Recently, there were media reports that the United Kingdom government had appointed a minister for "loneliness" after it was found that nearly 14% of its population complained of feeling lonely.
Loneliness is one of the risk factors for developing mental health problems such as anxiety, depression, alcohol and tobacco abuse. In elderly population, it could lead to mild memory difficulties and dementia. Social isolation is also found to be one of the risk factors for increased mortality. Traditionally, social isolation was used as a kind of punishment.
Ageing is associated with multiple physical health ailments, frailty, sensory impairments and reduced social life after retirement. Loneliness, reduced involvement in activities, physical health difficulties including aches and pains and abundant free time with no planned schedule, could result in negative thoughts and ruminations in the elderly. They could then start to dwell on negative past events, which may gradually increasing the threat to their mental health.
Our society is changing and with increasing economic migration and mushrooming of the nuclear family system, with most couples both employed, senior citizens may not have the social support system that their previous generations had.
Live recordings of functional MRI brain scans during active social interactions indicate that some areas of the brain receive stimulation, which means frequent interactions could be seen as mental exercise. Enjoyment in such interactions could motivate people to make social connections, encourage engagement in more activities and generate a positive thought pattern and emotions.
Therefore, the social lives of the elderly can be improved by getting them involved in senior citizens' forums or local clubs. Some people, if they are willing, could take up voluntary unpaid work as well. A busy social life could offer an increased sense of security.
Practising yoga, meditation, early morning walk or exercise can promote good physical and mental health. Meeting people of similar age groups in the local walkers' association and discussing topics of interest promotes emotional well-being. As people grow old, there is a tendency to avoid social gatherings, but it is healthier to attend wedding parties or birthdays to meet friends and family and engage in conversations.
Going on picnics or sightseeing holidays with other friends of the same age can be a part of routine activities for the elderly. Some may prefer to visit spiritual and holy places. But it is never too late to set goals and work towards achieving them. Retirement should not appear as loss of role and should be seen as another opportunity to explore one's activities of interest and hobbies, like watching or following cricket or football or politics or writing blogs.
Signs of depression
Preferring to be lonely by frequently avoiding socialising, if it is out of character, may be a sign of depressive illness or interpersonal problems with friends or family. Depression is common among elderly, and there could be a delay in seeking help or many could just suffer in silence.
It may be difficult for supporting adult children to suggest to their senior citizen parents to seek consultation with psychiatrists as this could easily be misunderstood or taken in a different context, so it will depend upon the level of trust. It can also occur as part of early symptoms of dementia. "Apathy", which refers to reduced emotional reactivity and loss of motivation, is being recognised as an increasing interference in activities.
As with regards to managing loneliness en masse, there should be government aid and support to increase senior citizens forums or groups, which run scheduled day activities in which people can get involved. Such forums need to network with other forums in their city. NGOs could also run more day centres to enhance access.
Advancement in technology and social media offer a good opportunity for senior citizens to network with the world. Smartphone applications may be developed to assist senior citizens and can be designed in a way that enables the elderly to use them. Training primary healthcare physicians to give advice on avoiding loneliness would be of help.
Having a pro-active action plan to tackle loneliness among the elderly can work as preventive care, reducing or delaying the onset of memory problems, and could be part of the state's public health agenda. All these initiatives, if implemented, are likely to promote mental health in elderly.
(The author is a psychiatrist and ad hoc faculty at NIMHANS, Bengaluru)