Editorial
Loneliness and Social Isolation among the Elderly: Are We Doing
Enough?
One of the most prominent policy actions taken by the
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United Nations in recent years was to declare and bring out
a related document, namely, the Decade of Healthy Aging
2021–2030, which includes four interconnected action areas
for safeguarding the health and well‑being of older people,
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their families, and their communities: (i) change how we
think, feel, and act toward age and aging; (ii) ensure that
communities foster the abilities of older people; (iii) deliver
integrated care and primary health services tailored to older
people; and (iv) ensure access to long‑term care for older
people.[1]
Before proceeding further, it is important to mention and
discuss briefly the reasons for focusing our editorial on
the concepts of “loneliness” and “social isolation” in the
elderly in the Indian context.
Although most developed countries such as the USA, many
parts of Europe, and Japan have a significantly larger aging
population compared with countries like India, as recently
as December 2020, under 7% of Indians were aged
65 years and over.[2] However, if we go by the cutoff age
of 60 years, then nearly 9% of the population has crossed
this mark in the 2011 census,[3] which by the UN standards
make India as an “aging nation.” This figure is expected
to rise in a decade’s time when it is projected that adults
aged 60 years and over will constitute over 13% of the
population in India by 2031, and by 2050, the figure will
be of over 500 million adults.[2] Hence, this exponential
growth of the elderly is of considerable concern and for
which services need to gear up to, including mental health
services.
In addition, in this rapidly industrializing and
technologically advancing world, where globalization is
spreading its tentacles far and wide, migration is a common
enough phenomena nowadays. The current and most
recent/previous generation migrating from rural to urban,
from town to city, from India to abroad (i.e. international),
etc., is a common, if not a routine, phenomena
nowadays.[1] This has led onto the fragmentation of the
traditional family system, which was considered a bedrock
of the Indian culture with its own strengths; details of
which are discussed elsewhere.[4,5] Furthermore, despite
the persistence of traditional family structures and cultural
norms that favor multigenerational households, a slow shift
is occurring toward smaller families and different types of
household, including living alone – as an elderly couple or
by self.[1] Due to this, “social isolation” and “loneliness”
have become even more relevant concepts to be examined
and addressed.
© 2023 Indian Journal of Social Psychiatry | Published by Wolters Kluwer - Medknow
To briefly recapitulate, loneliness is a subjective feeling
that one is lacking the social connections that are needed.
It makes the person feel that one is abandoned or cut off
from the people with whom they belong to despite having
them around; the feeling of closeness, trust, and genuine
affection is missing. Social isolation, on the other hand,
is an objective physical state of being alone and out of
touch with other people. This can lead to “loneliness” as
one is more likely to feel lonely if one rarely interacts
with others.[6] However, there is only a weak correlation
between these two concepts; socially isolated people are
not necessarily lonely and vice versa.[1]
It may be pertinent to mention that the document (the
Decade of Healthy Aging 2021–2030) came out in 2021, in
which the impact of the COVID‑19 pandemic was felt to a
significant extent on the mental health of people across the
world, especially the elderly. The salience and significance
of the terms “social isolation,” “loneliness,” “solitude,”
etc., not only came into prominence, but their relevance
and impact on mental health, especially of the elderly, were
reestablished and reunderstood.[1,6] The old age saying that
“ man is a social animal” came back to the fore.
Nevertheless, even in the prepandemic period, there has
been considerable research on the association and effect
of both “loneliness” and “social isolation” in the elderly.
High rates ranging from 20% to 34% of “loneliness” have
been reported from across the world (USA, Europe, Latin
America, and China); India is surprisingly not lagging
behind, with prevalence varying from 18% to 44%.[1] On
the other hand, the prevalence of “social isolation” has also
been comparable, ranging from 10% to 43% (USA, North
America); India has a prevalence of 20%.[1]
More specific India‑based studies are also available: a
prepandemic population‑based survey (BKPAI survey)
among the elderly reported social isolation in 19.3% and
psychological distress in 23.4% of those surveyed.[7] In
the first wave  (2017–2018) of the Longitudinal Aging
Study in India study, 20.5% of adults aged 45 years and
over reported moderate loneliness, while 13.3% reported
severe loneliness.[8] Nearly 1/5th of the 1001 elderly
participants (adults aged over 65 years) from the 10/66
Dementia Research Group reported feeling lonely.[9]
There is ample evidence that demonstrates that both
“loneliness” and “social isolation” are linked with increased
physical morbidity (stroke and cardiovascular disease)
and increased psychological morbidity (cognitive decline,
dementia, depression, anxiety, and suicidal ideation) and
mortality (suicide) with a lowered quality of life.[1,6]
1
 Khurana and Gupta: Loneliness and social isolation among elderly
Hence, there is an urgent need for the management and
intervention regarding “loneliness” and “social isolation”
being experienced by the elderly. A PubMed search between
1985 and 2023 with key words “Loneliness”  (all fields)
AND “India”  (all fields) generated 164 results, with only
one study focusing on mediation for loneliness: A plethora
of studies exploring the antecedents and consequences of
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loneliness among elderly are available with scanty research
on interventions.
The WHO has advocated reduction of physical and
psychological morbidity through face‑to‑face or digital
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interventions (cognitive behavior therapy, social
skills training, and befriending), improvement of
infrastructure (e.g. transport, digital inclusion, and built
environment) and promoting age‑friendly communities, and
through laws and policies to address; for instance, agism,
inequality, and the digital divide. They have advocated
that a specific strategy for reducing social isolation and
loneliness among the elderly should aim to (a) implement
and scale up elective interventions to reduce social isolation
and loneliness; (b) improve research and strengthen the
evidence regarding what works; and (c) create a global
coalition to increase the political priority of social isolation
and loneliness among older people.[1]
Keeping in view the high prevalence of both “social
isolation” and “loneliness” in the elderly, well‑thought‑out
interventions on the model as proposed by the WHO need
to be developed, with the delivery being based as per the
practical issues in a country like ours. Philip et al.[3] have
proposed a bottom‑up approach, wherein community care,
that is, primary care, forms the foundation and basis for
addressing this aspect. This has been done as the largest
care resource still currently remains the family/spouse, the
informal caregivers, and “scaling up” of services with (re)
establishment of social links/networks being the easiest at
the community levels.[3] As we discuss this, NIMHANS,
Bengaluru, has taken up this initiative in providing
e‑training to 10,000 nonspecialized health‑care workers
and community caregivers for the identification of mental
health issues and management of loneliness of the elderly
in the community.[10]
Although the well‑being of senior citizens is mandated in
the Constitution of India under Article 41, it is interesting to
note that primary care is practically nonexistent, and even
specialized care is inadequate.[3] The readers are advised to
read a recent review outlining and critically discussing the
training and policy needs for providing geriatric care.[3]
It is imperative that the government makes “care of the
elderly” as its focus, especially as we seem to be sitting
2 Indian Journal of Social Psychiatry | Volume 39 | Issue 1 | January-March 2023
on a potential epidemic. Addressing the basic issues of
“social isolation” and “loneliness” will be a step in the
right direction. In some countries, till recently, these were
neglected social determinants of health and had started
becoming pressing public and policy health issues.[1]
The United Kingdom and Japan appointed a “loneliness
minister” while the USA brought out a consensus report
to address these concerns.[1] The Indian Government and
Policy Makers can take a leaf out of their book! Even the
national associations (IAGMH, IPS, and IASP) can do their
own bit in a concerted and probably focused (if not a joint)
effort.
After all, one may prefer “solitude,” but no one voluntarily
chooses “loneliness” and/or “social isolation:” the
silent killers which our elderly have to face! As social
psychiatrists, we should be contributing toward effectively
managing these silent killers!
Hitesh Khurana, Nitin Gupta1
Department of Psychiatry, Institute of Mental Health, Pt. BD Sharma
PGIMS, UHS, Rohtak, Haryana, 1Gupta Mind Healing and Counselling
Centre, Chandigarh, India
Address for correspondence: Dr. Nitin Gupta,
Gupta Mind Healing and Counselling Centre, Chandigarh ‑ 160 009,
India.
E‑mail: nitingupta659@yahoo.co.in
References
1. World Health Organization. Social Isolation and Loneliness
among Older People: Advocacy Brief. Geneva: World Health
Organization; 2021.
2. Shankar A, Kidd T. Loneliness in older Indian dyads. Int J
Environ Res Public Health 2022;19:5302.
3. Philip  S, Gajera  G, Nirisha  PL, Sivakumar  PT, Barikar  MC,
Panday P, et  al. Future‑proofing geriatric mental health care
services in India: Training and policy directions. Indian J Psychol
Med 2021;43:S134‑41.
4. Avasthi A. Preserve and strengthen family to promote mental
health. Indian J Psychiatry 2010;52:113‑26.
5. Chadda RK, Deb KS. Indian family systems, collectivistic society
and psychotherapy. Indian J Psychiatry 2013;55:S299‑309.
6. Gupta N. From “normal” to “new normal” and from “social
isolation” to “social bubbles”: The impact of COVID‑19. Ind J
Soc Psychiatry 2020;36 Suppl 1: S1‑5.
7. Sujiv K, Kalaiselvi S, Tiwari MK, Deshmukh P. Social isolation,
social support, and psychological distress among the elderly
during the COVID‑19 pandemic: A cross‑sectional study from
Central India. Indian J Public Health 2022;66:451‑7.
8. Pengpid S, Peltzer K. Associations of loneliness with poor
physical health, poor mental health and health risk behaviours
among a nationally representative community‑dwelling sample
of middle‑aged and older adults in India. Int J Geriatr Psychiatry
2021;36:1722‑31.
9. Gao Q, Prina AM, Prince M, Acosta D, Luisa Sosa A, Guerra M,
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et  al. Loneliness among older adults in Latin America, china,
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10. Available from: https://indianexpress.com/article/india/nimhans‑tr
ain‑mental‑health‑workers‑help-senior-citizens-8188601/23. [Last
accessed on 2023 Mar 14].
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nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8K2+Ya6H515kE= on 06/07/2023

10.4103/ijsp.ijsp_64_23

How to cite this article: Khurana H, Gupta N. Loneliness and social

isolation among the elderly: Are we doing enough? Indian J Soc Psychiatry
2023;39:1-3.
Received: 14‑03‑2023, Accepted: 15‑03‑2023,
Web Publication: 29-03-2023

Indian Journal of Social Psychiatry | Volume 39 | Issue 1 | January-March 2023 3