Occupational scientist Ann Wilcock [1] claimed that “occupation and health are inseparable,” meaning that a person’s ability to function and perform in daily activities and occupations, especially meaningful ones, directly affects their health [2]. Previous studies have emphasized the substantial role of daily activity performance in maintaining and enhancing older adults’ health. More information should be gathered to explore the unique daily experiences of older adults during a crisis such as the COVID-19 pandemic, since they cope with specific age-related changes, including physical, psychological, and social factors [3].

Although COVID-19 presented additional major challenges to older adults’ daily activity performance and health, some remained active, most notably by using technology [4,5]. Since technology has become integral to modern life, it is essential to understand technology use among older adults in terms of their daily activity performance and health [6]. One major factor affecting older adults’ success in daily functioning and adopting technology is their social environment [7,8], including family and health professionals [9]. For example, family members can support technology challenges (choosing suitable devices and introducing basic functions), and health professionals can suggest appropriate technology [8]. Thus, a deep understanding of daily activity performance and technology use necessitates consideration of family members’ and health professionals’ experiences.

Nevertheless, previous studies focused almost entirely on older adults’ perspectives regarding daily activity performance. For example, Israeli studies of activity performance during the COVID-19 pandemic focused on adults (18 years and older) in general without addressing the specific needs and experiences of older adults (65 years and older) [5,10]. It remains unclear how older adults adjusted their daily activity performance in the face of the COVID-19 outbreak. Similarly, a study conducted among family members and health professionals regarding technology use did not specifically address the needs of older adults in terms of using technology to promote health in times of crisis [11]. Therefore, it is necessary to gain greater insight into Israeli older adults’ experiences of their daily activity performance and technology use during COVID-19 through the various perspectives of older adults, family members, and gerontology health professionals. In this study, technology is considered with daily activity performance. Hence, the term technology refers to devices that adults already own (eg, mobile phones, computers, and tablets) for carrying out these activities.

Previous studies focused mainly on older adults’ self-reports on their technology use [4,19-26]. However, because social support, often provided by family members or health professionals, can overcome gaps between technology and barriers to using it [8], it is also vital to explore the person’s social environment. The studies that were conducted among family members and health professionals focused on issues like assistive technology [27], robots allowing aging in place [28], technology for care services [11], strategies and barriers for communication technologies [29], and accepting personal alerting devices [30]. None directly addressed the older adults’ specific needs for using technology in meaningful daily activities to promote health in crisis periods.

This study aimed to fill the literature gaps by exploring daily activity performance and technology use experiences among healthy, independent, older Israeli adults during COVID-19 using a 3-dimensional perspective (including older adults, their family members, and health professionals).

This study is part of a larger project, Empathic Platform to Personally Monitor, Stimulate, Enrich, and Assist Elders and Children in Their Environment (ESSENCE). The ESSENCE used opportunities arising during the COVID-19 pandemic to study vulnerable populations, including older adults and children. This paper provides the results of focus groups exploring older adults’ daily activity performance experiences with technology in the COVID-19 pandemic context. The focus groups provided a multi-perspective window through diverse daily communication, allowing us to learn more about human experiences, desires, and concerns.

This study was approved by the University of Haifa Faculty Ethics Committee (086/21).

The 9 focus groups comprised 3 clusters. The clusters were:

Table 1 presents each group’s sociodemographic characteristics.

Each focus group lasted approximately 60-70 minutes. They were conducted via Zoom videoconferencing software, video- and audio-recorded in Hebrew, and stored on the researchers’ password-protected computers. The recordings were transcribed without details that could identify the participants. Once transcribed, the original records were deleted to maintain anonymity and confidentiality.

The researchers wrote reflective comments capturing verbal and nonverbal interactions during each focus group. Because the groups were conducted online, particular attention was paid to the older participants’ needs. For instance, we offered support for difficulties in using technology. Support included help setting up an internet connection in another room and repeating the conversation issues. The broad perspective on older adults’ use of technology during the focus group further enhanced the study’s credibility.

The moderator’s questions were customized for each group. However, the session structure, developed based on findings in the relevant literature [34], was similar for all three focus group types. It was designed to create a relaxing environment where participants felt free to share their experiences and thoughts. We invited the participants to introduce themselves and asked a general opening question to encourage active participation in the discussion: “What is your most enjoyable activity in your free time?” Additional questions were asked related to older adults’ general daily function and routines, for example, “Would you be able to summarize your ordinary day, starting from the moment you wake up to the moment you go to sleep,” daily activity performance during the COVID-19 period (“How has the COVID-19 affected your daily activity performance in comparison to the routine before the COVID-19?”), and technology (“Which technology devices do you use and how do you use them?” and “How has the use of technology changed since the COVID-19?”).

The data were analyzed according to thematic analysis and the constant comparative method [35] using Word (Microsoft Corporation) and Excel (Microsoft Corporation) worksheets. The researchers repeatedly reread the transcripts and reflective comments to familiarize themselves with the data and used the Office software to create memos related to the text. The data were then sorted, highlighted, and categorized by cases, and comparisons were made. Comprehensive coding was conducted to produce themes, and selective coding was performed to fit the theme precisely. Last, the quotations were rearranged into new categories and translated into English. We paid particular attention to the similarities and differences between participants’ experiences in each group and between the three groups [33,34,36,37]. In-depth discussions of any disagreements among the researchers were held in a series of research meetings with a researcher in the field and a qualitative researcher [38], improving the findings’ trustworthiness [36].

We identified two main themes, with two subthemes each:

Whereas older adults described how they adapted during the pandemic and used it for self-fulfillment, the family members and health professionals discussed its devastating effect, especially relative to physical and mental health.

While the COVID-19 pandemic was underway, technology allowed solutions to some challenges older adults faced. Thus, this extended period provided a window into their technology needs.

COVID-19 had a substantial impact on people’s health. Technology use supported the daily lives of Israeli older adults (65 years and older) and affected their health during the pandemic. Findings based on a 3-dimensional perspective (older adults, family members, and health professionals) highlight the overlaps and differences between perspectives and provide explanations of these findings. Overall, the findings point to older adults’ need to stay active as a factor motivating their technology use.

The participants described changes in daily activity performance, emphasizing COVID-19 constraints as causing emotional difficulties. Their descriptions demonstrate the effects of time and context on their activities and how doing and being interrelate from an occupational perspective [17]. Older Japanese adults described similar pain and fear emotions regarding their daily activity limitations [39]. The aging process alone includes substantial changes in routine (like retirement) and in the ability to engage in some activities due to biological, psychological, and social changes [3,40]. These aging characteristics, magnified in a crisis, underscore the importance of offering emotional support to older adults with daily activity performance limitations resulting from varying causes.

Despite limitations preventing them from reaching their aspirations and becoming, older adults seek adaptions and opportunities to remain active. They become involved in new activities, gain new skills, and find alternative methods (like using technology) to carry out their daily tasks. In line with previous research [19,20], this study’s participants describe how staying engaged in leisure, educational, and outdoor activities (eg, gardening and walking) supported their daily routines during COVID-19.

Interestingly, the older adult participants tend to emphasize engaging in secondary routines, associated with preference and motivation (eg, leisure and social activities) rather than primary routines. Primary routines are behaviors vital for survival (eg, sleep and personal hygiene) and establish the general pattern of daily life [41,42]. The participants stressed the benefits of meaningful activities of pleasure, social interaction, and mental health, which motivate them to participate [43].

Specifically, older Israeli adults frequently mentioned social activities with family members, including religious rituals. The activities perceived as meaningful vary across cultures [21]. Older adults in Brazil, Italy, Portugal, and the United States viewed their social environment, including family and friends, and religious rituals as coping mechanisms. They underlined the crucial role of the family as a support system during the COVID-19 pandemic [13]. Somewhat differently, the older Israeli adults in this study often referred to activities with their families, indicating that maintaining contact with their relatives was paramount and composed a substantial part of their daily routines. Even with cultural differences, the value of the family to older adults in times of crisis is cross-cultural.

Like the older participants, the family members described changes they noticed in their daily activity performance, including leisure, educational, and social activities. However, they exhibited greater concern for the older members of their families, prioritizing their loved ones’ safety and emotional support. For instance, they worried about the older adults’ increased vulnerability to the virus, the potential consequences to their health [7], and particularly their loneliness and unwillingness to share their struggles. Witnessing their loved ones’ health deterioration and accelerated aging while experiencing their own COVID-19 challenges could increase the family members’ mental burdens. Since they are a source of support for older adults [7], professional involvement is warranted in supporting both older adults and their family members during times of crisis.

Similarly, to older adults and family members, health professionals outlined changes in meaningful activities. However, they added a main focus on ensuring the health and safety of older adults, drawing upon their expertise and knowledge [44]. Notably, the professional participants represented a wide range of fields; several were older than 60 years, allowing for valuable and unique insights. They assessed the situation accurately and objectively from a medical perspective, being equipped with knowledge of the aging process, and addressed health consequences, including mental and physical implications. They particularly noted loneliness, anxiety, and physical health symptoms associated with COVID-19 in older adults and stressed the importance of maintaining meaningful activities to enhance older adults’ health. Consideration of these factors can contribute to older adults’ health and well-being whenever they are faced with similar situations.

All focus groups agreed on technology’s necessity. The need for technology during the COVID-19 pandemic might have played a role in the rise of older adults adopting and using technology [21]. Technology is indispensable for motivating them and meeting their needs in routine and crisis periods.

During the COVID-19 pandemic, older adults had to cope with an unknown situation requiring them to use technology. Adapting to unfamiliar situations and using technology effectively require higher-order cognitive abilities of executive functions (eg, inhibition, working memory, cognitive flexibility, planning, and problem-solving) [45]. Although possibly the first affected by the cognitive dysfunction associated with aging, executive functions have a remarkable ability to maintain physical and mental health [46,47]. Therefore, it is vital to leverage the COVID-19 period by creating opportunities for older individuals to engage in unfamiliar digital activities, which could benefit executive functions and improve physical and mental health.

Technology benefits include opportunities for daily activities, especially IADL (eg, shopping and receiving remote health care), education, leisure, and social activities. As in previous research, this study’s participants described how engaging in digital activities fostered a sense of belonging [48]. Focusing on technology’s uses and benefits sheds light on older adults’ needs, allowing them to increase their use of technology.

It is important to acknowledge this study’s limitations. First, participation in online focus groups requires high functional abilities. Thus, the study might present a limited perspective on digital activity performance because potential participants with less technology proficiency were not included. Further, most participants in all groups were female, possibly introducing gender bias and limiting the diversity of perspectives represented in the study. Finally, the snowball sampling method increased the likelihood that some participants, particularly health professionals, had preexisting relationships.

Future studies should include participants with a more diverse range of technological proficiency and gender. Because participating in digital technology is vital to physical and mental health among the older adult population, further research should be conducted in both a qualitative and quantitative manner exploring technology’s downsides, including its disadvantages and challenges for older adults. This could identify key principles for interventions to promote older adults’ technology use.

This study illustrates the profound interplay between daily activities, physical and mental health, and technology use among Israeli older adults (65 years and older) using a 3-dimensional approach. Specifically, it delves into the perspectives of older adults, their family members, and health professionals. In light of an occupational perspective, older adults emphasize family connection activities as a significant aspect of their lives. Thus, when activities are restricted, it is imperative to provide emotional support to them and their families. All three groups emphasize the importance of digital activities for coping with changes in routines and activities and promoting emotional and physical health during crises. These findings apply to various circumstances that older adults may encounter, ranging from health conditions to crises. Whether facing personal challenges such as the loss of a loved one or coping with social upheavals like war, their daily lives may be affected. The focus on technological uses and benefits during COVID-19 sheds light on what older adults need to increase their technology use. Interventions for improving digital activity performance can be tailored to meet their needs and preferences by focusing on their secondary routines.