LONLINESS AMONG ELDERLY

Introduction
Increased life expectancy and with advancement in health care has helped us to win over
debilitating medical conditions. However, this has also led to a disfigured population graph with
ever increasing proportion of graying population with a variety of disabilities. Certainly the high
technology medicine has given longevity but along with increased dependencies. On the other
hand industrialization based economy has also snatched the family structure leaving the elderly
alone in their houses or making them move to old age homes. Humans grow and develop
throughout their life span .At the extremes of age dependency needs of human beings are much
more than at any time. Unfortunately the advancements in health care technology and economy
has little to offer to the elderly people to meet their dependency needs. Thus along with longevity
the recent developments have given loneliness as its side effect to elderly people. The social
loneliness leads to psychological problems also which are detrimental to health of any individual.
This is particularly more significant for elderlies as the age related health problems make them
more vulnerable to adversaries in life.
The process of aging is lifelong. Late age can be visualized as a progressive functional decline or
a gradual deterioration of physiological functions, including a decrease in fecundity andor the
intrinsic, inevitable and irreversible age-related process of loss of viability and increased in
vulnerability. Human ageing is associated with a wide range of physiological changes that not
only make us more susceptible to death but also limit the normal functions and render us to be
more susceptible to a number of diseasesphysical and psychological norbidiyes.
Aging people undergo a wide range of biological, psychological and social changes which may
be adaptive as well as maladaptive. Many older adults contribute to their environment quite
consistent with Eriksonian theory of development. However the studies reveal that many aging
adults face challenges related to physical health, disability resulting in issues such as decreased
sense of self and capacity and wellbeing. Some of the most common issues are the compromised
mobility, biological changes, physical deterioration, empty nest syndrome, retirement, financial
constraints or death of spouse and friends.
In the light of disabilities highlighted as above, one of the most prevalent issue is the feeling of
loneliness amongst the elderlies. Loneliness has been described as the subjective, unwelcome
feeling of lack or loss of companionship. Loneliness has been defined as a personal subjective
feeling of a lack of satisfying human relationships, and for this reason, loneliness is a negative
feeling that impairs the quality of life of ageing adults sometimes causing depression. The quality
of social relationships plays an important role in whether or not people suffer from loneliness.
Elder loneliness is becoming a growing reality for numerous individuals. The number of elders in
senior homes is expected to double by the year 2030, one-third of whom will have a disability or
illness. It means that in the next twenty-five years, there will be about 72 million seniors in
elderly care communities. Not only has the loneliness meant increased isolation among elderly
but it has been seen as a serious risk factor associated with a variety of mental and physical
health problems. Loneliness is a known risk factor for depression and suicidal tendencies among
elderly. Disability due to physical illnesses is also much more among the lonely elderlies. They
also perceive lesser quality of life.
Aging
Aging is a process of becoming older. It is an accumulation of changes in an organism over time
referring to a multidimensional process of physical, psychological and social change. In almost
every country, the number of people aged over 60 is growing faster than any other age group. 1 As
they get older, the problems related with the health and other social factors rise up. Majority of
elderly people have at least one chronic condition and may also suffer from multiple chronic
diseases.
Social loneliness can be defined as the connection with the personal relationships such as the
size of the social network and social support exchanges.2 It has been noted that loss of spouse,3
friends and relatives makes life difficult for elderly to meet basic needs for human intimacy and
social integration, thus it contributes loneliness on them.4
Ones own disability negatively influences these characteristics because health problems restrict
the maintenance of someones personal relationships.5 Similarly spousal disability is related to
higher levels of social loneliness because it restricts the maintenance of social relationship after
increasing spousal care giving. Women are more socialized and family oriented. Men are more
strongly depend on their spouses for social supports, whereas women derive it from family,
friends and neighbours in additions to their partner.6
Loneliness can be further categorized into three types according to its causes.

Situational loneliness: Socio-economic and cultural factors contributes to situational loneliness.

For eg environmental factors like unpleasant experiences, discrepancy between the levels of
his/her needs and social contacts, and migration of population, inter personal conflicts, accidents,
disasters or emptiness syndrome, etc., lead to loneliness in old age. The increased life expectancy
and feminization of elderly population is a significant factor in developing situational loneliness
in females.

Developmental loneliness: Each one of us has an innate desire of intimacy and individualism
which is essential for our development as a healthy individual. For optimum development, there
should be a balance between the two. When there is misbalance it results in loss of meaning of
life leading to emptiness. For eg Personal inadequacies, developmental deficits, significant
separations, social marginality, poverty, living arrangements, and physical/psychological
disabilities often lead to developmental loneliness.

Internal loneliness: Ones subjective perception of their relationship with others defines
attachments and lack of them. Being alone does not essentially make a person lonely. Individuals
with low self-esteem and less self-worth are seen to feel lonelier than others. Factors responsible
for such a self-view include personality factors, locus of control, mental distress, low self-
esteem, feeling of guilt or worthlessness, and poor coping strategies with situations.
Challenges of late life

Failing health: It is commonly said that we start dying soon after we are born. This statement is
synonymous with failing health. Failing health due to advancing age happens because of a lot of
reasons such as in availability of health care service, inaccessibility to health care service, lack of
awareness and knowledge and high cost of disease management makes caring for ailing health a
burden to the person as well as the caregiver, this picture worsens for the elderlies from lower
socio economic status.
To overcome this quality healthcare should be made accessible to the elderlies. These should
focus on preventive measures keeping in mind the common problems faced by elderlies. Use of
primary secondary and tertiary healthcare centers to serve the elderlies suffering from various
diseases. Rehabilitation, community or home based disability support and end-of-life care should
also be provided in a holistic manner to effectively address the issue to failing health among the
elderly.

Economic Insecurity:
Elderly often feel the economic insecurity because they now lack the opportunity and capacity to
be as productive as they used to be. Aging physical and mental faculties, limited access to
resources, malnutrition and lack of awareness of entitlements often are the causes that make
elderly think they are economically insecure.
Elderly who are unable to generate an adequate income should be facilitated and enrolled in
some economically productive activity. For those who are incapable aid and grants from the
welfare department should be provided that at least fulfills their basic needs. Families and
extended families should be encouraged and counselled to support the elderly living with them.

Loneliness:
Loneliness and isolation are the most common complaints reported by elderlies. Few impose it
on themselves while others are abandoned by family members and communities they live in.
However it has to be understood that if this loneliness remains unaddressed it often leads to
deterioration of quality of life. It is necessary that elderlies feel wanted and included in things
around them, in family and society. Activities centered on older persons that involve their time
and skills help to inculcate a feeling of inclusion and can be useful to family and community as
well.

Neglect:
Elderlies having failing health, dependency need support and care the most. When they are
deprived of this they suffer from neglect. Demanding jobs, nuclear families, changing lifestyles
are often the prime reasons for neglect of elderlies. The best way to address neglect of elderlies is
to counsel the families and community. In extreme situations rehabilitation can be considered to
prevent serious consequences of neglect.

Abuse:
The elderlies ere more prone to abuse. The abuse is usually carried out by family member or
somebody close to the victim. As the elderlies are quite weak they are more prone to physical
abuse. Elderlies resources are also often misused such as financial resources. They may also
suffer from emotional and mental abuse for various reasons and in different ways.
The best way to overcome abuse is to prevent it. This should be carried out through awareness. It
has been seen commonly that abuse happens because of some frustration.
The elderlies should be made aware about their rights. Legal action should be taken against those
who willfully abuse elderlies.
Other challenges include fear, idleness, lowered self-esteem, loss of control, lack of preparedness
for late life.

Differentiating loneliness from solitude

Many times loneliness and solitude are mistakenly taken to be synonymous.
We may be surrounded with a lot of people but we might still feel lonely. The social presence
around us is more than just the physical presence. Loneliness is a state of psychological
emptiness or isolation due to inadequate socialization or network leading to dysfunction. It
creates negative emotional states in the mind. Solitude however is a positive state of mind is
enjoyed by people and it leads to creativity, self realization and is the prime step towards self-
awareness and connecting with our inner self. Loneliness leads to depletion whereas solitude has
an enriching effect in life.
Loneliness as health problem
Loneliness is a state of mind, a human emotion frequently talked about. However it is a
subjective unique and complex affective state. As it is unique there is no single common cause
for it therefore the management of same differs and is often tailor made. Across the lifespan the
damages caused by it differs so different strategies are required to resolve the same. Therefore
individuals understanding is of utmost importance apart from the consequences of loneliness. A
lonely person often feels low, helpless, separated, or discriminated; finds difficulty in
interactions; feels abandoned and alone. An individual perceiving himself/herself as like that
may not find anyone with him/her and thus increase their risk for developing biological
dysfunctions, psychological distress, and behavioral problems.
Aging and loneliness
Different theorists or psychologists have been describing loneliness in different ways.
Loneliness is an unpleasant experience that occurs when a persons network of social relationship
is deficient in either quality or quantity.7
In another definition of loneliness, its a situation in which number of existing relationship is
smaller than is considered desirable or admissible, as well as a situation where as close one
wishes hasnt been realised.8
The loneliness is recognized as emotion and includes both physical and psychological conditions
such as perceived ill-health, dietary inadequacies, and depression, personality disorders and
suicide.9 The loneliness encompasses emotional and social isolation.10
Loneliness among older adults is addressed to prevent the premature onset of adverse health
condition.11
The existing models of loneliness focus on social interaction along with physical health and
cognitive capacity to explain the increasing likelihood of experiencing loneliness with advancing
age.12
Loneliness is commonly seen in older adults and has its complications, aetiology which needs
proper management and care..
Loneliness in elderlies: epidemiological considerations
Often loneliness has been treated as a symptom of mental health problems; however, for elderlies,
loneliness qualifies as a disease in itself. There are epidemiological, phenomenological, and
etiological reasons to say that.
Diagnosing lonliness in elderlies holds great importance and is often assessed as

Level of experience of separateness

Levels of cumulative wear and tear

Complete physical/mental health status

Social network

Frequency and degree of loneliness

Causes of loneliness amongst elderlies
The cause of loneliness can be divided as Demographic factors, Socio economic factors,
health causes and others.
Demographic factors include age, gender, living alone, widowhood, retirement or job loss,
bereavement. A lot of studies have associated age with loneliness. Loneliness is said to be more
common among the older than younger older people. 4,13 However a lot of other studies have found no
relationship between age and loneliness and it has been seen that there is no proportionate
relationship between the two. Higher life expectancy of women exposes them to widowhood.
Hence women express their feelings of loneliness more than men. Loneliness has been found to be
more common in women than in men. Even though men express less feelings of loneliness than
women, they express more harmful associates of loneliness. Staying alone has been identified as one
of the prime risk for elderly loneliness. 13,14 Many studies have reported widowhood as a risk factor for
loneliness. The loss of spouse tends to create an atmosphere for the experience of emotional
loneliness.

Social factors include the activity schedule of an individual. Elderly peoples participation in
social activities can be affected by ill health, problems in mobility leading to reduction in
social activities or social isolation leading to loneliness. This type of loneliness according to
Weiss distinction is known as social loneliness.15 It has been seen that reduction in social
activity affects the subjective well being of elderlies.
Health causes include both physical and mental health.
Physical health causes: as discussed above difficulty in mobility and deteriorating physical
health condition have been seen as associated with loneliness. Other physical health causes
include impaired vison and hearing, inability to carry out activities of daily living, needing
help in these activities, inability to go to post office/bank. 13,14 These findings are also
confirmed in the studies of quality of life. 13,14 Mental health causes: Deteriorating mental
health also has severe impact on elderlies. Incapacity of cognitive resources, fluctuating
mood, anxiety have been found to impact elderlies the most. Most these remained
unidentified till a long time. Depression has been found to be the leading cause of loneliness
amongst elderlies.14,16 It is often seen that loneliness is the cause of depression or vice versa.
However, the treatment often ignore loneliness as a cause rather it is treated as a symptom
that may subside with treatment.17 Loneliness is linked with depression but not all depressed
elderlies are lonely and not all lonely elderlies are depressed.18
A decrease in mood, increases the risk of loneliness. Unfulfilled expectations from contacts
can affect the psychological well-being of the elderly.13
Other causes include elderlies their own view of this subjective feeling of loneliness.
Elderlies throughout the world have attributed various other causes such as Meaningless life,
absence of friends, living conditions (living apart from other settlements and poor
transportation and childrens stressful life, new living environment.13
Alleviating loneliness
As we have seen that loneliness has severe outcome it is very important to overcome it. A lot of
literature is available dealing with how loneliness can be alleviated amongst elderlies.
Social, educative activities group activities can target social isolation 18
A well-planned and psychosocial group intervention, it is possible to empower and to socially
activate lonely social older people and to strengthen their well-being.14
It has been found that physical and leisure activity improve wellbeing .The physical activities
include Performing of chores, walking, exercising to point of perspiration and participation in
competitive sports. Leisure activities included involvement in associations and religious
activities, handicrafts, reading and studying. 15
Psychological group rehabilitation can help to alleviate the loneliness of elderly people. 13
During this psychological group rehabilitation art activities, discussions, therapeutic writing
and group psychotherapy are included. Activities include sharing loneliness peer support
feeling togetherness overcoming own limits, courage to trust , doing together and sharing
experiences, group dynamics and development, support of adherence and objective oriented
group meetings.
Behaviours involving friends and family as an emotional resource, engaging to eating and
drinking rituals as means of social contact and spending time constructively by reading
gardening can ameliorate the experience of loneliness.
These interventions can also be grouped as individual and group interventions.13
Group interventions include group activities, volunteering, promoting friendship etc.
These interventions are the most widely used interventions for curbing loneliness in elderlies.
The goal of such activities is to provide opportunity for social interaction and social support
by increasing their social network.
Group activities: as per literature involvement in activity by elderly reinforces their sense of
subjective well being. As we have discussed above loneliness is identified with reduction in
social activities. Common group interventions consist of diverse activities that cover various
domains such as physical social leisure r recreational activities.
Volunteering: Elderlies need to be encouraged to participate in volunteer work as it leads to
both individual and social benefits which are gained as a result of utilization of both social
and cognitive skills. Therefore it has the potency to be an affective remedy to alleviate
loneliness.18
Promoting friendship: elderly individuals who are keen on improving their friendship can
benefit from this where individuals with common interests are grouped together during group
activities resulting in an increase in the quality and number of friends.
Whereas individual interventions include gardening, reading, paper craft activities, one to
one intervention and pet therapy etc.
Gardening: Gardening has been a age long activity for everyone. It can range from working
in the garden to just taking care of flowers on the roof top. With respect to elderlies
gardening provides a sense of functionality and purpose and helps them utilize their time.
Therefore generating a feeling of accomplishment increasing individuals self-esteem.
Elderlies who use garden as a means to alleviate their loneliness but who can no longer
engage in the activity due to their deteriorating condition can just look at the garden and have
a long-lasting sense of satisfaction.
 Pet therapy: loneliness is stressful however if tackled efficiently it can lead to regaining
lost relationships and engage in new ones. The use of pet therapy has been approved as an
intervention to curb loneliness. Elderlies tend to seek supportive relationships to overcome
the lost ones.19 Pets can be used in this to enhance attachment and support. Elderlies who
can manage taking care of a pet can be indulged in this. Walking a pet can generate
opportunity for social interaction with fellow pet owners.
Newspaper reading and watching television: these are the most widely used activities
amongst the elderlies. These activities help elderlies to keep themselves busy hence taking
their minds off loneliness.
Reading books and newspapers, watching the television create a link between the elderly
and the external world.15
Reading in group or watching television with fellows can increase social interaction and
provide elderlies with human company that they might have had from spouse or other
members of the family. However elderlies with deteriorating vision and hearing cant
make most of this intervention.

One to one interventions: these interventions are tailor made and provided to elderlies who
cannot avail much from the other interventions. These include support from caregivers, home
visits, assistance in services, telephone calls etc. Home visits have been identified as an
intervention measure for reducing loneliness among elderly who live alone.18
Having hobbies increases communication with the social environment and helps occupying
one with tasks that may be contributing to feeling busy, feeling less lonely and feeling
useful.13

Key points and directions for intervention and research

Elderly people living alone must be evaluated as a high-risk group and thus policy makers and
health personnel should be aware of the factors that can affect loneliness.
Social support systems and Psychological wellbeing of elderlies must be taken into account
It is crucial to benefit from the experiences of older people, to have them as role models and to
provide opportunities for them to develop their potential by allowing them to participate in social
activities instead of excluding them from society.
Highlights

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