Nowhere to go – Effects on elderly's travel during Covid-19

Abstract

The COVID-19 pandemic has presented numerous, significant challenges for elderly in their daily life. In order to reach a deeper understanding of the feelings and thoughts of the elderly related to their possibilities to travel and engage in activities during the pandemic, this study takes a qualitative approach to exploring the views of the elderly themselves. The study focuses on experiences during the COVID-19 pandemic. A number of in-depth semi-structured interviews with elderly aged 70 and above, were conducted in June 2020. Applied Thematic Analysis (ATA) was applied, as a first stage, to investigate meaningful segments of data. In a second stage these identified segments were combined into a number of themes. This study reports the outcome of the ATA analysis. More specifically we report experiences, motivations and barriers for travel and activity participation, and discuss how these relate to the health and well-being of elderly, and vice versa. These findings highlight the strong need to develop a transport system that to a higher extent addresses the physical as well as the mental health of old people, with a particular focus on facilitating social interactions.

1. Introduction

In early 2020, the COVID-19 virus had spread from Asia to Europe and the United States, and was eventually declared a pandemic by the World Health organization in early March. This resulted in various restrictions in order to enforce social distancing in an attempt to slow down the spread of the virus throughout the world, including travel restrictions, closing of events, shops and restaurants, or even lockdowns of societies or entire countries (De Vos, 2020). In Sweden, a number of restrictions and recommendations were implemented during the spring and summer of 2020, and although these were less invasive than in many other countries (Ludvigsson, 2020) several restrictions specifically targeted the elderly (above the age of 70) making this group exposed to additional, and more prolonged, restrictions than other age groups, including isolation. Restrictions related to the elderly were first imposed in March 2020, when individuals above 70 of age were recommended to avoid all physical interaction with other people, alongside a ban of visits to municipal elderly nursing homes and the implementation of general travel restrictions. (Ludvigsson, 2020).

Although some of these above restrictions were aimed at the general public, the Swedish Strategy explicitly emphasized that the main purpose of the general restrictions was to protect higher risk groups, which (with some exceptions) meant the elderly above 70. Thus, in line with the Son et al. (2020) conclusion of the situation for elderly during the pandemic, Swedish elderly faced disproportionate negative effects, not only due to the greater risk of experiencing severe complications from a COVID-19 infection per se (which is likely to trigger higher levels of fear of the infection), but as they also faced more severe restrictions in terms of reductions in activities and opportunities for social interaction, and exhortations of staying at home. This is troublesome, as research has shown that the need for social interaction does not decrease when people age (Shrestha et al., 2017), and a lack of social relationships are a strong influence on mortality equivalent nearly to tobacco use (Holt-Lunstad et al., 2010). In May 2020, the Swedish Public Health Agency published a report on decreasing transmission of the disease in elderly care, which was the starting point for a public discourse on the risks of social isolation among the elderly above 70, which at the time constituted 14.5% of the population in Sweden (Ludvigsson, 2020). As such, the elderly population may have dispropriotionately suffered due to restrictions on travel that are not evident with general population studies.

Previous research has shown that social distancing or isolation is likely to reduce subjective well-being and physical health, and increase levels of stress and depression (Brooks et al., 2020, Yildirim et al., 2021). In particular, maintaining social interactions has proven important for well-being when the life-space is restricted (Kamalyan et al., 2020) and when mobility opportunities decreased due to COVID-19 (Liu et al., 2021b). Santini et al. (2020) applied longitudinal mediation pattern analyses among a large sample of elderly where they show that social disconnectedness predicts higher subsequent perceived isolation, and that this relates to higher depression and anxiety symptoms. They concluded that social networks are highly important among older adults in general (Santini et al., 2020). Armitage and Nellums (2020) furthermore argue that especially people who rely on the support of voluntary services or social care may be placed at additional risk for mental health issues during a pandemic such as COVID-19, due to social disconnectedness. In a study on life satisfaction during COVID-19 Waygood et al. (2021) found that satisfaction with social interactions as well as missing social trips were significant explanatory variables. The types of trips that people most reported missing could be classified as social trips such as visiting friends, going to restaurants, or going for coffee. Further, they reported that the majority of respondents stated that they missed physical contact with others and social interactions with friends, family, and colleagues. Brooks et al. (2020) review of 24 studies on quarantine in relation to disease outbreaks showed that a majority of the studies found negative psychological effects, that may also be long-lasting, which were triggered by a number of stressors associated with isolation (e.g. boredom, infection fears, and duration of the quarantine). In a recent publication on the psychology of COVID-19, Haslam (2020) points out that the social isolation and social exclusion associated with COVID-19 restrictions put the elderly in a position of particular risk of decreased health and well-being, specifically due to their inability to access daily activities and interact socially with other individuals. Our study addresses these predictions by exploring the experiences of the elderly themselves during the pandemic.

De Vos (2020) proposed various possible health consequences related to the social isolation and subsequent reduction in physical activity that is associated with the COVID-19 pandemic, including reduced well-being and physical health, weight gain, and a lack of positive emotions promoted by travel. The current COVID-19 pandemic has given rise to an enhanced interest in how to maintain physical activity and social interaction opportunities for elderly in order to promote health and well-being (Ammar et al., 2021, Bentlage et al., 2020, De Vos, 2020, Girdhar et al., 2020, Son et al., 2020) and provide accurate information in order to reduce anxiety and depression (Yildirim et al., 2021). A recent survey-based study of 15,097 elderly in Italy showed for instance that public transport and car-use act as enablers for accessibility to activities, and were linked to increased physical and psychological health and social inclusion, especially regarding the older elderly (Crotti et al., 2020). Thus, experiences from the pandemic can give input to a wider discussion about the meaning of everyday mobility in later life, the meaning of access to modes of transport, and the meaning of social interaction and well-being.

Although a number of studies have previously shown that participation in activities and social interaction is important for the health and well-being of elderly, and can be enhanced by possibilities for travel and actual travel by public transport, car, or by walking (Crotti et al., 2020, Lättman et al., 2019), the pandemic created a world that poses heavy restrictions in the possibilities to travel and engage in daily activities, particularly for the elderly, and of which actual consequences we know very little. While some research has been published reflecting on the possible effects of diverse restrictions on elderly’s mental and physical health during COVID-19 (e.g., De Vos, 2020, Haslam, 2020, Son et al., 2020), a Canadian report (Findlay et al., 2020) showed that elderly above age 65 reported the highest perceived mental health, with no measurable differences between a 2018 study and March 2020. However, little is still known of the actual experiences and feelings the elderly face during the pandemic, how they view their future opportunities for daily travel, activity participation, and social interactions, and how this affects, and is affected by, their health and well-being.

This study is unique in that it takes a deep look at how restrictions of mobility impact the elderly’s health and wellbeing. Previous research has examined the impact of limited travel on elderly, but not in a situation where all elderly were restricted, or only identified correlations between conditions and outcomes. Previous research (pre-pandemic) may have captured only individuals who had underlying differences that resulted in their limited capacity to travel in contrast to the situation during the pandemic. The sudden change in the ability to travel has made many indirect impacts of travel clear. However, a lack of in depth research through qualitative methods has left various questions on how exactly elderly have been impacted.

Thus, in order to reach a deeper understanding of the feelings and thoughts of the elderly related to their possibilities of, and barriers to, engaging in activities and interacting socially, and their sense of independence, health, and well-being, this study takes a qualitative approach to explore the views of the elderly themselves. By conducting a number of in-depth semi-structured interviews with elderly aged 70 and above during the outbreak of COVID-19 we aimed at exploring the elderly’s travel experiences and thus identify and understand underlying motivations or barriers for travel and activity participation, and how these relate to their health and well-being.

2. Material and methods

2.1. Design - Applied thematic analysis

Thematic analysis is one of the most commonly used methods of analysis in qualitative research, especially in studies with a focus on health and well-being, and may refer to a number of approaches based on an array of theoretical and epistemological assumptions (Braun and Clarke, 2006, Braun and Clarke, 2014). Applied thematic analysis (ATA) provides a practical framework for an inductive but still rigorous thematic analysis approach. Although the approach may incorporate positivistic angles (e.g. data reduction techniques) it is often viewed as more similar to phenomenology since the research focus often lies in understanding everyday experiences of individual’s lives by empirical investigations, generally in terms of in-depth interviews or focus group data. Thus the primary aim with the ATA approach is often to describe and understand feelings, thoughts and behaviour that are related to specific contexts or happenings (Guest et al., 2012), which makes it appropriate for the exploratory purpose of the present study (experiences of travel during COVID-19). In ATA the researcher investigates meaningful segments of the data which are combined into themes or codes in order to generate descriptive and exploratory models. The specific approach used for this study is described in detail in the analysis section (2.3).

2.2. Participants and procedure

Data from 14 semi structured in-depth interviews were collected over the telephone in June of 2020 among elderly between 70 and 96 years of age. The technique used was a form of snowball sampling. Initially, participants were invited through contact with a social club for older people and through elderly acquaintances (of one of the researchers) who were asked to invite their friends and relatives to participate in the study. The participants were, after their own interviews, asked to suggest friends or acquaintances that would be willing to participate in the study, of which some did. The date and time of the interviews were agreed upon beforehand, and the participation selection frame was elderly (above 70) living in relatively close proximity to reasonably well served public transport infrastructure in Sweden. The participants included lived in large, medium or small cities. Table 1 summarizes basic information about the participants.

Table 1.

Characteristics of respondents.

Respondent	Age	Gender	Living conditions	Interview time in minutes	City size*	Mode use (pre covid)	Mode use (covid)	Out of home activity level (pre covid)**	Out of home activity level (covid)
1	74	Female	Single	25	Small city	Train, Car (passenger), Walk	Car (passenger), Walk, Bike	Moderate	Low
2	74	Female	Single	50	Large city	Car, PT, Taxi	Car	Low	Low
3	72	Male	Partner	40	Large city	Walk, PT, Car	Walk, Car	High	High
4	71	Female	Partner	30	Large city	Walk, Car, PT	Car, Walk	High	High
5	77	Male	Single	25	Large city	Walk, PT, Car	Car, Walk	Moderate	Low
6	70	Male	Unknown	20	Medium city	Walk, Bike, PT, Car	Walk, Bike, Car	High	High
7	74	Male	Partner	30	Medium city	Bike, Walk, Car	Bike, Walk, Car	High	Moderate
8	96	Male	Single	20	Large city	Taxi, Special services	None	Low	Low
9	75	Female	Partner	40	Medium city	Bike, Walk, Car	Bike, Walk, Car	High	Low
10	84	Female	Single	25	Large city	Special services, Walk	Special services, Walk	Low	Low
11	79	Female	Partner	30	Small city	PT, Bike, Walk, Car	Bike, Walk, Car	Medium	Low
12	87	Male	Partner	25	Medium city	Car, PT	Car	Medium	Low
13	87	Female	Single	25	Small city	PT, Walk, Car (passenger)	Walk	Medium	Low
14	85	Female	Partner	40	Large city	Walk, Taxi	Walk	Low	Low

Notes:

*Large city = more than 250,000 inhabitants; Medium city = 100,000 – 250,000 inhabitants; Small city = less than 100,000 inhabitants.

**High activity level = daily or almost daily activities; Moderate activity level = several activities a week; Low activity level = a few or no activities a week.

Before the actual interviews started the participants were informed of the purpose of the study, that the interviews would be recorded and the procedures to help ensure confidentiality. The participants who agreed to participate gave their consent orally, which was also recorded. The questions included in the interviews were framed in order to be easy to understand, and the participants were asked about their daily travel behaviour and their experiences of different forms of everyday travel and accessibility before, during, and hypothetically also after COVID-19.

Since the questions were open-ended the participants could speak freely about their daily travel experiences including activities, socialization, and perceived enablers and barriers to daily travel. An example of the questions included in the interviews can be found in Table 2 . The interviewer tried to keep a time limit of approximately 30 min for each interview to avoid cognitive pressure (see Table 1 for a detailed account of actual time frames). All the interviews were conducted by the same research assistant, who also took notes on the procedure and decoded the transcribed material from personal information and possible identifiers.

Table 2.

Examples of interview questions.

If you compare last week to a normal week before Covid 19, have you changed your traveling in any way? If so, how?
How satisfied are you with your everyday travel now compared to how you traveled before Covid 19?
Did you have the opportunity to use different means of transport last week?
Would you like to travel in a different way? If yes, what is stopping you?
How easy or difficult was it for you to participate in everything you wanted last week?
Are you doing different things now during Covid 19 than before? If so, which ones?
On the whole, do you feel that you can live the life you want now during Covid 19 considering how you travel?
Do you have any other thoughts about your travels in everyday life?

2.3. Analysis

Each of the 14 interviews was recorded separately and transcribed verbatim. In order to identify the emergent themes, a thematic analysis was performed, supported by the Nvivo (12 Pro) software. The analytical approach largely followed the Applied Thematic Analysis model (ATA) as described by Guest, MacQueen, and Namey (2012) in terms of data segmentation, coding rounds (structural and content coding), and lastly the identification and refining of themes.

2.3.1. Analysis plan

Before starting the analysis, an analysis plan was made up which stated the research aim, what data to be used and how, the role(s) of the people analyzing the data (one researcher performed the analysis, and the result was discussed by the whole research team), and the primary analytical purpose (descriptive and exploratory for a deeper understanding of the elderly’s own views and experiences).

The coding process was included in the analysis plan. It included a number of coding rounds, starting with structural coding (including text segmentation into phrases or keywords and analysis of words), and then coding data for content (main analysis). The final themes and codes were allowed to be on different levels of meaning and interpretation (broad and narrow), and were related in a number of ways (i.e., hierarchically or complementary) following the recommendations by Guest et al. (2012).

2.3.2. Structural coding

The initial coding involved structural coding of phrases (sentences or sections of the text) and keywords for each of the interviews separately (i.e., segmenting the text). This phase also included taking notes on code definitions (specifying what is included, and not, in a specific code) and possible relations between codes – such as conceptual relationships. The coding was then revised a number of times, including merging or hierarchical restructuring of conceptually related codes when applicable. To aid these initial rounds of structural coding, a word frequency query was performed for all the included data (50 most frequent, set to synonyms) alongside a text search (for chosen keywords) in order to look for the contexts of the interviews in which a specific word was used, and a cluster analysis illustration which helped in identifying plausible relationships between words and possible code combinations. Thus, this step of initial coding was primarily used for identifying interesting segments of data and their plausible relationships for outlining the analysis, in line with the ATA procedure for an exploratory study (Guest et al., 2012).

2.3.3. Thematic analysis - coding for content.

A content coding round was then conducted. Content coding focus meaning and interpretation of phrases and segments of data rather than only structurally coding the data (i.e., the analysis for themes). This phase involved rereading and using all the phrases and segments previously identified and coded from the different interviews resulting in a preliminary round of theme identification. After that, the coding researcher went over the material again (interviews, memos, themes, and theme relationships) and through this interactive process of understanding the data, the themes were narrowed and refined into the final themes and sub-themes.

Finally, a targeted review of the final themes and the associated text was performed in order to develop the final theme descriptions and identify illustrative examples of the themes in terms of quotes. In order to present the findings in a way that emphasizes the interconnections between themes and sub-themes the research team also developed an illustrative figure (Fig. 1 ).

Fig. 1.

Overarching themes and sub-themes with illustrative example quotes.

Although one researcher was responsible for the analysis, all Swedish-speaking researchers participated in the process, and the emerging and final codes and themes were discussed in the research group. A number of other strategies were used in order to support the rigor of the study. The transcripts were cross-checked against the included data to ensure quality, and reflective memos and analytical memos were used throughout the process of data generation and analysis. Moreover, the stepwise coding (structural and content) and interactive analysis process have been designed in itself to enhance reliability (Guest et al., 2012).

3. Results/findings

During the thematic analysis a number of themes describing how elderly experience their opportunities and barriers to travel and activity participation during COVID-19 were identified. Two overarching themes (1) perceived travel opportunities and restrictions and (2) importance of social interactions, and six sub-themes emerged. The themes are presented below with illustrative quotes. To summarize our findings, we have included a figure (Fig. 1) that provides an overview of the two overarching themes (including theme definitions), the six sub-themes and their proposed relationship to the overarching themes, and an illustrative quote for each sub-theme. Following Fig. 1, a brief presentation of the first overarching theme is presented, followed by the sub-themes 1–3. Then we give a brief presentation of the second overarching theme followed by a presentation of the sub-themes 4–6. In the results section, the term “some” is used to refer to two to four common responses from participants, and “many” is referred to five or eight.

3.1. Overarching theme 1: Perceived travel opportunities and restrictions

The first of the overarching themes reflects how all of the participants experience and express different opportunities and restrictions for their travel, based on environmental or individual barriers, enablers, and prerequisites, which highly influence travel choice (sub-themes 1–3). These experiences are related to the pandemic outbreak, although, the actual experienced opportunities and restrictions differ somewhat due to the alterations in context, including national restrictions and recommendations, and how limitations in actual travel opportunities and their own perceived individual abilities are related to these alterations. Examples of experienced barriers to travel among the participants were fear of COVID-19, increased dependence on others, or health issues (the latter two becoming more evident when certain modes of travel, such as public transport, were perceived as barriers due to the former). The following quote expresses how opportunities for travel during a pandemic can be reliant on accessibility of relevant modes, but also reflects the importance of being healthy enough to use these opportunities:

“My bike, and being able to use it, is my rescue” (Male, 74, medium sized city).

Thus, although this theme is closely related to the other overarching theme “importance of social interactions” the theme also reflects different dimensions of travel, such as the importance of activities to travel to (for social interaction and other purposes), and the perceived opportunities to do so (such as affording the cost of travel), alongside the role of individual abilities such as health aspects or car dependency.

3.2. Sub-theme 1–3: The role of travel opportunities, activities, and health

The role of travel opportunities differed among participants, given their own views on personal health and other abilities, as well as their perceived access to different modes of travel. However, the ability to have options to travel to activities of choice came out as important for quality of life as a whole, which is in line with previous findings by Chiatti et al. (2017), and which is illustrated well in the following quote:

“I feel that having many different opportunities for [daily] travel offers you a high quality of life. I mean, the more you have the possibility to go by public transport, bicycle, car, or just go walking or whatever you do, the more quality you will have in your life.” (female, 79, smaller city).

A majority of those who had access to a car, as driver or passenger, were less concerned about other travel opportunities, but at the same time expressed an insufficiency or inability of other modes (than the car) to offer satisfactory or realistic opportunities for travel. This can be understood in terms of car dependency, which refers to an incapacity (perceived or actual) of the transport system to offer adequate accessibility by other transport modes. The participants favored the car due to a number of reasons, including a lack of flexible options for daily travel, issues linked to perceived physical abilities (such as the ability to use the bus or walk long distances with groceries), or the habit of using the car regularly. One participant (male, 87, living in a medium sized city), who came out as particularly car dependent during the interview, was asked by the interviewer what it would take for him to leave the car in favor for another travel mode, to which he replied: “a driving ban”.

Other respondents emphasized both the importance of the car and their own health in relation to their perceived possibilities to participate in activities in the future:

“To be healthy and to be able to drive a car [is most important regarding facilitating future activity participation]” (female, 79, medium sized city).

Car dependency, despite underlying reasons, is important to acknowledge as ageing and decreasing health will eventually lead to an incapability of driving, which in turn may cause driving cessation (Edwards et al., 2009) and an inability to reach important activities and socialize, and further decrease health and well-being (Pellichero et al., 2020). In particular, if the car offers an affective value, rather than just a practical value, it will likely be perceived as harder to give up (and exchange for other travel modes) (Musselwhite & Shergold, 2013).

Even respondents who used active travel modes for activity participation to a greater extent experienced these travel opportunities as very important, albeit they also perceived them in relation to their own physical health.

”There are those that are far worse off than me. At least I am able to walk a little using a walker. Those who cańt do even that end up sitting about all day doing nothing, which is tough” (Male, 96, major city)

When describing their travel before COVID-19, some participants emphasized the lack of sufficient public transport to meet their needs, lack of information regarding public transport travel opportunities or high costs related to public transport as barriers for using public transport. The following quote by a female of 85 years in a major city illuminates the dilemma the elderly may experience when considering travel opportunities by public transport:

“My husband was having surgery in another hospital [than the closest one]…I was not able to visit him because it was too expensive to go there”

Having access to different travel opportunities was generally described as very important before COVID-19, but as the pandemic hit and they experienced a lack of possible activities, this made the opportunities for travel less important for some respondents. Rather, these respondents expressed an increased focus on their own health and ageing, in relation to a loss of independence and the ability to interact socially due often to health-issues. Others, mainly those that did not drive themselves, expressed concern over an increased lack of opportunities for travel due to an increased dependence on others:

“Now during the pandemic my children wońt allow me to take the bus, because of the risks of infection, so my options are to walk or try to get a ride with someone if I have to go somewhere” (female, 87, medium sized city)

“I wish I could do more, get more help [by others] to go places. I think I could, but not now when we are supposed to keep the distance to others. So…I do a lot less now” (female, 84, major city)

Although the respondents differed in how hopeful or fearful they were when referring to their travel and socializing possibilities after COVID-19, a majority expressed deep emotions and concerns over decreasing health and independence, and a prolonged pandemic, which they felt would highly affect how their future would be.

”Our lives are going to end with this [situation]. The last days of our lives will be like this, and that is a source of grief” (female, 86, large city)

3.3. Overarching theme 2: The importance of social interactions

In the beginning of the interviews, social interaction was described by many respondents as one of their main goals with, and motivations for, daily travel, which reflects previous findings by Musselwhite and Haddad (2010) who found that socializing and a sense of belonging were important aspects of travel for the elderly. However, reflecting the fact that our respondents were retired and no longer needed to travel to work or to address family-related matters, facilitating social interactions naturally had become the predominant cause for their daily travel although they had not thought about this before. The pandemic made these needs evident to those who had previously taken for granted the capacity to travel. Social interaction was also described as an important aspect in relation to other activities which involved travel (such as shopping or going for a walk). The elimination of travel again made such indirect impacts of travel evident that were not previously apparent to them. Several respondents described that they were surprised themselves to realize how important their social interactions were to them, when the pandemic put an end to many of their regular opportunities for interaction, including visits to friends and family, shopping, or leisure activities such as going to the theater or local club. How important the socializing aspect of travel is, and how it dawned on the elderly when most of the opportunities were washed away overnight is reflected in the quote by a male of 74, living in a medium sized city in mid-Sweden;

“Well, you could say that… you know the one with the cow and the stall.” Referring to a common phrase in Sweden: You dońt miss the cow until the stall is empty meaning that the importance of something is not clear until it is no longer there

Friends and family appear to be the most meaningful of social interactions, reflecting the findings for the general public by Waygood et al. (2021) that found these two groups to be the most missed. However, when access to friends and family becomes more difficult to maintain, due to distances or barriers related to COVID-19, the participants show an ability to modify their socialization with other peers or even random contacts. The need to socialize is a strong contributing factor to making trips. If those trips involve active travel, it addresses both physical and mental health needs. One female participant described her way of ceasing the moment for social interaction as the opportunities for ordinary travel decreased as:

”I just go on walks which offer me the opportunity to come out and meet random people and chat.” (Female, 84, large city)

3.4. Sub-theme 4–6: Self-efficacy and independence/autonomy, nowhere to go and Adaption

The pandemic created a unique situation where even individuals who were otherwise able to travel suddenly lost much of their autonomy. How the participants describe their travel behavior in terms of opportunities for travel and actual participation in activities is to a certain extent a consequence of their self-efficacy and independence. Self-efficacy and independence are part of the concept of autonomy (Friman and Olsson, 2020, Singleton and Clifton, 2021), and are reflected in how the respondents perceive their own abilities and resources to travel as barriers or enablers which are important especially for their ability to choose where, when, and how to travel. Self-efficacy and independence help the participants to feel that their travel is easy to participate in due to the beliefs in their own ability;

”Well, I suppose it is the experience I have of daily travel. There are always possibilities, if one thing doesńt work, there are always alternatives.” (Male, 70, middle sized city)

Self-efficacy and independence also facilitate feelings of safety and security for a majority of the participants during travel, which is reflected in the following travel behaviour descriptions;

“I feel confident in myself and have chosen to travel [on public transport] at times when the troublemakers areńt around. If they are, I choose the taxi instead.” (Female, 74, large city)

”I feel safe [traveling] because I know how to do it, I have done it before.” (Male, 74, middle sized city)

However, some participants perceive their own abilities as limited, and thus a lack of independence and self-efficacy, which in turn limits the resources which are experienced as possible means for travel and social interactions.

“To be able to go where I wanted was restricted mainly by my own limited abilities and not due to external causes” (female, 85, large city)

The above quote reflects many of the other participants’ views of travel in that belief in personal abilities and health in combination with actual travel opportunities had a large effect on perceived travel opportunities and restrictions, and actual travel behavior. The participants experiencing low self-efficacy and autonomy in the study also travelled less. Those participants that avoided public transport did so mainly because they felt that it is too complicated to use (e.g. due to digital solutions such as ticketing and timetables), or because they lack the means of travelling independently, without the help of others. Thus low self-efficacy and lack of independence came out as important barriers to travel during the pandemic. Lack of independence was often related to issues with aging or declining health, which resulted in a dependency on special services or taxis, but not for all participants. One participant, age 74 and in good health condition, felt that she could not manage to take the bus or train unless she travelled with someone else (e.g., her husband), so often she chose to walk instead. This likely highlights a sense of control with active travel that may not be the case with public transport or driving (due to speeds or other reasons).

“If my husband came along we used public transport or the car, if on my own, I chose to walk or cycle.” (female, 74, large city)

Even participants with generally high digital literacy experienced low self-efficacy regarding travel on public transport due to complicated and digitalized ticketing systems.

“Both me and my husband are comfortable with using the phone and the computer, but we still experienced this [digital ticketing solution] as very complicated and thus we have used the car a lot more due to this.” (female, 79, smaller city)

What these participants experience and profess can be related to findings from Franke et al. (2019) who found that participants with a high belief in their own abilities also experienced more motivation to maintain daily activities, and led more active lives. However, these mechanisms are not always conscious, and thus individuals may feel that they are content with their travel, even if they unconsciously discard certain options. This theme is also related to the theme of adaptation in terms of self-efficacy and independence as enablers for adapting to new contexts and travel restrictions, such as COVID-19, but also to new circumstances such as decreasing health, or the ability to find different ways of maintaining social interactions.

The fifth sub-theme (Nowhere to go) reflects the experience of the participants as the restrictions set in during the pandemic. Suddenly there was nowhere to go, regardless of travel opportunities, their own abilities, independence, financial situation, or health. This is something that all participants experienced and a new situation for everyone, which was reflected in the surprise many felt that it was not primarily their own ageing and health, or the lack of travel opportunities that had put an end to their travel – but rather that there were nowhere to go anymore, even if one were to disregard the recommendations of not traveling on public transport. Nearly all activities they wanted to go to were cancelled in an instant.

“I have not used the taxi services, and the reason isńt that I cańt use it anymore, but that everything that I used to travel to has been cancelled” (female, 84, major city)

“Well, I miss the activities, I do, and this is not related to my difficulties in getting there but rather that they [the activities] are cancelled, non-existent, most of them…If you are going to do things in your life, you cańt wait too long, and thus when being a bit older these limitations in going places makes one feel extra bound” (male, 74, medium sized city)

Previous to the restrictions and cancellations due to COVID-19, most participants still felt that they had some opportunities to participate in life and attend activities or at least to socialize with friends and family, even if some were more content than others with their options. Now they suddenly realized that social interactions are intrinsic to most activities that they normally do. Thus in that sense, having nowhere to go also largely incorporates a loss of not only activities per se, but also the main purpose of travel for older individuals.

A way of coping with the new way of life during COVID-19 was to adapt to the new circumstances the elderly faced, which is captured in the sixths sub-theme (Adaption). Adaptation (e.g., of travel means or activities) has been observed among elderly in previous research. For instance, Lord et al (2011) found that older people adapted their travel behaviour to more accessible locations when their circumstances changed. We found that some respondents actually changed their travel behavior due to the pandemic, from public transport to active modes, in order to maintain mobility to activities that were still available, such as shopping for groceries or going to the hospital, or maintaining social interactions. Although not all respondents found adaptation easy, the following quote reflects the experience of those who did adapt their travel;

“Before covid, I actually didńt have a bike. I bought it then [when the pandemic hit]” (female, 74, village area)

However, adaptation in light of COVID-19, or deteriorating health or quality of life, as several of the participants fear or experience, should also be understood in terms of adapting to “non-travel behaviour” or adapting to other means (than travel) for maintaining social interactions such as digital solutions for interacting. Several participants reflected on their own adaptation-process in terms of how to find new ways to interact that are in line with their own abilities, feelings of safety and security, and which may ultimately have a positive effect on their well-being.

“What is important for me are my social contacts…but if they stay the same or new opportunities open up [for interacting]…I think that social contacts are important, although these do not necessarily need to be performed in the same way” (female, 75, medium sized city)

Those respondents that found it easier than others to adapt their behaviour were also more motivated to find solutions for travel, demonstrating perhaps greater self-efficacy and independence. They reflected on the new circumstances and tried to adapt their travel accordingly. For some this was more related to when to travel than how to travel, like this female, 75 years old from a medium sized city:

“No, I dońt consider how to travel as much as when to travel. What I do now is go shopping at different hours than before….maybe at nine in the evening when the supermarket is rather empty”

Other respondents expressed a new way of thinking around their travel altogether and started to reflect on things they had not considered before.

”Well, I really would like to go back to normal circumstances, however I realize that doesńt work. It is really about my own adaptation. One needs to consider the situation and plan for when and where to travel a bit more. Before it was more of a routine behavior.” (Male, 70, middle sized city)

Although several respondents found ways to adapt, many respondents found adaptation a lot harder, and due to this expressed fear for the present circumstances as well as for their future lives in terms of opportunities for travel, activities, and social interactions. In fact, most respondents, even if they had found ways to adapt to their new circumstances, still expressed concern for their future possibilities of living a satisfactory life. Underlying reasons for this included a high dependence on their own health as a prerequisite for continuing to live an active life, or lack of independence.

“I think that given that I am still healthy [in the future], I will continue doing the things I want when possible” (female, 74, large city)”

“Well, of course I would like to [travel in the future], but it is difficult for me as I need a companion to be able to…and my children have their own lives to handle now so…” (female, 84, major city)”

The final quotes illustrate how the respondents voice their fear for a future life without conventional or comfortable ways of travel or possibilities for social interactions. It also demonstrates how some of them cope with the apprehensions of a very different society even after the pandemic is over.

“So, the question is, how will I be able to live the rest of my life? Have I, so to speak, lived my life already and what is left is down to sitting with my husband in our apartment and socializing via the internet?” (female, 85, major city)

”Then again, I realize that some things will be very different [even after covid-19], but I dońt want to take it in so I sweep it under the carpet instead” (female, 75, large city)

4. Discussion

In the present study, we aimed for a deeper understanding of the feelings and thoughts of the elderly related to daily travel and activities, social interactions, and the sense of independence, health, and well-being during the initial COVID-19 pandemic. The situation was unique as many otherwise able elderly individuals had their ability to travel eliminated or severely limited. Knowing how they reacted, adjusted, and felt about such conditions can help future transport policy. In our interviews, we identified themes of underlying motivations or barriers.

A major finding of this article relates to the realization of our participants to the intrinsic nature of social interactions in their daily activities (overarching theme 2). In many cases, these indirect impacts of transport were evident prior to the pandemic. Individuals talked about a lack of destinations to go, even if they were able to travel which may have been linked to a lack of potential for social interaction. An ability to adapt to new circumstances, and having access to social networks - such as friends and family – or even new acquaintances - came out as important facilitators for maintaining interactions and for keeping a certain quality of life during the pandemic. These social components of our lives were something that many of us took for granted prior to the pandemic, but it came clear how important they are and this can be seen in our respondents’ quotes.

This echoes results by Waygood et al. (2021) from a study during spring 2020 that reported on how missing social trips and missing social interactions with different groups of individuals (neighbors, family, friends, etc.) was statistically related to life satisfaction. Our study highlighted how this need stimulated excurisions simply for the chance to have some incidental social interactions.

Although the ederly population had greater restrictions on their travel, they also demonstrated resilience that was not apparent in previous studies. The older people in our study reported many examples of adapting, be it through travel behaviour change, adapting social interactions to other peers or involving online alternatives. Although activity participation and travel declined during COVID-19, a minority of the participants in the current study described that they actually used more active modes for travel than before, by replacing public transport and driving for walking and cycling, when perceived as possible. This is positive, as research has shown that active travel such as regular walking is related to improved physical and mental health in older people (Chiatti et al., 2017, Waygood et al., 2015, Nieuwenhuijsen, 2020). Further solutions can then be envisioned such as improving the walking and cycling quality towards important destinations such as shopping so that leisure or hedonic trips can benefit from the increased motivation/reason to conducted utilitarian walking and cycling (Cerin et al., 2017, Kang et al., 2017, Waygood et al., 2015).

However, there are also individuals who seemed either to want to ignore the chance that social interactions in the future would not return to how they were, or that their social lives were reduced to interacting over the Internet. In a complementary study, Waygood et al. (2021) observed that most people were not satisfied with their social interactions during the spring of 2020 (i.e., during the first few months of the pandemic) and were not satisfied with the substitution to online interactions. A key point here may be the reference point, which is “normal” social interactions. The ideal situation is likely to be able to physically meet with friends and acquaintances, but as a crutch some form of social interaction is likely better than none. These findings are in line with other studies who found that the social isolation during COVID-19 has led to decreased social participation (Ammar et al., 2020a), which in turn also facilitate other consequences such as decreased physical activity and life satisfaction (Ammar et al., 2020b, Ammar et al., 2020a) and an increase in mental health issues such as stress, anxiety or fear and phobias (Girdhar, Srivastava & Sethi, 2020). Indeed, a survey of elderly in 26 countries across Europe and Israel observed that especially those living alone had a higher risk for increased loneliness and feelings of sadness and depression in the time after the first COVID-19 wave (Atzendorf & Gruber, 2021). To better understand the meaning of everyday mobility in later life there is clearly a need to focus on social interaction and participation in society to a higher extent, which could be done by departure from the aging literature (see for instance a taxonomy on social participation presented by Levasseur et al. 2010).

Even if you are old, or because of becoming older, prerequisites for continued travel need to be created somehow. Reflected in our respondents’ views and experiences of perceived travel opportunities and restrictions (Overarching theme 1), and echoing recent findings by Luiu and Tight (2021), a strong dependence on one’s own health becomes evident, especially in combination with a perceived lack of accessible transport options, such as close by or easy to understand and use public transportation. In particular, our respondents expressed an increased dependency on having access to a car and/or the ability and independency to use a variety of other modes for maintaining travel during the pandemic, when the possibilities for travel became limited due to restrictions and social pressure. Some of the results suggest that programs to help elderly use modes other than car will be important additions. These might be “ambassador” programs that take public transport with older people who may not have used such means in many decades.

What cannot be seen often in surveys such as origin–destination surveys is the wherewithal that some individuals have to cope and overcome adverse changes in their lives. The research here showed how some of the participants found alternatives to their usual travel mode, or found other solutions (due to decreasing health, ageing and the COVID-19 situation). Supporting this self-efficacy with appropriate land-use planning and infrastructure would likely go even further to maintaining older people’s well-being. Such examples of infrastructure would relate to curb free intersections (e.g., slow slopes or raised crossings) or protected cycle paths (though this later point has not been investigated directly for elderly that we are aware of). Solutions could also involve improving mobility through social services that bring elderly to activities, or improving proximity where the activities are brought to the elderly. Ageing in place is an important consideration, but certain locations will better support lives when personal vehicles are difficult or not possible.

Accessibility is essentially the ability to conduct an activity and is fundamentally based on mobility and proximity. It may be possible to substitute certain “normal” activities with online ones, like interventions for increasing physical activity by means of digital technology as proposed by Ammar et al. (2021), or joining online events or socializing over the Internet with family and friends. However, what has become apparent is that this is not a desirable substitution for many of the elderly. Our findings also show that adaptation to new technology may be hard for elderly, especially for those with low self-efficacy and independence. This is strengthened by findings in China showing that the elderly with difficulties using smartphone-based services were restricted in their perceived accessibility to daily necessities and services during the pandemic (Liu et al., 2021a) and even after travel restrictions were lifted (Liu et al., 2021b). Similar findings is observed in a European contex, where older adults who maintain physical distancing have less social contacts, both in-person and electronically, and that some adults may face difficulties in creating electronic ties (Cohn-Schwartz et al., 2022). As such, as far as possible, facilitating trips is more desirable than replacing them with online activities. Moreover, a number of respondents expressed difficulties in traveling by public transport due to difficulties in understanding and using digital solutions, such as ticketing systems, which is an important point for public transport providers. Barriers like these will make it hard for some elderly to participate in activities even after the pandemic.

Given that there were new waves of the COVID-19 virus during the autumn and winter of 2021 in Europe and Sweden, resulting in new and more invasive restrictions, and that this is unlikely to be the last pandemic or crisis that hits us, it is important to understand the consequences that elderly in different context and cultures experience during these crises, and learn from this experiences so that we can be better prepared in the future. Our study was set in Sweden, using a small sample of older individuals, which is a limitation regarding representativity of the results outside Scandinavia and likely also given a non-restricted (non-COVID) context. However, our study, alongside studies from other contexts, add to the knowledge we are building up regarding older people’s travel experiences in times of crisis. Another example is a recent study from Liu et al. (2021) which offer insights from China on how older people maintained their mobility related needs and social interactions during the COVID pandemic through their social and cultural environment, which emphasizes a social norm of respecting the aged alongside the “virtue of Xiao”. The virtue of Xiao refers to Confusian ethics which regulates relationships between family members, focusing particularly on humility and obedience to senior family members. Consequently, a large number of older people moved in with their families during the pandemic, and by this they were able to socially interact regularly (albeit on a smaller scale) and were less dependent on mobility for necessities such as shopping or activities. In all, we hope that future studies can learn and depart from these early insights.

5. Conclusion

COVID-19 has shown us the importance of everyday travel for older people, in particular with respect to facilitating social interactions that are a cornerstone to their quality of life. The pandemic has also shown the responsibility the elderly have taken for their own (and others) health by following the recommendations presented by various authorities. Older people have self-isolated for a long period of time and have implemented significant changes in their daily routines. This study has facilitated an understanding of the experiences of older people regarding possibilities for travel and activity participation in everyday life during a pandemic. To date, we still do not know how and when this pandemic will end, but we can conclude that the COVID-19 situation has made clear the vulnerability of many elderly when it comes to possibilities of living a satisfactory life in a travel- and activity- restricted society. With climate change and an aging population, it is hardly desirable to return to “business-as-usual” after the pandemic. We need to take responsibility and build on this newfound knowledge in the continued development of a sustainable transport system that is not only inclusive and safe, but support the physical and mental well-being of all people. Above all, there is a need to put a particular focus on facilitating social interactions for older people.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.