Intergenerational Relations and Well-being Among Older Middle Eastern/Arab American Immigrants During the COVID-19 Pandemic

Abstract

This study aimed to examine the consequences of COVID-19 socialization restrictions on familial and social support systems of older Middle Eastern/Arab immigrants in Michigan, home to the largest, most visible concentration of Middle Eastern/Arab Americans in the United States. Six focus group (N = 45) interviews were conducted with Middle Eastern/Arab American immigrants aged 60 and older to assess difficulties faced during the pandemic as it related to familial, social, and medical care. Inductive analysis identified two major themes to advance meanings of intergenerational relations among older immigrants (a) the breakdown of family relations, which describes a shift in both the experience and expectations of intergenerational relations in Middle Eastern/Arab families; and (b) cultural sources of increased stress, illustrating how the pandemic interfered with valued family interactions to affect well-being. These findings indicated social and cultural sources of heightened stress linked to shifts in intergenerational relations among Middle Eastern/Arab American older immigrants.

Keywords

family Middle Eastern/Arab American stress immigration cultural factors aging

Introduction

Socialization restrictions during the COVID-19 pandemic posed new challenges for intergenerational relations. They resulted in social and familial disruptions with many exhibiting feelings of social isolation (Benke et al., 2020), especially older adults (Su et al., 2022). Although older adults were disproportionately impacted by the pandemic (Shahid et al., 2020), not all have the same experiences and struggles. These challenges likely initiated unique intergenerational stress in immigrant communities.

Intergenerational relationships are a key aspect of immigrant family life. Intergenerational relationships involve generations within the family circle, notably referring to relationships between older and younger generations, i.e. grandparents, parents, and children (Sharifi et al., 2023; Von Humboldt, Monteiro, & Leal, 2018). Social support is an important predictor of an individuals’ well-being across their lifespan (Brajša-Žganec et al., 2018; Hashemi et al., 2021). For immigrants, familial and social support are important contributors to well-being especially as a result of the immigration process that involves various changes to lifestyle, environment, and socioeconomic status (Brajša-Žganec et al., 2018). Older immigrants rely on intergenerational support to help in adjusting and adapting to a new country (Hashemi et al., 2021; Luchetti et al., 2020). Various studies report positive correlations between intergenerational or familial relations and subjective well-being among older adults (Reisig & Fees, 2007; Tian, 2016). Notably, older immigrants often express a preference for family members to care for them when in need (Attias-Donfut & Cook, 2017). This is also true among Middle Eastern/Arab American older immigrants (Ajrouch, 2005). Of particular significance is that Middle Eastern/Arab Americans report more contact frequency with their networks than Blacks and Whites (Ajrouch & Antonucci, 2018). With socialization restrictions during the pandemic, these sorts of support structures and interactions became limited and nearly nonexistent. Thus, the aim of this study is to examine the consequences of COVID-19 socialization restrictions on familial and social support systems of aging Middle Eastern/Arab immigrants in Michigan, home to the largest, most visible concentration of Middle Eastern/Arab Americans in the United States (U.S. Census, 2019).

Middle Eastern/Arab Immigrant Older Adults and Intergenerational Relationships

Various studies have focused on older immigrant adults and the importance of intergenerational relationships as a source of support as it relates to their White counterparts in the United States (Cao, 2021; Liu et al., 2017). For example, intergenerational support has shown to help older Chinese immigrants to manage cultural barriers and emotional stress due to migration, improving their mental well-being (Liu et al., 2017). However few studies have focused on the experiences of Middle Eastern/Arab immigrants, let alone the implications of COVID-19 on their support systems. Understanding how disruptions to family relations and support systems may impact older Middle Eastern/Arab immigrants is critical to enhancing well-being. Considered the third largest ethnic population in the state of Michigan and most concentrated Middle Eastern/Arab population in the United States, this group continues to remain invisible in aging research (Ajrouch et al., 2018; Salari, 2002). Moreover, even though immigration from the Middle East/Arab world dates back to at least late 17^th century, there has been an influx of new immigrants from the region since the 1965 Immigration and Natioanlity Act (Abdel-Hady, 2014). Political unrest and unstable governments across the Middle East region have led to continuous flows of new immigrants making them unique from earlier waves who tended to arrive for the purpose of seeking economic opportunity (Read et al., 2019). Further, Middle Eastern/Arab Americans are a religiously and ethnically diverse group, including Muslims and Christians as well as Chaldeans, Assyraians and other groups (Samhan, 2014). Despite the diversity that exists among Middle Eastern and Arab immigrants, they are highly family-oriented and value intergenerational and extended-family social connections as customary sources of support and everyday life. A large source of this cultural practice is due to weak welfare states in their country of origin requiring family and close connections with others to provide almost all aspects of care and support for older adults and their well-being (Abdulrahim et al., 2015; Ajrouch et al., 2018).

Intergenerational relations among older Middle Eastern/Arab Americans suggest distinct patterns by immigrant status. For example, compared to US-born Middle Eastern/Arab Americans, older immigrants report smaller social networks, more frequent feelings of loneliness, and lower overall ratings regarding their relationship with the adult child on whom they rely the most (Ajrouch, 2008). Yet, intergenerational relations seem to confer a potentially significant benefit for older Middle Eastern/Arab American adults, especially those who are most socio-economically vulnerable. Ajrouch (2007) found that those with lower levels of education who report an excellent relationship with their child have fewer functional limitations than those reporting less than excellent relationships. Additionally, elders with less education who perceive emotional support available from their child have fewer chronic illnesses than similar elders without such support (Ajrouch, 2007). Hence, relationships with children appear to confer important benefits to older Middle Eastern/Arab immigrants. Though new evidence suggests Middle Eastern/Arab Americans experienced alarmingly higher prevalence of COIVD-19 than their White counterparts (Dallo et al., 2022), the continuing challenges in identifying this population have made it difficult to study the psychosocial impact of COVID-19 on aging Middle Eastern and Arab Americans.

Theoretical Framework

When individuals or communities are faced with events or circumstances that change or alter their expectations as it relates to their social structure and family relationships, it may result in shifts in everyday cultural norms and practices. Ambivalence is a concept that illustrates the shifting contradictions experienced by individuals and their intergenerational relationships. Ambivalence arises when an actor is faced with specific situations that value opposing course of action rooted within the social structure (Connidis & McMullin, 2002). A key premise of ambivalence is the ongoing negotiation of contradictions in family relationships which is connected to the ways social life is organized, while also examining ways that family ties influence the world around them (Connidis, 2015). Ambivalence is useful when understanding intergenerational relationships as it serves as a concept to understand experiences based on thoughts, sentiments, relaitonships and social structures (Lüscher, 2011). Intergenerational relations generate ambivalences as incompatible expectations may be incorporated into a particular relationship. Ambivalence results when these norms require contradictory attitudes and actions (Lüscher & Pillemer, 1998).

For immigrants, there are often multiple levels of ambivalence at play, linked to both their country of origin and the place of resettlement, which results in a complex process of adjustment and incorporation into a new setting (Morawska, 1987; Smelser, 1998). Ambivalence arises when an actor is faced with specific situations, experiences or events that generate contradictory cultural expectations and sentiments among families, intergenerational relationships, and social life (Connidis, 2015).

The literature shows that immigrant families commonly exepreince ambivalence among both parents and children (Lewis, 2008). Often, parents experience a sense of conflict between their desire to preserve their cultural values and customs and their understanding of the necessity for their children to integrate and thrive in the new culture. In contrast, second-generation immgirants encounter a tension between their parents' expectations and their personal aspirations for pursuing their distinct goals and self fulfillment. Similarly, Rojas et al. (2016) examined the stressors among Hispanic adults from immigrant families in the United States and found that the cultural value of familismo often results in ambivalent feelings. Familismo refers to a deep connection and reliance on family members. However, familismo can result in stress for individuals who are torn between their family responsibilities and their own aspirations and goals.

Intergenerational ambivalence provides a useful framework by which to examine and elaborate the impact of COVID-19 on intergenerational relations for Middle Eastern/Arab American older immigrants. Further, their experiences will advance the ways in which ambivalence is experienced among older immigrants. Intergenerational ambivalence is often understood to emerge through tensions between cultural ideals, habits or traditions that conflict with the everyday and pragmatic realities by which the families function (Connidis, 2015; Lüscher, 2011; Lüscher & Pillemer, 1998). Of particular relevance in this study is the focus on the tension between cultural ideals and pragmatic realities in family relations that arise due to COVID-19 restrictions. The case of Middle Eastern/Arab American older immigrants introduces an opportunity to examine the ways in which a social structural barrier (COVID-19 restrictions) challenge cultural norms and influence family relations for those who are adjusting to a new country. Societal and familial changes brought about by COVID-19 speak to the need to incorporate ethnic and cultural factors in the analysis of intergenerational well-being, particularly when the family support systems are no longer made available to communities. This study sought to answer the general question: How did COVID-19 restrictions impact support structure and familial relationships, particularly for a community that relies on extended family and community for support and care?

Methods

Participants

A total of 45 participants participated in 6 different focus groups (ranged from 8-13 participants though one group had only three participants) in the metro-Detroit area in Michigan, US between January and August 2022. The participants in this study were from diverse Middle Eastern and Arab American communities including religious settings (i.e., churches and mosques) and other local social services. The eligibility criteria for participant recruitment included: (1) participants immigrated to the United States and were originally from the Middle East, and (2) aged 60 years or older. Focus groups were conducted in English and Arabic. All participants were given a $25 gift card for their participation.

Design

A qualitative approach was conducted to explore the impact of COVID-19 socialization restrictions on the familial and social support systems of aging Middle Eastern/Arab Americans. This study aimed to examine the challenges and difficulties imposed by the COVID-19 pandemic on the participants’ familial and social support structures, which included their well-being and medical care. We also investigated the role of sociopolitical experiences in managing pandemic stress. A semi-structured focus group method was used and lasted approximately 60–90 minutes; interview questions are presented in Table 1. The interview questions focused on three key areas: (1) general background and relationships, (2) medical care, and (3) sociopolitical background, see Table 1. This design allowed the participants to engage in more open conversations about their personal experiences and lifestyle changes due to COVID-19, while also permitting them to exchange various opinions on this matter. This also allowed for increased clarity on the issue of intergenerational relationships by allowing for in-depth, open-ended discussions, which provided greater insight and understanding of the topic from the perspective of the Middle Eastern/Arab American community.

Table 1.

Focus Group Interview Questions.

	Section	Questions
1	General background and household relationships	• How would you describe your household’s general life and wellbeing before the quarantine began?
		• Can you describe how the pandemic impacted your relationship to your family?
		• Did the pandemic restrictions impact how often you saw your family members?
		○ how does this relate to your pre-pandemic engagement with your family?
		○ where there some family members you continued to see?
		• How did these changes in family engagement make you feel?
		• How did this change your relationship with your family members?
		○ are your relationships between immediate and extended family members different now?
		• Do you have family members who share responsibility in your health and daily well-being?
		○ if yes, describe. What sort of care do they provide?
		○ if no, please describe
		• Do you have family members who were unable to visit or help with your care due to COVID-19 stay at home orders or restrictions?
		○ if yes, please describe. How did this impact you?
		○ Probe: What are some of the things that you found challenging?
		• Are there any other people who may assist with household/family needs or did so before the onset of coronavirus quarantine?
		• What are some of the things you find challenging now?
2	Medical care	• How often did you seek medical services or care prior to the pandemic?
		• Did that change during the pandemic? If so, what types of services did you no longer seek? Why?
		• What difficulties did you face in using such social or medical services?
		• Before the quarantine began, who would take you to your doctor appointments? Were your adult kids, brothers/sisters involved? Did that change during the pandemic?
		• Did you miss some medical visits or care due to the pandemic? Was transportation an issue at all?
		• How was quarantine affected your family’s ability to meet your general health needs?
		• Did the way you receive care change during pandemic? Was it virtual?
		• When you did attend to medical appointments, was care the same? Did you have any difficulties while being at the doctor’s office or medical center?
3	Sociopolitical background	• In what ways do your previous experiences (as immigrants or refugees) relate to experiences living under COVID restrictions?
		• Does it relate to previous experiences either prior to arrival or as immigrants in the U.S?
		• Do you see these experiences linked to politics in the US relating to arabs and experiences of belonging?
		• How does your memory and relationship to your past make you feel? Relate to your health currently

The interview questions were framed around understanding the changes in family relationships during the COVID-19 pandemic and how that affects the cognitive and psychological health of Middle Eastern/Arab Americans. Participants were asked to discuss what elements of their lives were most impacted, what challenges did they face and how did they address such challenges. Additionally, the interviews focused on identifying the challenges associated with maintaining health and well-being, as well as accessibility to medical care. After each focus group, researchers carefully reviewed the interview questions and reframed the questions for the next focus group to allow for more depth and richness in the data. For example, one of the interview questions was: how did the quarantine restrictions affect your family’s ability to meet your general health needs? The answers from the first focus group indicated an uneasiness when using telemedicine given, they did not have the same family support when it came to medical care. As a result, more time was spent on this matter in the next focus groups.

Procedure

After receiving the University’s Institutional Review Board (IRB) approval, flyers were distributed to social and religious settings, yet the ability to successfully recruit members came from community engagement activities. Each focus group was arranged by a community contact who also helped accommodate for their members. All interviews were conducted face-to-face. The location, date, and time was arranged in coordination with the social/religious personnel. The researchers started by explaining the study to the participants and then having them sign the informed consent. Prior to the interview, the participants filled out a short demographic survey (see Table 2). Two bilingual researchers, LS and MA, conducted the focus group interviews. At the end of the focus group interview, each participant received a $25 gift card.

Table 2.

Demographic Survey Questions.

	Category	Questions
1	General demographic	• What is your date of birth?
		○ Month/year
		• Are you?
		○ Male/Female
		• Are you?
		○ Single/Married/Divorced/Separated/Widowed
		• What is your highest grade in school you completed?
2	Household situation	• How many children do you have?
		○ if you have children, what are their ages?
		• How many hours of care does a family member provide, on average, per day?
		○ Hours/day
		• Do you currently live with a family member that helps with your care?
		○ yes/no
		• How many people, including you, live in your household currently?
3	Place of birth	• In what country were you born?
3	Place of birth	○ if not in the U.S., what year did you arrive to the U.S.?
4	Heath status	• How would you rate your health at the present time?
4	Heath status	○ Excellent/Fairly Good/Average/Not very good

The interviews were audiotaped and transcribed verbatim. If the interview was conducted in Arabic, it was first transcribed in Arabic and then translated to English prior to analysis. The transcripts were reviewed and verified for accuracy by the two bilingual researchers. After finalizing the transcript, files were uploaded to the NVivo software (v. 1.6.2) for analysis. The use of NVivo helped in organizing and tracking the analysis of transcript and field notes.

Data Analysis

The first and second co-authors independently coded and analyzed the data for all transcripts. A codebook was developed by reviewing interview questions and transcripts. The codes were then reviewed to identify patterns and similarities. The codes were clustered into categories and then major themes. Key themes were identified by the six focus groups with the frequency of each theme recorded. The definitions of the themes/subthemes were discussed and agreed upon by the researchers. Two major themes have been identified: 1) breakdown of family relations; and 2) cultural sources of stress.

Results

The mean age ranged from 60 to 89 (M = 73.6, SD = 8.2) years old. Most participants were female (75.6%, n = 34), had a less than high school education (43.2%, n = 19), and were widowed (46.7%). The participants had all immigrated to the United States and were originally from Lebanon (n = 22), Iraq (n = 13), Palestine (n = 4), and Jordan (n = 3). Most of the participants immigrated after the age of 18 at 93.3 % (n = 42) with 51.1 % immigrating between the age of 19–49 yrs (n = 23) and 42.2 % (n = 19) over the age of 50. Almost 85% (n = 37) of the participants perceived their health status as ‘fairly good’ or ‘average,’ and only 9% (n = 4) perceived their health status as ‘excellent’ and 6.8% (n = 3) as ‘not very good’ (see Table 3).

Table 3.

Demographic Characteristics of Participants (n = 45).

Characteristics	Frequency	Percentage (%)
Age (M ± SD)	73.6 ± 8.2
Gender (female)	34	75.6
Marital status
Single	3	7
Married	15	34.4
Divorced	3	7.0
Separated	1	2.3
Widowed	21	48.8
Level of education
Less than high school	19	43.2
High school	13	29.5
College	12	27.3
Place of birth
Africa (Lebanon)	2	4.4
Iraq	13	28.9
Jordan	3	6.7
Lebanon	22	48.9
Palestine	4	8.9
Syria	1	2.2
Age of immigration
Age 0–18	3	6.6
Age 19–49 years	23	51.1
Age 50+	19	42.2
Health status
Excellent	4	9.1
Fairly good	16	36.4
Average	21	47.7
Not very good	3	6.8
Average hours of care provided by family member (hours/day)	1.36 ± 5.05

Breakdown of Family Relations

The breakdown of family relations theme describes a shift in both the experience and expectations of intergenerational relations in Middle Eastern/Arab families for older adult immigrants.

In a conversation about changes to family and social interactions, Middle Eastern/Arab immigrants discuss how family used to visit but such interactions no longer exist as one participant noted she hasn’t seen her grandchildren in two years and feels that they have forgotten her due to the lack of interaction and visits.

P46F: I hope my grandchildren come to me and my daughters as well. There's no one, they've forgotten us here, they come here to shop and now they stopped it just to entertain themselves and stopped coming to me. When they came to my house, it was a house full of children and them, and I was very happy with them. Now it's been two years and I've never seen them. Two years I haven't seen them for two years and they haven't come to me. I have two children. I live near one of my sons, he is the best one because he is much more caring than the other one. My other son doesn't pick up the phone to call and check on me, and he doesn't even know which land I am in, thank God anyway. He lives in Kentucky and his two sisters live in this state. My daughter calls me and says why don't you come to us, and I told her I can’t live there, I want my son to be there when I die to wash me.

For most of the participants, their greatest concern was the shift in family interactions that no longer seem to occur even after the six-month showdown at the beginning of the pandemic lifted. Another participant indicated how the change has resulted in weekly family visits to every few months.

P11(M): Before the pandemic was normal, we saw the family every week on Sunday. But the pandemic changed that; I see them every six months. When we meet together, we put on the mask. This was a big change.

In a similar conversation, a participant indicated how relationships with cousins were no longer the same as before. For older Middle Eastern/Arab American adults, there is an importance in fostering relationships beyond the immediate family to the extended family and social community that serve to produce cultural meaning, support, and value in their everyday lives (Ajrouch & Fakhoury, 2013), as illustrated below.

P24F: The first 6 months were the hardest. That’s how it was. And then it became better. All people, not only with your kids, but with everyone, the relationships became weak. All of it was over the phone. For example, I have my cousins, it’s been a year since I haven’t seen them. We used to see each other often at least every month but now they don’t want to bother me, and I don’t want to bother them in case they are afraid.

A common sentiment was that participants still restrict their social activities and family engagement out of fear:

P16F: From the beginning of the pandemic until now, I have not gone anywhere, I do not attend any social events or marriages of my children who come to me now. But most of the time, I use the facetime phone, thank God everyone is fine, and they took three corona vaccinations.

In sum, the breakdown in family relations is discussed as not only something that occurred immediately during the pandemic, but clearly continued long past social restrictions were lifted. As a result, many older adults report ambivalence in their relationships as a response to COIVD-19. Though regular and frequent contact with family, especially children and grandchildren is desired, it is at the same time also very limited due to the actions of both the older and younger generations. The experience of ambivalence also led to the identification of cultural sources of stress.

Cultural Sources of Stress

Participants illustrated how they were witnessing a shift in cultural expectations common among Middle Eastern and Arab families due to the pandemic socialization restrictions that seem to have generated long lasting changes. The cultural sources of increased stress theme illustrates how the pandemic interfered with valued family interactions to affect well-being.

Participants expressed concerns over the lack of family interactions which have become normal despite the reopening from COVID shutdowns and restrictions. For many of these participants, they felt sense of ambivalence as they were saddened by shifting intergenerational relations caused by the pandemic that have made them become accustomed to limited interactions and have generated a feeling of comfort in being alone.

P26F: If you stay away from your siblings and family that you used to see every week. We used to see each other every week, meet one day, and now we're not like that anymore. If we met on a day, their children would come and see their aunts and uncles. This connection helps you. When they are far from us, these things disappeared. Something's missing, something's gone.

P30F: I will tell you what changed, what changed, like I missed my family, I missed my friends and now I'm able to see them. Believe it or not, I like to stay alone after having one or two days home alone. I got used to it. This is something new to me, it has its negative and positive. Like now we will go see each other but not like we used to, but I like to have one day home alone and do nothing. It makes me feel bad.

In another focus group, the participants discussed how visits have improved but fewer visits from children have become normal and something they are used to. This dialogue reflects the importance of meaning produced through group discussion as the participants expressed the loss of valuable family time.

LS: Before corona did you have anyone in the family in your household needs?

(collectively): Yes, yes our kids.

P23F: Our children would bring our things at least once or twice a week. They would come visit us.

P21M: Visit the old people.

P23F: we would eat together and sit together (with kids). Now we don’t do that.

P21M: Now, no way. That doesn’t happen.

LS: So you still don’t do that now?

P23F: It got less with Corona and now it’s become normal.

LS: So it’s become normal that you don’t gather with them?

P23F: Yes it’s become normal.

This fear not only created psychological hardship for older Middle Eastern and Arab older immigrants but has altered their relationships with their children.

P14M: Life was normal, and I was relieved (unclear voices), there was fear psychologically, and life became a little difficult. I am now uncomfortable.

MA: Describe to me how your life was before?

P14M: I was going out and visiting and there was no such psychological barrier before the Corona. Now the situation changed, it became complicated.

P15M: I am the same as well. Before there was fear you could accept your children and hug relatives and visit the neighbors. Now the situation is not like before, there is fear. We must make up our minds.

One participant reminisced about the changes in cultural norms and community engagement during times of death. Some customary practices of paying respect are no longer sustained and held as valuable as one woman indicated:

P31F: There are many important things that have changed. If someone dies, imagine there is no longer any respect, of course, unintentionally. Only the immediate family members take the dead person. Previously there was a memory or something like that. True or not? Every year an anniversary is held, and they gather. And now you see the doctors take him urgently. Like I saw in a video clip in Lebanon, only the brothers bury him.

The participants expressed feelings of remorse when they noted shifts in normative family expectations that reflect American cultural practices. Participants across the focus groups expressed grief over the loss of valuable intergenerational relationships. These relationships had been shaped by weekly visits that now seem to have been permanently changed to resemble normative American cultural norms not present before the pandemic.

P30F: American society, the difference between us and them is that they meet on holidays such as Christmas and Thanksgiving. But we meet at least once a week. It hurts.

For one particular focus group made up of recent immigrants with limited family in the United States, they felt the harshest effects of the pandemic where they felt alone and isolated. They struggled with the reality of living in American where extended family no longer interact in the manner they were used to back in their country of birth.

P44F: It certainly changed because the grandchildren came here when they were young and grew up here and they don't remember how our lives were before and how affection and compassion existed between us. Here everyone is just thinking of oneself and busy in their lives. I have my son, who is 30 years old. If he contacts me once a month, that's great. They do have a job to do and study.

P46F: The world makes them busy.

P44F: Not like our life previously, our relationships were very strong back there.

P45F: When I go visit my country, I see a thousand people telling me hello.

P44F: There are no relationships, even my son has three children, a wife, and a lives near me, and doesn't come much to me. I've been sitting alone in my apartment.

Concern over family dynamics is something that has produced much despair and stress as participants note that changes in the number of family visits and interactions seems to be a permanent change.

P45F: We became acutely depressed, horrified, and scared during this time and we have come to think about death and what will happen to our children next.

LS: Life was beautiful before the pandemic, right? You didn't feel any difficulties in your life?

P45F: It was sweet of course we were going to travel. We could see people and go to market and shops. Since the lockdown, we've been afraid and restrained. And we got compulsively obsessed, like, I'm afraid if I went somewhere and I got something. It was a hard thing.

LS: Now the coronavirus pandemic has changed your lives? How did this pandemic change your relationships with family members

P44F: Of course, it changed, like my son or daughter don't come to me, that they go out and travel and go to a number of places and are afraid to come to me for fear that they got something, especially because I have asthma. And I have very strong asthma and am afraid to come to them. So most of my time is at home alone and if they bring something to me, they put it at the door and call me to take it.

LS: How long does it take to see your sons? Is it a month or more?

P44F: Too many, sometimes more than three months, and they leave me alone. Just communicate through the phone. They weren't like this, but after the pandemic they became like this. My son and daughter's grandchildren weren't like this, but at the beginning of the pandemic, it was a terrifying period.

Despite their usage of phone and video calls to speak to their loved ones and make requests for their daily needs and supplies, participants indicated a shift in their emotional support. Across all six focus groups, participants indicated feelings of depression, anxiety, sadness, and stress related to the pandemic changes, which were linked to feelings of social isolation, loneliness, and lack of family engagement. Despite their usage of phone and video calls to speak to their loved ones and maintain connection, these cultural sources of stress affected health where participants indicated permanent behavioral shifts that have made them lonely and isolated.

Discussion

The overlapping concerns among the focus group participants in this study provides evidence of concerns over shifting intergenerational relationships and well-being for older Middle Eastern and Arab American immigrants. Our participants witnessed a shift in intergenerational and breakdown in family relations due to socialization restrictions and public health fears during the pandemic. Older adult immigrant experiences of familial support structure breakdown during the pandemic illustrated key cultural expectations related to intergenerational relations among Middle Eastern/Arab Americans. The cultural sources of stress theme reveals how the pandemic interfered with valued family interactions to affect well-being. Changes in cultural normative practices in family interactions created heightened depression, anxiety, fear and stress among Middle Eastern and Arab American older immigrants. This study suggests that socialization restrictions have resulted in short-term and possibly more long-term changes to Middle Eastern and Arab American familial norms as experienced by older adults. This study indicates ambivalent feelings about shifting intergenerational relationships may have a negative impact on the well-being of older immigrant adults. The resulting ambivalence in intergenerational relationships, as well as social relations more broadly, are discussed below.

Ambivalence arises when an actor is faced with specific situations that value opposing course of action that are rooted within the social structure (Connidis & McMullin, 2002). This study reveals that negotiating family and social relationships for older Middle Eastern and Arab immigrants is an ongoing challenge. Family has always been a dominant mode of support for older Middle Eastern and Arab adults who expect children and family to care for them as they grow older (Abdulrahim et al., 2015; Ajrouch, 2005). It is clear that the tensions between wanting to see family more frequently but refraining from doing so led to ambivalent feeling within families. This source of tension resulted from the onset of COVID-19 restrictions and its aftermath, clearly illustrating how a structural occurrence impinges on family interactions. Yet, the Middle Eastern/Arab case also illuminates how social and cultural sources of heightened stress showcase unique elements of ambivalence that influence older immigrant well-being.

Ambivalence faced by Middle Eastern and Arab American older immigrants during the pandemic where socialization restrictions limited them from sustaining cultural expectations as it relates to intergenerational relationships produced unique experiences of stress and anxiety. The type of ambivalence that emerged because of the COVID-19 pandemic has resulted in what appear to be shifts in cultural norms. These shifts have not only created short-term concerns during the early six-month shutdown but potentially have long-term effects as older Middle Eastern/Arab American immigrant adults witness a loss in family and cultural connectivity. Ambivalence for Middle Eastern/Arab American older immigrants was imposed by a structure that introduced new barriers to intergenerational relationships not only between parents and children but between community members and friends. Such findings indicate the importance of paying attention to cultural factors and intergenerational relationships when addressing community support structures and health policies. Cultural sources of stress can be seen in the stories of the participants describing the breakdown of family and social gatherings, which is viewed as an important source of cultural activity. This study reveals that COVID-19 has produced an ongoing challenge for older Middle Eastern/Arab American immigrants as they negotiate new meanings of intergenerational relationships.

The findings of this study are limited due to the sampling strategy that relied on community organizations and religious institutions. Consequently, we were unable to reach individuals more isolated or unaffiliated with these organizations. In addition, five out of the six focus groups included 2-3 participants that they knew, so this may have an impact on the information disclosed. However, there may have also been a willingness and a level of comfort to share experiences with individuals who were members of their self-identified community. For the most part, participants in each focus group were from the same Middle Eastern and Arab country of origin making their experiences relatable. Qualitative research allows for the richness of stories and dialogue from participants to capture their unique experiences, something missing in quantitative analysis.

Conclusion

In conclusion, for older Middle Eastern and Arab immigrants, the pandemic had a significant impact on intergenerational family ties resulting in increased feelings of stress, anxiety, and depressive symptoms. Middle Eastern and Arab immigrant older adults see contradictions and paradoxes embedded in the social structure emerging during and after pandemic socialization restrictions. These shifts due to the pandemic suggest that Middle Eastern and Arab Americans are experiencing shifts in intergenerational relationships and cultural practices. As this community continues to deal with the effects of the pandemic, it will be important to see the long-term impact of these changes for future generations and normative expectations.

Footnotes

Acknowledgements

The authors want to acknowledge and thank the participants and various community organizations for their time and willingness to share their experiences. They would also like to thank the support of the Michigan Center for Contextual Factors in Alzheimer’s Disease (MCCFAD) for their support in sustaining community engagement.

Author Contributions

Conceptualization, L.S.; methodology, L.S; formal analysis, L.S. and M.A; writing-original draft, L.S. and M.A., writing-reviewing, and editing, L.S., M.A., and K.A. All authors have read and agreed to the published version of the manuscript.

Declaration of Conflicting Interests

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

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This Research was supported by the Michigan Center for Contextual Factors in Alzheimer’s Disease (MCCFAD) which is supported by the National Institute on Aging of the National Institutes of Health under Award Number P30 AG059300. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Ethical Statement

ORCID iD

Linda Sayed

Author Biographies

Linda Sayed, PhD, is an Assistant professor at James Madison College at Michigan State University. She is an interdisciplinary scholar of the Middle East and its diaspora. Her research focuses on the politics of citizenship as it relates to questions of marginalized communities, refugee rights, healthcare accessibility, and systems of national and international governance that inform global public health concerns in the Middle East and among Arab communities in the United States. Dr. Sayed’s current research examines the impact of the COVID-19 pandemic on immigrant populations particularly as it relates to older adults, cognitive ageing, and families.

Mohammed Alanazi, PhD, is a Lecturer in the Department of Nursing at the University of Bisha, Saudi Arabia. He had a PhD in Nursing from Michigan State University’s College of Nursing (CON). He is a dedicated researcher specializing in studying coping strategies of heart failure patients. With extensive experience as a research project manager and assistant, he has collaborated with esteemed faculty members and authored several manuscripts and abstracts. His involvement in various academic and leadership roles, such as being the PhD student representative and president of the Doctoral Nurses Association (DNA) at Michigan State University, showcases his commitment to advancing science and fostering productive engagement among doctoral students.

Kristine J. Ajrouch, PhD is Professor of Sociology at Eastern Michigan University, and Adjunct Research Professor at the Institute for Social Research at the University of Michigan where she co-directs the Michigan Center for Contextual Factors in Alzheimer’s Disease (MCCFAD). Her research has focused, for over twenty years, on Middle Eastern/Arab American populations (MENA) beginning with ethnic identity formation among adolescent children of immigrants followed by the study of social relations, aging and health. Dr. Ajrouch’s current work addresses social aspects of Alzheimer’s disease (AD) where she is leading efforts to establish prevalence levels of AD among MENA older adults as well as adapt an AD caregiver intervention program to meet the needs of MENA families.

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