), vivant dans des logements ordinaires en Suède. Les entretiens ont été menés en juin 2020 dans le cadre d'un projet de recherche longitudinal plus large. Une approche d'analyse de contenu dirigée a été utilisée pour examiner les données en fonction des dimensions occupationnelles du faire, de l'être, du devenir et de l'appartenir. Résultats : Après 100 jours de confinement, les occupations quotidiennes avaient changé et les habitudes et routines étaient perturbées. Cependant, le besoin de s'engager dans des occupations était fort. Les participants ont discuté de la manière dont ils ont adapté leurs occupations en fonction des restrictions, mais aussi la manière dont leurs activités ont affecté leur bien-être, leur développement ultérieur et leurs opportunités d'interactions sociales. Conclusion : Les participants, qui étaient des personnes âgées sans diagnostic spécifique, ont réfléchi à leurs occupations quotidiennes au cours d'une expérience naturelle non répétée lorsque, plus que toute autre chose, les circonstances de l'environnement social ont changé. L'analyse élucide la manière dont le faire, l'être, le devenir et l'appartenir sont intégrés dans la vie des gens. L'étude peut servir de base à d'autres recherches sur la compréhension des besoins individuels des personnes en tant qu'êtres occupationnels.

Antecedentes: el momento y la forma en que las personas solían participar en sus ocupaciones cotidianas cambió repentinamente con la pandemia de coronavirus. Consideradas como grupo de riesgo debido a su edad, las personas de 70 años o más, habitantes de Suecia, experimentaron el confinamiento, como también lo hicieron los adultos mayores a nivel mundial. Objetivo: a los 100 días de iniciada la pandemia de coronavirus, explorar cómo el hacer, el ser, el llegar a ser y el pertenecer, en tanto dimensiones de la ocupación, se manifestaron en las vidas de personas suecas de 70 años o más. Método: la información se obtuvo mediante entrevistas semiestructuradas realizadas con 17 participantes (11 mujeres, seis hombres, con una edad media de 76 años), residentes en viviendas ordinarias de Suecia. Las entrevistas se efectuaron en junio de 2020 como parte de un proyecto de investigación longitudinal más amplio. Teniendo en cuenta las dimensiones ocupacionales del hacer, el ser, el llegar a ser y el pertenecer, se utilizó un enfoque de análisis de contenido dirigido para analizar la información. Resultados: después de 100 días de confinamiento, las ocupaciones diarias se habían modificado, alterándose los hábitos y las rutinas. Sin embargo, se sintió fuertemente la necesidad de participar en ocupaciones. Los participantes expusieron cómo adaptaron sus ocupaciones a las restricciones, pero también cómo su “hacer” afectó su bienestar, su desarrollo posterior y sus oportunidades de interacción social. Conclusión: los participantes, que eran personas mayores sin ningún diagnóstico específico, reflexionaron sobre sus ocupaciones cotidianas durante un experimento natural no ensayado, cuando, más que ninguna otra cosa, las circunstancias del entorno social cambiaron. El análisis esclarece cómo el hacer, el ser, el llegar a ser y el pertenecer están integrados en la vida de las personas. El estudio puede servir de base para futuras investigaciones dirigidas a comprender las necesidades individuales de las personas como seres ocupacionales.

KEYWORDS:

• Occupational science
• Meaningful occupation
• Theory
• Well-being

MOTS-CLÉS:

• Science de l'occupation
• occupation signifiante
• théorie
• bien-être

On 11^th of March 2020, the World Health Organization (WHO) announced that the COVID-19 outbreak had reached the stage of being a worldwide pandemic. Consequently, millions of people had to rapidly adapt and change their everyday lives, with more severe consequences for some sub-groups of the population than for others. Countries chose to handle this in different ways. For example, in some countries a complete lockdown was enforced while other countries chose to impose restrictions and handed over the responsibility to follow these to the citizens themselves. In Sweden, the Public Health Agency identified people 70 years or older as being at particular risk of severe disease and death and introduced restrictions targeting only the older segment of the population. They were strongly advised to reduce all social interactions outside of the household, avoid public places, and not to travel by public transport (Public Health Agency, 2020). Consequently, possibilities to engage in personally meaningful occupations (doing) were, overnight, disrupted for 15% of the Swedish population. Such a situation may affect an individual’s idea of self and their identity (being), and challenge future goals and ambitions (becoming), as well as the sense of affirmation that is generated from occupations performed together with others (belonging) (Fristedt et al., 2021; Hitch & Pépin, 2021; Hitch et al., 2014; Wilcock & Hocking, 2015).

People in their 70s and older belong to an extremely heterogeneous segment of the population regarding occupations, employment, income, and health (Abrahamsson et al., 2017; Ayalon et al., 2021). In Sweden, the older population is generally active and independent, and few live in poverty, but the group with a pension below 60% of the Swedish median income has increased. Retirement age is 67 and life expectancy is 81 years for men and 84 years for women. Most people 80 years and older live in ordinary housing, and about 16% live in residential care facilities (Swedish National Board of Health and Welfare, 2020).

Regardless of health conditions, daily routines generally support older adults in organising their day and keeping track of time (Björklund et al., 2015). Influenced by contextual factors, each individual has a set of occupational capacities, needs, and habits, which they have the right to engage in to sustain their health and well-being (Durocher et al., 2014). Understanding how meaningful occupations can affect health is essential to meet older adults’ individual needs and support them in developing their potential as occupational beings (Hitch et al., 2014; Wilcock & Hocking, 2015).

Based on Wilcock’s work, Hammell (2004) suggested that the meaningfulness that arises from occupations is obtained from the dimensions doing, being, becoming, and belonging. Doing is the active and visible engagement in occupations but can also be tacit (Hitch et al., 2014) such as sitting and thinking (Eriksson et al., 2011). A person’s doing is affected by a range of contextual factors (e.g., organisational, institutional), sometimes beyond the person’s own control. Emphasising the negative impacts that contextual factors may have on a person’s possibility for engaging in meaningful occupation, the concept of occupational deprivation has been defined as “a state of preclusion from engagement in occupations of necessity and/or meaning due to factors that stand outside the immediate control of the individual (Whiteford, 2000, p. 201) or the community to which they belong” (Wilcock & Hocking, 2015, p. 286). Occupational deprivation may have long-term effects on individuals and major consequences for their health. Further, occupational deprivation caused by a temporary condition such as an illness, has been identified as occupational disruption (Whiteford, 2000).

Through doing, individuals experience being, which is the essential nature or experience of performing occupations that drive individuals. The concept is closely connected to identity and occupational roles, such as being a grandparent (Wilcock & Hocking, 2015). Existential philosophy underpins much of the literature exploring this dimension of occupation, which is suggested as allowing people to be true to themselves and to provide a sense of purpose in life (Hitch & Pépin, 2021).

Together, doing and being can lead to a sense of becoming; an ongoing individual process of development and growth of an individual throughout life (Wilcock & Hocking, 2015). Like being, becoming is denoted by a person’s self-concept and desire to gain skills and competence. The process of becoming has been described as an unpredictable existential journey (Hammell, 2004) influenced by personal and environmental factors (Asaba & Wicks, 2010).

Belonging refers to connectedness to and interactions with other people (Wilcock & Hocking, 2015). It is about mutual support, friendship, a sense of inclusion, and affirmation from others (Hammell, 2004). By developing relationships and engaging in occupations, individuals experience a sense of belonging to people, places, organisations, cultures, and times (Wilcock & Hocking, 2015). To feel part of a social context can support a person’s ability to do, as well as contribute to the meaningfulness that occurs while doing (Hammell, 2004). In contrast, feeling excluded from reciprocal relationships might result in loneliness and social isolation, which increases the risk of a wide range of physical and mental health problems among older people (Smallfield & Molitor, 2018).

Occupational engagement and social participation require the maintenance of social relationships and involvement in community (Bassuk et al., 1999; Del Bono et al., 2007). Participating in occupational or social roles (e.g., volunteering for associations or non-profit organisations) (Berkman et al., 2000) and/or attending meetings (Utz et al., 2002), are examples of occupations that boost feelings of belonging to a community and enhance a person’s sense of value (Berkman et al., 2000).

Being confined to home may have a psychological impact such as stress symptoms, boredom, anger, and confusion (Brooks et al., 2020). In addition, while the restrictions for the older people in Sweden were enforced to protect them from COVID-19, such an arbitrary age cut-off may be seen as ageism and place additional strain on the lives of older people (Ayalon et al., 2021). At the beginning of the pandemic in Sweden, people 70 years and older reported more social distancing than those aged 65–69 (Kivi et al., 2021) and changes in this group’s everyday life affected their health and well-being (Fristedt et al., 2021). However, the longer-term effects of these changes are not known and empirical studies addressing the dimensions of doing, being, becoming, and belonging involving older people are sparse. This natural experiment gave a unique opportunity to explore a core focus in occupational science, that is, humans as occupational beings and how the possibility to engage in daily occupations influences their health and well-being (Calhoun, 2021; Yerxa, 1993, 2000). Therefore, in this study we explored how Swedish people, aged 70 years or older, experienced and managed everyday life during the early phase of the coronavirus pandemic, with the goal of generating new knowledge of the occupational impacts of living during confinement. More specifically, the aim was to explore how doing, being, becoming, and belonging, as dimensions of occupation, were manifested in the older people’s lives, 100 days into the coronavirus pandemic.

Methods

A qualitative cross-sectional study with a deductive analytical approach was selected to guide the study. Data were elicited through semi-structured interviews in June 2020 as part of a longitudinal research project on consequences of the pandemic for older adults’ everyday life and well-being (Fristedt et al., 2021). The Swedish Ethical Review Authority approved the study (Reg. No 2020-01493).

Participants and recruitment

The participants were recruited from a pool of possible candidates, who had previously been part of two research studies (n = 26) at the Centre for Ageing and Supportive Environments (CASE) at Lund University, Sweden and were willing to take part again, as well as volunteers who had signed up at a community event where researchers at CASE presented ongoing studies (n = 23). All lived in ordinary housing. The Ageing in The Right Place Study aimed to develop a housing counselling intervention for community-living older adults (Granbom et al., 2020) and the Planning Ahead Study explored housing decision-making among community-living older adults in relative poverty (Yadav et al., in manuscript). Thus, the potential participants lived under different socio-economic circumstances and in a variety of housing situations, household members, and neighbouring environments. Based on this pool of possible participants, 31 were aged 70 years or older. To obtain a purposeful and heterogenous sample, 18 candidates were contacted based on diversity of age, gender, living status, and urban/rural location. One declined, leaving a final sample of 11 women and 6 men aged 71–87 years old (mean age = 76). See Table 1 for sample characteristics. All names used are pseudonyms. Recruitment and characteristics of the participants have been described in more detail elsewhere (Fristedt et al., 2021).

Data collection

A semi-structured interview guide that was developed for the larger, longitudinal project (Fristedt et al., 2021) was also used for the current data collection. The interviews were carried out in Swedish by five of the co-authors (GC, MG, SF, OJ, & MK). All co-authors had previous experience of conducting in-depth interviews for research purposes with older people. Four of the authors were occupational therapists (GC, MG, SF, & MK) with experience of clinical practice among older people. One author was a designer by training (OJ) and had experience of considering older people’s everyday experiences to create conditions for the design of supportive environments. All interviews were conducted remotely via video conferencing software (n = 12) or phone (n = 5). Audio was digitally recorded on an external device and transcribed verbatim. The interviews lasted on average 51 minutes (range 31–75 min).

Table 1. Study participants (N=17)

Pseudonym	Gender	Age	Living status	Type of dwelling	Location	Care^a	Working^b
Anna	♀	78	alone	flat	urban	caregiver
Bjorn	♂	74	co-residing	house	semi-urban
Cecilia	♀	74	alone	flat	rural
David	♂	86	alone	flat	urban	safety alarm
Eric	♂	71	co-residing	flat	urban
Fred	♂	87	co-residing	house	rural	caregiver	yes
Gunilla	♀	75	alone	flat	semi-urban	caregiver
Helen	♀	75	alone	house	rural
Ingrid	♀	75	co-residing	flat	urban
Jane	♀	75	alone	house	urban		yes
Kurt	♂	79	co-residing	house	semi-urban	caregiver
Lena	♀	77	co-residing	house	urban
Marianne	♀	71	alone	house	urban
Nils	♂	73	co-residing	flat	urban
Odette	♀	76	alone	house	semi-urban		yes
Patricia	♀	74	co-residing	house	semi-urban
Rita	♀	78	co-residing	house	rural		yes

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

^b Yes = Retired but currently employed/self-employed as well.

Data analysis

We applied the theoretical dimensions of occupation—doing, being, becoming, and belonging (Hammell, 2004; Wilcock & Hocking, 2015)—in a directed content analysis (Hsieh & Shannon, 2005). Such a deductive approach is appropriate when prior research or theory exists, but the investigated phenomenon can be further explored and developed. First, two co-authors (LH & JE) independently coded data from 10 of the interviews by identifying meaning units on experiences and management of everyday occupations, extracting those, and coding the text to the predetermined theoretical concepts: doing, being, becoming, and belonging. In an iterative analytic process, LH, JE, GC, and MK compared and discussed the concepts and selected meaning units, refined them, and agreed upon them. Then, to increase the credibility (Graneheim & Lundman, 2004) of the analysis, GC and MK coded the remaining seven interviews, using the agreed-upon initial coding and iteratively refined the content of the dimensions. As a final step, all co-authors involved in the data collection compared and contrasted the content of the categories to the original transcripts and participated in a consensus discussion. Quotations were translated from Swedish to English and validated by the researchers as well as by a professional language editor, after completion of the analysis.

Findings

The findings showed how doing continued despite confinement. However, doing changed and was adapted in many ways. Surprisingly, the participants’ opportunities for being were not as limited as might be expected. Analysing the participants’ everyday life narratives showed that the possibilities for becoming and developing were severely restricted, and dreams and needs were put on hold. Maybe not so surprising, the sense of belonging was highly impacted by the restrictions and the participants expressed how disrupted belonging impacted on well-being.

Doing

Confinement had resulted in occupational disruption for all participants, with the most dramatic changes involving interaction with people outside of the household and participating in community and society. Nevertheless, after 100 days of confinement, the participants had become aware of how they used to spend their time before the pandemic and how the possibilities to engage in meaningful occupations had always been influenced by external factors to a high degree. Daily occupations had been changed, and habits and routines disrupted. However, the need to engage in occupations was strong and the participants expressed how they adjusted to the restrictions and found new ways of doing. In fact, at the time of the interviews, most participants had adapted well and described how everyday life was not so different anymore.

The participants described how they adapted previous occupations, such as now interacting with grandchildren from the window or shopping online instead of regular shopping. They also expressed how they had started doing occupations that had not been part of their occupational repertoire, such as doing jigsaw puzzles or listening to the 12 pm news. Doing also proved important in creating a new structure for everyday life. Some participants did not experience any problems in restructuring their days or passing the time. Others were surprised how fast time went even though they felt that they were not doing anything of importance. Some participants struggled with having too much time on their hands and they had a hard time adapting and creating new routines and habits. Adaptation to the new life seemed to be easier for participants who could identify which occupations they valued the most and who had pets or friends who needed them to maintain certain habits. One participant adapted her habits to focus even more on her dogs’ needs and another participant made sure she could interact with her friend who also lived on her own and was feeling very lonely: “Den här väninnan som jag har då, vi skiftas, vi äter tillsammans. Ibland gör hon mat och ibland gör jag mat, och så får man ju lite sällskap också ju. [This friend of mine, we take it in turns, we eat together. Sometimes she does the cooking, sometimes I do the cooking, and then we both get some company too]” (Gunilla, 75).

Taking care of themselves and their home, or doing grocery shopping, physical activity, gardening, and following the pandemic-related news were common occupations in most participants’ occupational repertoire. Purchases were made primarily with the help of others or online from grocery shops providing home delivery. However, participants expressed how in the beginning they stopped all visits to shops but had now gone back to shopping themselves, mostly because they did not want to bother relatives or because they were disappointed with the deliveries. They valued shopping on their own more than they had expected: “Vi handlar själv … Alltså det är något visst att se varorna innan dom kommer hem … dom sista två gångerna så fick vi liksom helt andra varor än vi hade beställt och lite fel … det störde mig. [We do the grocery shopping ourselves … You know, there is something special about seeing the groceries on the shelves, before you get them home … The last two times, we got completely different items than we had ordered, and there were some other mistakes … It was upsetting]” (Lena, 77). When they made purchases themselves, the actual doing of the occupation was adapted. They kept their distance, avoided busy times, and used gloves and face masks.

Physical activity was described as an important part of everyday life, more so during the confinement, and many had made walks or cycling in the neighbourhood a more prominent part of their daily routine than before. Some participants described that they appreciated the new daily national television programme promoting physical exercise at home “Hemmagympa med Sofia” [Sofia’s Home Workout]. They expressed that exercising in front of the television was a great way to get the day started, something they had never done before.

Gardening and home farming were described as a meaningful way to occupy time. They valued cultivating and harvesting and therefore they grew much more than they had done in previous years. Several of the participants had access to a garden, a summer house, or a balcony. They also enjoyed spending time in the garden; the chores gave participants structure for the day and were a meaningful way of doing something that felt useful. Working in the garden was also expressed as an important source of daily exercise. “Och här är ju gräsmattor att klippa … ja, här är att göra alltid, alltså! Du vet, men det är ju … det är ju bra att ha något och göra också, för det är tråkigt när man inte har någonting. [And here I have the grass to cut … yes, there’s always something to do here! But you know, it’s good to have something to do, because otherwise it’s boring if you don’t have anything to do]” (Fred, 87).

Even if the pandemic had changed daily life dramatically, the narratives of most participants showed how they had adjusted to new ways of doing and living to such an extent that they no longer reflected upon their new tasks, habits, and behaviour. For example, the routines of washing hands and using hand sanitiser, disposable gloves, and face masks were no longer considered out of ordinary. However, not being able to greet loved ones with a hug was harder to adjust to. A hundred days into the pandemic, distancing from other people had now become part of everyday life. “Man har väl vant sig vid detta nu ju … man håller sig på sin kant så att säga, för man vill ju inte ha det. [You’ve got used to it now … you keep to yourself, so to speak, because you don’t want to catch it]” (Gunilla, 75). Some participants were slightly more relaxed and noted that they sometimes tended to forget about maintaining a safe distance.

Being

Experiencing a new situation with a pandemic impacting the whole world, together with life being put on hold and having time to reflect, listen to inner needs, and gain new perspectives, gave being a more prominent place in the participants’ narratives. Yet, being was challenged by the lack of social contacts and lack of belonging. As time went by, the participants described how they set their own rules to manage the restrictions in order to regain some of their cherished occupations.

Many of the participants described a sense of being in the moment and listening to inner needs. As a strategy to feel okay and handle the situation, they described how they consciously strove to create enjoyable moments, for example by being out in nature. Indeed, spending time outdoors was experienced as relaxing and allowed them to be in the here and now. Many described how they had spent a lot of time indoors at the start of the pandemic and the winter season and how they now appreciated the warmer weather, which allowed them to be outside. As one participant expressed it: “Vi har en jättefin trädgård som är i sin fullaste prakt nu och vi är mycket ute i trädgården, vi sitter under äppleträdet varje dag och fikar, massor med äppleblommor har vi haft. [We have a lovely garden that is at its best now, and we spend a lot of time there. We sit under the apple tree every day and have coffee. We have had so much apple blossom!]” (Bjorn, 74).

Overall, the opportunity for a change of environment and being out in nature was expressed as a strategy to manage confinement and increase well-being. For example, one of the participants explained how important the green surroundings nearby his holiday home were for his well-being. Being able to go there was experienced as extremely important.

Sen upplever vi ju att miljön här nere är ju betydligt mer rogivande … det är det här med att man är ute i naturen. Det är ju en stor tillgång … Jag har nog upplevt det som en … en bra mental rensning och komma ut hit. [You know, we believe that the environment down here [Southern Sweden] is so much more calming … it’s about being out in nature. It’s a huge benefit … For me, it’s been a great mental cleanser, to be able to get out here.] (Kurt, 79)

Despite restrictions, several of the participants described how the slow pace of life made them discover or rediscover places in their neighbourhoods. Places such as nature reserves that they had lived nearby for many years but had only now taken the opportunity to visit. Some described how they discovered things that they had not previously noticed or that being in a known place could lead to a completely new experience, for example to discover a new kind flower or a tree. Marianne, who lived alone, described how she got help from her son to get to the coast.

Min son har faktiskt varit uppe och hämtat mig en gång … Jag satt i baksätet och så körde han ner till kusten. Åh, gud, vad jag hade längtat efter det! Det … blåste ordentligt och vinden stod mot land, så jag kunde riktigt få lukta [namn på hav] … Ja, det var underbart! [My son actually came here once and picked me up … I sat in the back seat, and he drove us down to the coast. Oh, God, how I had longed for it! It was … really windy and the wind was blowing ashore, so I could really smell [the ocean] … Yes, that was wonderful!] (Marianne, 71)

At the start of the pandemic, the participants described how they carefully followed the stay-at-home recommendations. Now, 100 days into confinement, some expressed how the absence of social occupations in everyday life affected their well-being in a negative way. As a strategy, they adapted the recommendations to what they felt they needed and regained some of their occupations. Jane, who lived alone, described what she did.

Då har jag kommit på … jag får göra upp mina egna regler … Jag orkar liksom inte vara i den här totala isoleringen längre … Jag håller distansen, jag träffar folk utomhus så mycket det går, jag har börjat jobba med min teatergrupp. Vi repeterar utomhus och jag har suttit på två möten inomhus, med stora avstånd … Så att jag får in verkligheten i tillvaron igen, för jag höll på och bli lite galen faktiskt … eller man kanske ska säga heldeprimerad och rädd? [Then it came to me … I had to set my own rules … I can’t bear to be totally isolated anymore … I keep a distance, I meet people outdoors as much as possible, I started work with my theatre group again. We rehearse outside and I’ve been to two meetings inside, but we keep big distances from one another … so I’ve managed to get some sense of reality back into life again, because actually I was starting to go a little bit crazy … or maybe I should say deeply depressed and scared?] (Jane, 75)

Other occupations the participants regained included going to the hairdresser and meeting with a close friend to resume a highly appreciated whiskey club. In addition, for those who appreciated privacy, being confined to home was described as something positive. For example, one participant shared that her need for privacy was now respected in a new way as people had to keep their distance and not get too close. Another explained how he had always enjoyed living alone without needing to spend time with lots of other people, which now was not questioned due to the social distancing recommendations.

Becoming

The participants expressed how hard it was to think about the future and have expectations for the future. Goals, dreams, and aspirations were put on hold. They had adjusted to not knowing what would happen and learned to take each day as it came. Instead of describing how they gained skills and fulfilled dreams, they described changes in life that were more negative. The participants wanted to remain active and independent but instead they felt old and out of shape. “Väldigt tråkigt att plötsligt så har vi blivit så gamla på något sätt. [It is very sad that we have suddenly turned so old, in some way]” (Cecilia, 74). The participants felt it was harder than usual to motivate themselves to do, for example, physical activity or some kind of social occupation even if it used to be something they valued before and was an important part of their identity. Most participants also considered themselves to be, before the pandemic, independent individuals with agency who were listened to and gave support to others. To retain that role was however extremely hard now during confinement, and some participants even thought they would never again be as independent as before.

Several participants used to live active lives and were involved in non-profit organisations or hobby groups. One described how she was used to having kennels and before the pandemic she had planned to be more active in breeding dogs too. That however, had to be put on hold during the pandemic.

Jag åker ju mycket på hundutställningar, men alla hundutställningar är ju inställda … Och jag har ju en tik som jag vill ha avla på, men det går ju inte. Tiden bara går och det är ju sådana aspekter också som är lite tråkiga, faktiskt. [I usually go to a lot of dog shows, but they’ve all been cancelled … and I have a bitch that I want to breed from, but that’s out of the question now! Time just goes, and those sorts of things are quite sad, don’t you think?] (Patricia 74)

However, some of the participants also expressed that the fact that they had more time on their hands and spending more time at home allowed them to engage more in certain hobbies and interests. One participant described how his interest in environmental issues and sustainability had grown and he had put solar panels on his roof, and another participant revealed that her engagement in politics had increased. “Jag sitter ju i socialnämndens utskott och där är mycket och läsa … Och det har jag ju tid med nu! Att fördjupa mig. [I am a member of the social care committee in our municipality and there is a lot to read … And now I have time for that! To immerse myself]” (Odette, 76).

David wondered if there was anyone who might be interested in hearing about the story of his life, maybe during the pandemic he could start filming video clips: “Jag funderar på om jag skulle starta någon sådan här kanal på Youtube och berätta historier från … mitt liv, men jag vet inte, jag har inte kommit därhän ännu … Det finns rätt många historier man kunde berätta! [I am thinking about starting one of those channels on YouTube, to share stories from … my life, but I don't know, I am not really there yet. I have many stories I could share!]” (David, 86).

Belonging

The participants’ social belonging had been severely disrupted, leading to feelings of disconnection from people and important places. No longer was feeling a sense of belonging to a social network, nor getting affirmation from others, was described with sadness, as a loss, which influenced the participants’ well-being. The limited possibilities of being physically close to family members was also described as difficult: “Jag tänker bara på det när jag träffar barnbarnen … Att man inte får krama om dom och så, det tycker jag är det värsta. [When I think about meeting my grandchildren, the first thing that comes to mind is that I won’t be able to hug them, and that is the worst feeling] (Lena, 77). Many also described that they missed socialising with friends in the way they used to before the pandemic. For example, one participant expressed how much he missed going to a football match and having the usual coffee with his friend afterwards. Another reflected upon the feeling of being disconnected by not being able to travel anymore. The participants who lived with a partner expressed gratitude for having someone by their side to talk, discuss, and argue with. Some participants who lived alone revealed that their social lives at the senior meeting places and within non-profit organisations were put on hold and virtually all social contact disappeared. No longer belonging to a social community was described as leading to feelings of boredom and loneliness.

To maintain belonging, the participants had found new ways to communicate. Talking more on the phone, using video calls, or being part of online meetings were some of the solutions that were described. Although alternative ways of socialising were better than not socialising at all, this did not fully bring the same sense of belonging (in their social life), especially in situations such as celebrations. “Och mitt ena barnbarn tog ju studenten och då livestreamade dom det, så de kunde man vara med på, på avstånd … Ja, det var konstigt … men det var i alla fall bättre än och inte se någonting. [When one of my grandchildren graduated from high school it was live streamed, so I could take part at a distance. It was weird … but better than not seeing anything]” (Jane, 75). Their sense of belonging to friends and organisations could also be maintained to some extent through adaptations. Some meetings were still held, in some way, but then often outside or online.

Usually, before the pandemic, several of the participants described that they used to spend parts of the summer holiday with their immediate family. The planning for this summer was not the same as usual. While some chose to cancel the meetings with the family, as it was not possible to find safe ways to spend time together, Jane’s family adapted the holiday accommodation to the recommendations so that she could take part:

Min son köpte en husvagn och ställde upp [på landstället] och så bor jag i den … så finns jag ändå där och kan prata med dom och hålla avståndet … nu har jag bestämt mig för att nu är det säkert och då har jag något och se fram emot riktigt så där. [My son bought a caravan and parked it up [by the summer house] and I will stay in it … so I will still be there and can talk to them and keep my distance … I have decided now that it is safe and so I have something to really look forward to.] (Jane, 75 years)

Generally, the participants perceived their families as protective, being careful that their older relatives would not be put at risk of infection. Both children and grandchildren explained their concerns to the participants and were careful to keep to the restrictions that existed. Gunilla said that her daughter urged her to keep total isolation.

Så därför är det bra att man är två, för hade man varit ensam då hade det nog varit tråkigt och det har jag sagt till min dotter också, för att hon var också väldigt att jag skulle vara ensam och inte träffa någon överhuvudtaget, ‘Då sa jag alltså säg inte det till mig … för då blir jag helt tokig’ … jag måste ha någon och prata med, jag måste träffa någon alltså. [It’s good if there are two of you, because being alone would probably be boring and I told my daughter that too, because she was saying I should be on my own and not meet anyone at all - and I said to her, ‘Don’t tell me that … because then I will go completely crazy’ … I need to have someone to talk to, so I have to meet others.] (Gunilla, 75)

Meeting family members outdoors was a strategy for socialising while reducing the risk of spreading the virus. Some had celebrated midsummer with their families in customised forms while others chose to stay at home due to the restrictions. However, participants expressed concerns that future festivities of social importance would also be affected. Fred, who lived with his wife, explained: “Det blir en katastrof ifall det är kvar denna bestämmelse, för … i hela mitt liv så har jag … alltså julen har jag här hos mig alltså och jag sköter hela … all mat och allting till julen. [It will be a total disaster if these restrictions remain in place, because … all my life I’ve been in charge of … it’s up to me to take care of … all the food and everything for Christmas]” (Fred, 87).

Discussion

This study elucidates how older people experienced and managed everyday life during the first 100 days of the coronavirus pandemic. The findings showed how doing was adapted and changed, how the pandemic gave opportunities for being and appreciating the moment, but that possibilities for becoming and developing were severely restricted, and the sense of belonging was disrupted, which seemed to influence well-being.

The Swedish Public Health authority strongly advised people 70 years and older to reduce all social interactions outside of the home, which meant that Sweden handed over the responsibility of following the restrictions to the citizens themselves. Older people took this seriously and several of the participants reported that they followed the recommendations and kept themselves up to date on the new guidelines through press conferences and media. The restrictions led to constraints regarding which occupations were possible to engage in and, more than anything else, reduced contact with family and friends.

A key message, in a review by Brooks and colleagues (2020) about the psychological impact of quarantine, is that most of the adverse effects come from restrictions of liberty, whereas voluntary quarantine is associated with less distress and fewer long-term complications. Living under quarantine means that future goals and ambitions are affected (becoming), but interpreting these results, the idea of self and identity (being) might be affected in different ways depending on whether the quarantine is voluntary or not. While studies comparing the effect on population health of different country-specific approaches (e.g., recommendations, complete lockdowns) during the coronavirus pandemic are sparse, some emerging empirical findings suggest that older people in Sweden have dealt with the situation fairly well. For example, in a previous study (Fristedt et al., 2021) conducted about one month into the pandemic, the theme “Suddenly at risk ‘ … but it could have been worse’”, describes how everyday life changed for older people. Similarly, a longitudinal survey study conducted by Kivi and colleagues (2021) showed that older adults were “up and about” and that they rated their well-being as high. However, both of these studies were conducted at the beginning of the pandemic and long-term health consequences were still to be seen.

Engaging in meaningful occupations is a catalyst for being, becoming, and belonging, and by performing various occupations during the day, structure and meaning are created in everyday life (Wilcock & Hocking, 2015). The participants in the present study stated that their habits could not be carried out as before due to the restrictions and many had trouble in coping with everyday life under the new conditions. They had lost their everyday taken-for-granted structure and the solid foundation to lean on, which may have consequences for their quality of life (Charmaz, 2002). Creating new routines takes both time and resources, just like when you retire (Van Dyk et al., 2013), which may explain why some of the participants were still struggling to form habits. In addition, experiencing a global state of crisis, and adjusting to not knowing what to expect or how the future will turn out, might influence people’s abilities to form habits in different ways. It is important to remember that not all the participants experienced the disruption as purely negative. Instead, participants described how they had adapted to the new circumstances and expressed that they had regained some cherished occupations or that they had started doing new occupations to fill their days. Doing and habits are embedded in a context and participants who lived together with a partner seemed to have had an easier way to find a new everyday routine than those who lived alone, which is supported by Ekerdt and Koss (2016) showing that a partner or a pet can contribute to a daily structure and promote routines.

In this study, the participants’ doing was influenced by the guidelines promoted by the Swedish health authorities (Public Health Agency, 2020) and visible actions were evidenced by using gloves, asking others for help with grocery shopping, performing physical exercises in front of the television or outdoors, gardening, and following the news updates. Yet, tacit actions (Hitch et al., 2014) were also implemented, such as new routines. The chance to engage in different occupations is challenged during a pandemic and people do not tend to think about all the small meaningful things in life that are taken for granted before something happens. Many felt that they had a more inactive everyday life, but the participants also found strategies to promote their well-being by reflecting on their occupations and their doing, which might lead to significant insights (Hammell, 2004). They described how they did more of some previous occupations and how they developed others.

One strategy applied by several participants was to change environment, for example, going out in the garden or taking a walk instead of just being inside their home, which had a positive effect on their mood. Inactivity had led to unwanted physical consequences such as loss of muscle mass and fitness. Deschasaux-Tanguy and colleagues’ (2021) and Pisot and colleagues’ (2020) studies show that reduced physical activity with the attendant risk of ill health was common in Europe during the pandemic. The interviews were conducted in early summer with nice weather. The participants enjoyed being outside and described how the slow pace of life made them discover or re-discover places in the nearby surroundings. Having time gave new perspectives and affected their choice of occupations. Batsis and colleagues (2021) underscored the importance of such strategies as changing environment and keeping physically active as key in promoting healthy ageing during the confinement period. Participants who had come further in the process of regaining control over everyday life seemed to have more moments of recovery and satisfaction, which is in accordance with the idea that doing is a prerequisite for being (Wilcock & Hocking, 2015). Yet, the lack of social contact started to become a challenge and several of the participants set their own rules to deal with the situation.

Being allows individuals to envision a future, to become, but during the coronavirus pandemic all future plans suddenly had to be placed on hold. In the literature, becoming is expressed in positive terms describing the idea of making life worthwhile through a constant striving to become a better self and to achieve life goals (Hammell, 2004). However, the findings in this study suggest that opportunities for becoming were severely challenged. Rather than speaking about becoming as a development with positive connotations, the participants expressed negative changes in their everyday lives. Importantly, they described how not being able to engage in occupations they previously valued had altered the way they viewed themselves. Participants had to rapidly change their lives to adapt to the social distancing recommendations, which imposed a gap between their occupational goals and realisations.

To be able to engage in everyday occupations is a prerequisite for developing and maintaining social relationships (Wilcock & Hocking, 2015). A hundred days into the pandemic, the participants in the present study described how their social belonging had been severely disrupted and had had negative consequences for their health and well-being. Their opportunities for social interactions were constrained and at the time of the interviews this loss was described as burdensome. Family and friends distanced themselves to reduce the risk of spreading the virus and most organised social occupations were put on hold. As a consequence, several of the participants experienced loneliness. This result is in line with Lehtisalo and colleagues (2021) showing that older people became lonelier during the first period of the pandemic. In addition, some of the participants in the present study described that social distancing had contributed to a decrease in mental well-being. This is also found in a literature review conducted by Sepúlveda-Loyola and colleagues (2020) showing increasing rates of anxiety and depression in older people following social distancing recommendations. Many studies in this review describe belonging to a social community as being vital for active and healthy ageing (Giulio de Belvis et al., 2008; Hajek & König, 2020; Lee et al., 2019; Mackenzie & Abdulrazaq, 2021). Furthermore, Sepúlveda-Loyola and colleagues (2020) described how older people often have fewer resources to reduce the negative consequences of social isolation. Still, several of the older people interviewed in the present study had strategies to reduce the feeling of isolation and combat loneliness, for example, they used telephone, social media, and video calls more often as a resource to be able to maintain contact with their family and friends. However, they did not feel that this fully compensated for their previous approach, which is contradicted in a study by Chen and colleagues (2021), where a great satisfaction was expressed with being able to manage contacts virtually.

Strengths and limitations

Focusing on experiences of everyday life and health during the coronavirus pandemic was a fruitful way to prompt reflections about the dimensions of occupation in an older population. The participants consisted of both women and men, residing in different types of accommodation, who were, in general, healthy. Taken that most occupational therapy research that has studied the dimensions of occupation has focused on people with chronic illness such as bowel cancer (Martin et al., 2020) or mental health recovery (e.g., Doroud et al., 2018), this study adds to the current knowledge base regarding the role that occupation plays in health among older people.

The rather small study sample (n = 17) can be seen as a limitation. However, following recommendations for qualitative research (Malterud et al., 2016), we considered our sample to be large enough to show diverse experiences and sufficiently small to allow for in-depth analysis of all aspects of the data. To increase trustworthiness and credibility of the findings, site triangulation (Shenton, 2004) was considered in the recruitment phase, meaning that the participants lived in different socio-economic circumstances and in a variety of housing situations, household members, and neighbouring environments. Even if the participants in our study varied to some extent, a general limitation in studies conducted during the pandemic is that people with higher digital competence have participated due to the data-collection methods.

Occupational engagement is a complex concept, assumed to directly influence individuals’ health and well-being, which means that the dimensions of occupation interact and cannot be completely separated (Hammell, 2004). However, in the analysis process, to elucidate the core content of each dimension (Denzin & Lincoln, 2000) emerging findings were iteratively discussed and verified within the research team. We discussed alternative interpretations until consensus was reached. In addition, we used the software NVivo (version 12) (Edhlund & McDougall, 2019) for the analysis, and reported the study in line with the COREQ (COnsolidated criteria for REporting Qualitative research) guidelines for qualitative studies (Booth et al., 2014).

The findings of this study are indeed contextually bound and cannot be generalised to all older people in Sweden, or elsewhere. Countries have had a wide range of approaches to minimise the spread of the virus (Public Health Agency, 2020). In addition, the participants in the present study were in general healthy and active, which might have an impact on transferability of the findings to older people at large.

Turning to different sub-groups, more women than men participated in the present study meaning that men’s perspectives are underrepresented. As recent research shows, it is important to address experiences in different sub-groups such as gender, age-groups (Buecker et al., 2020) and educational level (Rotenberg et al., 2021). In addition, the time when data is collected during the pandemic is also important to consider as experiences might differ. Hence, longitudinal perspectives on doing, being, becoming, and belonging are of great interest, because many older people and people with chronic illness (Charmaz, 2002) experience disrupted occupations, regardless of whether there is a pandemic or not.

Conclusions and Implications

The participants, who were older people without any specific diagnosis, reflected upon their daily occupations during an unrehearsed natural experiment when, more than anything else, the social environmental circumstances changed. The participants in the present study were in general healthy and active, and the analysis elucidates how doing, being, becoming, and belonging were interlinked and contextually bound. The exploration of these dimensions reveals similarities and differences in people’s experiences of meaningful occupations. Feelings about distancing and being dependent varied, as well as experiences of new ways of socialising but, overall, the loss of the sense of affirmation that is generated from occupations performed together with others was described with sadness. Strategies were developed to continue their doing, such as adapting the recommendations to what they felt was necessary, and in that way regaining some of their occupations. The results must be interpreted in the context of the less strict forms of lockdown that the Swedish authorities implemented, compared to many other countries. Nevertheless, the results deepen our understanding of how doing, being, becoming, and belonging are manifested in people’s lives. The unique situation with rapidly changed and uncontrollable contextual circumstances offered us an opportunity to collect and analyse data during a rare time in history. Our study applying the theoretical concepts contributes to occupational science and the growing knowledge base about occupational engagement and health. Thus, the knowledge can contribute to development of individual and societal interventions that support older people’s individual needs as occupational beings.

Authors’ Backgrounds, Competences, and Relationship with Study Participants

Gunilla Carlsson is a registered occupational therapist with a PhD in health science. She is an associate professor at the Department of Health Sciences at Lund University, Sweden. Her research interest concerns how society can support older peoples’ occupations. She is one of the core researchers in the larger longitudinal research project and conducted some of the interviews.

Marianne Granbom is a registered occupational therapist with a PhD in health science. She is associate senior lecturer at the Department of Health Sciences at Lund University, Sweden. She combines undergraduate and graduate teaching in occupational therapy with research on housing and well-being in later life. MG is PI for the longitudinal “Suddenly at Risk” project and took part in all phases of the research project as well as writing the current publication.

Sofi Fristedt is a PhD, researcher at the Department of Health Sciences at Lund University, and an associate professor at Jönköping University, Sweden. Her research interest concerns how community mobility and technology relate to active and healthy ageing. She is one of the core researchers in the larger longitudinal research project and conducted some of the interviews.

Oskar Jonsson is a PhD in Design Sciences. He is a researcher at the Department of Health Sciences at Lund University, Sweden. His research interest concerns human-environment interactions. He is one of the core researchers in the larger longitudinal research project and conducted some of the interviews.

Louise Hägg has a BSc in occupational therapy. She is a registered occupational therapist, working at Kristianstad Hospital, Sweden. She analysed 10 of the interviews and wrote a Swedish draft of the paper together with JE as part of her BSc.

Jenny Ericsson has a BSc in occupational therapy. She is a registered occupational therapist, working for Kävlinge Municipality, Sweden. She analysed 10 of the interviews and wrote a Swedish draft of the paper together with LH as part of her BSc.

Maya Kylén is a PhD, and a researcher at the Department of Health Science at Lund University and at Dalarna University. Her research interest concerns the interaction between older people and the environment, with a specific focus on the home. She is one of the core researchers in the larger longitudinal research project and conducted some of the interviews.

Acknowledgements

We are most grateful to the older adults who willingly participated in our study in the midst of the COVID-19 pandemic.

Disclosure Statement

This study was conducted within the context of the Centre for Ageing and Supportive Environments (CASE) at Lund University, Sweden. It was supported by the Ribbingska Foundation and the Department of Health Sciences, Lund University. All authors declare that they have no potential or competing conflicts of interest.