Not so long ago, India was known as a country where the family elders were treated with utmost reverence and families revolved around them. But in the last decade or so, with individualistic mindsets on the rise, the seniors are being accommodated according to our convenience and comfort. With the rat race consuming the best of us, our parents and grandparents have been left behind to fend for themselves. With no peers for company and not wanting to interfere in their children and grandchildren’s lives, an increasing number of elders are experiencing isolation & loneliness like never before, more so in cases where one partner has passed on. The way living spaces are being designed and built isn’t helping either. The ubiquitous apartment culture maybe a boon for the convenience seeking youngsters but have turned into a bane of the older people’s existence. With their friends scattered all over the world, and their own limitations imposed by ageing, they are being increasing left to their own defenses.
Let’s face some well researched facts. India is going through a major sociodemographic change. There is a rapid increase in elderly population. Further, over the years, gradually, with the erosion of joint family system and the upswing of nuclear families; an increase in migration from rural areas to urban areas within the country and also migration to other countries for better job prospects and better quality of life, the elderly parents are being left far behind. The consequence - loneliness. Although loneliness is considered as a symptom, some experts in geriatric care suggest that loneliness should itself be considered as a disease.A disease that has manifested in modern societies as a consequence of living in stand-alone concrete structures.
Loneliness is understood as ―the discrepancy between an individual’s desired and achieved levels of social relationships.‖ Related term which is used in association with loneliness but is considered to differ from loneliness includes social isolation. Social isolation is understood as an actual quantifiable shortfall in the social relationships of a person, which can be measured in the form of size of the social network of the person and frequency of contacts. Loneliness is determined by the quality of social interactions.
Loneliness is understood as an emotion and an indicator of social well-being. The experts have also attempted to describe different subtypes of loneliness. A feeling of missing an intimate relationship is understood as emotional loneliness, whereas missing a wider social network is understood as social loneliness. Some of the experts have tried to categorize loneliness into three types based on its causation - situational loneliness, developmental loneliness, and internal loneliness. Situational loneliness is considered to arise due to socioeconomic and cultural factors, such as migration, interpersonal conflicts, accidents, and disasters. Developmental loneliness is thought to be an outcome of discrepancy in the need for individualism and desire for intimacy. Internal loneliness is understood as an internal perception of being alone, which is often fuelled by low self-esteem, low self-worth, and poor coping with the adverse situations.
The prevalence of loneliness varies from study to study. Some of the studies which have evaluated the prevalence of loneliness among the elderly suggest that about half of the elderly experience loneliness.
Loneliness has been shown to have a multitude of negative consequences, both in terms of physical and mental ailments, which leads to poor quality of life and increased risk of mortality. Available data suggest that loneliness is associated with depression, various anxiety disorders, schizophrenia, suicide, and cognitive decline including dementia.
Loneliness has been shown to be associated with disruption in sleep. Loneliness has also been linked with alcohol misuse and smoking. In terms of negative physical health outcomes, loneliness has been shown to increase the risk of coronary artery disease and cardiovascular ailments, malignancies, and susceptibility for various infections.
Loneliness has also been linked with reduced physical activity and increase in functional decline. A reciprocal relationship has also been reported for depression and immobility with loneliness, i.e., these factors themselves can increase the risk of loneliness. Loneliness has also been shown to be associated with increased health and social care utilization.
In terms of potential factors which mediate the association of loneliness with negative health outcomes, it is suggested that interaction with others improves the healthy behaviors, whereas poor interaction and loneliness are associated with unhealthy behaviors, which lead to adverse mental and physical health outcomes.
The negative impact of loneliness on physical health is possibly thought to be mediated through depression and sleep disruption. The association of depression and coronary artery disease is well established. Insomnia is thought to have a negative impact on immunity, leads to glucose dysregulation, and increases the risk of cardiovascular diseases and cognitive decline.
Evidence suggest that loneliness is associated with older age, women, living alone or living in a residential care, living in institutional setting compared to home setting, living in rural locality, loss of spouse, lower education, lower income, lack of friends, poor health status, poor functionality, lower level of social contact, poor social support, decreased physical activity, childlessness (especially in women), the elderly not involved in care of grandchildren, close and distant forms of social engagements, and psychological distress. Psychological attributes which are shown to be associated with loneliness include low self-efficacy beliefs, negative life events, and cognitive deficits. Other factors associated with loneliness include poor self-reported health, poor functional status, boredom and inactivity, and recent loss of family and friends. If one attempts to evaluate these factors, it is clear that majority of these factors are modifiable.
Various experts, across the globe, have evaluated the efficacy/effectiveness of various interventions on loneliness among the elderly. These interventions have used strategies such as incorporation of recreational activities, physical exercise, improving community knowledge and networking with other participants using educational, cognitive, and social support programs, reminiscence therapy, exercise-talk discussions, social engagement-directed discussions, coaching, use of the Internet, pet therapy, and use of companion robots. Some of these interventions have been shown to reduce loneliness among the elderly.
There is limited information on loneliness among the elderly from India. A nationwide survey which included 15,000 participants from 300 districts of 25 states and union territories of the country reported that 47.5% of elderly people reported being lonely. The prevalence of loneliness was higher among the elderly residing in urban locality, with a prevalence of 64.1%. The factors which were shown to be associated with loneliness included living alone or living with spouse only (compared to living with children), poor health, and lack of social interactions. A recent study, which included about 300 participants attending the two community health centers, reported the prevalence of loneliness to be about 55.4%, with moderate-to-high severity of loneliness in more than one-third of the study participants. The presence of loneliness was associated with anxiety and elderly abuse. Another study, which evaluated loneliness among elderly patients with depression, reported loneliness in about three-fourth (77.3%) of the patients. In terms of specific loneliness symptom, lack of companionship was reported by 62.5%, feeling of being left out in life was reported by 58.7% of the patients, and 56.5% of the individuals reported felt isolated from others. More severe loneliness was associated with a higher severity of depression, anxiety, and somatic symptoms.
Elderly population is rapidly increasing in India and in times to come, loneliness among elderly population is going to pose a significant challenge, with respect to their health and social needs. There is an urgent need to improve the awareness about loneliness among the elderly, both with respect to its prevalence and adverse health outcomes. Further, there is also a need to improve the awareness of general population with respect to loneliness, so that the traditional family structure is maintained and elderly people are kept in the same household.
Data shows the association of loneliness with negative physical and psychological health outcomes. As the impact of loneliness on health outcomes is influenced by various mediators, which include familial, social, and clinical factors.
There is a need to evaluate the culture-specific factors associated with loneliness. Conventionally, in India, religion & culture have had a significant importance in everyone's life. Participation in religious & cultural congregations can not only help in fulfilling the spiritual needs but also help in improving social connectedness and reducing loneliness.
To conclude, it can be said that loneliness is highly prevalent in the elderly across the globe, with India, being no exception. With the changing demographics and social structure, and increasing prevalence of noncommunicable diseases, which are going to be associated with poor mobility and higher disability, it can be said those in times to come, loneliness is going to become a major challenge among the elderly. Accordingly, there is an urgent need to focus on loneliness and act, before it is too late.
The effects of social isolation on mental health are unique to each individual. You or someone close to you may have experienced mental health struggles in the past which have now worsened, or you may be feeling emotionally different in response to the pandemic and wondering whether this is normal and if it will pass. Here are some signs that you should take seriously:
Sleep is critical to good mental health, but a new schedule or the lack of one can cause sleep disruptions leading to grogginess, disorientation, and low mood. Keeping track of time in isolation becomes challenging. You may have asked ―What day is it?‖ or ―What time is it?‖ Your screen time increased with more internet searching or shopping or binge watching your favourite shows. Increased exposure to blue light suppresses your body’s production of melatonin and is associated with insomnia, tossing and turning, and even nightmares. Sleep disturbances can, in turn, cause depression and anxiety.
Prior to the global pandemic, mental health experts were discussing a serious, existing epidemic namely, loneliness, which naturally increased in our isolation. Experts tell us human connections are essential for us all to survive and thrive, but you can be lonely in a crowded room of people you know well. Loneliness stems from feeling disconnected on an emotional level and is personal in nature, so increasing social time doesn’t always solve the problem. While most of us experience loneliness in our lifetime, chronic loneliness is painful and associated with a variety of serious health issues, including depression and anxiety.
The world over, people are reporting more symptoms of depression related to the COVID-19 virus than prior levels and, based on research related to the SARS pandemic of 2003, those symptoms will likely persist. Low mood, fatigue, sadness, feelings of emptiness and hopelessness, suicidal thinking, and planning for suicide are all symptoms of depression, which is serious in nature and requires immediate attention.
Along with depressive symptoms, stress and anxiety are also on the rise since we began isolating at home, and may now have concerns about integrating back into society. Constantly feeling on the edge can disrupt your sleep, lower your immunity, elevate cortisol levels, and cause digestive issues, heart palpitations, fatigue, difficulty concentrating, and diminished coping skills, among other things.
Depression, anxiety, sleep disruption and loneliness can be inter-connected and are just some effects that may linger as the quarantine begins to lift. If symptoms persist beyond four months, you may be diagnosed with Post-Traumatic Stress Disorder (PTSD). Symptoms of PTSD typically appear soon after a trauma occurs, but can develop months or years later. The trauma may be experienced personally or through someone else’s experience and can be related to feelings of isolation from loved ones or fear of access to basic needs.
Consider these self-care tips for lifting your mood, calming your anxiety, and improving your overall mental well-being.
Comfort foods are great, but the connection between your diet and your mental health is real. We know our bodies need high-quality ―fuel‖ for good physical health, so it’s logical that our brains need that same good nutrition to perform cognitive functions, boost and regulate mood, and process our thoughts and emotions. It’s no surprise that highly-processed, sugary foods are not brain-friendly, but delicious foods like eggs, almonds, blueberries, fish, avocados, and dark chocolate can contribute to better mental health.
You’ve most likely spent more time on your couch in recent weeks, but humans are built for movement. In the last two generations, physical activity has dropped 32% across the globe. Experts tell us that we have a ―sitting disease‖ that is just as dangerous to our health as smoking. Walking – especially in nature – benefits your physical and mental well-being. If you aren’t able to walk, simple stretching or gentle yoga yields benefits as well. Explore new types of exercise to find a variety of things you can do to activate the release of endorphins, which trigger happy feelings. Mark your calendar and make regular time for physical activity to enjoy maximum mental health benefits.
Repetitive or racing thoughts are exhausting and will take a toll on your mental health. Relaxation may feel like the last thing you can achieve when you are deeply stressed, but with a little practice, you can be successful at self-soothing. Try deep, steady breathing, meditation, sound therapy, or visualizing quiet and peaceful surroundings to calm yourself. Stay with it even when your mind begins to wander back to the worries of the day. With time and regular practice, you can find stress relief in as little as 5 to 10 minutes a day. You may find yourself developing a more extensive relaxation practice when you begin to feel the positive results.
Humans are built for movement, we are wired to connect to each other. While developing satisfying relationships takes a little time, the mental health rewards are worth the effort. Start by deepening the healthy, emotional connections you already have with your family members and friends. Widen your social circle by joining a class with people who share your interests. Being part of a group creates a sense of belonging and stimulates your mind with new thoughts and ideas. Volunteer with others on behalf of a cause you support, which is proven to increase feelings of happiness and decrease loneliness.
Social isolation, loneliness in older people pose health risks.
Human beings are social creatures. Our connection to others enables us to survive and thrive. Yet, as we age, many of us are alone more often than when we were younger, leaving us vulnerable to social isolation and loneliness—and related health problems such as cognitive decline, depression, and heart disease. Fortunately, there are ways to counteract these negative effects.
Research has linked social isolation and loneliness to higher risks for a variety of physical and mental conditions: high blood pressure, heart disease, obesity, a weakened immune system, anxiety, depression, cognitive decline, Alzheimer’s disease, and even death.
People who find themselves unexpectedly alone due to the death of a spouse or partner, separation from friends or family, retirement, loss of mobility, and lack of transportation are at particular risk.
Conversely, people who engage in meaningful, productive activities with others tend to live longer, boost their mood, and have a sense of purpose. These activities seem to help maintain their well-being and may improve their cognitive function.
Losing a sense of connection and community changes a person’s perception of the world. Someone experiencing chronic loneliness feels threatened and mistrustful of others, which activates a biological defense mechanism, according to Steve Cole, Ph.D., director of the Social Genomics Core Laboratory at the University of California, Los Angeles. His NIA-funded research focuses on understanding the physiological pathways of loneliness (the different ways that loneliness affects how your mind and body function) and developing social and psychological interventions to combat it.
For example, loneliness may alter the tendency of cells in the immune system to promote inflammation, which is necessary to help our bodies heal from injury, Dr. Cole said. But inflammation that lasts too long increases the risk of chronic diseases.
Loneliness acts as a fertilizer for other diseases,” Dr. Cole said. “The biology of loneliness can accelerate the build up of plaque in arteries, help cancer cells grow and spread, and promote inflammation in the brain leading to Alzheimer’s disease. Loneliness promotes several different types of wear and tear on the body.
People who feel lonely may also have weakened immune cells that have trouble fighting off viruses, which makes them more vulnerable to some infectious diseases, he added.
NIA-supported research by Dr. Cole and others shows that having a sense of mission and purpose in life is linked to healthier immune cells. Helping others through caregiving or volunteering also helps people feel less lonely.
"Working for a social cause or purpose with others who share your values and are trusted partners puts you in contact with others and helps develop a greater sense of community," he noted.
Researching genetic and social determinants of loneliness
In another NIA-funded study, researchers are trying to understand the differences between social isolation and loneliness and how they may influence health. They are also trying to identify potential interactions between genes and the environment of older adults affected by social isolation and loneliness.
Previous studies have estimated the heritability of loneliness between 37 percent and 55 percent using twins and family-based approaches. ―Individuals who are not prone genetically to feeling lonely may, for example, suffer much less from social isolation, while others feel lonely even though they are surrounded and part of a rich social life," according to Nancy Pedersen, Ph.D., a professor of genetic epidemiology at the Karolinska Institutet in Stockholm, Sweden. ―We are also interested in understanding what role socioeconomic status plays in such associations."
Using data from twin studies, Dr. Pedersen and researchers found that both social isolation and loneliness are independent risk factors, and that genetic risk for loneliness significantly predicted the presentation of cardiovascular, psychiatric (major depressive disorder), and metabolic traits. Family history does not strongly influence this effect.
Beyond genetics, understanding social determinants of health, and the role of social and interpersonal processes in healthy aging and longevity, is another research direction at NIH. Scientists are beginning to apply this framework to research on social isolation and loneliness.
Older adults living alone with cognitive impairment—a growing and vulnerable population—face unique challenges. Elena Portacolone, Ph.D., assistant professor of sociology at the University of California, San Francisco, leads an NIA-funded study to understand their daily experiences, social networks, and decision-making ability, with the aim of designing culturally sensitive interventions to improve their health, well-being, and social integration.
"Whereas most researchers of isolation study the personal traits and behaviours of isolated individuals, my research focuses on the role that structural factors (i.e., institutions, social policies, ideologies) play in exacerbating the social isolation of vulnerable individuals," says Dr. Portacolone.
These structural obstacles included fear of being robbed, disconnect with neighbours, limited availability of appropriate services, dilapidated surroundings, and limited meaningful and positive relationships. Having few friends or family members attuned to their concerns was another factor exacerbating social isolation. Study participants expressed a desire to be socially integrated, an idea that runs against the prevailing assumption that isolated older adults are alone by choice.
As a result, older adults with cognitive impairment living alone spend much of their time managing their household and their health, Dr. Portacolone said. They are often reluctant to show they need help because they fear being forced to move from their homes.
"The primary takeaway from this research is that interventions to increase older adults’ social integration should address not only their behaviours, but their overall surroundings. We need to concentrate our attention on building communities that have empathy & compassion embedded in the everyday experiences of older adults,‖"Dr. Portacolone says.
Organo’s eco-habitats have been designed with spaces that encourage inter-generational bonding, with farming at its core which enables the seniors to engage with gardening, spend time with nature & indulging their need for attention with community activities that include cooking & mentoring the younger lot. As Dr. Portacolone recommends, empathy & compassion are in-built in the structural and philosophical design of Organo’s eco-habitats. With easy access to safe food, clean air & water to ensure physical wellness, yoga & meditation decks for holistic wellness & opportunities to meet others for a breezy chat on the Racha Banda or just sit and watch the world pass by, Organo Antharam’s cluster homes are just what the doctor ordered for people of all age groups with varying needs.
1. Tiwari SC. Loneliness: A disease? Indian J Psychiatry 2013;55:320-2.
2. Perlman D, Peplau LA. Toward a social psychology of loneliness. In: Duck S, Gilmour R, editors. Personal Relationships in Disorder. London: Academic Press; 1981. p. 31-56.
3. de Jong GJ, van Tilburg T, Dykstra P, Vangelisti A, Perlman D. Loneliness and social isolation. In: Vangelisti A, Perlman D, eds. The Cambridge Handbook of Personal Relationships. Cambridge: Cambridge University Press; 2006. p. 485-500.
4. Singer C. Health effects of social isolation and loneliness. J Aging Life Care 2018;28:4-8.
5. Malcolm M, Frost H, Cowie J. Loneliness and social isolation causal association with health-related lifestyle risk in older adults: A systematic review and meta-analysis protocol. Syst Rev 2019;8:48.
6. Jong Gierveld J, van Tilburg T. A shortened scale for overall, emotional and social loneliness. Tijdschr Gerontol Geriatr 2008;39:4-15.
7. Nyqvist F, Cattan M, Conradsson M, Näsman M, Gustafsson Y. Prevalence of loneliness over ten years among the oldest old. Scand J Public Health 2017;45:411-8.
8. van den Broek T. Gender differences in the correlates of loneliness among Japanese persons aged 50-70. Australas J Ageing 2017;36:234-7.
9. Hawkley LC, Preacher KJ, Cacioppo JT. Loneliness impairs daytime functioning but not sleep duration. Health Psychol 2010;29:124-9.
10. Cacioppo JT, Cacioppo S. Social relationships and health: The toxic effects of perceived social isolation. Soc Personal Psychol Compass 2014;8:58-72.
11. Wang H, Zhao E, Fleming J, Dening T, Khaw KT, Brayne C. Is loneliness associated with increased health and social care utilisation in the oldest old? Findings from a population-based longitudinal study. BMJ Open 2019;9:e024645.
12. Schulz R, Beach SR, Ives DG, Martire LM, Ariyo AA, Kop WJ. Association between depression and mortality in older adults: The cardiovascular health study. Arch Intern Med 2000;160:1761-8.
13. Savikko N, Routasalo P, Tilvis RS, Strandberg TE, Pitkälä KH. Predictors and subjective causes of loneliness in an aged population. Arch Gerontol Geriatr 2005;41:223-33.
14. Cohen-Mansfield J, Shmotkin D, Goldberg S. Loneliness in old age: Longitudinal changes and their determinants in an Israeli sample. Int Psychogeriatr 2009;21:1160-70.
15. Dykstra PA, van Tilburg TG, de Jong Gierveld J. Changes in older adult loneliness: Results from a seven-year longitudinal study. Res Aging 2005;27:725-47.
16. Dykstra PA, Fokkema T. Social and emotional loneliness among divorced and married men and women: Comparing the deficit and cognitive perspectives. Basic Appl Soc Psychol 2007;29:1-12.
17. Tsai FJ, Motamed S, Rougemont A. The protective effect of taking care of grandchildren on elders' mental health? Associations between changing patterns of intergenerational exchanges and the reduction of elders' loneliness and depression between 1993 and 2007 in Taiwan. BMC Public Health 2013;13:567.
18. Dahlberg L, Agahi N, Lennartsson C. Lonelier than ever? Loneliness of older people over two decades. Arch Gerontol Geriatr 2018;75:96-103.
19. Cohen-Mansfield J, Hazan H, Lerman Y, Shalom V. Correlates and predictors of loneliness in older-adults: A review of quantitative results informed by qualitative insights. Int Psychogeriatr 2016;28:557-76.
20. Poscia A, Stojanovic J, La Milia DI, Duplaga M, Grysztar M, Moscato U, et al. Interventions targeting loneliness and social isolation among the older people: An update systematic review. Exp Gerontol 2018;102:133-44.
21. Agewell Foundation. Changing Needs and Rights of Older People in India: A Review. New Delhi: Agewell Research and Advocacy Centre; 2017.
22. Grover S, Verma M, Singh T, Dahiya N, Nehra R. Loneliness and its correlates amongst elderly attending non-communicable disease rural clinic attached to a tertiary care centre of North India. Asian J Psychiatr 2019;43:189-96.
23. Grover S, Avasthi A, Sahoo S, Lakdawala B, Dan A, Nebhinani N, et al. Relationship of loneliness and social connectedness with depression in elderly: A multicentric study under the aegis of Indian Association for Geriatric Mental Health. J Geriatr Ment Health 2018;5:99-106.