INTRODUCTION
Because of their social vulnerabilities, older persons are among the most affected special population during the coronavirus disease 2019 (COVID-19) pandemic.
1) Moreover, this population has higher risks of acquiring such illnesses owing to their advanced age and the presence of chronic comorbidities.
2) In the Philippines, there were 1,276,004 confirmed cases of COVID-19, with 21,969 deaths, with a high mortality rate disproportionately affecting older Filipinos.
3) This health crisis has a notable disproportionate impact on most marginalized and vulnerable individuals, including older adults.
4) The incidence of diseases, such as hypertension, diabetes mellitus, heart failure, and some respiratory problems, in most older people has greatly affected the prognosis of most patients with COVID-19, especially those aged 60 years and above.
5) Moreover, compared to younger adults, older people affected by this illness have higher numbers of documented cases and risk of developing complications related to COVID-19 owing to the abovementioned factors.
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Filipinos in their later years are often strongly religious and hold strong beliefs about God’s influence on their health and well-being. Their deep spirituality and faith serve as a source of strength and protection against stress and sorrow.
7) For older adult Filipinos, regularly attending church (masjid for Muslims) services and participating in church events are normal routines in their everyday lives.
7,8) However, the social restriction measures that the society was forced to implement have created imbalances and disrupted the social interaction of older persons within their respective communities.
1) These policy decisions and actions have aggravated the conditions of these older individuals, in turn resulting in poor healthcare access and limited sources for their individual basic needs.
9) Social isolation and disconnection itself poses a serious health concern in this special group considering both psychosocial and physiological aftereffect it may create during such crisis which includes mental health issues and other at-risk health problems.
10) In fact, multiple studies have shown that this COVID-19 crisis has led to psychological morbidities in older people including but not limited to depression, anxiety, increased level of stress and fear, sleep disturbance resulting to poor sleep quality, accelerated cognitive decline and some physiological problems such as poor cardiovascular and impaired immunity functions while on home or quarantined at healthcare facilities.
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Social engagement which includes meaningful interactions and connectedness with others is an essential stimulus necessary for older person to improve their physical and mental health as individuals.
1,6) Positive social connections and relationships are considered to be an integral factor for older person’s well-being as social beings.
4) Hence, in the presence of this social disequilibrium, older adults are triggered to develop strategies in order to cope with such situation.
1,2) These coping strategies are natural adaptive capacities known as internal resiliency
12) developed by older person in respond to the process of ageing and stressful life experiences such COVID-19 crisis.
1) Coping strategies are essential factors that determine one’s well-being in old age.
13) It compensates or alleviates stressful circumstance through reformulation and adjustment to a new and positively assessed environment.
12,13)
The theory on need-threat internal resiliency proposed that in times of crisis, health needs develop into a health threat that compels older persons to develop internal resiliency in order to preserve their integrity, well-being and quality of life as individuals.
12) Internal resiliency refers to the ability to adapt well in the face of adversity, dangers, trauma, or significant sources of stress, collectively known as crisis (e.g., COVID-19 pandemic), to sustain a sense of purpose and vigor, as well as to emerge stronger from such stressful situations.
1,12) In connection, this study aimed to validate one of the assumptions of this theory which states that in times of crisis when threat is perceived, older persons developed a sense of internal control and adaptation to the changes it creates known as internal resiliency,
12) through a qualitative exploration of older person’s experiences and coping strategies in the midst of COVID-19 pandemic crisis. Instrumental case studies allow the researchers to utilize the case as a comparison point in different circumstances where the phenomenon may be present while testing established theories.
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To produce novel insights and a more detailed understanding of complex realities, diverse lived experiences, and how older people are making sense of and coping with what is happening around them during this crisis, qualitative insights are needed, influencing their resiliency and adaptation to such difficult situations as the COVID-19 pandemic.
15) Moreover, understanding these factors and mechanism that drives older adult’s internal resilience during such situations could guide healthcare practitioners including nurses in providing an effective and efficient intervention approaches to such special population who have been greatly affected by this pandemic illness.
6,16)
DISCUSSION
This study tested one of the assumptions of Need-Threat Internal Resiliency Theory, which states that when a threat is perceived in times of crisis, older persons develop a sense of internal control and adapt to changes caused by the crisis, known as internal resiliency. We identified five key themes, each of which illustrated and described the different internal regulations and adaptations that evolved to adapt or cope with the ongoing pandemic crisis, as proposed by the Need-Threat Internal Resiliency Theory.
The first theme, everyday struggles, explains how, during the COVID-19 crisis, challenges with their daily lives forced older adults to adapt and deal with their situations, a response referred to as internal resiliency. As we face the COVID-19 crisis, older adults are among the most vulnerable populations because the pandemic has severely tested their resources and capacities for adaptation and resilience.
22) The individual coping strategies in this population are significantly affected by financial problems.
23) These events may be attributed to the imposition of community quarantines and lockdowns in most areas, in which public and private establishments, including businesses, public transit, workplaces, and other essential operations, were halted for months, causing vulnerable communities (e.g., older adults and people living in poverty) to struggle in terms of day-to-day survival.
23,24) These preventive community strategies have made it impossible for older persons to leave their homes, even to obtain basic necessities, without making other arrangements for food and social security. Furthermore, in most cases, as was the case for the participants in this study, community outreach programs were disrupted, adding to the structural alienation of older adults during the pandemic. The findings of this study, in which most of the older adult participants expressed financial insecurity and a lack of income, were consistent with Li and Mutchler
24) prediction that the financial resources of the older population would be severely impacted due to the COVID-19 crisis.
The second theme, embracing reality, described how, during the COVID-19 pandemic, older adults created a sense of internal resiliency by embracing reality to adapt or cope with the current crisis. Religion, spirituality, and belief systems have always played a variety of roles in the daily lives of older adults, including providing strength, hope, and comfort in challenging situations, such as the COVID-19 crisis.
25) With age, these beliefs become even more important as they serve as a foundational source of strength for achieving positive health outcomes and fostering coping mechanisms, particularly in times of adversity owing to various life crises.
26) These aspects are critical and unique features of resilience in the older population as they are effective coping mechanisms that allow them to adjust to their evolving needs.
27) The participants’ descriptions of how they have recognized the COVID-19 crisis as having been planned by God and that the only way for them to adapt or cope with it is to embrace its reality is consistent with the findings reported by Manning,
26) wherein the participants stated that religion, spirituality, and belief systems helped them adapt and develop resiliency in challenging times, including the COVID-19 crisis.
27)
The third theme, cultivating a strong spirituality, explains how, during the COVID-19 crisis, older adults usually cultivate a deep spirituality to respond to such situations, which is referred to as internal resiliency developed by such population groups to adapt or cope with these circumstances. Spirituality is a collection of values that adds vitality and value to people’s lives by guiding them to find meaning and intent of their lives, as well as providing hope, compassion, inner peace, comfort, and support.
28) Accordingly, high spirituality levels during times of hardship owing to a crisis can lead to peace of mind and calmness, which can influence an individual’s quality of life and resilience, particularly in older adults.
29) Spirituality has the greatest impact on older adults’ everyday lives because it offers a structure that guides them through life struggles, allowing them to separate the positive from the negative.
26) This result is reinforced by the findings of a Brazilian study, which concluded that religiosity and spirituality among long-living older adults were important mechanisms of resilience that helped them cope with pathologies, depression, and other significant demands, such as pandemic crises, which reduce their individual well-being and quality of life.
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The fourth theme, finding things to enjoy, describes how, during the COVID-19 crisis, the older adult participants in this study were prompted to engage in enjoyable activities, referred to as internal resiliency, to better adapt and cope with their situations. The vulnerability to the COVID-19 crisis, which has resulted in social isolation, has greatly increased the likelihood of certain psychosocial health problems in this group.
16) Religious and spiritual activities during times of crisis are important for assisting individuals, especially older persons, to adapt and cope with such situations.
31) The results of this study are consistent with those of Lucchetti et al.
27) who found that three out of four older adults recognized how religious and spiritual activities (e.g., prayers, reading holy books) have improved the ability of these individuals to cope with the current crisis, especially in terms of their mental and social well-being. Moreover, the participants in this study engaged in recreational activities such as gardening in their small backyards and watching television with their family members to distract themselves. These activities provided them time to do things they would not normally do and taught them to appreciate small things, which has helped ease their concerns and feelings of uncertainty, as well as adjust to their circumstances. This may also explain why the older adults in this study built a sense of internal control and adaptation in response to the perceived threat of this crisis as physical activity in older age is closely linked to higher resilience and the absence or fewer psychosocial issues in times of crisis.
32) The final theme, health consciousness, describes how older adults became more health-conscious during the COVID-19 crisis, particularly when danger was perceived, which motivated them to cope with the situation. This internal resiliency in response to the circumstances allowed them to maintain their individual well-being, integrity, and quality of life. During the COVID-19 pandemic, public activities were suspended in many locations, including recreational facilities, senior daycare centers, and places of worship, to minimize the risk of virus transmission within the population.
33) This proactive strategy negatively affected the everyday lives of older people, making it difficult for them to adapt to new situations,
33,34) as demonstrated by the study participants. The participants in our study strictly followed preventive measures to minimize COVID-19 exposure, such as proper handwashing, social distancing, and wearing a mask and face shield. They used these behaviors as coping mechanisms to protect themselves, their family members, and others. As expressed by the participants, such practices helped them manage stress, limit their fears of infection, and keep busy during the pandemic, allowing them to adapt and live normally throughout the crisis. This finding is consistent with that reported by Finlay et al.
15) who found that older adults often used and identified coping strategies to be resilient amidst the COVID-19 crisis, including changing habits, following public health recommendations, and avoiding health-restricting behaviors (e.g., overeating), all of which encouraged them to have positive adjustments as individuals. Furthermore, Igarashi et al.
34) reported increased self-awareness as a coping mechanism that was unique to older adults.
Conclusion
Resiliency is a common concept that is underestimated among older populations due to a variety of factors, including aging, sexism, vulnerability, and discrimination. The results of this study provide valuable lessons on coping and resilience strategies among older adults during crises; these strategies included (1) everyday struggles, (2) embracing reality, (3) cultivating a strong spirituality, (4) finding things to enjoy, and (5) health consciousness to adapt or cope in their daily battles against difficult and demanding circumstances. The sources of internal resilience identified in this study may have practical implications for promoting the well-being, integrity, and quality of life of older people during the current pandemic and future societal crises. Moreover, health professionals, particularly nurses on the front lines, must recognize and understand the complex needs of older people and tailor their care to support their patients’ ability to adapt and cope well in these circumstances. By being aware of their coping strengths as a population group, nurses may be able to identify older adults at risk of being unable to respond to a crisis. This knowledge is essential for bolstering coping strategies that foster internal control and adaptation, also known as internal resiliency, while also considering the personal interests, autonomy, and capabilities of older adults during any crisis. In addition, policymakers, healthcare providers, communities, gerontology experts, and advocates should work together to help this marginalized group by developing and strengthening infrastructures and programs that assist them in connecting to critical resources and services when they are in need, such as in the case of a pandemic crisis, to easily adapt and cope with these situations. In summary, the older adult participants in this study established certain internal resiliency in response to the changes caused by the COVID-19 crisis, resulting in adaptation and coping with the situation, as proposed by the Need-Threat Internal Resiliency Theory.
Limitations
To date, no other studies have assessed older persons’ experiences, coping strategies, and resilience in the context of Filipino culture during the COVID-19 pandemic. Thus, this study contributes to the advancement of literature on the Filipino older population during this crisis. However, this study included only five participants and was undertaken in a specific setting (transitory shelters) with identified pre-criteria parameters; therefore, older adults in other areas or communities may have had different experiences and used different coping strategies during the COVID-19 crisis. Future research should apply both qualitative and quantitative approaches to investigate the presence of internal resilience within this population during a crisis (e.g., COVID-19) in a more representative sample.
Implications for Practice
• Resilience, as experienced by the older adult participants in this study, does not imply that a person will not face difficulty or distress during a crisis; indeed, the path to resilience will almost certainly include significant challenges in most aspects of their lives, including their physiological, sociocultural, psychological, developmental, and spiritual well-being.
• Spiritual well-being is important for crisis adaptation and coping in older persons as it can lead to a better quality of life at such times.
• In times of crisis (e.g., the COVID-19 pandemic), providers of direct care to older people, such as nurses, doctors, and other allied healthcare professionals, must always consider the individual’s overall well-being when providing care and assistance as it can promote resilience.
• Understanding and recognizing the holistic requirements of older people in times of crisis could help nurses and other healthcare providers to tailor their care to support the ability of their patients to adapt and cope with difficult circumstances.
• The sources of internal resilience and coping strategies of older adult participants in this study could have practical implications in promoting the well-being, integrity, and quality of life of this population, particularly during pandemics and community crises. This further suggests that legislators, community members, healthcare professionals, and advocates involved in the care of the older population should devise and implement community initiatives that support older people’s positive coping methods to increase their individual resiliency.