In tough times, the old adage ‘go with the flow’ may gain new meaning in nursing homes, where older adults experience loneliness made worse by COVID-19 restrictions.

‘Flow’ is a psychological term referring to the enjoyment that comes from being deeply involved in meaningful activities that require high skill levels and concentration, sometimes referred to as being ‘in the zone.’ Such activities could include playing a musical instrument, painting, dancing or writing, among others.

Concerned by the impact of pandemic isolation on older residents in nursing home in Canada and abroad, Brock Assistant Professor of Recreation and Leisure Studies Pei-Chun Hsieh and her colleagues turned to flow theory to see if and how leisure activities could lift residents’ spirits.

“Older adults in long-term care facilities have been the most affected by social distancing and other guidelines since they have largely not been allowed to visit their loved ones in person during the pandemic,” says Hsieh, who researches how leisure can support healthy aging in older adults. “The feeling of social isolation and loneliness may have worsened for older adults since the beginning of the pandemic.

“We were curious to see how we could support this population,” she says. “Flow, which is a prominent theory in my field, promotes the state of concentration, engagement and optimal leisure experience that can be achieved by completing a task that challenges one’s skills.”

Hsieh became a member of an international research team headed by Liang-Chih Chang from the National Open University in Taiwan and including researchers from Pennsylvania State University as well as Lunghwa University of Science and Technology in Taiwan.

The team wanted to test out whether enjoyment from challenging activities would decrease loneliness among older adults living in nursing homes, an area not extensively researched.

Near the start of the pandemic, researchers conducted in-person interviews with 235 residents aged 65 to 93 years in four nursing homes in Taiwan. The average age of participants was 77.

The residents were asked to rate their general health, the degree to which they felt emotionally supported by their leisure companions, how they experienced enjoyment in the activities they took part in at the nursing home, and their perceptions of loneliness.

“The team found that people who had meaningful, challenging leisure experiences were less lonely than those who did not,” says Chang.

Interestingly, this was true “even when higher levels of social contact and support were not available,” he says.

The team found that “experiencing flow was associated with a more significant decrease in loneliness” than receiving more general social support, says the study.

However, the team found that the older the person, the less that flow decreased loneliness.

“Helping people achieve flow can reduce loneliness in situations where social support is insufficient,” says Chang. “More importantly, it can reduce loneliness for people in any situation.”

The study, titled “Relationships of leisure social support and flow with loneliness among nursing home residents during the COVID-19 pandemic: An age-based moderating model,” was published in November in the journal Geriatric Nursing.

The paper was published shortly after Chang came to Brock through the University’s Visiting International Scholar program.

During his term, Chang and Hsieh continued to explore how leisure activities helped other groups of people with their overall well-being.

Hsieh says that, although the research was conducted in Taiwan, the results are relevant for nursing homes in Canada, as loneliness is a universal human emotion.

“We would encourage practitioners to facilitate flow within a leisure context by engaging older residents in meaningful activities that either match with their skills or slightly challenge them and to consider programs that can cultivate grit and skill development as a way to help older residents combat the feelings of loneliness and social isolation,” says Hsieh.