A Phenomenological Study of Nursing Home Residents’ Experience During the COVID-19 Pandemic: Lessons Learned

Abstract

Background:

The COVID-19 pandemic has inflicted widespread fear and distress on older populations globally. As highlighted by the World Health Organization, those residing in nursing homes are especially at risk due to the communal living arrangements and the high prevalence of chronic health conditions among residents. Because of the increased vulnerability of nursing home residents, harsher restrictive measures, such as social isolation, were implemented as part of infection control strategies, with a particular emphasis on reducing mortality rates and limiting the spread of disease. As a result of social isolation, older residents experienced feelings of loneliness that have been shown to be associated with many deleterious physical and mental health consequences. Despite the abundance of literature about the COVID-19 pandemic, little is known about how older residents themselves experienced this crisis. This phenomenological study explored the lived experiences of nursing home residents during the COVID-19 pandemic to uncover lessons for future care and preparedness.

Aim:

This study aims to explore the impact of COVID-19 restrictions on the lives of nursing home residents, with particular emphasis on their perceptions of how social isolation has influenced their overall well-being. Additionally, it seeks to uncover key lessons learned from the pandemic experience.

Design:

Descriptive phenomenological research methodology.

Methods:

Semi-structured in-depth interviews were conducted with 14 older residents. Data were analyzed using thematic analysis following a general inductive approach.

Results:

Four themes emerged from analysis of data: Embedding resilience, decreased connectedness with loved ones, using spiritual and religious practices, and reminiscing on their past experiences.

Implications:

This study offers new qualitative insights into how older adults have managed and adapted during the COVID-19 pandemic highlighting the importance of centering residents’ voices in long-term care policies and emphasizing the need for holistic, person-centered approaches in times of crisis. Lessons learned from this study can inform more compassionate and responsive practices in nursing homes during future public health emergencies.

The findings also lay the foundation for developing evidence-based interventions aimed at enhancing positive coping mechanisms and resilience among older residents and informing clinical intervention measures tailored for this population.

Reporting Method:

Two standards were followed for reporting this study: Standards for Reporting Qualitative Research (SRQR) and Consolidated Criteria for Reporting Qualitative Research (COREQ).

Introduction

Older adults residing in nursing homes represent a highly vulnerable population, largely due to the congregate living arrangements and the elevated prevalence of chronic comorbidities within these settings.^1,2 Epidemiological evidence has consistently demonstrated the heightened susceptibility of long-term care facilities to respiratory disease outbreaks, including COVID-19, ³ with estimates suggesting that between 19% and 72% of pandemic-related fatalities occurred in these institutions. ⁴ This heightened vulnerability not only increased residents’ risk of adverse health outcomes but also necessitated the adoption of stringent infection-control measures, including prolonged periods of social isolation. This study investigated older adults’ experiences during the pandemic and analyzed the impact of protective protocols—particularly isolation—on their quality of life and psychological health and identified lessons for future emergency care planning.

Background and Motivation

Nursing homes were among the hardest-hit settings during the rise of the COVID-19 pandemic, accounting for 40% to 80% of related deaths. ⁵ The highest fatality rates occurred in residents aged 85 years and older, followed by those residents aged 65 to 84 years. ⁶ This vulnerability is due to older adults’ advanced age, existing health conditions, and the close-contact environments of nursing homes, which facilitate the spread of infection and increase mortality risk. The close interaction between people in nursing homes increases the risk of death. ⁷

Multiple safety measures were adopted to mitigate the spread of COVID-19 among older adults in Lebanese nursing homes, with social isolation emerging as a particularly prominent intervention. ⁸ While early containment strategies demonstrated initial effectiveness, their sustainability was undermined by the fragility of Lebanon’s healthcare system. ⁹ The Lebanese government’s longstanding neglect in establishing a safe and effective long-term care infrastructure, ¹⁰ lack of formal disaster preparedness guidelines and gaps in crisis preparedness and coordination ¹¹ was illuminated by the pandemic. As a result, older residents faced intensifying loneliness, defined by Walton et al ¹² as a mismatch between desired and actual social interactions. Simard and Volicer ¹³ described isolation as limited relationships or infrequent contact, which correlates with poor mental and physical health,^14,15 isolation is further linked to serious illness,^16,17 increased mortality risk,^18,19 and heightened dementia risk among older adults. ²⁰

At the start of the pandemic, therapeutic activities in nursing homes were suspended, and family visits prohibited, disrupting residents’ emotional and social support systems. ²¹ Nonessential activities like entertainment, communal dining, and certain services were also suspended to reduce infection risk. While these measures helped protect physical health, they caused unintended harm—loneliness, physical decline, anxiety, and depression due to prolonged separation. Social isolation is a major risk factor for morbidity, mortality, ¹⁴ and diminished quality of life. ²² For residents with cognitive impairment, isolation deepened disengagement and emotional suffering. ²³ Studies from the US and Canada show increases in depression and cognitive decline during this period.^24,25 Some facilities eased these effects with virtual visits, ²⁶ but in others, no-contact policies intensified loneliness. ¹³ Isolation is linked to high blood pressure, cognitive deterioration, ²⁷ and weakened immune responses. ²⁸ It also hindered healthy behaviors, limiting exercise and nutrition, which raise risks of falls and conditions like reduced heart and lung capacity. ²⁹ The CDC reports that social isolation significantly raises the likelihood of premature death. Guarnera et al ³⁰ connect it to a 50% higher dementia risk, while Xia and Li ³¹ cite elevated risks for heart disease (29%) and stroke (32%). These effects further amplify vulnerability to vascular and neurological diseases. ³²

Beyond the physical threat of illness, the restrictive measures imposed also pose emotional and psychological risks. In Lebanon, social isolation has been shown to be the most significant predictor of developing mental disorders. ³³ Mental health professionals reported reduced access to psychiatric care for older adults due to fear of infection and digital exclusion. ²¹ This multitude of factors created the perfect medium for psychological stress and its debilitating effects on quality of life. The hashtag #BoomerRemover, popular among younger social media users, reflected and reinforced ageist attitudes, widening the generational divide. ³⁴ Media coverage that downplayed the virus’s threat to younger people further fueled ageism. ³⁵ These perceptions worsened older adults’ mental health, making it clear that addressing loneliness is just as crucial as meeting physical care needs. ³⁶ In Lebanon, social isolation has been shown to be the most significant predictor of developing mental disorders. ³³ This negative impact on the well-being of older adults is also attributed to other aspects of the pandemic; sources of stress such as general changes to everyday life, uncertainty about the future, and of course the risk of serious illness or death also play a major role. ³⁷ Similar restrictions in the United Kingdom (UK) limited personal autonomy and heightened emotional distress among the residents. ³⁸

Significance of the Study

While there is some existing literature, on COVID-19’s mental health impact on older adults in Lebanon, ²¹ no study has examined how social isolation affected nursing home residents’ well-being and psycho-behavioral responses. Prior research in Lebanon and the Middle East focused on healthcare system strain, economic/security implications,^{9,11,39 -42} and the mental health of healthcare workers. ⁴³ This qualitative investigation fills a vital gap by identifying the organizational, structural, and care-related changes made during the pandemic, assessing their rationale and impact. Understanding older residents’ experiences during quarantine is key to developing best practices that reduce isolation and avert future failures. Liotta et al ⁴⁴ stress that fostering social connectedness helps mitigate loneliness and distress. Nursing homes must balance safety with compassionate, human-centered care. Unlike quantitative models, which often miss essential social aspects, this study reveals the lived reality of residents during public health crises.^2,45 These insights deepen our understanding of how older individuals navigate collective trauma. Our findings uncover diverse perspectives, meanings, and coping strategies among older residents in Lebanon, highlighting notable psychosocial resilience throughout the pandemic.^2,46

Research Question

How do nursing home residents describe and make meaning of their lived experiences during the COVID-19 pandemic, and what lessons can be drawn from these experiences?

Research Aim

The central objective of this phenomenological study was to examine the lived experiences of older adults residing in nursing homes throughout the COVID-19 pandemic, with a particular focus on their perceptions of how social isolation influenced their overall sense of well-being and to identify lessons learned to avert tragedies like this in the future.

Research Objectives

The objectives of the research are:

1. To explore the experiences of nursing home residents during the COVID-19 pandemic and to give insight into the residents’ perceptions and attitudes toward the measures that were put in place.

2. To enrich the evidence base and draw lessons that inform strategies and best practices for mitigating the effects of social isolation in future pandemics.

3. It also aims to guide caregivers and policy makers in preparing for post-pandemic care and to encourage policy changes that go beyond basic legal requirements. ⁴⁷

Methods of Inquiry and Analysis/Materials and Methods

For reporting this qualitative study, 2 standards were followed: Standards for Reporting Qualitative Research (SRQR), ⁴⁸ Consolidated Criteria for Reporting Qualitative Research (COREQ). ⁴⁹ The authors used the COREQ checklist to ensure depth in reporting interviews. They also used the SRQR to ensure general standards for qualitative rigor are met. This option enhanced both the transparency and the quality of the research work.

Type of Study

This study employed qualitative phenomenological research methodology to examine the lived experiences of the older residents as it appeared to consciousness and to describe the meaning of their experience—both in terms of what was experienced and how it was experienced.

The epistemological underpinnings of a phenomenological study are rooted in the idea that knowledge is subjective and constructed through lived experience and conscious awareness, rather than being an objective, universal truth. ⁵⁰ Key concepts included intentionality, where consciousness is always something. ⁵¹ Recognizing that understanding is mediated by the individual’s perspective, the goal was “clearing the mind” of pre-conceived notions to gain an unclouded understanding of the participant’s experience. This approach focused on how individuals experienced and made meaning of phenomena, making their lived experiences the foundation of knowledge. The methodological principles that the researchers were guided by included emphasizing openness, questioning pre-understanding, and adopting a reflective attitude. ⁵² To reduce the risk of phenomenological bias, the authors used reflexive writing—such as memos and field notes—to acknowledge personal perspectives and assumptions throughout the research process. These techniques captured key interpersonal dynamics affecting participants and their data. ⁵³ To achieve transcendental subjectivity, the impact of the researcher on the inquiry was constantly assessed and biases and preconceptions neutralized, so that they did not influence the object of study. ⁵⁴ Another reflexivity strategy used was centered on collaboration between the 2 authors. Because assumptions become most evident when viewed from the point of view of others who do not share them, diversity of perspectives can be quite beneficial for reflexivity. ⁵⁴

Sample and Setting

The participant sample was recruited by the researcher from 2 nursing homes in Lebanon (nursing home A and nursing home B). Permission to conduct the study first obtained from the Institutional Review Board of the academic institution, and the administrators of the nursing homes, after which a facility liaison (a social worker and the nursing director) was appointed by the administrators to serve as an access point to the residents in the nursing home. A meeting was then arranged with each of the nursing unit managers during which the researcher asked for assistance with some practical issues such as the best days and times to interview the residents. After setting the time frames with the nursing managers, the researcher made herself available during these days and times for possible interviews. Conducting an interview was always left to the discretion of the residents.

Selection of individuals to be approached for study participation was made in consultation with key stakeholders, including the attending geriatrician, the family caregiver, the nurse manager, and the researcher’s independent assessment. Inclusion criteria for resident participants required individuals to: (1) be aged 65 years or older; (2) be in permanent residence; (3) possessing verbal communication abilities; (4) demonstrating willingness and capacity to provide informed consent; and (5) being cognitively intact. Accordingly, residents with significant mental or physical impairments were excluded, such as those with dementia, individuals with terminal illnesses (eg, late-stage cancer), or those with severe disabling conditions (eg, major stroke) whose care focused primarily on palliative interventions. Cognitively intact was defined as having a Clinical Dementia Rating (CDR) score ≤0.5.33. ⁵⁵ Data saturation was reached after interviewing 14 residents.

Data Collection

A comprehensive literature search was conducted by 2 authors, and the insights gained from this review informed the development of a semi-structured interview guide used for data collection. ⁵⁶ The process of developing the interview guide involved the following considerations: Researcher’s own experience but with some important considerations, including open-ended and non-leading questions, allowing participants to describe their own lived experience rather than fitting into the researcher’s assumptions, grounding the questions in the research purpose. During the data collection process, the researcher witnessed coping strategies (virtual calls), so, included questions about connection and coping in subsequent interviews.

Interviews began with broad questions, then the researcher moved into questions that helped uncover the deeper, subjective layers of lived experience: feelings, values, and personal interpretations. During the entire interview period the researcher used prompts and probes to help deepen the discussion.

Due to visitation restrictions, gaining access to the nursing home was highly challenging. Therefore, the interview guide was piloted with a colleague, and the wordings were adjusted to make the questions easy to understand. Baseline demographic data, including age and gender, were collected. The interviews were conducted in a comfortable setting in a private location. The researcher explained the study’s purpose, procedures, and confidentiality to the participants. To establish trust and security the researcher maintained appropriate eye contact to show presence and connection, gave full attention, responded appropriately, and used verbal cues like “mm-hmm” to show engagement in the conversation. Other strategies like nodding, smiling, offering brief affirmations validating their contributions and showing that their input was valued also contributed to the establishment of trust and security.

The primary data collection method involved semi-structured in-depth interviews, beginning with: “Could you please tell me how your life has changed since the coronavirus restrictions?” Open-ended probes were employed where appropriate, encouraging participants to elaborate and share personal anecdotes. The interview questions targeted participants lived experiences, emotions, beliefs, and personal convictions. Key questions addressed their daily life before Covid-19 restrictions were imposed and afterward, such as how often they had visitors, left their nursing home for routine activities, went outside to enjoy fresh air, where they ate their meals, and other indicators of daily changes. After establishing trust and ensuring confidentiality, participants were invited to narrate their experiences in their own words with the researcher adopting an empathetic stance, listening deeply without judgment. Participants were viewed as experts of their own experiences. The relationship was conversational rather than interrogative. The research sought to elicit perspectives and insights that may be distinctive to Lebanese cultural contexts. Employing the process of bracketing, the researchers set aside their own subjectivity to focus solely on the internal realities of the participants. This approach enabled the interviewer to grasp the world from the residents’ perspective, illuminating the meaning of phenomena as directly experienced by them. Researchers maintained reflexive distance, ensuring that their interpretations did not interfere with the authenticity of participants’ narratives. These qualitative interviews provided profound insight into residents’ experiences during pandemic-induced lockdowns—capturing their reflections on isolation protocols, adjustment strategies, stories of resilience, emotional responses to public health regulations, sources of distress, and coping mechanisms. They also discussed the overall impact on their well-being, current health status, and behavioral changes linked to social distancing. Individual interviews were conducted in Arabic and audio recorded in a private room within the nursing home. On every visit to the nursing home the interviewer obtained permission from the nursing home director to conduct in-person interviews, contingent on presenting a negative PCR test. The interviews ranged between 30 and 60 min at most.

Data Analysis

Audio-recorded interviews were transcribed and translated into English. Each transcript was first read with an open mind, then examined line by line. Holistic reading helped identify key statements reflecting participants’ experiences, allowing the researcher to engage deeply with the data and uncover underlying meanings. Relevant passages aligned with the study’s aim were noted during this process.

To ensure the reliability of qualitative coding, an initial codebook was developed inductively from a subset of transcripts and informed by the study’s research aims. To assess consistency, 20% of the transcripts were double coded independently by 2 members of the research team using the preliminary codebook. Differences in coding were reviewed in joint meetings, during which definitions were clarified and, where necessary, new codes were created. This iterative process continued until consensus was reached on code definitions and application. Remaining 80% of data was coded independently. Random spot-checking was conducted during the final phase to ensure consistency. As the analysis progressed, meanings related to each other were compared to identify differences and similarities. Then the researcher reduced the data to meaning units, re-read those reductions, engaged in thematic clustering, compared the data, and wrote descriptions. Lastly, the researcher organized themes into a meaningful wholeness. ⁵² Data analysis was an ongoing process of continually engaging with the data, identification of meanings, organizing these into patterns, and writing reflections and summaries until the researcher could describe the essence of the lived experience. ⁵⁷ The researcher used imaginative variation to create structural (the how) description, combining these descriptions to form the essence of the phenomenon. ⁵⁸

To provide transparency and a transparent record of how the research was conducted, an audit trail was maintained to document coding decisions and revisions, peer debriefing was conducted with colleagues to test for bias. To Enhance credibility of the study and in keeping with the phenomenological approach, the researchers engaged in bracketing to set aside preconceptions, remained attentive to the participants lived experiences, and suspended judgment safeguarding the authenticity of the emerging themes. The researchers also implemented self-reflection by keeping reflexive journals and memos to note their assumptions and monitor how their perspectives might influence interpretation. Bracketing helped researchers minimize bias and remain as open as possible to participants lived reality. It increased the trustworthiness and rigor of the study, ensuring findings are grounded in participants lived experiences rather than the researcher’s expectations. The themes identified were not taken back to the participants for confirmation due to visitation restrictions. However, at the end of each interview key points were summarized and participants were asked to clarify or correct their views.

Ethical Approval

The study received ethical approval from the ethics committee of the institution. Special attention was given to the choice of time and place to conduct the interviews whereby the participants were willing and felt comfortable at the nursing home. They were given sufficient time to read the consent form, ask questions, and sign the form prior to the start of the interview. They were informed that by participating in this study they will be contributing to science and the well-being of the older population residing in nursing homes in Lebanon. Participants were informed of the voluntary nature of participation so that they could withdraw from the study at any time without having the care delivered to them affected. Those who agreed to participate were asked to sign a consent form and were assured of strict confidentiality. Data were anonymized due to the adoption of a code to identify each participant, and pseudonyms were used for qualitative quotes. The researcher took all the steps necessary to maintain confidentiality and anonymity, such as keeping all transcripts and other data files locked and separated from personal identifiers. No personal identifiers were used for either the participants or the researcher on data collection forms or audio taping. All tapes were kept with the PI in a locked cabinet and will be destroyed after 3 years of study completion. Residents could refuse to participate without loss of benefits to which they are entitled, and this would not affect their relationship with the institution. It was made clear that the interviewer or the participant could discontinue the interview whenever the participant wishes, or the interviewer deems it necessary due to their discomfort, fatigue, or distress. Participants were also given the freedom to stop the tape at any time. All interviews were conducted in a private room in the nursing home and the PI made sure that the staff are not around while conducting interviews to avoid any sensitivity to the participants so they will be able to share their experiences freely without any discomfort.

Results

Data saturation was reached after 14 interviews where researchers realized that additional interviews or observations did not generate new categories or patterns. The data collected were rich enough to answer the research question thoroughly and results were grounded in sufficient data. Nursing Home Residents’ Demographics are presented in Table 1. Four main themes with subthemes captured the impact of COVID-19-related social isolation on older residents’ well-being: embedding resilience, reduced connectedness with loved ones, reliance on spiritual and religious practices, and reminiscing about past experiences. These themes and subthemes provide contextual grounding regarding the experiences of older residents during social isolation because of COVID-19. The findings associated with each of these categories are presented below.

Table 1.

Nursing Home Residents’ Demographics.

Participant code	Nursing home	Gender	Age (years)	Marital status	Education	Previous occupation	Duration of the interview (min)
R1	A	F	>70	M	Illiterate	Housewife	50
R2	A	F	81	M	Illiterate	Housewife	40
R3	A	M	74	M	Elementary	Sells vegetables	60
R4	A	M	65	M	Elementary	Skilled laborer	40
R5	A	M	65	D	Elementary	Waiter	40
R6	A	M	66	D	Illiterate	Sells vegetables	40
R7	A	F	85	W	Illiterate	Housewife	55
R8	B	F	72	D	Illiterate	Housewife	50
R9	B	F	>80	S	Illiterate	Housewife	40
R10	B	F	75	M	Elementary	Housewife	40
R11	B	M	90	W	High School	High school teacher	50
R12	B	M	85	W	University	Pilot	60
R13	B	F	89	W	University	painter	60
R14	B	F	77	D	High school	Preschool teacher	50

Theme 1: Embedding Resilience

Subtheme 1.1: Developing Coping Mechanisms

Some older residents showed greater tolerance to the effects of isolation and managed periods of high stress by reminding themselves that the situation was temporary, practicing acceptance, and focusing on self-care. They also sought stimulation through developing new coping mechanisms such as engaging in activities like personal grooming, washing, drying, and sewing, and seeking emotional strength through acceptance and hope.

Considering current events as a temporary problem that will pass can help us develop a more stable perspective, regulate our emotions, and take time for self-care. When your body feels strong and healthy, so, too, will your mind.

(Interview B2)

Being isolated is helping to keep myself and others safe.

(Interview A4)

We can think about ways to stay hopeful and to continue with our lives within the limits of lockdown.

(Interview A7)

Participants agreed to wear masks, but they were interested to know more about the virus and the consequences it might have. They also had an interest in understanding infection-control measures and were curious about how wearing masks could keep the virus from infecting them.

The nurse explained why wearing masks was important. They distributed masks and demonstrated how to put them on correctly. We follow the guidelines by wearing masks and keeping our hands clean through regular washing.

(Interview A8)

Others stated that they turned to hobbies to stay distracted and motivated—such as knitting, weaving, cooking, or reaching out to family and friends.

When available, older residents made use of online technologies—such as messaging platforms and video calls—to maintain connections with relatives and friends. Expressing a need for emotional closeness and continuity, 1 participant shared:

I call my sister to find out about her, and we make those video calls.

(Interview B5)

Participants were fulfilled by the medical and nursing care provided by the nursing homes such as necessary medical examinations and treatment.

I have diabetes, but I’m not too concerned about it. The nurses and doctors here are supportive—they might not have the same resources as those in major hospitals, but they’re still able to relieve my symptoms and help me feel better.

(Interview B2)

One of the residents was worried about her fellow residents with mild cognitive impairment.

I’ve noticed that those with memory challenges seem more withdrawn, especially

due to the face masks. The masks act as physical barriers—they prevent lip-reading, which is crucial for their understanding. This not only hinders communication but also introduces an added sense of separation.

(Interview A3)

Two residents reported encountering a range of biological symptoms, including confusion, and a decline in memory and thinking.

I’m not just anxious about the pandemic; I also struggle to remember important things. There are times when I feel confused and disoriented.

(Interview B3)

Subtheme 1.2: Seeking Emotional Strength Through Acceptance and Hope

Staff tried to instill trust and confidence and relieve the residents’ concerns. They tried to spare the residents the negative information and excessive watching of the news. Moreover, they showed affection through touch, a look, a smile, or an encouraging comment.

Sometimes I talk to a nurse who I trust, and I feel better. When we share what’s bothering us with someone, we will feel relieved and better understand the situation. Talking to a friend or family member makes me feel better.

(Interview A1)

Subtheme 1.3: Finding Comfort in Staff’s Reassurance

During the pandemic, staff played a pivotal role in fostering an optimistic atmosphere by consciously avoiding the overemphasis of risks, regulating residents’ exposure to distressing media, and ensuring access to accurate and reliable information. These actions significantly helped mitigate unnecessary worry and buffered the emotional impact of news containing traumatic content. The residents expressed sincere appreciation for the support they received from staff, noting how professionals made efforts to cultivate moments of ease and relaxation despite their own fatigue and demanding workloads.

They didn’t let the TV run all the time. They said it was too upsetting for us to watch the news. They’d just tell us what we needed to know, and that was enough. It made me feel safer, you know? and we didn’t have to worry so much.

(Interview A4)

Theme 2: Decreased Connectedness With Loved Ones

Subtheme 2.1: Emotional Distress Due to Limited Physical Contact

Many older residents experienced a profound sense of confinement and disconnection from the broader community, stemming from restrictions that prevented them from leaving the nursing home.

Not having the freedom to go out burdens me. I used to go for a walk every day, I feel like a prisoner in the house.

(Interview A10)

Residents expressed a deep sense of sadness and grief stemming from prolonged separation from their loved ones. They also expressed emotional distress due to limited physical contact with them.

I feel heartbroken being apart from my loved ones. It hurts not to be with my sister and niece, and I miss them deeply.

(Interview B16)

When asked about the worst thing about COVID restrictions, one of the residents responded:

Not being able to go to see my grandchildren, they are the keeper of my heart, my life does not have any meaning if I don’t see my grandchildren.

(Interview A7)

Many residents expressed concern not only about contracting the virus, but also about the overwhelming proximity of fellow residents. They were also worried about their family members catching the virus.

Yes, I’m worried because of this illness going around. My first concern is for my grandchildren—I fear they might catch it. Then I start worrying about myself and the rest of my family.

(Interview A11)

Residents who encountered barriers to using communication technologies—stemming from illiteracy, sensory impairments, or motor difficulties such as hand tremors—reported experiencing sadness, emotional overwhelm, and heightened anxiety. Apprehension regarding one’s own health and that of their beloved ones as well as immense unpredictability related to future circumstances, exacerbated negative emotions such as depression, anxiety, and indignation.

I wanted to see mt daughter, to hear her voice, but I didn’t have the means. I used to get intense feelings of sadness and concern. I kept thinking, ‘What if something happens to her? What if I get sick and no one knows?

(Interview B2)

They shared their frustration over the cancellation of regular enjoyable activities that had brought joy to residents through engagement with volunteers and students (eg, celebrating mothers’ day).

The volunteers no longer come by, so there are no enjoyable activities anymore. They used to bring us newspapers, but now they’re not permitted to enter.

(Interview B15)

An older resident who was confined to bed because of Multiple Sclerosis expressed her frustration:

I’m suffering and deeply unhappy. I no longer see the point of living so long, especially when I face the prospect of spending the rest of my days without my family. They’ve always been my support during difficult times. My health is already deteriorated, being half paralyzed—and with COVID-19, the future feels terrifying and uncertain. There’s nothing ahead that brings me any hope.

(Interview A11)

Due to their vulnerability to infection, some participants—especially those in quarantine—remained confined in their rooms all day, leading to reduced physical activity and frustration.

That burdens me, not having family and friends visit, not having a source of entertainment, not being able to move in the nursing home

(Interview B18)

Subtheme 2.2: Concern About End-of-Life Loneliness

Many older adults spend their final days in care homes, unable to receive visitors. They described experiencing anticipatory grief, marked by emotional distress stemming from the fear of dying alone—without the opportunity to bid farewell to cherished family and friends.

One resident shared her grief and trauma over a close friend—a fellow resident—dying alone. This was a very disturbing scenario for her which deeply troubled her. She was left feeling extremely bewildered and anxious.

They wouldn’t let me see her for the last time; I couldn’t say goodbye . . . “They wouldn’t let me see her for the last time; I couldn’t say goodbye . . . I had my heart broken”

(Interview B9)

It dawned on me that I could be dying here one day without having my children around me. That scared me a lot, you know?

(Interview B2)

Theme 3: Using Spiritual and Religious Practices

Subtheme 3.1: Finding Comfort in Prayer, Rituals, and Faith Traditions

Religion and prayer emerged during the interviews as coping mechanisms linked to solace and hope. Religious and spiritual beliefs helped them combat perceptions of helplessness. One of the residents commented.

Spirituality or religion helps you to deal with your difficulties and problems.

(Interview B13)

Participants emphasized the significance of religious beliefs in emotionally navigating the challenges of lockdown. For many, spiritual gratitude, particularly the belief that being spared illness was a divine blessing, provided comfort, strength, and a sense of emotional stability during an otherwise distressing time

When you genuinely place your trust in God and allow Him to guide you, you can confront any hardship life presents. I firmly believe His divine strength will lead me. I thank God—my faith is strong, and prayer brings me peace. I pray every single day. My Bible stays by my bedside; after dinner I head to bed, read Scripture, and pray before sleep. I pray often, and it brings me comfort.

(Interview A10)

Subtheme 3.2: Deepening Trust in Spiritual Protection

Through praying and other religious practices older residents were hoping to derive support from a divine being, making meaning of the distressing restrictive measures, which led to the promotion of resilience, healing, and well-being. They felt comfortable and calm, and more importantly, they felt heard—even when physically alone. Engaging in religious rituals deepened their trust in spiritual protection, fostered inner development and personal change, ultimately contributing to a feeling of overall wellness. ⁵⁹ For these participants, their relationship with God served as a source of support and strength, expressed through prayer.

Prayer is an important part of my life during lockdown; When I pray, I get a sense of well-being, a feeling of connectedness, and hope.

(Interview A3)

They missed going to Mass, with members of a religious congregation, spending time with God, and receiving his graces.

On Sundays and on holy days I used to participate in the Mass, I miss that so much

(Interview A7)

Muslim older residents (males) missed going to the mosque for congregational prayer held on Fridays.

Praying together as a community gives me the feeling of unity.

(Interview B2)

Participant residents who were physically inactive/sedentary because of being isolated in their rooms, had high levels of anxiety and appeared fretful. They also experienced confusion and decline in memory and thinking.

I excessively worry about my family and myself to the extent that I have trouble thinking about anything else. I cannot even concentrate to say my prayers and speak to God.

(Interview A2)

Theme 4: Reminiscing on Their Past Experiences

Subtheme 4.1: Drawing Strength From Past Challenges

Several participants highlighted the importance of maintaining ties with their earlier life to handle social isolation and loneliness. These ties pertained to memories of objects evoking memories of the past such as personal items that hold sentimental value, pictures of family and friends that they recognize, pieces of poetry, which show part of their lives that they have lived until now, meant a lot.

I read this poem many times a day as I liked to read it when I was younger

(Interview B5)

Another resident who had lost her husband recently said:

I Listen to an old song because my husband loved it

(Interview A5)

Another method to preserve memories from earlier life was talking to nursing home staff about their earlier life, telling them about their life story, about skills or interests they had (baking delicious cakes), remembering who they had in their lives, the people with whom they had an inner relationship.

Subtheme 4.2: Finding Joy and Meaning in Recalling Family and Community Memories

Many older residents wished to preserve what was previously the status quo. The past identity that had significance and richness.

I find comfort in reminiscing about past events and experiences. We’re not allowed to go out, so we’re disconnected from the present world—but the world I hold onto is the one I remember, the past. That’s where I find joy.

(Interview A4)

I feel more connected to my family, my loved ones; I crave to feel the positive emotions that I felt at the time; I feel connected to the version of myself I was at that time

(Interview A6)

By recalling and reflecting on significant individuals and experiences from their past, participants reconnected with people and objects that symbolized earlier chapters of their lives. This process cultivated a sense of personal history, reinforced life continuity, and supported identity formation—allowing them to remember who they once were and reassert who they are in the present moment (Figure 1).

Figure 1.

Discussion

The aim of this study was to explore nursing home residents lived experiences of social isolation during the COVID-19 restrictive measures and to shed light on its impact on their emotional, psychological, and social well-being. Although research on the impact of COVID-19-related isolation in nursing homes is growing, this study is, to our knowledge, the first in-depth qualitative exploration of how older adults in Lebanese nursing homes experienced the pandemic. The current findings identified 4 main areas helping the older residents handle the adversities of social isolation and loneliness: embedding resilience, decreased connectedness with loved ones, using spiritual and religious practices, and reminiscing on their past experiences.

Embedding Resilience

Participants described building resilience during the pandemic’s social restrictions by staying hopeful, viewing the situation as temporary, following preventive measures, and relying on staff support. This resilience was key to preserving their well-being and health. These results correspond with the theoretical framework introduced by Wrosch et al, ⁶⁰ referenced in Wu et al, ² which sheds light on how older adults can effectively manage and move past difficulties or obstacles they face. The model offers a framework for understanding how older adults maintain well-being amid challenges, highlighting adaptive processes that foster resilience in later life. Some participants demonstrated strong emotional regulation and problem-solving skills, presenting a counternarrative to the commonly negative portrayals of aging. Our findings are strongly consistent with the theoretical framework proposed by Wrosch et al. ⁶⁰ Older adults being resilient has also been reported by Gooding et al ⁶¹ The authors emphasize that older adults can steer clear of negative outcomes during challenges or crises by practicing adaptive self-regulation—a key factor in promoting well-being and enhancing life satisfaction and success^2,62 as was the case in our study. Self-regulation allowed them to be more resilient and stay calm under pressure. Moreover, Hofmann et al ⁶³ have found that self-regulation skills are tied to a range of positive health outcomes such as better resilience to stress, increased happiness, and better overall well-being.

The findings show that older residents generally accepted mask-wearing but expressed a need for more information about the virus and its potential health impact if infected. Similar observations were reported by Wu et al. ²

Experiencing confusion, cognitive impairment and memory decline by some of the residents suggest that factors beyond mere fear and despair may have contributed to the observed changes in their overall well-being. The presence of cognitive decline and other biological symptoms points to a more complex interplay of psychological, physiological, and possibly environmental factors influencing the health outcomes of older individuals. ¹¹ Understanding the interplay between these factors is key to developing interventions that address both mental and physical health in this population. These findings corroborate with the results of studies conducted by Corbett et al, ⁶⁴ Sepúlveda-Loyola et al. ⁶⁵

Decreased Connectedness With Loved Ones

Our study revealed how weakened social ties can adversely affect residents’ well-being, stemming from reduced contact with family and friends. These observations align with earlier research on nursing home populations during the COVID-19 pandemic.^2,66 A report by Jeffers et al, ⁶⁷ indicated heightened levels of loneliness and depression, along with marked deterioration in residents’ mood and behavioral patterns. Social isolation meant there were no trips, no meaningful activities, no volunteers to entertain them, no birthday parties, no going to Mass, no prayer in the mosque, leading to persistent emotional distress among residents, manifesting as frequent feelings of sadness, anxiety, depression, and restlessness. ⁶⁸

Participants expressed feelings of anticipatory grief, driven by weakened connections with loved ones due to social isolation. Many feared spending their final days without family nearby. This fear of being alone and uncertain about life without their loved ones led to intense anxiety and sorrow, likely stemming from isolation and limited social support. They also voiced concern about the risk of infection—for themselves, their families, and fellow residents. Older residents experiencing unrelenting sadness and sorrow had less access to digital communications attributed to different barriers to the use of technologies, such as computers, the Internet, inefficiency in the English language. These findings coincide with previous studies.^{68 -71} Ageism that became ingrained in the community in the earlier developmental stage of the outbreak because of the exposure to distressing news and media coverage contributed to heightened anxiety and depression among residents, particularly when confronted with narratives suggesting diminished societal concern for older adults and the limited availability of critical medical resources and the need to ration or limit resources in healthcare institutions. Similar results were reported by Peterson et al, ⁷² and Wu et al ² During social isolation, support from healthcare staff and fellow residents helped ease anxiety, fear, and depression. This sense of connection allowed residents to process a range of emotions and feel heard and protected. These findings align with

Chan et al, ²⁴ who highlighted the role of staff in offering support and maintaining close contact during isolation. Similarly, Vickery et al ³⁸ and Crespo-Martin et al ⁶⁸ asserted that social support acted as a protective factor against the detrimental effects of isolation on mental health. Their findings emphasized the value of sustained interpersonal connections, particularly close contact between residents, which significantly contributed to reducing depressive symptoms and bolstering mental resilience.

Social support—through phone or video calls with family lifted spirits and gave residents a sense of purpose. Similarly, Patterson and Margolis ⁷³ highlight that for older adults, the quality and strength of family relationships are just as crucial as their mere presence. This is clearly reflected in our findings, where residents who struggled with technology had limited family contact, leading to heightened feelings of loneliness. Schneider et al, ⁷⁴ and Dunn and Robinson-Lane, ⁵⁹ similarly emphasizes the pivotal role of close familial relationships in promoting psychological well-being among older adults.

Using Spiritual and Religious Practices

Our study revealed that spiritual coping fostered an inner connection with God, helping residents reframe hardship as manageable rather than devastating. Prayer and religious rituals promoted resilience, offering comfort, acceptance, and a sense of relief amid social isolation. Those with an active spiritual life often found greater solace during this time. These results corroborate with the results of a literature review conducted by Dunn and Robinson-Lane ⁵⁹ who stated that spiritual coping, when used to help deal with illnesses and/or stress, has been found to enhance physical, psychological, and social well-being among older adults across the globe. Similarly, McGowan et al ⁷⁵ concluded that older adults who reported higher levels of organized religiosity had low levels of depressive symptoms. In the context of aging and managing adversity, effective spiritual coping has been shown to reduce negative biological and psychological outcomes, including depression, anxiety, stress, confusion, and cognitive decline.^37,59,76

Reminiscing About Their Past Experiences

Reminiscing on past experiences brought residents a sense of peace and comfort, helping to ease pandemic-related fears—such as vulnerability to infection or the risk of spreading the virus. Their memories offered joy, reminded them of the richness of their lives, and provided continuity that helped counter fear and uncertainty during the pandemic. Our results lend support to the conclusions of Sales et al, ⁷⁷ who examined the effects of reminiscence therapy implementation in people with dementia and concluded that reminiscence therapy increased cognitive functions and quality of life and decreased depression symptoms in people living with dementia. Extreme feelings of loneliness and depression experienced by participants who had difficulty in embedding resilience were overcome by recollecting prior events, activities, and experiences. Reflecting on meaningful people, events, and past successes gave residents a sense of contentment and renewed confidence in their ability to overcome the current crisis. Our findings extend the evidence provided by Wong et al, ⁷⁸ Al-Ghafri et al, ⁷⁹ and Pinazo-Hernandis, ⁸⁰ who confirmed the effectiveness of life review and reminiscence in improving depression levels in older adults. Our results also substantiate the results of Yan et al, ⁸¹ who synthesized and described the research evidence and quality related to reminiscence interventions for older people through an evidence-mapping approach.

Study Rigor

The rigor of the study was ensured through multiple strategies that enhanced trustworthiness and credibility. Interviews were audio-recorded, transcribed, translated, and carefully analyzed using both holistic and line-by-line readings to identify key statements and underlying meanings. An inductively developed codebook guided the coding process, with 20% of transcripts double coded by 2 researchers to establish consistency, followed by consensus meetings and iterative refinement of codes. Thematic analysis involved clustering, comparison, and reduction to meaning units, supported by imaginative variation to capture both structural and essential aspects of the phenomenon. Transparency was maintained through an audit trail documenting coding decisions, while peer debriefing helped check for bias. Credibility was further strengthened by bracketing to set aside preconceptions, reflexive journaling to monitor researcher assumptions, and continual engagement with participants lived experiences. These measures collectively minimized bias and safeguarded authenticity, ensuring the findings were firmly grounded in participants’ realities.

Strengths and Limitations of the Study

One of the key strengths of this study is its commitment to emphasizing the voices of older residents, a population whose perspectives are frequently underrepresented in research. By capturing and analyzing their lived experiences, the study provides a nuanced understanding of their needs and priorities. This focus not only contributes to filling a critical gap in the literature but also supports the development of interventions and policies that are more responsive to the realities of this population.

The findings of this study may be limited by sample size and setting (2 nursing homes). The resident sample is comprised of the more able subpopulation of residents and is not representative of all individuals in the nursing home. The authors can only speculate about the residents who did not consent to participate. This should be explored further in future research. A greater focus on cognitively impaired residents should also be considered a priority given that they number such a significant proportion of residents in nursing homes in Lebanon, ⁸² the 2 nursing homes participating in this study were sampled based on the willingness of their administrations to take part in the research during the times of covid restrictions; so, they may not represent the typical nursing home in Lebanon.

Interviews in the present study were “one-off” events, and this affected the opportunity to “check-out” participants’ interpretations of the data collected. Therefore, the limitations of a “one-off” interview due to restricted visitation must be acknowledged. Whilst the researcher practiced bracketing, maintaining a reflexive journal, and collaboration between the authors, the potential for researcher bias in qualitative research must be noted.

Conclusion

This study offers new and valuable insights into the lived experiences of older adults in Lebanese nursing homes during the COVID-19 pandemic, shedding light on the emotional, psychological, and social challenges they faced amidst strict isolation and limited contact with loved ones.

The findings show that reduced activities, limited family visits, loneliness, and intergenerational divides on social media may have contributed to negative emotions. However, supportive care, family contact, spiritual practices, and reminiscence helped ease these experiences. These insights highlight the need for nursing homes in Lebanon to develop interventions that foster resilience among residents during times of crisis. It is hoped that the findings in this study will draw the attention of administrators, nursing staff, and policymakers and will bring about flexibility in care delivery. Service needs to be increasingly centered on the residents based on consultation, independence, making selections, personal care, and resident participation in decision-making.^{83 -85}

Introducing older adults to modern tools like video calling is essential to maintaining family connections during future periods of social isolation. It is essential for the Lebanese government to prioritize comprehensive preparedness strategies tailored to the unique needs of these facilities. This includes investing in staff training, ensuring access to medical supplies and protective equipment, and structured training of the older residents in digital platforms to maintain connections and support emotional health. The authors are fully aware of the challenges facing the operationalization of some concepts presented in this study. As Lebanon is a country in transition with limited resources, introducing change as part of reform should utilize the least resources. However, by proactively addressing these challenges, the government can safeguard the health and dignity of older residents, reduce preventable mortality, and build a more resilient healthcare system capable of withstanding future pandemics.

Recommendations, Lessons Learned, and Way Forward

The COVID-19 pandemic led to widespread illness and death worldwide, putting immense strain on healthcare systems, especially with the surge in infected patients. Lebanon was similarly impacted by the crisis. Nursing home residents were disproportionately affected by the virus. The pandemic highlighted the need for an extraordinarily broad range of difficult decision-making. Moving forward, it is crucial to learn from nursing home experiences to better support residents and safeguard them during future outbreaks or healthcare disruptions. The pandemic exposed the ongoing threat of social isolation and loneliness among older adults, highlighting the serious consequences of disconnection and the vital need to maintain social engagement, especially during times of crisis or major change. As we move forward into the post-pandemic era, we have an opportunity—and a responsibility—to address the persistent and often overlooked challenges faced by older adults. Let this moment serve not only as a reflection on what was endured, but as a commitment to cultivating environments that promote social connection, dignity, and well-being for those who have long deserved our attention and care. To mitigate the effects of social isolation on the well-being of older residents the authors recommend putting well-being and mental health of the older residents at the forefront of recovery efforts and prioritizing workforce well-being. Mitigating the adverse consequences of loneliness and social isolation among older adults requires the adoption of targeted strategies—such as preserving meaningful social and familial connections, engaging in health-promoting activities, and proactively managing emotional and psychiatric symptoms. These measures can play a crucial role in enhancing resilience and fostering a greater sense of well-being in later life. ⁸ The authors suggest prioritizing strategies to mitigate the impact of such pandemics in Lebanese nursing homes.

1. Effectively managing a pandemic demands strong leadership, clear communication, and reliable science. ⁸⁶ Leadership creates an environment that supports communication and scientific research. In turn, communication informs leadership and science by raising awareness of the pandemic and the challenges faced by key populations. Science contributes by providing evidence on effective prevention and treatment, guiding resource allocation and program development.

2. Preparedness, adaptability, innovation, and collaborative engagement across individuals, families, mental health professionals, NGOs, and governmental institutions must be regarded as essential components in safeguarding the physical and psychological well-being of older residents and mitigating the adverse effects of pandemics within long-term care settings. ²¹ The pandemic is over, but its effects on the wellbeing and mental health of older residents of nursing homes will remain for a long time. It is now crucial to learn from past events in nursing homes and take proactive steps to better protect residents during future outbreaks, emergencies, or healthcare disruptions.

3. For recovery to be successful, identifying and assessing the level of the needs of older nursing home residents is essential. As social isolation becomes more common during crises, teaching older residents to use virtual communication tools offers a practical way to maintain connections and support emotional health. Structured training in digital platforms can reduce loneliness and improve well-being and should be prioritized to enhance quality of life. Equally important are future initiatives aimed at the development and testing of age-friendly technological applications designed to support the mental and social well-being of older adults. These tools should not only foster meaningful engagement and alleviate isolation but also provide accessible, reliable information and practical guidance during public health emergencies. ²¹ Research on digital technology and its applications suggests that it can enhance cognitive abilities, improve physical and mental health, and overall enrich the lives of older adults. ⁸⁷ One effective way to maximize these benefits is by ensuring that older people have support from technology experts when using technology.^{87 -89}

4. Strengthening the skill of gerontological nurses to transform patient suffering into more manageable and meaningful experiences by exploring methods or mechanisms such as spiritual coping, reminiscing, and fostering resilience in nursing home residents is imperative. Gerontological nurses should be trained to serve as advocates, companions, and sources of support for this vulnerable population. Well-qualified staff are essential to ensuring safe, high-quality care in nursing homes.

5. Research: The complexity of the responses provided by the participants in this study highlights the necessity of employing further qualitative methods to comprehensively assess and integrate the preferences of nursing home residents into the provision of person-centered care. Intervention studies are needed to evaluate the effectiveness of these strategies and support evidence-based nursing practice. The study’s novel findings, developed through rigorous analysis, highlight areas needing urgent and long-term attention and offer a foundation for setting priorities, guiding future research, and informing evidence translation.

6. To strengthen infection control, the Centers for Medicare & Medicaid Services (CMS) in the United States mandated that nursing homes appoint a trained Infection Preventionist (IP) to lead their prevention efforts. Lebanon could adopt a similar approach, as having a dedicated IP plays a key role in reducing infection risks and improving resident safety.

7. Although visitation to nursing homes has been restricted, it remains essential to provide families with opportunities to maintain contact with older residents, in accordance with established safety protocols. Older adults should be given frequent opportunities to connect with loved ones, whether through private in-person visits or virtual communication. Caregivers must offer consistent support, resources, and protection to ensure residents’ safety. Visitor policies should be developed collaboratively with residents and families to address holistic care needs. Letting the older residents know that emotional support is available will do wonders for them and keep depression at bay. When the older residents have support networks, they will be better equipped to deal with the challenges of social isolation. Regular social interaction and conversation provide essential mental stimulation that may help prevent dementia and Alzheimer’s disease. During lockdowns, nursing homes should continue recreational programs to reduce isolation, adapting them to ensure resident engagement while maintaining safety.

8. Volunteer programs that provide essentials like food, medicine, and clothing should be sustained in nursing homes. When well-coordinated, they can also offer counseling and emotional support. Involving younger volunteers helps build intergenerational connections, an important tool in reducing loneliness among older adults during times of crisis.

9. It is essential for the Lebanese government to recognize the pivotal role of the Pandemic Agreement of World Health Organization (WHO) aimed at enhancing global preparedness for future COVID-19-like pandemics and mitigate the risk of similar catastrophic consequences. ⁹⁰ The Pandemic Agreement recommended that prevention and preparedness receive the funding and attention they deserve, alongside response efforts. ⁹¹ Proactively engaging with this global initiative would help Lebanon better prepare for future pandemics and strengthen public health resilience. In addition, targeted policies must address the specific needs of vulnerable groups, especially older adults in nursing homes—who are at greater risk during health crises. This subgroup is especially susceptible to adverse health outcomes during pandemics, underscoring the necessity of prioritizing their physical and mental well-being through dedicated support services and mental health interventions. ⁹¹ Failure to do so risks exacerbating existing health disparities and undermining the overall effectiveness of pandemic preparedness strategies.

Why Does This Study Matter?

This study is the first of its kind in Lebanon, conducted by a nurse researcher to explore the lived experiences of older nursing home residents during the restrictive measures of the COVID-19 pandemic. The study highlighted both the harmful effects of social isolation and the protective factors that can ease them. These insights can help shape future policies and support healthcare professionals in delivering person-centered care to lessen the negative impact of isolation in similar crises. The new insights, gained through a rigorous comprehensive analysis, highlight areas that require both immediate and long-term focus.

This paper highlights residents lived experiences—their feelings of isolation, fear, resilience, and coping strategies, and provides evidence for policies that prioritize not just survival, but dignity and well-being. By documenting residents’ perspectives, the study can inform international guidelines on balancing between safety and quality of life. The lessons learned can guide international preparedness for future pandemics such as ensuring communication technology, safe family contact, and mental health support that are essential services everywhere.

Additionally, the study highlights key research priorities regarding the COVID-19 pandemic and beyond. These findings lay the groundwork for future research, evidence-based policy development, and nursing interventions designed to prevent the negative effects of social isolation.