Under Reconstruction: The Impact of COVID-19 Policies on the Lives and Support Networks of Older People Living Alone

Abstract

The Austrian government introduced in spring 2020 COVID-19 containment policies that had various impacts on older people living alone (OPLA) and their care arrangements. Seven qualitative telephone interviews with OPLA were conducted to explore how they were affected by these policies. The findings show that the management of everyday life and support was challenging for OPLA even though they did not perceive the pandemic as a threat. To better address the needs of OPLA, it would be important to actively negotiate single measures in the area of conflict between protection, safety and assurance of autonomy.

1. Introduction

In spring 2020, governments around the world implemented measures to deal with the COVID-19 pandemic. One of the main goals was to protect so-called ‘high-risk groups’ from being infected with the virus. Because of the higher risk of older people developing serious illness and dying, strategies strongly focussed on them in this period of the pandemic (Mueller et al, 2020).

However, the ambiguity of COVID-19 measures reinforced entrenched ageism, including age-related discrimination and stigmatisation of older people (United Nations, 2020). Discussions on rationing care and triage in response to bed shortages in intensive care units ran the risk of open ageism as such discussions positioned older people as being more expendable than those in other age groups (Ayalon et al, 2021). In this regard, the need to uphold older people’s human rights has been emphasised in recent debate (McGrath, 2020, Peisah et al, 2020). Furthermore, the stigma of being an old person was strengthened by the public misconception that COVID-19 mainly affects older people, with a widespread strict age limit of 65 (Ayalon et al, 2021). This led to a narrative focussed on vulnerability which incorrectly portrayed old age as the primary indicator of risk, although other factors played a more important role (Fraser et al, 2020, Swift and Chasteen, 2021). Devaluing older people could contribute to feelings of worthlessness or to a sense of being a burden (Brooke and Jackson, 2020). Moreover, the risk of social exclusion of older people was increased by policies restricting mobility and physical contact, such as curfews, quarantine and lockdown, especially when they remained in place over a long period of time. While COVID-19 containment measures still seem to be crucial to ensure everybody’s safety, the realities faced by older people cannot be ignored (United Nations, 2020). Although older people have received unprecedented public attention, it seems that the realities and perspectives of older people were not and are still not sufficiently reflected in policymaking. This is especially true for the life circumstances of older people living alone.

In Austria, as in many other countries, the number of older people living alone has increased in recent years. About half of all households of the over 65s are single households, rising to two thirds in the over 85s (Statistik Austria, 2020). This phenomenon affects women more than men, especially because women reach old age more often. The increasing number of older people living alone is a phenomenon linked to changing life patterns in society: People live less frequently in long-term marriages and remain childless more often. Furthermore, smaller family networks due to declining birth rates and greater geographical mobility influence the housing situation in old age in favour of single households (Reher and Requena, 2018). It is evident that older people living alone are at higher risk of institutionalisation if their care needs increase (Pimouguet et al, 2016). In an ethnographic study that covered a heatwave in Chicago and aimed to examine the phenomenon of everyday urban isolation, Klinenberg (2001) found that older people living alone were particularly vulnerable in acute crises. However, it is important to acknowledge that living alone in old age does not automatically mean being affected by loneliness or social isolation. Research on living alone, loneliness and social isolation suggest that it is imperative to distinguish between these concepts (cf. Cloutier-Fisher et al, 2011, Klinenberg, 2001, Smith and Victor, 2019). Smith and Victor (2019) showed that both loneliness and social isolation can be conceptualised in various ways. However, these definitions of loneliness share the view that it can be understood as a subjective feeling that arises because of a lack of meaningful relationships. Social isolation, in contrast, is understood as an objective state of being alone or as a lack of integration within social networks (Smith and Victor, 2019). In the context of the pandemic, the restrictive measures led to social isolation.

As living alone implies that every single personal social contact is with a person outside the household, older people living alone were particularly affected by measures that not only aimed to reduce social contact in general but also specified how many other households individuals were permitted to interact with. For people living alone with care needs, this situation was particularly challenging as support beyond formal care services is necessary to enable them to live independently in their own homes (Gomes et al, 2013). If older people living alone do not have family nearby, they often rely on so-called ‘non-kin carers’ such as friends, acquaintances and neighbours to cover care needs (Pleschberger and Wosko, 2017). As non-kin carers do not live in the same household, these care arrangements might have been particularly challenged by the requirements of ‘social’ and ‘physical distancing’ as key measures to contain the COVID-19 pandemic.

The research project ‘Older people living alone – non-kin carers’ support towards the end of life (OPLA study)’, a qualitative longitudinal study, sheds light on non-kin care in the context of older people living alone (Pleschberger et al, 2019). In response to the COVID-19 pandemic, a series of additional interviews (OPLA sub-study) was conducted to explore questions such as how older people living alone were affected by COVID-19 containment measures and how their support networks evolved through these policies. This paper presents the findings of the sub-study.

1.1. Measures to contain the COVID-19 pandemic in Austria

We summarise the policies implemented by the Austrian government that particularly affected individuals’ private lives between March and August 2020, which is the period in which the study took place. Like many other European countries, the Austrian government reacted to the pandemic in spring 2020 with a lockdown. The measures were rather strict as there were supply shortages for protective equipment, especially at the beginning. All non-essential shops, restaurants and bars as well as state-owned parks and gardens were closed. Contact restrictions and a curfew based on a new COVID-19 law came into force, bringing public life largely to a standstill. Entering public places was allowed for the following reasons: (1) in case of imminent danger, (2) to care for persons in need of support, (3) to meet basic needs and (4) for professional purposes (BMSGPK, 2020). For meetings in public spaces with other people who did not live in the same household, a distance of one meter was specified, and the same suggestion was made for private homes. At the end of March masks became compulsory in shops, and at the beginning of April, masks became mandatory on public transport. Because of the low number of infections, the government began to ease the lockdown at the end of April, initiating a period of rather loose restrictions which lasted until late summer. Hairdressers and other close-contact services reopened and it was again possible to attend church while adhering to safety standards, such as physical distancing and face masks.

2. Method

The sub-study is part of the OPLA study, a qualitative longitudinal study on support provided by non-kin carers. For additional information see fig.1. Because of the substudy’s exploratory character, a qualitative design was the best approach.

Figure 1.

Design and aims of the study ‘Older people living alone – non-kin carers’ support towards the end of life’ (Pleschberger et al 2019)

2.1. Participants

The sample for the sub-study was drawn from the eleven people who had completed the third wave of the longitudinal study. One person had died, ten were contacted and seven agreed to participate. Table 1 provides information on some basic sample characteristics.

Table 1. Basic characteristics of participants.

Characteristics	n = 7
Age	Ø 85 years (79-94)
Gender
men	1
women	6
Region
urban	6
rural (non-isolated)	1
Care needs (level 1-7) Levels following the Austrian Care Allowances Scheme (’Pflegestufen’)
none	2
level 2    more than 95h of care/month	3
level 3    more than 120h of care/month	2
other levels (1, 4-7)	0

Six women and one man participated in the interviews. They were between 79 and 94 years old (mean age 85 years). All participants were white and German native speakers. At the time of the interview, six participants were living in a single household. One participant had moved into a retirement home shortly before the interview took place but had still lived at home during the period of interest for the study (the first lockdown in spring 2020). Their socio-economic status was not recorded systematically although in the course of the qualitative interviews for the OPLA study we aimed to gain insights into their financial situation. It turned out that the income of all participants corresponded more or less to the mean annual net income of pensioners in Austria (€20.624 p.a., cf. Statistik Austria, 2020). None of the participants had any family nearby. Two had children but they lived at least 200km away. All of them received some kind of support from at least one person, here named a ‘non-kin carer’. The non-kin care arrangements consisted of neighbours, friends and various club or church members. Non-kin support included social monitoring (e.g. daily phone calls, checking in on each other), accompanying the participants to appointments, shopping, cooking, doing finances and housework.

Differences regarding their care needs had been identified according to the 7 levels of the Austrian Care Allowances Scheme (’Pflegestufen’), with level 7 indicating the maximum amount of care needs (BMSGPK, 2021). The participants’ care needs, as shown in table 1, were rather light or moderate. The Austrian long-term care system is a needs-oriented cash-for-care scheme which is not related to income (Riedel and Kraus, 2010). An individual’s care needs are based on their need for assistance as determined by representatives of health care professions (e.g. doctors, nurses, etc.). After their care needs have been assessed, individuals are entitled to a care allowance, which they can use to pay for care services or to compensate informal caregivers (Riedel and Kraus, 2010). Support through formal care services was part of the care arrangements in four of the five cases in which the participants were eligible for a care allowance (at levels 2 and 3). Utilization varied from daily to twice a week.

2.2. Data collection

Qualitative interviews were conducted by phone in July and August 2020. In an initial phone call, information was provided on the study and consent obtained for an interview. Some participants wanted to do the interview during that first call; the other interviews were arranged for a few days later. The length of interviews varied between 10 and 60 minutes. They were audiotaped and transcribed verbatim. The interview guide included open questions on the following topics: experiences during the spring lockdown, maintaining social networks and relationships in times of ‘social distancing’ and perceptions of the future with regard to a second wave of the pandemic. Information on formal and informal support networks had been extracted from previous interviews within the OPLA study and served as the basis for the interview guide.

2.3. Data analysis

Data analysis was performed using a qualitative approach based on the framework method (Gale et al, 2013). This includes coding the data in a line-by-line analysis focussing on inherent meanings and the presentation of themes (Schreier, 2013). These procedures help organise the data within a provisional framework suggested by an analysis of the literature. Additional topics which arose in the coding procedure were discussed thoroughly by the research team and either related to the framework or added to the framework structure so that in the end the results were organised according to six thematic issues: (1) attitudes towards the pandemic in general, (2) dealing with COVID-19 containment measures, (3) the influence of the pandemic on everyday routines, (4) the impact of the pandemic on social networks, in particular on support arrangements, (5) negotiating autonomy and (6) attitudes towards the general public. The analysis was carried out using MAXQDA software as a means of managing the data.

2.4. Ethical approval

Ethical approval to conduct the OPLA study was granted by the Ethics Committee of the Province of Lower Austria in 2018 and extended on an annual basis. It was last renewed in summer 2020, including information on the sub-study related to the COVID-19 pandemic. Written informed consent was sought from all participants at the time of the baseline interview in the main study (OPLA study) and updated orally before each interview.

3. Findings

The findings are presented based on the main areas of interest and themes that unfolded during the analysis, more specifically: (1) attitudes towards the pandemic situation and its threats, (2) dealing with hygiene measures, (3) managing everyday life and support, (4) shifts in support networks, (5) negotiating autonomy and (6) older people and the general public.

3.1. Attitudes towards the pandemic situation and its threats

The participants did not appear to be burdened by or stressed about the overall situation and were unperturbed by the restriction measures. The key tenor of the interviews was that they had already experienced so much in the course of their lives, as illustrated in the following quote:

’Well, honestly, at my age, we’ve had all kinds of things, er… happening. So this is not… the first time that something has happened.’ (woman, 84)

The data indicate that the participants have already lived through some crises, such as growing up in times of war or after the Second World War. Thus, they were able to draw on a wealth of experience to successfully overcome crises.

As a key pattern in the data, participants did not claim that loneliness was an issue. Instead, implicit concerns were identified, which tended to be expressed as insecurities and ambivalences regarding the pandemic and the containment measures, as shown in the following quote:

’Well, what went through my mind? That it’s, er, it’s really the right, necessary measures. (…) It did annoy me (laughs), but then I said to myself, it’s better this way, because maybe we can prevent it and contribute a little bit. To nothing happening.’ (woman, 83)

Concerns like these were commonplace but may have been exacerbated by the uncertain situation, which was also reflected in ambivalent and contradictory media coverage. It is likely that the possibilities of buffering and mitigating these concerns were constrained as conversations and exchanges of views with other people tended to be limited. “Everyday encounters” like polite conversations with the cleaner at home, small talk at church events or at the bank and chatting with the taxi driver on the way to a doctor’s appointment usually take place incidentally and are part of everyday routines. Due to the restrictions, encounters like these were generally lost. Participants did not refer to this absence and its consequences directly or on an emotional level. Instead this loss appeared as an issue in some narratives, suggesting that such everyday encounters were of substantial relevance for a basic feeling of social participation. Even if these are rather loose contacts, they seemed to contribute to the well-being of older people living alone and as such contributed to limiting aspects of social isolation.

An interesting phenomenon found in the data was that some participants raised the issue of the way people were treated in nursing homes. In terms of policies, the need was emphasised for an improved balance between protective measures, such as social isolation, and social connections. For example, one participant stated:

’It wasn’t okay how they actually locked old people away in some nursing homes, don’t you think? That was hard. Maybe a lot of them died because they were aggrieved.’ (woman, 80)

The participant’s closeness and solidarity with ‘old people’ who had been locked away in some care homes, as presented in this quote, is touching as she had recently moved into a nursing home herself. However, by referring to ‘old people’ generally, she seems to imply a certain distance from this group, probably indicating the difficult process of her own transition. The relevance of social contacts is particularly emphasised by associating social isolation with aggravated by mortification in this quote. By limiting her observation to ‘some nursing homes’, there is further room for hope that she might not face this fate. As we discovered in our research, older people living alone claimed greater autonomy for themselves than people living in nursing homes. In the light of this and as illustrated by the quote above, we found that the COVID-19 pandemic might have reinforced fears of entering institutional care as people in long-term care homes were the most isolated due to the high risk.

3.2. Dealing with restrictions and hygiene measures

Coronavirus containment measures were generally well accepted by the participants, who stated that they were aware of the risk of spread and that it was important for them to comply with the measures. Some participants explained their compliance on a rational level, for example, an 83-year-old woman who often spoke of her own ‘expiry date’. It seemed to be characteristic for her to thoroughly weigh up the risks in dangerous situations:

’I am not reckless in that I put myself in danger when I can see it. I wouldn’t do that. I don’t climb a mountain when I know I’m not sure footed.’ (woman, 83)

The behaviour of the other participants could be interpreted as being compliant with social norms as well in that they all referred to themselves as ‘well behaved’ in terms of the recommended measures. For example, in the context of good behaviour, an 87-year-old woman explained that she wore a mask even though she had trouble breathing and even though she felt that people on the street looked at her strangely because early in the outbreak, wearing a mask was not common in Austria.

In general, the attitudes expressed towards the mandatory use of face masks were rather positive, even if wearing them was not always comfortable, as some participants noted. They claimed that they adhered strictly to the guidelines in this regard. However, the degree of strictness varied, as it presumably does in all social groups: Some of the participants said that they wear one whenever they were in contact with other people regardless of the place; others reported that they wore one outside their homes but not at home when they had visitors or had a mask on but did not cover up their noses.

Older people living alone were particularly affected by the measures concerning everyday encounters, as for this group any social contact was with a person not living in the same household. While professional carers and most of the non-kin carers wore face masks in the presence of the participants, some people in the participants’ networks did not, even when asked to do so. Experiences like these tended to be stressful for the older people living alone, as illustrated by the following quote about the daughter of one of the participants:

’My daughter came on my birthday, for example. Without a mask, without… She says that’s just… she said that the politicians were making too big a deal out of it. Um, well, she didn’t really take the pandemic seriously.’ (woman, 80)

This participant went on to stress the importance of wearing masks quite extensively and stated that she herself always wore one when meeting other people. Nevertheless, the excitement of her daughter’s visit prevailed and she stopped insisting on the mask; the situation, thus, remained unresolved. Others also talked about unsuccessful attempts to force others to wear masks in their homes. Thus, compliance with measures relating to everyday encounters always remained a matter of negotiation, and a potential source of conflict. These conflicts might cause feelings of powerlessness and dependency.

Due to their particular circumstances of living alone, the restrictive measures which required staying at home did not represent a fundamental change in the perception of most of the participants, as illustrated by the following quote:

’Since I’m always alone anyway, it didn’t make any difference to me at all.’ (man, 94)

Some of them already had a rather limited range of mobility before the pandemic for health-related reasons. Even among those who led a more active life, the mood was one of calmness and confidence; For example, when asked about the first thing that went through her mind at the outbreak of the pandemic, one woman replied:

’Well, I thought to myself: “Well, I’ll just have to stay at home".’ (woman, 84)

The fact that these participants reported that they had become active again immediately after the measures were loosened suggests that their composure regarding the pandemic was fostered by the awareness that many of the restrictions were only temporary. Alternatively, this can be interpreted as "conforming to social norms", i.e. adhering to the measures only for as long as they were prescribed by law.

Like for most groups in society during the pandemic, small incidents tended to turn into catastrophes, and ‘staying at home’ might be difficult if ‘home’ was an unpleasant place. For example, one participant suffered from a plague of ants at home during the lockdown followed by construction work because the exterminator could not get rid of them. For the participant, being at home with ‘her’ ants was more terrifying than the threat of the coronavirus:

’Because of them… my ants. That was, that surpassed the, the, the virus by far, by far. It was terrible. I was sitting there, they crawled all over me, they were so… they nipped, you can’t say more.’ (woman, 87)

In addition, she was worried that she may have been scammed about the cost of the ant removal procedures. Sharing similar experiences, such as knowledge about costs or recommendations for craftsmen, with other people could have alleviated her concerns. A sense of powerlessness characterised her situation, just like a number of further challenges older people living alone faced in that time.

3.3. Managing everyday life and support

During the lockdown, the participants had to adapt their daily routines, reorganising activities of daily living such as grocery shopping and housework. Consequently, even those participants who normally went shopping themselves had to organise someone else to do it for them so that they could stay at home. Some of the participants had private cleaners who were not allowed to come because of the restrictions. When the participants could not do household chores themselves due to health-related issues it became necessary to organise a replacement.

It was not only activities of daily living that required adjustments but also activities in the sense of meaningful pursuits, such as practising faith or pastimes. Some of these adjustments were temporary, while others were permanent, as illustrated in the following example of two women for whom practising faith was very important. Since churches were closed during the lockdown, they sought new ways to attend worship. They were confident about using these new opportunities and streamed the weekly services online. After the measures were eased, one participant was able to attend the services in person again. For the other one, attending church was too high a risk, showing that for some, the transition to digital services was to be used for good:

’I will never be able to go [to church] again. It’s over. Because the risk of infection is just too high. It’s such a big congregation, there are always 300, 350, 400 people.’ (woman, 79)

The example suggests that for many older persons it would be not possible to return to their old routines due to the progression of disease, or functional and other impairments like frailty.

In terms of maintaining relationships, we observed from the data that physical distancing necessitated some adaptions. Most participants reported that during the lockdown, they had less to no physical contact with others such as visits or other joint leisure activities with friends or neighbours beyond what was necessary. With few exceptions, the participants’ social environment responded rather cautiously to the pandemic because they belonged to a high-risk group themselves or because they wanted to protect the people they cared for, as one lady emphasised:

’The neighbour, she’s younger, she didn’t come in, she often put something in front of my door, she was very careful, you know.’ (woman, 93)

During the lockdown, relationships were mainly maintained by phone; in some cases even using a computer and applications like Skype. However, staying in touch via new information and communication technology (ICT) was rather limited because this type of communication had not yet become common in the participants’ networks. Those participants who had had an active social life before the pandemic claimed that they talked more on the phone than before. Telephone contacts were an effective way of preventing loneliness, as one participant stated:

’Well, I mean, you stay in contact by phone and, and… if it wasn’t for that, it might be lonelier. If you can’t or don’t want to go out, or… somehow… Then you would be lonely. If there was no telephone or something like that.’ (woman, 84)

It is interesting to note that even if physical contact with others decreased, all participants had at least one person they could rely on. This contact was mostly embedded in a standard storyline: ‘If I needed something, they would be there.’ For example, when talking about members of her church community, one participant said:

’If there’s anything, right away: How is she, what’s going on there, can we help?” Or something like that. We are actually a small… a small, close-knit community.’ (woman, 83)

"Being able to rely on someone" is an important precondition for living alone in old age. Participants were able to maintain these types of non-kin relationships during the pandemic, even though many of these arrangements were at a distance and by phone. In addition, the feeling that someone was there in an emergency can help in creating a sense of security.

3.4. Shifts in support networks

As mentioned above, the participants had been interviewed earlier as part of the longitudinal main study. Thus, there is a deeper insight into pre-existing network structures and support arrangements. Informal networks include neighbours and friends as well as members of the church or seniors’ organisations.

At first glance, there seemed to be no changes in the networks. On deeper reflection, shifts in the networks became visible. Regarding informal support, some of the network members gained in importance while others tended to fade into the background. These shifts seemed crucial to keep support structures in balance but also required the renegotiation of support arrangements between participants and their carers. Some of the shifts were triggered by the restrictive measures. For example, one participant had been in active contact with her neighbours before the pandemic. While most neighbours withdrew during the lockdown, there was one who supported her in activities that required physical proximity:

’Well, I had the feeling that they [the neighbours] backed off more. Except for one, one even came when I needed something doing, let’s say, taking off my stockings, where you have closer contact.’ (woman, 80)

Not all of the shifts that happened were based on the active decisions of the older people living alone. One example shows that the autonomy and self-determination of older people living alone with regular care needs was threatened by effects of the pandemic that did not concern them directly. A 79-year-old woman who received daily care from home-care services was affected by a major shift in her network caused by their needing to reallocate their resources for an unknown reason. The neighbour was called by the agency and asked to take over her care. This happened without the prior agreement of the participant. She complained and started negotiations with the agency in order to have help with her weekly shower at least, and she agreed to regular informal support from her neighbour. Successful negotiations with the home-care services gave her back a feeling of control over her situation. Her relationship with the neighbour had a major influence as the latter even went into isolation during the lockdown, with not even her grandchildren being allowed to visit, in order to protect the 79-year-old woman from the virus. In earlier interviews the old woman explained that she had wanted to be less reliant on her neighbour, so that some ambivalence might have characterised this period of time for both women, as indicated in the quote below:

’The neighbour who took care of me cut herself off from her surroundings. She didn’t go… she didn’t leave the house. She was only there for me. (…) I also said that that was admirable. (…) She was really there just for me. For five whole weeks. Just imagine!’ (woman, 79)

The example in the paragraph above suggests that shifts in the support network of older people living alone are strongly linked to issues of autonomy.

None of the other participants who used professional care services reported changes in frequency like reduced visits. Apart from this, changes in care procedures were reported, such as enforced hygiene measures and physical distancing whenever possible.

3.5. Negotiating autonomy

Autonomy proved to be a key issue for this group of people, particularly with regard to complying with public health measures during the pandemic. This change was particularly noticeable in the case of shopping. To be able to stay at home and not to come into contact with other people during the lockdown, shopping was mainly done by neighbours or professional carers. These arrangements were usually organised in a way that the neighbour who went shopping placed the shopping bags in front of the door without the participant being present. Such reductions in autonomy were apparently not an issue during the lockdown. However, as soon as measures were eased, the participants reclaimed their autonomy.

Not all participants were willing to compromise on their self-determination. For example, one participant kept on going shopping on his own, even during the strict lockdown. He refused support that was offered by people he did not know from the neighbourhood, justifying his behaviour by explaining his desire to choose his own food. This is just another example which illustrates the importance of autonomy for older people living alone at home even when they have care needs.

3.6. Older people living alone and the general public

Even though the participants largely adhered to the recommended measures, they had no control over how other people acted in this respect. In the perception of some of the participants, most members of the general public did not comply with the measures once the strict lockdown was over. They therefore believed that another wave of the pandemic was inevitable. In some cases, a kind of aggression was noticeable, especially against the younger generation as the following quotes illustrate:

’In the village, the young people, they’re hanging out… Well, my goodness, that really upsets me.’ (woman, 79)

’When the idiots have parties all the same, like complete idiots, you see, young people then spread it [the virus]. They are not used to foregoing anything. (…) And it’ll get even worse because they… Nobody is sticking to the rules anymore, are they? Not at all.’ (woman, 87)

These reactions are another indicator of a feeling of powerlessness or dependency on others. Alternatively, they indicate reactions to an exacerbated intergenerational conflict. This conflict may have been fuelled by the fact that older people had become the focus of media coverage. This aggression can be interpreted as a coping strategy against undesirable public attention.

4. Discussion

The aim of this sub-study was to explore the experiences of older people living alone during the pandemic and how their lives were affected by COVID-19 containment measures. We also investigated how their support networks evolved due to these policies. As it turned out, the participants were not that stressed about the pandemic situation, but implicit concerns became visible. Overall, the participants accepted and adhered to the measures, particularly in relation to staying at home and wearing a mask. Shifts in their networks became visible across the participants’ narratives. Most of these shifts seem to have been necessary to keep their support structures in place. In addition, a rather negative attitude towards the general public became apparent.

Being aware that quite a few themes have unfolded in our exploration of the experiences of older people living alone during the COVID-19 pandemic, we would like to focus on three aspects in our discussion. These aspects seem to be of special interest in order to establish a coherent argument towards general issues of caring for older people living alone and lead us to potential policy implications of the findings.

The first aspect concerns the agency and resilience of older people living alone during the COVID-19 pandemic with regard to their support network. Although older people seemed to be more vulnerable, they were more likely to have developed resilience through prior biographical disruption or historical events. Lind et al (2021) explored three strengths of older people during crises: (1) a tendency towards life reflection, (2) the adaptive use of personal memory and (3) a temporal focus encouraging generativity. Based on the life story approach, the authors showed how these concepts might be applied when dealing with the challenges of the pandemic. A picture emerged of older people having the potential to demonstrate considerable psychosocial strength despite the adversities of the pandemic (Lind et al, 2021). In our interviews, we found evidence to support these assumptions about the potential strength of older people living alone to cope with the situation. Especially regarding the pandemic in general but also with regard to the restriction measures, the participants did not appear to be overly burdened. Some explained their calmness by pointing to challenging past experiences, so this can be understood as a cohort effect of the oldest old. This strength can also be seen as an argument in favour of the agency of older people organising their care network during the crisis.

The participants’ networks mostly appeared to be stable, so it seems that the pandemic became part of normal processes of negotiation within those networks. Changes concerned formal care as well as informal care giving. Sometimes the negotiation processes were asymmetrical and induced by the COVID 19-measures, as some of our examples showed. In this context, the mask could serve as a symbol for disregarding boundaries within the participants’ own homes as well as for dependence on others. Dependence on others, whether in connection with a positive event like a family member visiting or because help was required, could reduce older people’s autonomy. However, independence does not necessarily mean being without any support but being able to maintain autonomy with support (Allen and Wiles, 2014). This involves redefining situations and what is understood by normality, making compromises and maintaining a positive attitude towards receiving support. Independence also means maintaining control over one’s situation (Caswell and O’Connor, 2017). In this context, it is important that things that can be done by the individual are not taken out of their hands (Isherwood et al, 2017). Older people want to decide for themselves whether and how much assistance is needed (Allen and Wiles, 2014). Uninvited support that goes beyond the basics can be perceived as paternalistic and as a threat to one’s autonomy.

The examples presented in this paper show the importance of a relational understanding of autonomy in care relationships, which feminist scholars in particular have described (Mackenzie and Stoljar, 2000, Veltman and Piper, 2014), an issue which has also been covered in care ethics discourse (Gómez-Vírseda et al, 2019). Limitations, dependency and the need for help do not make autonomy superfluous, as a static form of autonomy would suggest. Like other feminists, Fox Keller (1995) shows how the culture of the global north mistakenly associates the image of an autonomous person with segregation and independence from others. From a psychological and feminist perspective, she argues that autonomy should be understood as a dynamic process in the field of tension between relationships with and separation from other people. To realize relational autonomy in practical care relationships, Gómez-Vírseda et al (2019) state the need for dialogical developments in decision making, especially in end-of-life situations. Enabling and promoting autonomy should be a collaborative endeavour and should combine the patients’ views with those of their professional and informal caregivers. This balance of formal and informal support and changes in the care network characterizes some of the challenges that COVID-19 has imposed and is still imposing on the lives of those older people living alone. As our findings show, the tensions and contradictions between keeping distance and the need for social and other support caused conflicts. Because of being dependent on these care relations some of the actual needs of the older people living alone are neglected. The second aspect is connected with the “loose contacts” that seem to be so important in the everyday lives of older people living alone but that were restricted during the pandemic. With regard to the significance of everyday encounters, reference could be made to Hannah Arendt’s pointer that the Latin verb ‘to be among people’ was also used with the meaning of ‘to live’ and the verb ‘to cease to be among people’ also meant ‘to die’ (Arendt, 1998 [1958]: 7f). Everyday encounters might represent the more passive act of ‘being among people’. Because of the pandemic, these encounters had been reduced significantly. Stewart et al (2015) conceptualised encounters similar to those described above as ‘civic socialising’, which can be understood as follows: ‘Older people’s interactions in their local neighbourhood shops embody authentication of themselves as individuals and as community members, and their co-construction and co-preservation of the milieu of their local neighbourhood shopping precinct with a view to sustaining their ongoing autonomy’ (Stewart et al, 2015: 750). Thus, everyday encounters could be an important aspect of maintaining identity, membership and civic participation. For older people living alone, especially for those with reduced mobility, civic socialising might not only involve encounters that happen outside the household but also those that take place in their homes, such as with the cleaner. This type of contact is difficult to capture as it might not seem obvious or important in the sense of emotional connectedness. Nevertheless, it could play an important role in mitigating social isolation. Future research might focus on these types of contacts and investigate the extent to which loss of everyday encounters is linked with social isolation and the subjective feeling of loneliness, especially when pandemic measures are maintained over a long period of time as the absence of these contacts might only become apparent after the passage of time.

Research on the impact of COVID-19 restriction measures on loneliness among older adults during the first lockdown in Austria showed an increased level of loneliness, but these effects seemed to be temporary, that is only for the duration of the lockdown (Stolz et al, 2020). There was no evidence of increased loneliness in our data. Nevertheless, there was implicit evidence that social isolation did affect older people living alone. This was mainly expressed in terms of uncertainties, and sometimes increased worries. The negative effects of everyday issues could also be an indication that the lack of interaction with others and thus the possibility of alleviating everyday worries exacerbate social isolation in older people living alone. These interpretations highlight the significance of loose contacts and raise the question as to whether some of those loose contacts could also play an important role for care giving. They offer social participation and at the same time empower self-determination (for detailed argumentation see Rummery and Fine 2012, p 329ff)

In this context, it is important to take a critical look at the digitalisation of communication as ICT is widely promoted as a solution to help maintain relationships. However, maintaining close ties always involves considerable effort, which everyday encounters do not demand. ICT cannot replace the latter as the use of such technology even requires proactivity to ‘encounter’ others as it cannot simply happen on an incidental basis. As some recent research has already suggested, younger generations are affected more than older generations by pandemic-related stress, social isolation and general life changes (Birditt et al, 2020). Among older people, being reliant on the phone for contacts was associated with higher levels of negative effects, specifically loneliness, for those living alone compared to people who lived with others (Fingerman et al, 2020). These findings are not evident in our study. Participants reported either positive experiences or no change in patterns regarding phone contacts. However, as we have shown, ICT could help with less obvious issues during the crisis, such as practising one’s faith (i.e. when church services were streamed online).

The third aspect that requires a closer look is the positionality of older people in society. In terms of the participants’ rather aggressive attitudes towards the general public-and especially towards young people-we raised the question as to whether othering in this context is an expression of powerlessness and loss of control or whether those attitudes are a sign of intergenerational conflict intensified by public discourse – and thus a reaction to the process of othering in the ageist discourse that emerged during the pandemic. Othering can be understood as a process of treating individuals or groups as different and subordinate to the dominant social group (Griffin, 2017). The interdisciplinary concept of othering has mainly been used in relation to analyses of racist and sexist discourses but is slowly being considered in age-related discourse as well (Søraa et al, 2020). Søraa et al (2020) emphasise that is important to raise awareness of ageist bias during the pandemic in order to implement measures that make societies more equitable, responsible and inclusive. The extent to which ageist discourses and negative stereotypes of old age affect younger generations and, thus, society as a whole should be taken seriously. The division between old and young with the consequence of ageism, but also between different social groups and gender, and the increased crises in care are effects of the COVID-19 pandemic that require taking the societal implications of the findings into consideration.

Following the idea of a “caring democracy” (Tronto, 2013), it seems to be obvious that care in a broad sense is the most important concern of today’s societies. Tronto emphasises that caring should be the highest value in political decision making and should shape the life of every human being. This follows the insight that care is at the centre of (human) lives. This simple but radical change of perspective helps to create a more inclusive society. For the situation of older people living alone during the COVID-19 pandemic, this affects the aspects of social inclusion as well as a more general attitude towards care giving, also in daily encounters. On a societal level this would go along with higher investments in the formal provision of care as well as adequate and qualified staffing of formal support but also the empowerment of informal care networks especially with the focus on non-kin care.

5. Conclusion

Our study provides insights into the lives of older people living alone during the pandemic and the ways they maintained and reorganised their everyday lives and support while facing the challenges of the pandemic. Even if not much changed on the surface, great flexibility and willingness to negotiate were required to maintain the structures necessary to preserve their autonomy and independence. In order to create a balance between protecting them and allowing them to maintain their autonomy, measures should be implemented that consider and encourage the support structures of older people living alone.

6. Limitations

Although the findings of this study are rich and diverse, it is not possible to generalise them due to the rather small sample. Likewise, an intersectional analysis with regard to class, ethnicity and old age was not possible. It is likely that with each extra factor of inequality, the negative impact of COVID-19 increases disproportionately (cf. D’Cruz and Banerjee, 2020). Another limitation might be the timing of the interviews. The pandemic worsened after the interviews were conducted, resulting in restrictions being put in place that lasted for a longer period of time. Major social events like Christmas and New Year were also affected by the containment measures. This might have had a much more significant impact on the lives of older people living alone and their support networks.