Understanding the Impact of COVID-19 Lockdowns on Older Adults’ Routines and Well-being: 3 Case Reports

Abstract

The COVID-19 pandemic has significantly impacted the daily lives of older adults. Three case reports illustrate how individuals have coped with loss, maintained routines, and faced emotional challenges. Understanding these experiences can guide efforts to promote the well-being and resilience of older adults during this time. Interview questions included “What was your daily routine and any leisure activities you participated in before COVID-19? During the height of social distancing?” to explore the impact of this pandemic on older adults’ daily routines and the effects on their mental and physical health.

Keywords

routines COVID-19 older adults routines and well-being

Introduction

The emergence of COVID-19 in early 2020 marked a pivotal moment for the United States (CDC COVID-19 Response Team et al., 2020). Widespread lockdowns and isolation measures swiftly followed as the virus spread globally, significantly disrupting daily life, particularly for older adults. This study investigates the profound impact of COVID-19 on their routines and well-being, acknowledging its secondary implications for mental and physical health. Before the pandemic, older adults maintained structured routines encompassing work, leisure, and social engagements. However, the sudden onset of COVID-19 necessitated unprecedented changes, confining individuals to their homes to curb transmission (Sangster Jokić & Jokić-Begić, 2022). This disruption posed challenges across physical, social, and psychological domains, amplifying feelings of fear, loneliness, and isolation. With a significant portion of older adults shifting to remote work, the pandemic further disrupted established routines, especially for those aged 65 and above, who faced increased vulnerability to severe illness (Centers for Disease Control and Prevention [CDC], 2021). Leisure activities, integral to older adults’ well-being, became inaccessible due to stay-at-home orders, exacerbating feelings of isolation and distress (Gonçalves et al., 2022). This study seeks to bridge this gap by examining how COVID-19 has altered their lives and affected their mental and physical health, aiming to inform interventions and support initiatives post-pandemic (Michèle et al., 2019). Routines, defined as observable, regular, and repetitive patterns of behavior, play a crucial role in structuring daily life and contributing to overall well-being (Boop et al., 2020; Di Corrado et al., 2020). Disruptions to routines during lockdowns have been associated with adverse mental and physical health outcomes, highlighting the importance of maintaining routines for well-being (Leigh-Hunt et al., 2017; Van Tilburg et al., 2021). Incorporating physical activity into daily routines is essential for maintaining physical health, with outdoor activities linked to increased pleasure and higher activity levels (Barr-Anderson et al., 2011; Cabrita et al., 2017).

Case Description

In this study, we used a case study methodology to investigate how older adults experienced the COVID-19 lockdowns and how their daily routines were disrupted. This approach offers an in-depth exploration to examine individual experiences (Rasalingam et al., 2023; Yin, 2018). We conducted three case studies involving older adults aged 65 years or above, aiming to capture diverse experiences within the population. The study received ethics approval from the Institutional Review Board (IRB). All participants provided informed consent before participating in the study.

Methods

The data analysis in this study employed a thematic analysis approach, beginning with the transcription of interviews (Braun & Clarke, 2006). The research team carefully transcribed the audio recordings verbatim and reviewed them for accuracy. Familiarization with the data was achieved through repeated readings of the transcripts, allowing the researchers to gain a deep understanding of the participants’ experiences and initial insights into potential themes (Braun & Clarke, 2006).

An inductive coding process was used, with codes derived directly from the data (Braun & Clarke, 2006). This process involved systematically analyzing the transcripts to identify significant statements and patterns. Two researchers independently coded the data to ensure reliability, resolving any discrepancies through consensus (Nowell et al., 2017). The codes were then grouped into broader themes, capturing the essential aspects of the participants’ experiences. These themes were refined through iterative discussions to ensure they were coherent and distinct (Nowell et al., 2017). The final themes were reviewed in the context of the entire dataset, with sub-themes identified to capture the nuances of the data (Braun & Clarke, 2006). A detailed report was produced, including descriptions of each theme supported by participant quotes. This approach ensured a comprehensive and credible representation of the participants’ experiences during the COVID-19 pandemic.

Participants were recruited through flyers posted at community centers and online advertisements. Aiming for diversity, we sought older adults with varying experiences during the pandemic. Three individuals responded and consented to participate. Semi-structured interviews were conducted via Zoom, and the audio recordings were transcribed for thematic analysis. Questions regarding their routine and challenges during COVID-19 were provided (Tables 1).

Table 1.

Interview Questions (Daily Routine and Experience During the COVID-19 Pandemic).

1. Daily Routine (including leisure activities) before the pandemic:
a. What was your daily routine like before COVID-19?
b. Were there any activities you enjoyed before the pandemic that you couldn’t do because of social distancing?
2. The change or persistence of daily routine during the pandemic:
a. How did your daily routine change during the strict social distancing period?
b. Were there any parts of your routine that stayed the same during the pandemic?
3. The obstacles arising from the alteration in their daily routines that participants encountered during the pandemic:
a. What challenges did you face during the pandemic?
b. How often did you feel lonely or stressed during the lockdown?
c. Did you have any other health problems during the lockdown?
4. How to deal with these challenges:
a. How comfortable are you using smartphones or other technology to stay connected with others?
b. How did you handle emotional stress during the pandemic?
5. The impact of managing these challenges on subsequent physical and mental health:
a. Did you get COVID-19? If yes, did your opinion about how serious the virus is change?
b. When do you think you’ll feel safe going back to a routine similar to what you had before the pandemic?

Case 1

MG, an 82-year-old resident of an apartment in New York City, lost her husband shortly before the COVID-19 pandemic. Before the pandemic, MG’s daily life largely revolved around caring for her husband, who had Parkinson’s disease and had fallen frequently. She described his passing led to a sudden and profound change in her routine, requiring her to navigate both grief and a new way of living. During the lockdown, MG engaged in outdoor activities, such as walking in a park alone or with a friend. She found that spending time in nature provided a therapeutic outlet, which helped her manage the challenges associated with isolation. She also maintained connections through phone calls with family and friends and occupied her time with reading and watching television.

MG described her emotional challenges, including loneliness and sadness, following her husband’s death and throughout the pandemic. At the urging of her children, she sought therapy, addressing the impact of these events on her mental health. Her actions demonstrate a proactive approach to managing her emotional well-being. In terms of technological adaptation, MG initially expressed discomfort with texting and emailing but gradually began to use these methods. Despite a preference for traditional communication methods like voice calls, she recognized the necessity and advantages of technology, particularly during the pandemic. This shift was influenced by the encouragement of her family and the demands of the situation. As conditions improved, MG cautiously resumed activities such as indoor dining and using public transport, while taking necessary precautions. Her decisions were informed by a sense of increased safety as infection rates declined, reflecting her adaptability to the changing circumstances.

Case 2

GK, an 80-year-old retired professor in a suburban neighborhood in New York City, navigated the challenges of the COVID-19 pandemic with his roommate. GK lived in a community-based apartment for many seniors and prioritized precautionary measures to reduce the risk of COVID-19 transmission. He and his roommate remained vigilant by avoiding crowded places and strictly adhering to safety protocols. Prior to the pandemic, GK’s daily routine included activities like swimming and pickleball. However, during the lockdown, he adjusted his routine to include early-morning grocery shopping and walks around the golf course alone in his neighborhood. Despite disruptions to some leisure activities, GK continued playing pickleball with appropriate precautions. One significant challenge GK faced was the difficulty in scheduling and obtaining the COVID-19 vaccine. Despite the initial hurdles, he eventually received the vaccine. GK had limited engagement with technology, preferring traditional communication methods like voice calls. He occasionally used FaceTime on his smart phone to communicate with family but preferred to use phone. GK said he had distress related to financial losses in the stock market but tried to remain hopeful. Engaging in outdoor activities such as walking and playing pickleball and spending time outdoors helped him to relax. As restrictions eased and COVID-19 cases declined, GK began to resume activities like his pre-pandemic routine. He expressed a sense of safety in re-engaging with leisure activities and social interactions.

Case 3

HL is a 72-year-old woman living in an apartment in New York City. Before the pandemic, HL led an active and socially engaged lifestyle, frequently participating in clubs and outings with friends and family. However, at the onset of COVID-19, she stopped social activities with friends and family to follow safety protocols. HL started to explore new activities such as walking and doing community gardening but avoided contact with other people. She described the absence of regular outings and gatherings that made her feel isolated and lonely. During the pandemic, HL described difficulties accessing essential amenities such as groceries, and navigating the uncertainties associated with the virus. She said she was very anxious, feeling lonely and worried about the future. She said lack of regular social interactions and leisure activities made everything worse. She described life was so difficult and felt helpless at the time and was not interested to learn how to use smart phone or technology.

Results

The analysis of this study revealed distinct patterns across four emerging themes: adaptations, emotional challenges, technological adaptation, and the resumption of normalcy among older adults during the COVID-19 pandemic (Table 2).

Table 2.

Emerging Themes.

Theme	Case 1	Case 2	Case 3
Adaptations in covid	Using outdoor activities; maintaining connection, reading, watching TV	Modified routines (early morning grocery shopping)	Adapted daily routines with stringent safety protocols, communal gardening
Emotional challenges	Loneliness, sadness, seek therapy	Coping with uncertainties, anxiety	Loneliness, anxiety, emotional challenges
Technological adaptation	Gradual adaptation using technology	Limited technology usage, prefer phone calls	Minimal engagement with technology
Resumption of normalcy	Resumed indoor dining, public transport with precaution	Gradual return to pre-pandemic routines	Gradual return to normalcy

Adaptations

Participants adapted to the pandemic in various ways. Case 1 increased digital communication, Case 2 adjusted his routine by shopping early and walking alone to avoid the crowd. Case 3 engaged in community gardening. These adaptations provided a sense of structure and purpose, helping the participants manage the disruption to their daily routines.

Emotional Challenges

All participants experienced emotional challenges, including anxiety, loneliness, and frustration. The intensity and specific focus of these emotions varied among the cases. Case 1 was particularly anxious about health risks, Case 2 expressed frustration with ongoing physical restrictions, including limited access to outdoor spaces, disruptions in social interactions, and the inability to engage in routine activities such as medical appointments or group leisure activities, and Case 3 struggled with loneliness.

Technological Adaptation

Technology played a crucial role in maintaining social connections and accessing services, but participants’ engagement with digital tools varied. Case 1 was willing to learn how to learn digital literacy, while Case 2 hesitated to use it due to limited skills, and Case 3 showed little interest in using it.

Resumption of Normalcy

All participants expressed a desire to return to pre-pandemic routines. However, their attitudes toward resumption differed: Case 1 adhered strictly to health guidelines, Case 2 was eager to resume normal activities, and Case 3 was skeptical of the virus’s severity and frustrated by ongoing restrictions.

Discussion

This study examined the experiences of older adults during the COVID-19 pandemic, focusing on how they coped with disruptions, maintained routines, and addressed emotional challenges. The findings showed that older adults demonstrated resilience in adapting to significant changes in their daily lives, aligning with previous research on their ability to cope during crises (Brooke & Jackson, 2020). Although participants shared common experiences, they displayed unique strategies in response to the pandemic, emphasizing the personal nature of their adaptations.

During the pandemic, all participants had to make adaptations to their daily schedules. This aligns with the research of Whitehead and Torossian (2021), who highlighted the significance of engaging in meaningful activities for mental well-being. However, each person had their own approach: one used digital communication, another adapted their routine to avoid physical contact, and the third participated in community activities. These differences demonstrate the various ways older adults maintain structure, based on their resources and comfort levels.

The participants commonly experienced emotional challenges such as anxiety, loneliness, and frustration, which reflected the broader psychological impacts of the pandemic (Sepúlveda-Loyola et al., 2020). The intensity and focus of their emotional responses varied, with some individuals feeling more anxious about health risks, while others were frustrated by physical restrictions. These findings highlight the importance of providing pesonalized psychological support, as older adults experienced stress differently based on their unique circumstances.

The use of technology was crucial for maintaining social connections, although participants showed different levels of engagement. As Nimrod (2020) noted, one participant fully embraced technology, while others hesitated due to limited digital literacy. These differences highlight the ongoing issue of digital inequality, which continues to be a challenge for older adults, especially during times of crisis.

The study found that older adults had varying attitudes toward returning of normal activities after the COVID-19 pandemic. Some were cautious and followed health guidelines, while others were eager to resume pre-pandemic activities. These differences in attitudes reflect the diversity of risk perception in older adults, which is influenced by their personal beliefs and external messaging (Finlay et al., 2021).

In conclusion, the study emphasized the importance of providing personalized support strategies for older adults as they navigate the challenges oof the pandemic. It underscores the need to consider individual adaptation methods, emotional needs, and access to technology.

Comparison With Other Studies:

Our findings are consistent with other studies that have documented the significant impact of COVID-19 on older adults’ routines and well-being. Like our study, research found that disruptions to daily routines and social isolation were common challenges faced by older adults during the pandemic (Gonçalves et al., 2022; Lai et al., 2020). However, our study also highlights unique aspects, such as the proactive adaptation to increase physical activities like case 1 and 2, which may not be as prominently featured in other studies. This suggests that while there are common experiences, individual differences in coping strategies and resilience are also important to consider. Literature also reported that older adults experienced significant disruptions to their daily routines and increased feelings of loneliness and isolation (Fristedt et al., 2022; Kim et al., 2021). Our findings align with these studies, particularly in highlighting the emotional challenges faced by older adults. However, our study adds to the literature by adding details that illustrate how case 1 coped to these challenges through using technology to maintain connection and case 2 continued engaging outdoor physical activities such as walking alone and doing shopping early to avoid the crowd.

Some studies suggest that while some people were able to maintain a sense of routine and stability, others struggled significantly, leading to a decline in their mental health and overall quality of life (Lebrasseur et al., 2021; Robbins et al., 2022). This is similar with our case 3 who found difficulties in adjusting to the changes. Studies also found that physical activity, social connections and using technology played crucial roles in maintaining older adults’ well-being during the pandemic (Fristedt et al., 2022). Our study supports these findings and further emphasizes the importance of physical activities and social interactions in mitigating the negative impacts of the pandemic on mental health. By focusing on individual cases, we provide a understanding of how these factors contributed to resilience and adaptation in different contexts.

Conclusion

This study highlights the significant impact of the COVID-19 pandemic on older adults’ daily routines and emotional well-being. The findings underscore the resilience and adaptability of this population, as well as the need for targeted interventions to support their mental and physical health during crises. Promoting digital literacy, facilitating safe outdoor activities, and providing accessible mental health resources are essential strategies to mitigate the negative impacts of social isolation and routine disruption. Future research should further explore these areas, focusing on long-term effects and strategies to enhance resilience among older adults in future crises.

Contribution

This study contributes to the field of gerontology and geriatrics research by illustrating how older adults demonstrate resilience through adaptive strategies. The findings support the socioemotional selectivity theory, emphasizing the significance of emotionally meaningful activities and social connections during crises (Carstensen, 1992). Additionally, the participants’ coping strategies are in line with resilience theory, particularly in their ability to maintain psychological well-being despite adversity (Windle, 2011). These theoretical contributions highlight the importance of considering individual differences in resilience and coping strategies, which have implications for designing interventions to support older adults during future public health crises.

Practical Implications

Based on our findings, we recommend several strategies to support older adults during crises. Encouraging safe outdoor activities can enhance both physical and mental well-being, while facilitating virtual and in-person social interactions can help reduce feelings of isolation. Providing accessible mental health resources, including therapy and counseling, is crucial. Supporting older adults in establishing and maintaining daily routines can offer much-needed structure and stability. Additionally, offering training and resources to help older adults use technology for social connections and essential services is vital in ensuring their continued engagement and support.

Research Limitations and Future Developments

The small sample size is inherent to the case study methodology, which allows for an in-depth exploration of individual experiences. Additionally, the COVID-19 pandemic created unique recruitment challenges that limited participant availability. Despite this limitation, the study provides valuable insights into the diverse coping strategies employed by older adults. Future research could benefit from larger, more diverse samples to explore the broader impacts of the pandemic on older adults. Longitudinal studies could also provide insights into how older adults’ coping strategies and well-being evolve. Further research could investigate the role of technology in supporting older adults during crises and explore interventions that promote social connections and routine maintenance.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Approval

This study was approved by Hofstra IRB #20230324-OT-HPHS-PIN-2

ORCID iDs

Yu-Pin Hsu

Margaret Walters

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