key: cord-0855404-2ebzz7uy
authors: Nartker, Kate
title: Crafting in COVID: Engagement With Textile Arts and Crafts Among Senior Living Residents Throughout the COVID-19 Pandemic
date: 2022-02-23
journal: Gerontol Geriatr Med
DOI: 10.1177/23337214221079164
sha: 5448078b4cf0ba494e3b8b67fbea058ffc9999bb
doc_id: 855404
cord_uid: 2ebzz7uy

When the World Health Organization declared the COVID-19 pandemic in March 2020, the elderly were identified as a vulnerable group due to their significantly higher risk of severe or fatal outcome of COVID-19. Senior residential facilities were heavily affected and in an effort to constrain the spread of the virus, many organized enrichment programs were paused. This was a concern to many as clinical literature in the fields of Occupational Therapy and Art Therapy has found that art enrichment courses, including textile arts and crafts activities, are effective in managing excess time and coping with loneliness and other emotional challenges. The purpose of this research is to understand how senior residents engaged with textile arts and crafts independently and through a time of increased stress. Due to socializing restrictions, the pandemic provided a unique opportunity to examine the benefits and challenges seniors face when working with textile crafts. Twelve interviews with senior participants were conducted and analyzed to locate key themes related to their experiences. Results of this analysis have applications for enrichment programming in senior housing facilities, design planning for senior housing, and in shaping further clinical research on the potential benefits of textile crafts.

Engagement with textile arts and crafts can be effective when coping with emotional challenges, including loneliness and depression (Collier, 2011b; Mayne, 2016; Pöllänen, 2015) . Therapeutic benefits from activities such as knitting, crochet, and quilting include stress reduction, coping with illness, or managing unresolved grief (Brooks et al., 2019; Reynolds & Prior, 2006; Riley et al., 2013) . In a survey conducted with 821 women handcrafters who work with textiles, the women who used textile activities to change mood reported more success and rejuvenation than women who did not use textile craft techniques to cope (Collier, 2011a (Collier, , 2011b . These findings are in line with research that determined textile art activities can be effective in not only coping with negative feelings but also in feeling joy, confidence, and social connection (Reynolds, 2004; Sarıoglu et al., 2020) .

The use of textiles as a therapeutic tool or occupational intervention is of significance to the elderly, with whom depression is prevalent. Older adults who relocate to senior residential housing facilities in particular experience challenging lifestyle changes related to their physical and social environments and reduction in responsibilities (Lotvonen et al., 2018; Roberts & Adams, 2017) . Findings show that depressive symptoms among seniors are more common in women, and for seniors who live alone or in residential care facilities (Mohebbi et al., 2019) .

There has been an increasing interest in studying how art and craft activities can improve the lives of the elderly. In addition to a positive enhancement in mood, it has been argued that older adults who work with crafts are also able to adapt more effectively to physical, psychological, and psychosocial changes associated with old age (Flood & Phillips, 2007) . In a study aimed to understand how knitting contributes to health and well-being, participants noted that knitting stimulated mental activity and supported cognitive functions (Brooks et al., 2019) . Additionally, it has been shown that craft activities can structure the day for the elderly (Pöllänen, 2012) .

Of the benefits identified in research on the elderly and textiles, social connection is a persistent finding. Participation in guilds, craft circles, and organized enrichment activities has been shown to offer opportunities for reciprocity, strengthened relationships, and improvements in social interaction (Liddle et al., 2013; Maidment & Macfarlane, 2011; Schofield-Tomschin & Littrell, 2001) .

There is, however, a lack of understanding on how seniors engage with textiles independently, and the meanings they find through sustained craft making. COVID-19 provided an opportunity to analyze the ways in which seniors work with textile crafts in a time of increased stress and with limited resources. By looking at craft engagement outside of social settings, it is possible to focus more clearly on the direct benefits obtained from the processes of craft making and to identify the greater meanings seniors find when working with textiles. Understanding the benefits, challenges, and the degree to which textile crafts contribute to seniors' well-being can inform the use of textile craft activities as a cost effective tool in managing stress and isolation.

A qualitative research method informed by phenomenology was adopted to explore participants' experiences when working with textile crafts in senior living facilities throughout the COVID-19 pandemic. A phenomenological approach is useful in examining issues that are ambiguous and have an emotional component (Smith & Osborn, 2014) . It has been found to be especially useful in researching older populations as issues related to aging are complex and multifaceted (Price, 2003) . Gaining perspectives from individuals is useful in responding to issues as they emerge and can contribute to the development of new theories that shape long-term care practices. Hence, applying phenomenological principles was appropriate to clarify how senior living residents worked with textiles during the unprecedented COVID-19 pandemic and to explore common features of the experience.

Twelve women residing in senior living facilities in North Carolina and Virginia were interviewed, aged 70-90 years. Nine women lived in Continuing Care Retirement Communities (CCRC), and three women lived in Assisted Living (AL) facilities. In order to take part in the interview, participants had to be engaged with textile arts and crafts between March 2020 and March 2021 and residing in a senior living facility. A recruitment flyer was sent to Enrichment and Activities Directors in senior living facilities, inviting potential participants to contact the researcher for information. Study details were provided, and upon verbal consent, an interview was arranged.

Data were collected using audio-recorded semi-structured interviews lasting 45-60 minutes over Zoom or on the phone. Interviews were conducted in March and April 2021.

Participants provided demographic information on age and the number of years they have lived in a residential senior community. Questions explored their background in textile crafts and how their engagement with craft making changed when moving to a senior living community, and again during the COVID-19 pandemic. They were encouraged to discuss their experiences in working with textiles alone and in group settings. The semi-structured conversational style of the interview allowed the researcher to ask different questions as required to gain an understanding of the phenomenon (Mason, 2002) . The phenomenon, in this case, was how the elderly in senior living facilities engaged with textiles throughout the COVID-19 pandemic.

Interview transcripts were read multiple times, and through the use of Qualitative Data Analysis Software, QSR NVivo, tentative codes were created to label the most common concepts described by participants. These codes centered on how participants engaged with textiles and what benefits they received from working with textiles. The codes were then organized, categorized, and compiled into five key themes, as seen in Table 1 . The various reactions participants had to the reduction of social activities were also captured.

A reflective journal was used throughout the research to bring awareness to the interviewer's thoughts and feelings. The aim of the reflection journal was to support the researcher in acknowledging their own presence throughout the research process (Vicary et al., 2016) . This included the identification of themes and interpretations of participant responses. Effort was made to describe findings using the participants' own words as often as possible.

There was a range of reactions to the suppressed social interaction, with some participants finding it more challenging than others. While all 12 participants acknowledged that it was at times difficult, with two referring to it as "devastating," three participants said they were not significantly affected by the isolation, as they generally prefer to spend most of their time alone.

I do really good if I'm just by myself, you know, I'm very content with "me". So the world kind of goes around and I'm sitting here. I'm folding paper, watching videos on how to do something new.

Access to digital technology was useful for staying preoccupied, connected to a community, and expanding participant craft practices. While some participants did not feel comfortable using the internet, seven found it helpful for ordering supplies, joining online classes, and watching instructional videos. Zoom and YouTube were the digital platforms mentioned most often, and one participant joined the online fiber art community, Ravelry.

If it weren't for the internet, you know, we'd all be going nuts.

And so without being able to go to class, I relied more on YouTube videos to get answers on how to do things. And there's always an answer on YouTube.

Three participants organized occasional craft meetups on their own and found ways to socialize in safe settings. Effort was made to meet despite uncomfortable environments, and it was pointed out that crafting was one of the few activities they could still do together.

Loneliness is the main issue around here. People are so lonely. We can't eat together, we can't socialize together. But we can sit 6 feet apart with masks and quilt together.

We don't have people coming in that do craft classes and music and entertainment. We just have to entertain ourselves with each other.

The following five themes describe the lived experience of senior housing residents working with textile arts and crafts throughout a time of increased isolation. These themes provide insights into the ways textile craft processes offered support for senior residents.

1. A way to stay busy.

The need to "stay busy" was described by many participants while implying that working on textile projects may have served a role in supporting their mental and physical health. Several commented that without their craft work, they would be "going crazy" or "climbing walls". It was often described as "time killing," and that it "kept me sane" or "got me through". One participant described it as addictive and recounted that years ago she replaced her dependency on alcohol with "stitching".

Oftentimes for participants, the actual project or final result was inconsequential, as it was the act of making something that was important. It fulfilled the need to simply do something.

I always have to have something in my hands.

I want to do something and get it done and move on to the next thing.

When I finish a piece, I have no interest in it anymore. I'm done. I hang them because you have to do something with them.

It always gave me something to work on, something to look forward to, something to figure out how to do. So I had something stimulating to do.

COVID-19 introduced a new level of stress and anxiety for many participants. One was recovering from long-term health complications due to COVID-19, and another participant expressed concern over lost time.

At our age, losing a year when you're young is bad. But at our age, losing a year is a lot. Hey, we lost a year.

While many seniors directly attested that crafting assisted in managing stress ("It calms my brain."), four subthemes were identified to specify the ways textile crafts may have been used to reduce anxiety or unease: (1). Focus, (2) Repetition, (3) Familiarity, and (4). Documentation.

Engagement with textile processes provided something to focus on for all participants, and offered a distraction from other stressors. Becoming engulfed in the process was noted by participants.

You can't really deal with all the outside influences because you're concentrating on what you're doing. You're totally focused.

It's a way to shut that off and just focus on things you like to do yourself. So it's sort of self-healing to sit and do some of these things.

I think it helped me through the isolation. I don't know what people do that don't have something to do like that.

Several participants discussed the repetitive nature of textile processes and found this to be a therapeutic characteristic of weaving, knitting, and crochet.

[Weaving] is this repetitive rhythm, like a ritual. It is.

I like the rhythm of [knitting]. It's the rhythm that is warming to me.

I love the double crochet. You know, you can go row after row after row. You start at the center and go around and around and around.

Senior residents mentioned a multi-sensory familiarity with textiles and expressed that there was comfort found in the tactile qualities, processes, and tools.

I like the fact that I've done it for so long and do things that are so familiar.

My mother was a lifelong knitter and she would knit in the dark. She would knit at the movies. She would just always be knitting and I use aluminum needles to knit with because the sound of it reminds me of my mother.

Occasionally I'd just like to knit things because of the feel of them.

A few participants created work directly in response to COVID-19, attesting that craft was used to process and document their experiences. One participant created a series based on the coronavirus cellular structure. This included embroidery of SARS-CoV-2 cells floating above flowers with the words "COVID 2020" stitched in French knots, as seen in Figure 1 . This participant also sewed a collage of buttons onto blue fabric in the shape of the COVID-19 cell (Figure 2 ). In describing this work, she said, "It's something that I can hand down to our grandson and say, dear God, I hope we survived COVID." Her work serves as documentation for this unprecedented time, and as a material artifact that can be passed on through generations.

Another participant created a medical uniform for a duck figurine, which included a mask covering the duck's bill ( Figure 3 ). As the participant described it as "silly," this lighthearted piece can be interpreted as a way of using humor to respond to the pandemic.

All participants mentioned giving their textiles away as gifts to family and friends, or to supply handmade items to charities. This included organized efforts to send knitted hats to newborns, blankets to the homeless, and burial buntings for stillborn infants. Participants expressed satisfaction in helping others, but also in being productive. One participant discussed working with a group within her senior housing facility that made textile crafts for other residents. In this case, crafting provided an opportunity to directly help others who were struggling emotionally due to COVID-19.

We formed this group and we do craft projects and stick them in people's cubbies. There are a lot of people having big time depression with COVID because we're confined in our spaces, our own apartments.

Participants discussed their enjoyment in the act of creating something. For some, there was interest in creative expression, and for others, following a step-by-step pattern was preferred. Four subthemes were named to identify the features of craft making that participants enjoyed the most: 1. Experiment, 2. Assemble, 3. Materialize, and 4. Color.

For those who enjoyed experimenting with materials and processes, there was a sense of curiosity in wanting to try new techniques and observe the resulting outcomes. Participants displayed courage and confidence in exploring things on their own. 

Many participants found satisfaction in building something gradually, stitch by stitch or piece by piece. There was a sense of awe in observing the process and creating something over time.

It's so precise. It's one little tiny square at a time, and eventually it becomes a beautiful image. I love to see how stitches come together, and to realize that I've done that with my hands. I think that's one of the things I liked about counted cross stitch so much was to watch it come together and the colors make the pattern and to stand back and see how it all blends together.

Similar to the additive nature of creating textiles, there was also pleasure found in simply creating something. Participants mentioned starting with modest materials ("just a ball of yarn" or "material scraps") and finding pride in transforming that into something greater. It's actually being able to create something from nothing. I mean, you have a piece of material and you have some string, some yarn, whatever, and you turn that into something that is meaningful.

While textures and patterns were mentioned as elements of interest, color was discussed most often as the compelling feature when working on a project. Participants described an interest in color mixing, selecting yarns and materials based on their favorite colors, and repeating projects in new colors. I don't do terribly exotic crochet or knitting, but I like creating the color combinations. For example, the kids' hats that I make are scraps of yarn because you can use up little bits to make a hat and putting colors together that make it interesting, That is fun to do for me.

I have a very keen sense of color, which to me, color is just fascinating. I just take the colors and the textures and put everything together and, and create all kinds of things that many of which have never existed before.

The ability to articulate the process and experiment to this degree may be due to the fact that all participants interviewed had decades of experience with multiple textile techniques. In fact, several participants mentioned that the classes offered in their facility prior to the pandemic were not advanced enough ("Nope. Don't do those."). It was mentioned that projects were below their skill set, such as "gluing stuff on stuff" or making construction paper chains "like you did in kindergarten". Descriptions of some participants' craft making processes were in contrast to the ability of their peers.

My hands are used to handling tiny beads and finding thread and metallic thread and things like that. Most people here are having trouble holding a regular needle.

We have people that can't cut anything because their hands don't work.

It was mentioned that there were limited activities throughout COVID-19 that participants could engage in, given their age-related impairments. While there were some significant physical disabilities among participants, the most common challenges were related to memory and vision. One participant had dementia and described knitting as a visual record that could remind her of the progress she had made.

What else am I going to do? I can't read because I can't remember the paragraph that I just read. So it doesn't interest me anymore. And this is so visual. You can just see the work that you've completed. Right there in front of you.

Several participants believed that engaging in textile crafts supported cognitive health.

Figuring out how to embroider, it would stimulate my mind. And so it helps, it helps my brain.

The variety of yarns and tools also offered flexible solutions for visual impairments. For example, one participant mentioned that cross-stitch became "too tiny" so she moved on to knitting. I'm exclusively knitting because the needles are bigger, the threads are bigger.

Problem is with my eyes. I can't read more than a page and then the words get blurry. But with knitting I can look up and down and around. The stitches are bigger than the words.

For one participant dealing with chronic pain, textiles offered a distraction.

Because if I don't, if I'm not busy, I hurt worse. It's not that I really hurt worse, but I'm conscious of the pain. If I can keep my mind off the pain, even for short periods of time, that's a plus.

Textile craft activities provided critical support to all 12 participants throughout the increased isolation brought on by COVID-19. From the interview excerpts presented, craft making was a therapeutic tool in managing stress, occupying time, and in providing a purpose as well as an outlet for creativity and expression. While various working methods were found, there was a shared gratification in being productive or in creating something meaningful.

The familiarity and comfort that participants traced to textile materials align with research on the use of textiles as an occupational tool in dementia care practices (Jakob & Collier, 2017) . Woven and knitted sensory blankets with zippers, buttons, and other closures are commonly used to offer tactile stimulation and comfort to older adults with dementia. In the design and development of textiles for Multi-Sensory Environments for dementia, familiarity is one of seven key criteria identified (Jakob & Collier, 2017) . Due to the ubiquitous nature of textiles, there is an inherent familiarity when engaged as an occupational therapy tool or as a creative outlet. This high degree of familiarity can perhaps be attributed to daily contact with textile materials from clothing and bedding to home interiors, such as curtains, carpets, and upholstery. Few other mediums have the potential to integrate the same degree of comfort with creative expression.

The additive nature of constructing textiles was another consistent observation among participants. Most techniques mentioned offered a type of labor that requires hands to move continuously. This satisfied the need to stay busy and contributed to the enjoyment found in the rhythmic nature of textile craft processes. The connection that participants located between repetition and stress reduction is echoed in research that has shown repetitive ritual interventions serve as effective relaxation techniques, such as mantra repetition or counting rosary beads (Anastasi & Newberg, 2008; Bormann et al., 2006) . The process of constructing something through repeated actions also allowed participants to simultaneously engage in other activities, such as watching television or socializing online. As one participant noted, there was a sense of feeling productive even while relaxing.

Participants made profound observations in specifying why textiles are uniquely suited to support the aging process. As one participant with dementia pointed out, knitting offered a visual reminder of what she had completed, unlike a book which would require re-reading previous pages. Further clinical research could locate the mechanisms behind "muscle memory" and textile practices, and perhaps support the directed use of craft activities to older adults with memory loss and cognitive impairments. As the predominance of female participants in this study and others is an indication of the gendered nature of textile crafts, there is a potential and strong reason to expand the use of textiles as a therapeutic tool to populations that are not as familiar, such as older men.

Without the support of enrichment programming, participants were tasked with creating their own work spaces in their living environments. Eleven of the 12 participants mentioned that they had given up processes that require a lot of space and mobility, such as quilting or machine sewing. This limited participation to "lap crafts," activities that can be done while sitting and with minimum equipment. While the majority were content to focus on these techniques, a common complaint was that there was no room to store supplies and many mentioned that they had to give away most of their fabrics when moving into senior housing. One participant in a shared room noted frustration from her roommate that her supplies were "taking over". A standard storage system for residents or access to shared supplies could better support independent craft making.

While the reduction in enrichment programming and craft classes disappointed some of the participants, it should be highlighted that there were also those who felt indifferent or disinterested in the classes. Research demonstrating the benefits of arts and crafts participation often supports funding for enrichment programs, but there may be a need to look into ensuring that classes are suitable for a wider range of skill sets. As the aging population continues to grow, the spectrum of abilities widens as well, resulting in the need for a broader range of enrichment activities.

It was also found that the internet and online communities served a valuable role in providing social support and instruction for new craft techniques. Increasingly, the elderly are becoming more tech-savvy and there may be a need for designing application interfaces that offer rich interactive experiences in arts and crafts.

These findings can contribute to a greater understanding on the use of textile crafts among the elderly as an occupational tool, in art therapy, or in developing appropriate enrichment activities in senior housing. By exploring senior residents' experiences in working with textiles without the support of organized enrichment programs, key themes were identified that speak to the benefits and challenges seniors faced when engaged in craft making. Given the consistent enthusiasm seniors expressed over working with textiles, and in attributing textile crafts as a predominant activity that supported their mental and emotional health, further research on the use of textiles as an occupational intervention or as a stress management tool is merited. This identification of activities that can be carried out with physical and mental impairments, and in a range of settings, is critical to support healthy aging and well-being among an increasingly growing population.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article. This work was supported by North Carolina State University, grant number Faculty Research and Professional Development Prog.

Kate Nartker  https://orcid.org/0000-0002-1308-371X

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