Journal of Geriatric Mental Health

: 2019  |  Volume : 6  |  Issue : 1  |  Page : 1--3

Loneliness: Does it need attention!

Sandeep Grover 
 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Prof. Sandeep Grover
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh

How to cite this article:
Grover S. Loneliness: Does it need attention!.J Geriatr Ment Health 2019;6:1-3

How to cite this URL:
Grover S. Loneliness: Does it need attention!. J Geriatr Ment Health [serial online] 2019 [cited 2020 Sep 20 ];6:1-3
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India is going through a major sociodemographic change. There is a rapid increase in elderly population. Further, over the years, gradually, there is an erosion of the joint families and we are moving toward nuclear families. Further, there is 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. Due to this, usually, elderly parents are left behind. This makes the elderly vulnerable to loneliness. Although loneliness is considered as a symptom or manifestation of mental disorders, some of the authors suggest that loneliness should itself be considered as a disease.[1]

 What is Loneliness?

Loneliness is understood as “the discrepancy between an individual”s desired and achieved levels of social relationships.“[2] 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.[3] A socially isolated person usually has less contact with friends and family members and less often belongs to groups, such as religious groups and clubs. Hence, to understand the difference between loneliness and social isolation, it can be said that the term social isolation indicates the quantitative isolation, whereas loneliness is more of qualitative isolation. Accordingly, loneliness is determined by the quality of social interactions.[4] A person may not be lonely, despite being socially isolated, whereas a person having large social network may still be lonely.[5]

Loneliness is understood as an emotion and an indicator of social well-being. The authors have also tried 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.[6] Some of the authors have tried to categorize loneliness into three types based on its causation. The three types of loneliness include 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.[1]

 How Common It Is?

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.[7],[8]

 Adverse Health Consequences Of 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.[5] Loneliness has been shown to be associated with disruption in sleep.[9] Loneliness has also been linked with alcohol misuse and smoking.[5] 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.[5] Loneliness has also been linked with reduced physical activity[5] and increase in functional decline.[10] 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.[11]

 Factors Which Mediate The Adverse Effect of Loneliness on Health

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.[4] 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.[12] Insomnia is thought to have a negative impact on immunity, leads to glucose dysregulation, and increases the risk of cardiovascular diseases and cognitive decline.[9]

 Factors Associated With Loneliness

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,[7] 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,[10],[13],[14],[15],[16] childlessness (especially in women),[8] the elderly not involved in care of grandchildren,[17] close and distant forms of social engagements, and psychological distress.[18] Psychological attributes which are shown to be associated with loneliness include low self-efficacy beliefs, negative life events, and cognitive deficits.[19] Other factors associated with loneliness include poor self-reported health, poor functional status, boredom and inactivity, and recent loss of family and friends.[19] If one attempts to evaluate these factors, it is clear that majority of these factors are modifiable.

 Interventions For Loneliness

Various authors, 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.[20]

 Research On Loneliness From India

There is limited information on the prevalence of 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.[21] 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.[22] 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.[23] There is a lack of data from India, on any intervention for loneliness among the elderly.

 Need Of The Hour

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 in the health administrators and policy-makers, 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.

Research on loneliness is limited to a handful of studies. Although data from developed countries show the association of loneliness with negative physical and psychological health outcomes, none of the studies from India have evaluated this association. As the impact of loneliness on health outcomes is influenced by various mediators, which include familial, social, and clinical factors, findings from one country cannot be generalized to the other. There is a need to evaluate the culture-specific factors associated with loneliness. Conventionally, in India, religion had a significant importance in everyone's life. Participation in religious congregations can not only help in fulfilling the religious needs but also help in improving social connectedness and reducing loneliness. Till today, none of the studies have evaluated the relationship of participation in the religious congregations and religious activities with loneliness. There are no intervention studies from India, and there is a huge scope of evaluating the role of traditional methods of participating in religious congregations, on 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.


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