The study, conducted within the framework of the larger Swedish randomized controlled CGA Swed trial, set out to explore how frail older people managed everyday life in quarantine during the first year of the pandemic. Frailty, in the clinical sense, refers to a state of reduced bodily function, increased vulnerability, and diminished ability to handle stressors, often assessed through criteria such as general weakness, reduced endurance, weight loss, low physical activity, and slow walking speed. Because frailty markedly increases after the age of 80 and is associated with reduced quality of life, impaired cognition, and heightened risk of depression and pain, the researchers reasoned that this group would experience pandemic restrictions differently from healthier older adults. Yet, until now, in-depth knowledge about the consequences for frail older people specifically remained scarce, leaving a gap in both gerontology and occupational therapy research.

Twenty participants, aged 78 to 100 years and including 11 women and 9 men, were recruited through strategic sampling designed to capture heterogeneity in age, illness, functional ability, and dependence in activities of daily living. Almost all depended on home-help services, two lived in nursing homes, and seven rated their health as good while the rest described it as fair or poor. Because meeting in person posed an unacceptable infection risk, the researchers conducted semi-structured telephone interviews between October 2020 and February 2021, lasting from 11 to 33 minutes with a median of 23 minutes. Notably, recruitment and data collection never occurred digitally, an advantage the researchers highlight given that digital exclusion is itself a barrier for this population. The interviews were transcribed verbatim and analyzed using the qualitative content analysis method described by Graneheim and Lundman, in which meaning units are coded, grouped into categories, and distilled into themes, ultimately yielding one overarching theme and four subthemes.

That overarching theme, everyday life in double exposure, captures the central insight of the study: even before the pandemic, limitations already existed across multiple domains of these participants’ lives as consequences of ageing and illness. Dependence on elder care services could negatively affect control over daily routines, and most participants had already adapted their leisure activities to a reduced capacity. The loss of friends to old age had narrowed social interactions, and reliance on relatives for support had heightened dependence. The restrictions then compounded every one of these pre-existing limitations. Rather than confronting the pandemic from a baseline of healthy autonomy, these older people faced a crisis that amplified vulnerabilities they were already struggling to manage, and their diminished capacity to generate new coping strategies made the disruption especially destabilizing.

The first subtheme, powerlessness under the restrictions, describes the tension between adhering to public health guidance and struggling with its suffocating impact. Participants spoke of the pandemic period as a lost year, a time of living unnaturally under a new set of rules about how to exist. The constraints heightened their awareness of life’s finite nature and intensified the desire to engage in meaningful occupations, while simultaneously undermining their sense of autonomy and occupational identity. For those in care homes, limitations were particularly severe, with periods when residents could not move through common areas or meet relatives, and when fellow residents died from the virus. One participant described a common room where only three grieving residents remained after many others had died at the same time. Relatives’ opinions also shaped what activities participants felt permitted to pursue, an external control that reinforced feelings of limited agency and left some waiting for something to change without knowing how to influence their situation.

To manage this powerlessness, participants adopted a strategy the researchers termed acceptance and trust in the restrictions. Accepting the necessity and effectiveness of the measures became a way to cope with double exposure, allowing participants to focus on external factors such as vaccination prospects or changing seasons. Strict adherence, including avoiding all social contact, provided a sense of security for some, while others balanced precautions such as masks, sanitizers, and physical distance with continued essential activities. Healthcare was still sought when needed, and routine visits continued. Yet the study uncovered a novel and troubling finding: inconsistent adherence to safety measures among elder care staff, such as variable use of protective equipment, undermined participants’ sense of security and even led some to cancel support services they clearly needed, despite having extensive care needs that limited that option. Over time, pandemic behaviors like distancing and abstaining from handshakes became routine, but adherence occasionally relaxed, with some participants prioritizing physical contact with close relatives over fear of infection, weighing emotional needs against physical risk.

The third subtheme, limitations in everyday life beyond control, documents how the pandemic profoundly restricted activities and deepened boredom. The inability to meet relatives, socialize with friends, or leave the home for everyday societal activities such as shopping, using public transport, or simply sitting on a bench was experienced as particularly restrictive. Shifting social and religious activities to digital platforms was often impossible due to limited technological skills or resources, meaning that lost participation also meant lost routines, health benefits, and intellectual engagement. Dependence on family members introduced further constraints, as feelings of being a burden inhibited participants from expressing their own needs. Practical frictions multiplied; one participant described the difficulty of coordinating a hairdresser visit with home care schedules that had themselves become unpredictable because of pandemic staffing uncertainties. One participant, asked what she did when spontaneous meetings were no longer possible, responded through tears that she simply lay down in bed and fell asleep, calling the situation awful.

Against these losses, the final subtheme, striving for meaningfulness in everyday life, reveals remarkable resilience. Participants adapted leisure activities to fit within restrictions, meeting friends outdoors when weather permitted, maintaining phone contact, and turning to solitary hobbies such as reading, puzzles, radio, crosswords, and television. Some expanded their use of smartphones and tablets to access social media or games, while others relied on relatives for basic digital tasks, but for many, technology remained inaccessible due to lack of access or competence. Crucially, even participants with digital tools did not perceive online interaction as a true replacement for in-person contact, consistent with prior research on occupational disruption. In care settings, the social interaction provided by care staff grew increasingly important, and some participants supported peers facing greater challenges, demonstrating solidarity, such as one resident who gave fruit to and talked with two women who died the very same night.

The authors conclude that frail older people may have limited capability to adapt to new circumstances, make active decisions to influence their situation, and proactively manage their health, which underscores the central role of occupational therapy in mitigating the impact of disrupted everyday life. Occupational therapists, the study argues, are uniquely positioned to identify how frailty constrains activity performance and participation, to co-create modified routines, to enable safe engagement in daily activities, to strengthen social participation through both digital and non-digital means, and to work with families and care staff to stabilize expectations around daily roles. Addressing digital exclusion, ensuring stable and predictable care environments, and strengthening continuity in primary care through designated contact persons emerge as concrete priorities. Perhaps most significantly, the mechanisms identified here, including reduced activity opportunities, disrupted roles, and weakened belonging, operate not only during pandemics but also in ordinary circumstances where illness, mobility limitations, or restricted social networks chronically isolate frail older people. The study’s findings thus serve as both a record of a lost year and a blueprint for sustaining leisure, connection, and wellbeing in future disruptive events.

Subject of Research: Managing Everyday Life in Double Exposure: Frail Older People’s Experiences During a Pandemic

Article Title: Managing Everyday Life in Double Exposure: Frail Older People’s Experiences During a Pandemic

Article References: Sjöberg, K., Dahlin-Ivanoff, S., Wilhelmson, K., & Andersson Hammar, I. (2026). Managing Everyday Life in Double Exposure: Frail Older People’s Experiences During a Pandemic. Scandinavian Journal of Occupational Therapy, 33(1), Article 1. https://doi.org/10.1007/s44474-026-00001-7

Image Credits: AI Generated

DOI: 10.1007/s44474-026-00001-7

Keywords: Managing, Everyday, Life, Double, Exposure, Frail, Older, People, Experiences, During, Pandemic, scientific research

These figures deserve careful reflection because they come from a group of people whose primary reason for visiting the hospital was the management of a chronic physical illness rather than a mental health concern. In many low- and middle-income countries, chronic disease clinics are structured around biomedical monitoring: blood pressure readings, blood glucose measurements, prescription refills, and brief consultations. Psychological suffering in such settings can remain invisible unless clinicians actively ask about it. The pattern observed in this study suggests that distress is not an occasional complication of chronic illness but a common companion to it. When more than two thirds of a sample reports extremely severe anxiety, the finding points to a systemic gap in care rather than an isolated clinical problem.

The study also examined how participants coped with illness-related challenges, drawing on the Africultural Coping Systems Inventory, a measure designed to capture coping strategies rooted in African cultural contexts. This choice of instrument is significant. Much of the coping literature has been developed in Western settings and tends to emphasize individual-oriented strategies such as problem-focused planning or cognitive reframing. The Africultural Coping Systems Inventory instead recognizes approaches that are commonly observed in African communities, including collective coping, in which family members, friends, and community networks share the burden of a problem, and cognitive-emotional debriefing, in which individuals work through their feelings by talking them out with others. Measuring these strategies acknowledges that coping is a culturally embedded behavior, not a universal script.

Gender differences emerged in both distress and coping. Female participants reported significantly higher depression, anxiety, and stress scores than male participants, and the effect sizes fell in the moderate-to-large range, indicating differences that are not merely statistical artifacts but meaningful disparities in lived experience. Male participants, by contrast, reported significantly greater use of collective coping and cognitive-emotional debriefing, although the effect sizes here were small. This asymmetry in magnitude is noteworthy. The gender gap in psychological distress was substantial, while the gender gap in coping strategies, though statistically reliable, was more modest. In other words, women in this sample were carrying considerably more emotional weight, and the coping differences detected did not appear large enough on their own to explain that burden fully.

Several lines of reasoning, supported by broader scientific understanding of chronic disease and mental health, help contextualize these findings. Hypertension and diabetes are both conditions that require sustained self-management, and the demands of that management interact with social and economic circumstances. Women in many households assume caregiving responsibilities not only for themselves but for children, partners, and older relatives, which can compress the time and energy available for managing their own health. Dietary recommendations, medication schedules, and clinic visits may be harder to follow when a person is also responsible for feeding a family or working in informal employment without sick leave. Economic vulnerability can also amplify the stress of a condition that requires regular medication, since interruptions in supply or affordability are common in resource-constrained health systems.

The finding of extremely severe anxiety in a majority of participants also invites attention to the biological and psychological interplay between chronic metabolic or cardiovascular disease and emotional states. Anxiety and stress activate physiological pathways that can affect blood pressure and glycemic control, creating a potential feedback loop in which poor mental health worsens the physical condition, which in turn deepens distress. Depression is similarly consequential: it is associated with reduced medication adherence, poorer dietary self-care, and less engagement with follow-up care, all of which can compromise long-term outcomes in hypertension and diabetes. Recognizing this bidirectional relationship strengthens the argument, made by the study’s authors, that routine mental health screening should be embedded within chronic disease clinics rather than treated as a separate service that patients must seek out on their own.

Screening, however, is only a first step. Identification of distress must be linked to accessible psychosocial support, and the study’s findings about coping strategies offer guidance on what such support should look like. Because men in the sample leaned on collective coping and cognitive-emotional debriefing, interventions that mobilize family and community structures may resonate more effectively than purely individual approaches. Support groups organized through existing chronic disease clinics, peer-led discussion sessions, and involvement of household members in counseling could build on strategies that patients already find natural. Culturally relevant care of this kind respects the social fabric through which many Ghanaians navigate illness, rather than importing models that assume an isolated, self-reliant patient.

The higher distress reported by women suggests that gender-sensitive care must go beyond identical treatment for all. It requires attention to the specific pressures women face, which may include economic dependence, caregiving overload, and, in some contexts, limited autonomy in health decisions. Health workers could be trained to ask about these circumstances during routine visits, and referral pathways to counseling or social services could be established within the hospitals where patients already receive care. Task-shifting approaches, in which nurses or trained lay counselors deliver basic psychological interventions, have been explored in various low-resource settings and may offer a practical route to expanding mental health support without requiring large numbers of specialist psychiatrists or psychologists.

The study’s methodology also merits consideration when interpreting its results. As a cross-sectional investigation, it captured a single moment in time for each participant, which means it can document associations between gender, coping, and distress but cannot establish causal direction. It remains possible, for example, that higher distress shapes how people cope rather than the reverse, or that both are influenced by unmeasured factors such as disease duration, severity, income, or social support quality. The reliance on self-report measures introduces the possibility of response bias, and the recruitment of patients from two public hospitals in one region means the findings may not generalize to people managing chronic conditions in private care, in rural communities distant from hospitals, or in other countries. DASS-21 is a screening tool that categorizes symptom severity but is not itself a diagnostic instrument, so the reported percentages reflect symptom burden rather than clinical diagnoses of depressive or anxiety disorders.

Even with these caveats, the scale of the distress documented is difficult to dismiss. The analytic approach, using descriptive statistics and independent t-tests conducted in Jamovi statistical software, was straightforward and transparent, and the moderation of claims about coping differences through small effect sizes reflects a careful reading of the data. The open access publication of the work, carried in Discover Social Science and Health, makes the evidence available to practitioners, policymakers, and researchers in Ghana and beyond, which is particularly valuable for a topic that has received limited attention in resource-constrained settings.

For clinicians, the most immediate implication is the value of asking. A brief, validated screening question about mood or worry during a routine hypertension or diabetes visit costs little and can uncover suffering that patients may not volunteer. For health system planners, the findings argue for integrating mental health services into chronic disease care, a model sometimes described as collaborative or integrated care, so that psychological support becomes a routine component of managing conditions that patients will live with for decades. For communities and families, the findings highlight the role that collective coping already plays and the potential to strengthen it deliberately.

For researchers, the study opens several avenues. Longitudinal designs could clarify how coping strategies and distress influence each other over the course of chronic illness, and how clinical outcomes such as blood pressure control or glycemic stability relate to mental health over time. Qualitative work could illuminate what severe anxiety feels like for a patient managing diabetes in a context of medication shortages, or how women experience the competing demands of illness and family responsibility. Intervention studies could test whether culturally grounded psychosocial support reduces distress and improves self-management.

Ultimately, the study underscores that chronic medical conditions and mental health are inseparable dimensions of the same human experience. The 457 patients who shared their experiences in two hospitals in Ghana’s Central Region reveal a population carrying a heavy and unevenly distributed psychological burden. Women bear more of the distress; men, on average, draw somewhat more on collective and debriefing strategies. Neither pattern can be addressed by biomedical care alone. A health response that treats the blood pressure reading and the glucose value as the whole story will miss the anxiety, depression, and stress documented here. A response that includes routine screening, gender-sensitive support, and culturally relevant psychosocial care would align chronic disease treatment with the full reality of patients’ lives.

The authors’ conclusion, that mental health screening and gender-sensitive, culturally relevant psychosocial support should be considered within chronic disease clinics, is a practical and evidence-based recommendation. Its implementation would require training, resources, and coordination, but the alternative is a system in which the majority of patients with chronic illness experience extreme anxiety without anyone asking about it. This study provides the local evidence needed to begin changing that.

Subject of Research: Gender differences in coping strategies and mental health outcomes among people living with chronic medical conditions

Article Title: Gender differences in coping strategies and mental health outcomes among people living with chronic medical conditions

Article References: Ninnoni, J. P. K., Commey, I. T., Harmah, E. B., Amoadu, M., & Opoku-Danso, R. (2026). Gender differences in coping strategies and mental health outcomes among people living with chronic medical conditions. Discover Social Science and Health. https://doi.org/10.1007/s44155-026-00479-3

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00479-3

Keywords: Gender, differences, coping, strategies, mental, health, outcomes, people, living, chronic, medical, conditions