Table 1 was set up based on the sociodemographic questionnaire responses for better visualization and characterization of the participants. There was no significant difference regarding the variable “gender” among the patients. However, in relation to the variable “gender” of the accompanying family member, there was a predominance of women.

Regarding the patients’ sociodemographic data, all participants had some comorbidity. The data demonstrate that there was a predominance of patients vaccinated with at least one dose of the COVID-19 vaccine. Regarding the hospitalization unit, most patients at the time of the interviews were in a private room or ward, that is, from the moment of hospitalization they remained or progressed from the ICU to this type of accommodation. Considering that data collection occurred at a time when vaccines had already been made available, and that most of the older adults had already received 1 to 2 doses, it is possible that the variable “vaccine” had some influence on the variable “Profile of Hospitalization Units”, since one of the purposes of the vaccine is to prevent the worsening of the disease.

In order to extract data that would allow us to understand how social and hospital isolation that were adopted by hospital institutions for virus mitigation/protection, affected the mental health of older adults hospitalized with this disease, a general corpus was generated consisting of 489 Text Segments (TS), with 373 TSs (76.28%) being used. A total of 16,925 occurrences (words, forms or vocabulary) emerged, with 5,510 distinct words and 1,350 words with a single occurrence.

The content reviewed was categorized into four classes (Figure 1). Class 01: The diagnosis of COVID-19 and the fear of the unknown, with 115 TS (30.83%); Class 02: The treatment trajectory, with 102 TS (27.35%); Class 03: Hospital dynamics and older adults, with 100 TS (26.81%); Class 04: The implications of loneliness and hospital isolation for older adults, with 56 ST (15.01%).

For better visualization, a diagram was developed with the list of words from each class generated from the chi-square test (χ²). The evocations that presented similar vocabulary and vocabulary different from the other classes was displayed (Figure 2). The classes that emerged in the descending hierarchical classification are described, operationalized and exemplified below.

Class 01 – The diagnosis of Covid-19 and the fear of the unknown – involves 30.83% (f = 115 ST) of the total corpus analyzed. It is the class that is most distant from the others. It consists of words and radicals in the range between χ² = 5.75 (Vaccine) and χ² = 63.05 (COVID-19).

The discourses of this class take us back to the beginning of the pandemic. The content presents the way in which it changed the daily lives of these families. Significant changes are identified in the context of the home and in the family dynamics. Here, we see narratives that illustrate how the quarantine periods began and the adaptation to the new habits necessary for viral control.

The risk of contamination and the reconfigurations imposed by COVID-19 have imposed a stressful setting in the households. We can see how the requirements for social distancing, quarantine periods and adaptation to new routines were assimilated. In Class 01, the concept of environmental docility emerges as a perspective for understanding the negative implications of this period.

Concerns about physical and mental health were identified. Family members reported that they experienced constant fear of carrying the virus home and thus being responsible for infecting their loved ones, especially the older adults. The responses indicate the adoption of behaviors and practices to protect older adults. The statements express feelings that convey guilt, fear, anxiety and uncertainty.

In addition to the physical dimension, the COVID-19 pandemic has affected all areas of human life. Most intensely, Class 01 manifests the negative impact of detecting the first symptoms and the perplexity of a positive result for COVID-19. For older adults, a “positive for COVID-19” diagnosis is loaded with stigma, fear and uncertainty about the course of the disease. The content of this class indicates a mix of “incomprehension” and “hope” regarding the use and objectives of the vaccine.

Old age is a period of more frequent reflections on finitude and death, given the loss of loved ones and the recognition that the end of life is near. However, it is noted that the COVID-19 pandemic has made death even more tangible and obvious. Dying has become a possibility and a constant fear in the daily lives of older adults and their families.

Class 02 – The treatment trajectory – belongs to a different sub-axis from Classes 03 and 04, but with an intermediate proximity. It involves 27.35% (f = 102 ST) of the total corpus analyzed. It consists of words and radicals in the range between χ² = 3.63 (Hospital) and χ² = 32.38 (God).

Faced with the reality experienced during the COVID-19 pandemic, patients and their families go through a phase of intense emotional exhaustion. It is clear that feelings of failure, fear, anguish and suffering emerge throughout the illness. There is also a fear of complications in the patient’s prognosis.

The utterances indicate that patients and family members live in a constant state of alert. There is a concern about being constantly available, as changes in the patient’s clinical condition may occur at any time. Improvements in test results are monitored and celebrated on a daily basis.

It is clear that patients and family members seek to adapt to technical terms and data related to clinical exam results (pulmonary impairment, saturation and intubation). This is due to the need for better monitoring of the patient’s condition, as well as understanding the medical information provided.

The talk indicates the impact that a stressful environment has on the therapeutic process. Here, we can see the fear of the worsening of the disease and the dread of the need to be transferred to an ICU, and/or even the need for intubation, since, throughout the COVID-19 pandemic, intubation was seen as synonymous with “not coming back”. It is worth noting that, in hospital practice, this is one of the places with the greatest technological support for care. However, the perception of solitary death is amplified in the ICU, since COVID-19 has imposed greater restrictions and changes to this space.

It is clear that the accentuation of loneliness and longing for family become even more present in this environment. For family members, the desire for information about the patient’s clinical condition and the feeling of imminent loss cause anguish and suffering. It is noted that spirituality emerges as a coping mechanism for the illness process, since it allows a new perspective on losses and pain.

Another important point that emerges in this class concerns the humanization of health care. Family members report concerns about the way the healthcare team conducts the treatment. In addition to technical knowledge, the talks demonstrate the importance and weight of interpersonal relationships and how the social bonds established in the hospital space can give this environment a restorative aspect.

Class 03 – Hospital dynamics and older adults – covered 26.81% (f = 100 ST) of the total corpus analyzed. It consists of words and radicals in the range between χ² = 7.83 (Connect) and χ²= 23.17 (Speak). The concept of environmental docility and privacy occupy an important position in this class.

In this connection, the rupture with the home environment becomes more intense, and encourages the expression of complaints regarding the treatment process. The speeches demonstrate that in the scenario of COVID-19, in a more pronounced way, the hospital institution had to disregard the individual demands of its users. It is also clear that the need for social and hospital isolation led to feelings of insecurity and anxiety.

We can see that patients and their families have difficulty adjusting to the hospital dynamics and flows. The context of COVID-19 has imposed greater rigidity on the routines of this environment, a factor that further accentuates the decline in older adults’ skills, as well as the manifestation of psychological distress. Patients in the ICU present agitation, anxiety and discomfort.

Family members report that the means of communication and the time allocated by the hospital (health professionals) to provide daily updates on the patient’s clinical condition are unsatisfactory. The resources employed by the institution are perceived as limited, inhumane and insufficient to meet the need for information. The suspension of older adults’ right to have a companion at bedside is perceived as something aversive and triggers feelings of loneliness and helplessness.

Regarding hospital rules, patients and family members perceive themselves as passive figures in relation to the treatment procedures. The institution is the one that controls access and schedules. Confinement and the loss of privacy lead to increased environmental stress and, consequently, the manifestation of problems related to mental health.

Class 04 – The implications of loneliness and hospital isolation for older adults – is the closest to Class 03, involving 15.00% (f = 56 ST) of the total corpus analyzed. It consists of words and radicals in the range between χ² = 3.88 (Weakened) and χ² = 33.67 (Alone).

The accentuation of loneliness described in this category corroborates the traumatic aspect of family separation. Concerns about mental health and signs of psychological distress return with greater intensity as a result of the breakdown of social ties. The content of this class demonstrates that sadness and anxiety, resulting from social and hospital isolation, have become predominant in the daily lives of hospitalized elderly patients.

The statements indicate that being hospitalized for treatment of COVID-19 is different from being hospitalized for treatment of other pathologies. The accentuation of loneliness is perceived as an aggravating factor for the therapeutic process of older adults. Once again, there are indications that isolation promotes a disruption in the daily routine of patients and family members, and triggers stressful situations. The negative impacts resulting from health measures produce questions regarding the effectiveness of the treatment.

The increased rigor of flows and dynamics in areas designated for the treatment of COVID-19 has fostered negative feelings towards the hospital setting. It is observed that confinement in the ICU increases episodes of spatial and temporal disorientation. Another important point that emerges again in this class is the perceived imbalance between the demands of older adults and the social isolation resulting from hospitalization.

It is clear that hospitalization for COVID-19 treatment is full of pain and loneliness. For older adults, the losses experienced are immense, since patients are isolated from their family, they lose their autonomy, and experience the hospitalization process with stress, sadness, anxiety and suffering.

In general, interpersonal relationships, uncertainty about the future, and environmental quality are related to stress levels, whether as promoters or reducers. The evocations of Class 01 (The diagnosis of COVID-19 and fear of the unknown) portray how the Covid-19 pandemic has changed the daily lives of families.

Significant changes in daily routines and the social aspect of the home are evident (Ferreira et al., 2020; Ferreira et al., 2021). The home has come to group together public aspects of life, not just private ones (Castro et al., 2021). Excessive care with the maintenance of sanitary measures and the changes imposed increase the manifestation of stressful aspects of the residential environment, and are perceived as factors that trigger anxiety (Ferreira et al., 2021).

This class highlights concerns about the burden of age and fear of complications due to comorbidities (Bessa et al., 2023). A positive diagnosis for COVID-19 produced high levels of psychological distress (Bessa et al., 2023). Being “old” during the COVID-19 pandemic fueled stereotypes and social behaviors of overprotection, which camouflage ageist discourses and attitudes (Canali & Scortegagna, 2021).

It is clear that the need to protect the older adults, within the context of uncertainty, intensified the discrepancy between the skills of the elderly and the demands of the environment (Günther, 2022). Characteristics such as the loss of control over oneself and one’s routines became even more explicit in the COVID-19 scenario. The physical and psychological harm perceived in this scenario corroborates the harmful effects of environmental stress (Altman, 1976; Günther, 2022).

Environmental Psychology enhances the concept that every environment can cause emotions, and that, through our actions, new meanings and affections can be inserted into the environment (Ferreira et al., 2020). Therefore, in order to minimize harm to older adults, whether in a pandemic scenario or not, we ought to make adjustments to the home space that allow the maintenance of some level of autonomy. It is understood that docile and restorative environments favor the well-being of the older adult, and the positive connection to the location (Günther & Elali, 2018).

In the evocations of Class 02 (Treatment trajectory), feelings of vulnerability and helplessness caused by the illness arise. The COVID-19 pandemic highlighted the high degree of fragility of older adults (Bessa et al., 2023). The disease appears unexpectedly and imposes countless losses. The family needs to adapt to a new reality, which leads to emotional imbalance and an immediate feeling of helplessness (Ferreira et al., 2021).

The feelings of uncertainty and fear that arise when faced with a COVID-19 diagnosis make the process of care and well-being of older adults even more difficult, and interfere with stress levels (Giron et al., 2024). Reports also suggest that any indication of the need for hospitalization, especially in an ICU, is seen as distressing and causing psychological distress (Barbosa et al., 2021; Shumaker & Reizenstein, 1982).

People with the most debilitated health conditions and the most serious conditions are taken to the ICU (Costa et al., 2020). During the COVID-19 pandemic, this environment has become one of the most feared places for patients and their families, and this space has been given a status equivalent to a “death sentence”. It is potentially a stressful environment (Barbosa et al., 2021).

The ICU is also one of the places that will cause most a decline in autonomy and privacy of patients especially of older adults (Felippe & Silveira, 2019). Since these are aspects that are fundamental to the health and well-being of older adults, it is essential that adjustments be made to give older adults some level of personal control (Figueiredo, 2005).

The discourses indicate that spirituality and the use of faith promote adaptation and well-being, and function as a positive strategy in coping with the process of illness and the need for hospitalization. It was observed that to resort to a religion or belief minimizes loneliness and fear, and facilitates the care procedures and the reduction of stress (Barbosa et al., 2021; Bassani, 2020).

Furthermore, Environmental Psychology reinforces that maintaining positive social relationships during hospitalizations serves as support for older adults since they promote the humanization of care and help patients cope during periods of crisis. Impaired patient attachment to the care setting hinders adherence to treatment and jeopardizes the establishment of connections with health professionals (Felippe & Silveira, 2019; Gressler & Günther, 2013).

Therefore, interventions that enable the humanization of the therapeutic process and the strengthening of bonds are essential for the prevention of psychological problems, especially in critical scenarios, such as the COVID-19 pandemic. Humanized care connects closely with the aspects that make up gentle and restorative environments. Therefore, enhancing the relationships between patients, families and healthcare teams favors the construction of strategies aimed at promoting health, care and psychosocial rehabilitation (Campos-de-Carvalho et al., 2017; Canali & Scortegagna, 2021).

The evocations of Class 03 (Hospital dynamics and older adults) show that the norms and routines of hospitalization awaken in patients and family members the feeling of loss of freedom, as well as the reduction of privacy and autonomy. The insecurities perceived in this context are related to the difficulty in adapting to the sanitary measures of social and hospital isolation imposed to mitigate viral contamination; to the obstacles in adapting to the routines and schedules established by the institution.

It is understood that the hospital physical space bears an impact on the therapeutic treatment of the patient, and that environmental quality directly affects the process of treatment adherence (Figueiredo, 2005). Regardless of COVID-19, the hospitalization process is already indicative of an event that triggers stress and insecurity in any age group (Paris et al., 2021; Shumaker & Reizenstein, 1982).

In connection with COVID-19, the hospital has become even more depersonalized and depleted of identity figures, and consequently favored the increase in stress levels and oppositional behaviors (Felippe & Silveira, 2019; Paris et al., 2021). Barriers in the hospital environment, whether physical or emotional, tend to cause greater cognitive and physiological losses in the elderly (Albuquerque & Günther, 2019; Figueiredo, 2005).

It is understood that the subtraction of the right to privacy can lead to a series of negative consequences, such as increased stress, reduced sense of control over the environment, decreased satisfaction with life and impairments in the older adult cognitive performance. It can also negatively affect social interactions and the sense of personal identity (Altman, 1976; Cavalcante & Pinheiro, 2018).

It is understood that the effects of hospital dynamics, together with the fragility imposed by disease and aging, are integral parts of the health-disease relationship (Costa et al., 2020). Patients hospitalized in the ICU and their families experience daily the fear of the patient undergoing invasive procedures and complications in his/her clinical condition. Furthermore, the fear of a lonely death increases (Canali & Scortegagna, 2021).

It is therefore necessary for older adults to have a greater level of control over the environment and over the management of their needs (Albuquerque & Günther, 2019; Altman, 1976). It is worth noting that, in this connection, environmental docility enables greater balance in human-environmental relations and less damage to the physical and mental health of older adults (Paris et al., 2021).

The evocations of Class 04 (The implications of loneliness and hospital isolation for older adults) demonstrate that the accentuation of loneliness increases the likelihood of the patient’s mental illness and the worsening of his/her clinical conditions. Once again, the concept of a stressful environment emerges to better understand the harm caused by isolation and loneliness (Gressler & Günther, 2013).

For older patients, the process of hospitalization implies separation from their home environment and family members (Felippe & Silveira, 2019). Hospital isolation, associated with factors such as social isolation and bed rest, give the environment a stressful aspect. As a result, disorientation and suffering are observed (Bessa et al., 2023).

It is understood that, in order to control infection levels and protect life, issues related to mental health, especially for the most vulnerable groups, such as older adults, had to be put on the back burner (Barbosa et al., 2021). However, it is worth noting that interpersonal relationships and maintaining some level of personal control are aspects that enable a better quality of life and healthy aging (Gressler & Günther, 2013; Günther, 2022).

Strengthening and maintaining social ties are fundamental in the dynamics of hospitalization in old age. For older adults, family relationships and emotional bonds become fundamental in the therapeutic process, and prevent feelings of loneliness and abandonment during hospitalization (Canali & Scortegagna, 2021).

Reducing loneliness and building meaning considering social and hospital isolation facilitate adherence to the proposed treatment and positive environmental adaptation (Giron et al., 2024; Lawton & Nahemow, 1973). Therefore, a closer look at how human-environmental relationships occurred in hospital institutions during the pandemic period allows us to better understand the health and disease processes of older adults (Günther & Elali, 2018).

Furthermore, the incorporation of restorative aspects into the hospital, such as green areas, works of art and affective decoration (personal objects) makes it possible to reduce environmental stressors, and consequently reduce stress levels, psychological problems and improve adherence to treatment (Alves, 2017; Gressler & Günther, 2013).

In general, it is clear that the environmental quality of the hospital institution and interpersonal relationships are related to stress levels, either as promoters or reducers. It is understood that social and hospital isolation, adopted for virus mitigation/protection, affected the mental health of older adults.

It was found that the loss of autonomy and privacy of older adults in the hospital environment promoted physical and cognitive losses. The relevance of social bonds and family support for the quality of the care procedures was also observed. It is concluded that the concepts of Environmental Psychology and the deepening of human-environmental relationships can help in the establishment of therapeutic models that favor the care of older adults in situations of social and hospital isolation.

We should point out that limitations arose during the course of this investigation. The first limitation concerns the sample and its characteristics, since it primarily involved participants from the private health network and from the Northeastern region. Therefore, results cannot be considered representative of the Brazilian population. In addition, many elderly individuals had cognitive and speech impairments, and were therefore unable to participate in the interviews. Consequently, the inclusion of family members made it possible to reduce this barrier and provide a closer understanding of the phenomenon.

Another important factor concerns the use of narrative interviews, which, despite being a rich instrument for data collection, allow participants to have the freedom to record and organize their experience in a broader way, going beyond the theme of the person-environment relationship.

Furthermore, this work does not end here, but serves as a starting point and an encouragement for health professionals, specialists and managers to collaborate in the discussion, research and development of effective models for the comprehensive care of the elderly population in view of the need for social and hospital isolation. Therefore, it is suggested that research be expanded to enable a more in-depth assessment of human-environmental impacts and a more comprehensive understanding of the challenges faced by this population.