The Impact of the Covid-19 Pandemic on the Wellbeing of Healthcare Workers over 50.

Photo by Karolina Kaboompics: https://www.pexels.com/photo/light-blue-one-use-medical-protective-masks-4197562/

Introduction

Existing literature regarding the Covid-19 pandemic impact on healthcare workers over fifty, especially those of parents, is fundamentally under-researched. While the latter has minimal exploratory qualitative research studies, the intersectionality of the two is a subject that has yet to be considered by sociologists. This gap is substantial given the ageing population and the demographic information that approximately 75% of healthcare work is performed by women (Farrow 2022). I am therefore interested in examining and revealing the unspoken challenges, insights, and concerns healthcare workers over fifty experienced during the Covid-19 pandemic. The core of this study is outlined in the research question: What is the impact of the Covid-19 Pandemic on the wellbeing of healthcare workers over the age of fifty?

Background and Literature

In March 2020, the Covid-19 pandemic rapidly changed individuals’ everyday lives, especially for healthcare workers. Three years into the pandemic, it is increasingly important to study its short- and long-term effects and address the factors negatively impacting healthcare workers to mitigate current and future harm. Recent Australian scholarly studies regarding this topic have examined the psychological impact the pandemic has had on healthcare workers (Smallwood et al. 2021), while others have examined how it has impacted female workers. While these are crucial sociological studies, a fundamental gap in the current literature exists, ignoring how the core changes in healthcare workers’ lifestyle, wellbeing, work-life balance, health beliefs and outlook on life are interrelated issues for those over fifty.

The demographics of healthcare work reveal a significant avenue of research, as women provide “75% of the health and social care services” (Farrow 2022:24). Farrow examines female healthcare worker’s dramatic lifestyle changes, negative wellbeing, and strained work-life during Covid-19, identifying that women are “the largest and most diverse demographic that is negatively affected when disasters strike” (Farrow 2022:24). Highlighting the increase in unbalanced gendered labour, she cities more parenting and household chores for women. Similarly, the research of Sheen examines the strain on parents who are healthcare workers during the Covid-19 pandemic, focusing on “family functioning” (2022:2) and investigating the “roles, routines and rules as well as challenges and strengths.” (2022:2) Sheen concludes that “male FHWs already had systems” preventing their work from impacting their family (Sheen 2022:16), yet women “tended to pick up responsibility for home-schooling” (Sheen 2022:16) in addition to their work. This insight confirms Farrow’s (2022) supposition, as “the pandemic exacerbated gender inequalities” (Sheen 2022:16), highlighting the “culminative stressors” (Sheen 2022:13) that negatively impacted their mental health.

The nationwide ‘Australian Covid-19 Frontline Healthcare Workers Study’ further examined this issue, revealing that 59.8% expressed mild to serve anxiety, 70.9% had moderate to serve burnout and 57.3% suffered from mild to serve depression (Smallwood et al. 2021:1). This research concurs with Farrow (2022) and Sheen (2022), providing clear evidence that being a woman in healthcare has “predictors for worse outcomes on all scales” (Smallwood et al. 2021:1). This research reveals that healthcare workers are in dire need of resources to de-stress, an issue addressed by Uhing and Tannenbaum (2022) in their suggestion of experiencing nature to improve healthcare worker’s “mental health, physical health, and prosocial behaviours.” (3)

The alarming results of these qualitative social research studies give rise to the importance of further studying how healthcare workers are impacted by the Covid-19 pandemic, including workers over fifty.

Research Methods and Ethics

A qualitative methodology was adopted to conduct this research, utilising a Criticalist paradigm to highlight participants’ diverse experiences. The Criticalist paradigm understands “social reality as being shaped by a whole range of values and biases” (Waller et al. 2016:10). This includes the “social, political, cultural, economic, ethnic and gendered aspects” (Waller et al. 2016:10), which are core factors that this research aims to reveal. The qualitative approach allows for in-depth, rich narrative data, revealing participants’ thoughts, feelings, and beliefs through a conversational approach. The methodology of face-to-face, semi-structured interviews was chosen, and conducted over a week during participants’ work breaks. This method allowed for the written recording of written bodily observations while also being an empowering “two-way flow of information” (Waller et al. 2016:81) that centred participants’ wellbeing through sharing experiences and the providence of self-care resources.

Purposive sampling was utilised, with the data collected from my network. The inclusion criteria (Waller et al. 2016:67) require employees who have worked at a healthcare facility from March 2020 to the present, the timeframe paramount in examining the long-term impact of the Covid-19 pandemic. Before interviews commenced, demographic information was collected to display participants’ similarities, noting that the factor of age was a significant element to study and highlight.

The Criticalist paradigm of this study, demonstrated by highlighting of participants’ perspectives of reality and empowerment through a “two-way flow of information” (Waller et. al. 2016:81), allowed participants to retell their experiences. Within this, my relationship with participants as healthcare co-workers influenced how we discussed their experiences. Participants provided thoughtful and in-depth reflections on these circumstances, revealing data that answered the research question. The interviews were voice recorded through a phone and bodily observations documented via handwritten notes. After the interview, I transcribed the data, removed identifying features, and undertook thematic coding. These personal narratives have limited generalisability as the experiences are highly dependent on individual demographics, healthcare roles and location, culminating in varied impacts on wellbeing during the pandemic.

The ethical integrity of the social researcher is critical to the correct conduction, collection, and analysis of data, ensuring the production of genuine research results. As the researcher, I was granted ethics approval, upholding the ethical standards of the National Statement on Ethical Conduct in Human Research. The Participant Information Statement, identified as No. H- 2012 0040, was given to participants, and addressed issues of consent, risk, confidentially and for further contact information to my studies supervisor.

In reflection, the sampling method provided a valuable method of data collection, allowing for the successful retrieval of narrative experiences that were rich and in-depth. Presented with no challenges, except the minor issue of interested ineligible participants, the conducting of the project presented no ethical issues. My ability to be reflexive has been essential in this process, as through reflexivity, my relationship with the participants and employment as a healthcare worker did not obstruct my task of collecting, analysing, and interpreting the data, upholding its validity.

Findings

Accessing Resources to De-Stress

Each participant identified accessible resources that reduced the pandemic’s negative impact on their wellbeing, with the accessibility revealing insightful information regarding the benefit of the participant’s age and gender. All participants identified that their relationships, notably with family, were their most important resources for de-stressing. Participant Diane, a sixty-four-year-old immigrant woman with twenty-seven years of healthcare experience, recalled how her husband would remind her that “one-day things going to get better” (Diane), helping her to de-stress emotionally. Similarly, participant Julie, a fifty-six-year-old female immigrant who has worked twenty-three years in healthcare, highlighted how her husband reassured her that they “were in it together” (Julie). Likewise, Carol, a fifty-four-year-old immigrant woman and a healthcare worker with fifteen years of experience, proudly identified how sharing roles with her teenage daughter relieved the pressures of at-home duties, stating,

I gave her the independence because she was getting bored, she had nothing to do. So if I say, ‘can you please clean the house?’, she would go above and beyond and clean then house. ‘Can you make your bed?’, ‘can your iron for everybody?’, ‘can you try and do mash potatoes today?’ Which she didn’t know how to do… In a way, it was good because I sat back and I watched, but if it was the normal time, I would be in control of the whole house and kitchen, but now with Covid because she was bored… I give her something to do and she became so independent after that… I sat back and I let her do it, cause she had to fill in all that time.” (Carol)

Existing literature identifies that women, who perform “75% of the health and social care services” (Farrow 2022:24), were uniquely disadvantaged during the Covid-19 pandemic. This was due to the “dramatic lifestyle changes” (Farrow 2022:24) of increased unbalanced gendered labour, including parenting and household chores. By utilising her child’s support, Carol accessed a resource that helped her to reduce the pandemic’s negative impact on her wellbeing. This contrast to the existing literature reveals how older female healthcare workers have access to resources, such as teenage children, that allow them to share roles, unlike their younger co-workers.

The accessibility of resources is revealed in the narrative of Ralph, a sixty-four-year-old man and healthcare worker for thirty-two years. Working in the racing industry as a side business and hobby, Ralph was permitted access to a Covid Exemption. Able to travel alone and with his wife, role share with a business partner and socialise at racing meets, Ralph had access to numerous resources that enabled him to de-stress. Sheen (2022) identifies the accessibility to such resources as being contingent on gender, concluding that most male healthcare workers already had systems that allowed their work to not affect their family, while women did not (Sheen 2022:16). Ralph identifies how critical this resource was to his wellbeing, stating,

“I would have been bored out of my brain. Stuck at home. Not being able to go outside of your community. So having the exemption was a lifesaver”. (Ralph)

The intersection between accessible resources and gender is apparent, as Ralph’s exemption allowed him to access multiple resources that benefited his physical, emotional, social, financial, mental, and vocational wellbeing. However, Diane and Julie only identified their family as resources, while Carol reported her family, Church, and daughter’s school. The difference in accessible resources confirms the research of Sheen (2022) and Farrow (2022), the lack of support revealing why being a woman in healthcare has “predictors for worse outcomes on all scales” (Smallwood et al. 2021:1).

Inaccessible Resources to De-Stressing

Three out of four participants identified resources that, pre-Covid, were important in maintaining their wellbeing and reducing stress, the most discussed and inaccessible resources being socialisation and family. Significantly, these respondents were Carol, Diane, and Julie, as Ralph was unrestricted from accessing any resource, further supporting Sheen’s (2022) findings on accessible resources and gender benefits.

For the female participants, socialisation was a significant resource inaccessible to them for a variety of reasons. Julie recalls the negative social interaction with a friend early in the pandemic, stating,

“She thinks I got the disease [Covid-19], she stay away from me, she covering her face with a scarf.” (Julie)

While Julie retold this story with laughter, her blushing and body language revealed that this was an embarrassing memory, a consequence Sheen (2022) describes as the phenomenon of healthcare workers experiencing “stigma due to concerns regarding their frontline status” (11). Another barrier to socialisation was the restrictions within the workplace, such as social distancing, with Diane recalling how she could not “talk to the people on different breaks” and “travel in the car with another [co-worker]”. This “social change” (Smallwood et al. 2021:2) and disruption, though significant, was a minor contributing factor to healthcare workers increased negative wellbeing (Smallwood et al. 2021). Diane was also restricted from socialising with her family due to concerns for her sick daughter-in-law’s health, unable to “cook for them” (Diane) and minimising her “opportunities to engage in wellbeing-related activities” (Sheen 2022:2). Importantly, Sheen (2022) documents that three out of four participants experienced a “loss of social connection” (Sheen 2022:7) due to “shifts in relational connections” (Sheen 2022:7), a fact this study reflects and confirms.

The resource of the family was restricted to the female participants as they are all immigrants with family overseas, who they haven’t seen for “nearly two years” (Carol). Specifically for Julie, the inaccessibility of her family was largely self-imposed, as she chose her health over her family, stating,

“Mother didn’t even have vaccination, even now… And it makes me angry because I can’t go home them because you didn’t get vaccine. So, I can't see you.” (Julie)

Like Diane, Julie assessed the “contagion risk” (Sheen 2021:11), relying on her husband for emotional and mental support throughout the pandemic. Though most healthcare workers expressed “fear and anxiety” (Sheen 2021:11), the experience of hypervigilance was recorded by Sheen (2021), with Julie’s husband exhibiting anxiety regarding both their health, negatively impacted her wellbeing and restricting her from de-stressing. Julie recalled how,

“Every time we cough he go “what is you got Covid” and I feel like slapping him, because “oh my God I just got cough!” (Julie)

This caused Julie to experience more stress and anxiety over her and her husband’s health, her dramatic tone and gestures reflecting her exhaustion and frustration over being continually monitored for Covid-like symptoms. Smallwood (2022) notes that “three-quarters were worried or very worried that their role will lead to Covid-19 transmissions to family” (3), a phenomenon evident in Julie’s narrative. The inaccessibility of her husband's emotional support prevented Julie from de-stressing, instead negativity impacting her wellbeing as for a large quantity of time he “was just like, worry worry worry” (Julie).

Work-Life Balance

All participants identified a change in their work-life balance, with the themes of a strong sense of duty to work and changes to family life identified. Ralph experienced longer workdays due to his four am starts and running a business with live animals, meaning he would “get back to bed at eleven o’clock at night and then have to be up at 3:30 again.” (Ralph) This prolonged day and disrupted “sleep routine” (Sheen 2022:10) reflects the literature on changes in healthcare workers’ lifestyles. Ralph also increased his workload throughout the pandemic, “working extra to cover” (Ralph) his sick co-workers, the “increased demand” (Sheen 2022:10) due to feeling “obligated” (Sheen 2022:10) evidently contributes to his slumped posture and exhausted facial features. Despite the negative impact on his wellbeing, Ralph displayed a significant sense of duty to his role and co-workers, unbothered by the demand in his statement,

“It was a good bit more put on. But I don’t mind, I don’t mind the work.” (Ralph)

The strong sense of duty is most present in the language of participant Diane, as she demonstrates her resilience and commitment to her role throughout the pandemic. Proudly stating that she “turn up to work every day!” (Diane) and “didn’t take no sickies” (Diane), Diane’s statement reflects Sheen’s (2022) findings that “for healthcare workers, their roles also appeared to provide an additional source of pride… conveyed in the way participants spoke about their roles.” (15) A strong sense of duty and pride is acknowledged by Diane, recognising that she has “got a responsibility” (Diane), a theme echoed by Julie's belief that “work is important” (Julie). Julie also demonstrates pride in her role through her strong sense of duty, believing that “we just have to do the right thing” (Julie). This noble sentiment reflects the “high resilience” (Smallwood 2021:1) identified among healthcare workers by Smallwood (2021).

Participant Carol experienced significant changes to her work-life balance, negotiating between her work hours, her husband’s work hours and caring for her child. Having to “leave them at four in the morning” (Carol), she and her husband “had to adjust to that and swap working hours” (Carol), while also undertaking home-schooling. Sheen (2022) describes the pandemic for parent healthcare workers as a significant “time of change” (8) as their family’s routines and roles, personal routines and responsibilities were forced to adapt. (8) Farrow (2022) confirms the complexity of this issue, as women experienced more duties at home such as home-schooling, “traditionally considered as women’s work” (24), in conjunction with increased work demands. Carol describes a multitude of feelings and experiences tied to her work-life balance, stating that “when you go home, you do have a lot of stuff you take in your mind” (Carol), yet home was also a place where she “got to live as well” (Carol), distancing herself from her healthcare role. Having “done more hours” (Carol), Carol’s lack of time at home and increased demand from her dual roles, left her feeling like her life was extremely constrained, identifying that it was,

“Work – home, that’s it. You couldn’t stop anywhere.” (Carol)

This reduction in lifestyle and movement reduced healthcare workers’ identities to their work roles, as their sense of duty and commitment ultimately confined them, a theme experienced by all female participants.

Changing Wellbeing

All participants experienced a change to their wellbeing during the Covid-19 Pandemic, the increase in negative emotions and health anxiety prevalent in their experiences. All female participants identified strongly with a weakened mental state, an issue Smallwood et al. (2021) addressed in their large-scale study, finding 57.3% of healthcare participants experienced depressive symptoms. Carol describes this time as “very dark and grey” (Carol) and “not the best of times” (Carol), recalling how she,

“Still felt so lonely, cause… you don’t know when you’re going to see them [family] again, and to think that you cannot plan ahead… So, everything came at a full stop, not knowing what will be there tomorrow. It was a very had situation at the time.” (Carol)

To compound the restriction from her overseas family, the change to her family life and increased demands as a healthcare worker, Carol also “lost friends” (Carol) to Covid-19. This negatively impacted her wellbeing and led her to change her health beliefs. Previously hesitant about getting vaccinated, Carol notes that “after seeing how people were dying, that changed my perspective.” (Carol) To protect herself, Carol keeps hand sanitiser on her person and has created a new routine for her family, now, “as soon as we go through the door, the first thing we do now is go to the sink and wash our hands.” (Carol) Carol’s protective measures are a reminder of the presence Covid-19 still has in healthcare workers’ minds, significantly as they “have an increased risk of anxiety, depression” (Hill 2022:25) and other mental health issues.

Similarly, Diane’s narrative experience reveals how the pandemic impacted her wellbeing. In our interview, Diane repeated the negative feelings she endured, focusing on how she was “very scared” (Diane) and “stressed” (Diane). This expression of her acute distress reflects the experience of approximately 57% of healthcare workers during the pandemic. (Smallwood et al. 2021:6). Though her language is limited in depth, Diane’s pained facial expressions and wringing of her hands demonstrate the negative impact on her wellbeing. Noting that she was “uncomfortable and like mentally, I just, I was a mess” (Diane), Diane recalls how her anxiety manifested into health practices she ritually enacted to protect herself. Describing how she could not “touch somethings” (Diane), Diane began “wearing the gloves in the shop” (Diane), identifying with “one-sixth [of healthcare workers] suggesting they feared contracting the virus outside of work.” (Hill 2022:27). The personal use PPE as “a barrier to infection” (Hill 2022:29), reflects Diane’s mild to serve health anxiety, experienced by 59.8% of her sector (Smallwood 2021:1). The connectedness of Diane’s work and home-life, both in their strains and restrictions, is evident in how her workplace practices flow into her personal health practices, reflecting her increased anxiety as a healthcare worker.

The narrative of participant Julie reflects the data of Smallwood et al. (2021), Hill (2022) and Sheen (2022), as her experience demonstrates the negative impacts the pandemic had on her wellbeing. Describe the challenging time as “scary” (Julie), Julie recalls how she would “forever worry” (Julie) as Covid was “all the time in your head” (Julie). This unceasing worry corresponds with Sheen’s (2022) findings of “fear and anxiety being expressed” (11) by healthcare workers. Like Diane, Julie also “outlined the procedures [she] undertook to minimise risk, potentially as a means of controlling [her] anxiety” (Sheen 2022:11), stating that she would go to the “shops like when everyone is home” (Julie), particularly “at night-time” (Julie). In addition to this, Julie’s anxiety manifested in her use of hand sanitiser, specifically, “when we get home” (Julie), “before you touch the trolley” (Julie), “in the car” (Julie) and “before and after dinner” (Julie). This increased “hypervigilance” (Sheen 2022:11) reflects Julie’s negative wellbeing during the pandemic, with the mental, physical, emotional, and psychological toll of the Covid-19 pandemic leading Julie to feel “sick of Covid” (Julie), a sentiment most, and especially healthcare workers, can identify with.

The women's experience contrast with Ralph's narrative, revealing how gender expectations and stoicism can obfuscate the true nature of experience. Throughout our interview, Ralph repeatedly claimed that his wellbeing had not “changed one bit” (Ralph) and that his “life virtually never changed” (Ralph). Through a charismatic tone of voice and signature smirk, Ralph attempted to protect his belief that he was unaffected, stating that “after a while, it [Covid-19] was all bullshit”. (Ralph) Despite this, specific questioning helped reveal Ralph’s emotions, as he described the pandemic as “being drowned into the ground for almost two years” (Ralph). This emotional depiction, corroborated by his hunched posture and raised eyebrows, reflected Ralph’s negative wellbeing. This supposition is supported by his belief that now “you just got to do what you can and do it quickly before anything happens. Just in case just something does hit home, or I get it.” (Ralph) Though Ralph believes his wellbeing was not impacted by the Covid-19 pandemic, his verbal and body expressions depict a contradictory experience. This raises the question regarding the existence of other older male healthcare workers’ unrecorded experiences during the pandemic, undocumented due to gender expectations.

Conclusion

The experiences of healthcare workers over fifty during the Covid-19 Pandemic demonstrate the pandemic’s effects. Despite the differences in impacts, all participants’ wellbeing negatively changed during the pandemic, with the female participants being the most affected. This reflects the existing literature, as it identifies women as being subject to more physiological and physical strains and stresses (Farrow 2022, Sheen 2022, Smallwood et al. 2021). However, the existing literature centres on the demographic majority in healthcare, young women, lacking an analysis of the impacts older healthcare workers experienced. Significantly, the female participants had access to limited resources, namely their family, which were vital to support their wellbeing through emotional care and role sharing with children. Despite this, the female participants also experienced inaccessibility to the de-stressing resources of socialisation and family. Gender inequalities exacerbated the inaccessibility, corroborating Sheen’s (2022) findings that male healthcare workers have access to resources that separate their work and home, allowing them to destress. The importance of these resources is demonstrated by the minimal negative impact on the male participant’s wellbeing and most evident in how the restricted access to these resources further created harm.

For the participants, the pandemic was also a time of significant changes, impacting their lifestyle, work-life balance, work hours, roles, and responsibilities. The increased demands of their work and their sense of duty to their role evidently created a cycle of perpetual stress and worry that contributed to their negative wellbeing. The prevalence of this sense of duty shared by all participants is a significant theme the literature has yet to discuss, particularly regarding healthcare work and the pandemic. All participants identified the negotiation between duty to their family and their role, with all describing how they ultimately worked more to support the healthcare system and its patients. Therefore, while these experiences are individualistic and thus difficult to generalise, these healthcare workers' experiences demonstrate that the Covid-19 pandemic significantly impacted their wellbeing.

Reference List

Australian Government 2023, ‘Coronavirus (Covid-19) Case Numbers and Statistics from 01 Jan 2022 to 14 Mar 2023’, Department of Health and Aged Care, https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics

Waller, V, Dempsey, D & Farquharson, K 2016, Qualitive Social Research: Contemporary Methods for the Digital Age, Sage.

Farrow, M 2022, ‘A shortage of Women in the Care Sector’, The Australian Journal of Emergency Management, vol. 37, no. 1, pp. 24 – 25, Informit, ISSN:1324-1540.

O’Leary, Z 2014, The Essential Guide to Doing Your Social Research Project, 2nd ed., Sage.

Sheen, J, Clancy, E, Considine, J, Dwyer, A, Tchernegovski, P, Aridas, A, Lee, B, Reupert, A & Boyd, L 2022, ‘Did You Bring It Home With You?’ A Qualitative Investigation of the Impacts of the COVID-19 Pandemic of Victorian Frontline Healthcare Workers and their Families’, International Journal of Environment Research and Public Health, vol. 19, no. 4897, pp. 1 – 20. https://doi.org/10.3390/ijerph19084897

Smallwood, N, Kairmi, L, Bismark, M, Putland, M, Johnson, D, Dharmage, S, Barson, E, Atkin, N, Long, C, Holland, A, Munro, J, Thevarajan, I, Moore, C, McGillon, A, Sandford, D & Willis K 2021, ‘High levels of psychosocial distress among Australian frontline healthcare workers during the COVID-19 pandemic: a cross-sectional survey’, General Psychiatry, vol. 34, no. 100577, pp. 1 – 11. Doi:10.1136/gpsych-2021-100577

Tannenbaum, L & Uhing, W 2022, ‘Getting Back to Nature: Healing the Mind, Body, and Spirit of Healthcare Workers’, Journal of Interprofessional Education and Practice, vol. 29, no. 100583, pp. 1 – 3, Doi: 10.1016/j.xjep.2022.100583

Appendix:

Semi-structured Interview Schedule:

1. Thinking back to the height of the pandemic, how did working as a healthcare worker in these conditions changed your lifestyle?

· Is it the same still now?

· Did you change how often you went out?

· Did you think about Covid-19 when going out?

· Holidays?

2. Has Covid-19 changed you overall wellbeing? This can include your mental, physical, social, and spiritual aspects.

· Have you experienced more negative or positive feelings over the pandemic? Or a mix?

· How did you cope with these changes in your wellbeing?

· Was that experience different to now?

3. Did the Covid-19 pandemic impact your work-life balance?

· How did the 4:30 starts impact you?

· Did you take work home with you?

· Were your relationships at home impacted by this change?

4. As a healthcare worker, has Covid-19 changed your health beliefs?

· Did you get vaccinated pre-Covid?

· Did masking, isolation and social distancing impact you?

· Have you adopted any health practices for your safety since Covid-19?

· Opinions on getting Covid-19?

5. As a government employee and a member of the local community, did the government and its policies impact your work and life?

· Did the decisions to not lockdown or mask mandate effect how you did your job?

· Did the lockdowns, social distancing and mask mandates impact your wellbeing?

6. How were your relationships, as a healthcare worker, impacted by the Covid-19 pandemic?

· Were you restricted from seeing your family? How did you cope?

· Did you experience any relationship stress or strain?

· How did your partner help support/not support you through this experience?

7. From everything that has happened and is still happening regarding the Covid-19 pandemic, do you think you have changed your outlook on life?

· Have your priorities changed?

· How do you value work and family now?