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| LETTER TO EDITOR |
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| Year : 2021 | Volume
: 3
| Issue : 2 | Page : 120-122 |
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Loneliness in Older People: From Analysis to Action
R Srinivasa Murthy1, Debanjan Banerjee2
1 Professor of Psychiatry (Retired) Formerly, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| Date of Submission | 05-May-2021 |
| Date of Acceptance | 06-Aug-2021 |
| Date of Web Publication | 31-Aug-2021 |
Correspondence Address:
Dr. R Srinivasa Murthy
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | 1 |
DOI: 10.4103/wsp.wsp_37_21
How to cite this article:
Murthy R S, Banerjee D. Loneliness in Older People: From Analysis to Action. World Soc Psychiatry 2021;3:120-2 |
The recent editorial by Basu on loneliness is an important consideration for social psychiatry.[1] He highlights the biopsychosocial model of loneliness, especially in light of the ongoing pandemic and cautions against the “medicalizing and pathologizing” of a subjective mental state misconstruing it as a psychiatric disorder. Basu has also rightly warned about the danger of conceptualizing loneliness as a “disease” using mechanistic neurobiological models runs the risk to “look for pharmacological drug targets for treating it” thereby compromising the “essential role of social connection and mental health in understanding, preventing, and mitigating loneliness and its consequences.” The author also emphasizes that this is where social psychiatry needs to own up and help unravel loneliness as a multidimensional concept.
The above valuable observations need to be converted into actions. We present our ideas for such an attempt to address loneliness in older people cantered around the theme of positive aging-aging is to be celebrated, stage of aging is a growth opportunity.
In the last fortnight of July and August 2021, the Heritage Foundation had organized 6 days of an international symposium on geriatric care and social work. More than a dozen country experiences were presented. All of them related to services and benefits but strangely none addressed the strategies of achieving and promoting positive aging. This focus on “fighting” aging is seen in a recent book Booming: A Life-changing Philosophy for Aging Well by Marcus Riley who was also one of the presenters. He outlines the goal, as the key to living later life to the full are positivity, planning, being engaged, passionate and capable of adapting to changing circumstances, good health, sufficient finances, and living everyday as a flesh and blood rebuttal of ageism in the society and workplace.[2] Similar is the view of most authors, including those from India.[3] There are many innovative ways of increased support and social connectedness such as layperson-delivered empathy-focused telephonic conversations.[4] Western interventions targeting loneliness in the older communities have focussed on active participation of the individuals, belief system, and multi-systemic approach including healthy lifestyle modifications.[5] It is important to note that the most recent National Institute of Health plan for the 2021–2025 includes lifestyle modifications for healthy aging as one of its goals. It states that at least one promising lifestyle intervention to prevent Alzheimer's disease and related dementias will be rigorously demonstrated in the next five years.[6]
This shows that there is a need for thinking of the issue in innovative ways.
This view of focussing on “continued normalcy” misses the complimentary view of considering aging not as loss but as a transition in life. This is the essence of the spiritual approach to aging as reflected in the “Ashrama” system of India.[7],[8] The focus is to move from loneliness to solitude that is filled with tranquillity and peace. Instead of considering it as a “separate pathological entity” that deserves a “special treatment,” why not deal with it as part of aging by “letting go when it's time.” The approach forms the foundation of Hindu philosophy.
The central theme of all Indian or Eastern religions, Hindu, Buddhist or Jain is the idea of Tyaga or renunciation. This has been a powerful concept that has withstood civilizations for years. It has been linked to the last two Ashramas (stages of life) according to Hinduism, i.e. Vaanaprastha (Forest Dweller) and Sanyas (Ascetic). Wig has written about the applicability of Vaanaprastha in modern society.[9] The literal translation of living in the forest definitely does not hold true in today's socioeconomic context but rather refers to acceptance, wisdom, maturity, and solitude as a person ages. Manu Smriti also describes how Eastern traditions aim for being with oneself (oneliness instead of loneliness), optimism and hope which are associated with letting go of one's abilities in a graded yet respectful manner rather than lamenting for the loss. This concept of living in old age is fully developed in the “Sadhana Panchakam” of Sri Adi Shankara.[10] The five slokas present 40 tips to guide a person in his spiritual unfoldment making it a practicable approach to old age in general and loneliness in particular. Wig[9] (based on a lecture delivered at Servants of the People Society, Lajpat Bhawan, Chandigarh in October, 2004) has synthesized it as follows: (i) voluntary withdrawal from the routine hustle of live and trying to unify emotionally with nature, (ii) deliberately attempting to reduce one's needs to maintain a balance with the available resources, (iii) acceptance of aging and associated limitations, enjoying the positive constructs and wisdom of age, reduced need to be in control, (iv) contribution to the society and focusing on social welfare to the extent possible, and (v) pursuit of spirituality. Similar themes are echoed in the English translation of Upanishads by Shearer and Russell[11] to quote from it:
”At the heart of this phenomenal world, within all its changing forms dwells the unchanging Divine. Hence, go beyond the changing and enjoying the inner cease to take yourself what to others are riches.” The systematization and making it an activity incorporated in daily lifestyle could be the greatest gift of all religions to humanity.
There is growing interest in the importance of spirituality and health since the seminal work Loneliness: The Experience of Emotional and Social Isolation by Weiss.[12] According to Koenig, spirituality is distinguished from all other things – humanism, values, morals, and mental health – by its connection to what is sacred, the transcendent. This involves a search outside self.[13]
Spirituality is now recognized to be one of the most important factors in coping, resilience, hardiness building, and stress-reduction strategies. This is not exclusive to Eastern research and beliefs. A path-analysis model study from Portugal showed the mediating effect of spiritual practices between aging and perceived social connectedness as well as life-satisfaction.[14] A pragmatic group intervention trial in the senior housing communities of U.S. involved savoring, acceptance, gratitude, and engagement in value-based activities to improve resilience and reduce loneliness.[15]
However, there is a pragmatic yet age-old concern. Spirituality is often seen as belief and faith and not a growth process. There is an urgent need for systematic examination of the inclusion of spirituality (as outlined in all religions) in interventions targeting loneliness and evaluation of the outcomes [Table 1]. | Table 1: Approaches to develop practice of spirituality and evaluate its impact
Click here to view |
The recent worldwide acceptance of yoga/meditation as a health intervention gives hope for similar integration of spirituality, when it is systematized and evidence supported. We recognize that there is place for other nonpharmacological interventions to address loneliness, such as voluntary groups in each locality, volunteers linking with older persons, online support, and lifestyle modifications. They all need similar considerations [Table 1]. These are areas to actively pursue in the coming years as populations age and loneliness becomes an essential part of life of all individuals. We agree with Basu[1] that this is where social psychiatry needs to own up and help unravel loneliness as a multi-dimensional concept, in understanding, exploring and intervening at the level of individuals, families, communities, and administrative services. A recent book It is Okay: To reach out for help by Kapur based on cultural strengths in counseling is a good initiative to follow for relevant future directions.[16]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Basu D. Ah, look at all the lonely people. Will social psychiatry please stand up for ministering to loneliness? World Soc Psychiatry 2021;3:1.  |
| 2. | Riley M. Booming: A Life-Changing Philosophy for Ageing Well. Australia: Impact Press; 2018. p. 13. |
| 3. | Jayaprakash I. Senior Support – An Informative Booklet for Healthy, Active and Graceful Aging. Published by Federation of Senior Citizens Forums of Karnataka (FSCFK). 2012. India. |
| 4. | Kahlon MK, Aksan N, Aubrey R, Clark N, Cowley-Morillo M, Jacobs EA, et al. Effect of layperson-delivered, empathy-focused program of telephone calls on loneliness, depression, and anxiety among adults during the COVID-19 pandemic: A randomized clinical trial. JAMA Psychiatry 2021;78:616-22. |
| 5. | National Academies of Sciences, Engineering, and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: National Academies Press; 2020. |
| 6. | |
| 7. | Murthy RS. Hinduism and mental health. In: Verhagen PJ, van Praag HM, Lopez-Ibor JJ, Cox JL, Moussaoui D, editors. Religion and Psychiatry: Beyond Boundaries. USA: John Wiley and Sons; 2010. p. 159-79. |
| 8. | Tiwari SC, Pandey NM. The Indian concepts of lifestyle and mental health in old age. Indian J Psychiatry 2013;55:S288-92. |
| 9. | Khandelwal SK. The joy of mental health: Some popular writings of Dr NN Wig. Indian J Psychiatry 2006;48:207. |
| 10. | Shankarananda S. How to Live in Old Age. Mumbai: Central Chinmaya Trust; 2014. |
| 11. | Shearer A, Russell P. The Upanishads (Harper Colophon Books). New York, USA: Harper and Row; 1979. p. 25. |
| 12. | Weiss RS. Loneliness: The Experience of Emotional and Social Isolation. Cambridge, USA: The MIT Press; 1973. |
| 13. | Koenig HG. Religion, spirituality, and health: The research and clinical implications. Int Sch Res Not 2012;2012, Article ID 278730, 33 pages doi:10.5402/2012/278730. |
| 14. | Lima S, Teixeira L, Esteves R, Ribeiro F, Pereira F, Teixeira A, et al. Spirituality and quality of life in older adults: A path analysis model. BMC Geriatr 2020;20:259. |
| 15. | Treichler EB, Glorioso D, Lee EE, Wu TC, Tu XM, Daly R, et al. A pragmatic trial of a group intervention in senior housing communities to increase resilience. Int Psychogeriatr 2020;32:173-82. |
| 16. | Kapur M. It is Okay: To Reach Out for Help. New Delhi: Vitasta Publishing; 2020. |
[Table 1]
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