This article covers the medical, social and psychological problems related to loneliness in senior members of society. Armed with references from research material, statistics from WHO, as well as quotes from a few elderly members; it presents a holistic view of the problem and ventures some recommendations.

The evolution of the elderly

The twilight years of life were captured so aptly in the concluding lines of one of William Shakespeare’s verses –

“Last scene of all, that ends this strange eventful history,

Is second childishness and mere oblivion;

Sans teeth, sans eyes, sans taste, sans everything.”

Changing family dynamics have impacted the quality of life of the aging population in human civilization.

In the last few decades, an evolution in education and economy has led to financial independence, extension in retirement age, as well as migration of younger generations to other cities or countries.

With healthcare touching new horizons, life expectancy too has increased. This has led to an overall rise in geriatric population across the world. As the body ages, the accompanying frailties and disabilities affect the spirit as well.  Loneliness and social isolation in older adults are serious public health risks as per the National Council on Aging.

Loneliness is the feeling of being alone regardless of the amount of social contact. People who go through social isolation are vulnerable to Alzheimer’s disease, dementia, and other medical conditions.

A report from the National Academies of Sciences, Engineering, and Medicine (NASEM), points out that more than one-third of adults aged 45 and above feel lonely, and nearly one-fourth of adults aged 65 and older are considered to be socially isolated. 

Inspirational case studies

MyndStories spoke to three elderly members and we discovered that each of them has adopted a unique approach to this issue. We also spoke to Saee Patwardhan, a clinical psychologist, who has her own practice in Pune for some insights on this prevalent problem.

Case study 1: Vibha Desai

Vibha Desai (aged 87) resides alone in a two-bedroom, fully furnished rented apartment in Pune. She hails from Sangli, Maharashtra, where her family had a well-established pharmacy business. She stayed alone in the sprawling 8-bedroom bungalow after her husband’s death a decade ago, while all of her four children had moved to different places within and outside India.

Unfortunately, she had to evacuate when floods ravaged her native place and water entered the ground floor of her home. This event, followed by the Covid 19 lockdown, uprooted her from Sangli. For the last two years, she has been residing in Pune until all her pending affairs get settled. This city has better access for all her children when they visit.  

Vibha used to be an athletics champion in her academic years, and has represented her college in athletics. She had even traveled to Sri Lanka to represent India. Her husband had been an avid tennis and badminton enthusiast and encouraged her to play too. She is also an accomplished artist.

She had her own art studio in her family home, where she used to make greeting cards on order. She is now enthusiastically engaged in fabric painting. Her painted sofa-back covers, pillow covers, tissue paper box covers, as well as sarees, are in high demand.

She prefers to cook her meals, watches only the news and sports programs on TV, and loves to read the newspaper. Despite her displacement she is able to  indulge her wish of a place of her own, where she can pursue her art, entertain her guests, and not be a burden on anyone. Indeed, her home is a cozy nest, decorated with pictures of family, and pieces of furniture aesthetically adorned by her hand-painted fabrics. 

“I tend to lose track of time when I am painting. Interruptions in the form of the doorbell or phone calls and messages, and having to cook and eat, feel annoying sometimes,” she laments.

Her independence does come at the cost of loneliness. Practicalities of life such as maintenance of the house whenever something malfunctions, booking a cab for commuting, grocery shopping, and coordinating with neighbors to contact plumbers, etc. frustrate her sometimes.

Though help is just a phone call away in the form of extended family, kind neighbors, and her doting son who lives closest to her, she misses the warmth of conversation and impromptu visits with familiar acquaintances in this alien city.

Clinical psychologist Saee says that most of the statistics regarding loneliness among the elderly are for the US demographic and lack the Indian context. However, it’s a theme that runs uniformly across all geographies.

World Population Review states that there is an uptick in the median population age, and loneliness is rampant. Elderly men are especially vulnerable as they feel “unseen” by their families .

For instance, if there is a dessert prepared, it is assumed that the family patriarch cannot consume it on account of his diabetic condition. Elderly women, on the contrary, are better integrated with family and household activities and therefore, they remain relevant and visible for longer.

The personality of the elderly also plays a key role—some elders do not actively seek help or speak up. Signs such as watching too much TV, or spending too much time on digital media, can point to clinical depression.

Depression among widowers is more prevalent than in widows. The mortality rate is also higher in newly widowed spouses, literally leading to death from a broken heart.

Saee says that when professional help is sought for such elders, psychologists work with the family to “schedule” visits for these elderly members.

Various family members and well-wishers are roped in to call or visit them at regular intervals. Thus, they have something to look forward to and also have someone to unburden themselves with.

Case study 2: Dr. Varsha Joshi

A retired professor and published author from Pune, Dr. Varsha Joshi (aged 80), sought to address the age conundrum through science, in which she enjoyed an impressive career.

Originally from Mumbai, she completed her Masters from Purdue University, US, as well as her PhD in Physics from Pune University.

Varsha retired in 2003, after serving as the Head of the Physics Department at Wadia College, Pune. Post-retirement, she has been contributing weekly articles on science to Marathi dailies like Saptahik Sakal and Lokmat, which have met with stellar reviews. Since then, she has been on a mission to underline the importance of science in all aspects of life.

She has authored multiple books in Marathi including The Impact of Science in the Kitchen, which brings out the effect of science on food while The Miracle of Threads brings out the impact of science on clothing.

Her two daughters are settled in the same city as her and support her whenever required.

Varsha is not embarrassed to hire and manage domestic help. She has an attendant to keep her company during the night, another to do her grocery shopping, and run sundry errands.

Varsha likes to experiment in her kitchen, and fondly calls it her “laboratory”. Her nutritious and delicious recipes are popular among her friends and acquaintances. She loves to sing and had received training as a vocalist in her childhood. She formed, and manages, a singing club among a group of elderly ladies in her society about a year ago.

She firmly believes that possessing an attitude of adjustment, accepting one’s “diminished importance” in life, discovering how one can be of use to others, and the pursuit of a creative hobby are vital to combat the emptiness brought on by aging.

Creating art, engaging with music, expressive writing, cooking, etc. have immense healing effects. Having learned the importance of the ability to work with others in her tenure as Head of the Department, she stresses on maintaining a healthy equation with family, neighbors, as well as domestic helpers.

“Communication is a skill everyone should cultivate. And this needs to begin much before you enter your sixties. Additionally, having a specific agenda and routine throughout the day helps to tide over this phase”.

She feels that mandating children to take care of aging parents is counter-productive. Instead, parents should strive to mold themselves into less critical, unimposing, as well as non-interfering individuals.

Saee provides a fresh perspective and says financially dependent parents have no option but to cohabit with their children’s families. This can add to the stress of having to adapt to an unfamiliar environment, especially if there is a significant generation gap.

In such cases, a healthy adjustment with the family can make a huge difference in their quality of life. The relationship should be such that elder care does not feel like a chore, but just another part of adult responsibilities.

Case study 3: Madhura Masurkar

Madhura Masurkar (aged 71), from Baroda, Gujarat, has been a resident of Pune for 13 years now. A graduate in Chemistry, she served in the Food and Drugs laboratory with the Government of Gujarat for three decades. Having retired as a Class 1 officer, she moved to Pune along with her husband, to help tend to their two grandchildren.

However, life threw a curveball when she lost her husband to cancer within five years of relocation. She was always very self-sufficient, thanks to which she was able to handle all financial affairs, maintain her apartment, and travel and socialize on her own after his demise. She initially battled with insomnia and anxiety regarding her future. She tackled this by consciously spending time with her grandchildren and finding a community among the senior ladies of her apartment complex.

“Not having a companion to travel with or share my fears with was difficult at first. Understanding how others managed to cope not only helped, but also inspired me. I have been very lucky that my children have always been around to support me. I could not have managed without them. But I do feel for others who are not as fortunate as me.”

“Neglect can be devastating for one’s mental health, and society should ensure that the elderly do not feel ignored,” she says 

Playing with her grandchildren, cooking for them, and learning to use her mobile phone for shopping, booking cab, etc. from them, gave her purpose.

She loves to read books on history and geography, solve puzzles like sudoku, play games on her tablet, watch interesting videos on YouTube as well as her favorite TV shows.

She is an active member in a senior citizens’ group and loves to participate in various competitions, be it singing patriotic songs, chanting bhajans during festivals, playing antakshari, or cooking contests.

Her passions include listening to old Hindi songs, especially on the radio, where there is often commentary about the song that’s on air.

Of late, her knees have started bothering her. Her philosophy is that the body eventually gives out and you have to depend on others. “No matter where the children are, one should be prepared to move in with them, or to an old age home, if required. Till then, one should try not to be a burden on anyone.”

Saee observes that the elderly community in the Aundh locality of Pune is quite evolved and extremely active. It has subdivisions for all interest groups right from trekking, walking, and sharing of information on the latest topics, and interactive games, to reading and music clubs. Such communities are booming and a viable solution for elders who wish to ‘age in place’.

Elder care facilities in India are also gaining traction. Palliative care requires professional attention, especially for seniors with disabilities, or those suffering from complex or terminal illnesses. Such facilities have requisite support under one roof and should be explored where required. 

Aging in the Indian context

In India, most older adults prefer to age in place rather than in an institutional care facility. Aging in place is associated with a sense of identity, attachment, social connection, familiarity, and security, as per this study by the National Library of Medicine.

The study aims to provide a profound understanding of the meaning, attitude, and perceptions of older adults toward aging in place. An explicit social motive found in this study is the societal expectation of children to take care of their aging parents, which is uncommon in Western countries.

Proximity to grandchildren and other youth is another factor of consideration. Spirituality, which is articulated through religion, also contributes to the preference for aging in place.

Some points that came up from the study include –

• The lack of proper social support systems, like neighbors and relatives living nearby, can cause loneliness and isolated feelings in the elderly.
• Aging in place, especially in an Indian setting, is associated with a high risk of falls and frailty. The lack of adequate age-friendly facilities in houses impacts the physical health of older adults.
• Aging in place when living alone soon after the death of the spouse is challenging. 
• Aging in place can lead to higher “empty nest” and “retirement” blues for those who are living alone.

Role model for in-place aging

A major strategy is to modify the existing environment and make it more age-friendly. A delicate balance between individual comfort and a vibrant community life needs to be implemented.

The World Health Organization(WHO) has already developed and published a comprehensive framework to build age-friendly communities. 

The Age-Friendly Sarasota program implemented in Florida, U.S., is a sustainable model for many countries to replicate based on their environment and cultural context. Sarasota’s homes are increasingly designed with features that enhance safety and mobility – from no-step entrances and wider doorways to user-friendly kitchens and bathrooms.

Most high-income countries (HICs) have a large older adult population, while low and middle income countries (LMICs) are relatively young. Nations like China and India, are expected to hold 80% of the world’s total senior citizen population by 2050.

According to the United Nations Populations Fund India Aging Report of 2023, the population of people above 60 will double from 10.5% to 20.8% by 2050. This calls for urgent action by the Indian society as well as the government to ensure the care and support older adults require to lead a healthy and fulfilling life with dignity. 

As we gear up to either join the elderly population, or to care for them in the upcoming years, awareness of all the available options, as well as mental and financial preparation, is key.

As a society, we need to be more inclusive of the seniors amidst us and strive to make their twilight zone as comfortable as possible. The seeds that we sow today will bear fruit by the time we are the ones in need.