When Antoinette Alvares lost her husband suddenly in 2019, she could not get over the shock for many months. “I wouldn’t go out, I didn’t want to talk to anyone, and I didn’t want to wear any of my [usual] clothes. I only wanted to wear dark clothes,” says the 69-year-old from Mumbai. Everyone in her family was worried as Alvares, usually a cheerful, outgoing person, became unrecognisable. “It took me a lot of time to even smile or look at the world differently,” says Alvares.
A life-changing event like losing a partner or spouse can be emotionally devastating for anyone in any age bracket, but for the elderly, though they may be culturally better conditioned to accepting it, the loss often means severing a final connection with their old selves—along with a reminder of their own mortality. While younger people may be able to ‘move on’ because they have jobs, responsibilities, and often children to care for, bereaved elderly partners may face loneliness and a complete loss of purpose. Grief and bereavement-associated crises are among the top reasons older persons start experiencing mental health issues like depression and anxiety, even though they may not have suffered from any of it before—and it often goes unnoticed. According to the World Health Organisation, over 20% of adults over the age of 60 suffer from a mental or neurological disorder.
A 2022 paper, Social Exclusion and Mental Health Among Older Adults: Cross-Sectional Evidence From a Population-based Survey in India published in BMC Psychiatry, said: “Almost one-third (31%) of the rural-dwelling older adults reported depressive symptoms, while 27% of the urban-dwelling older adults reported depressive symptoms.” The study sampled over 30,000 60-plus Indian adults, and looked at how social isolation and exclusion from community activities contributes to depression and other mental health issues.
Before we look at social isolation, geriatric health experts say we must recognize that the physical process of ageing itself brings its own set of challenges. As various physiological changes happen in the body, older persons report a higher incidence of cardiovascular diseases, arthritis and joint problems, chronic pain, and other illnesses. They may start losing mobility, hearing, eyesight to a greater or lesser degree, which makes them feel less in control or frustrated at not being able to do things they were able to enjoy easily earlier. This has a direct impact on mental health.
“It’s important to understand that physical and mental illnesses are extremely interconnected, especially in old age. So, be it diabetes, high blood pressure or hypertension, thyroid issues, prostrate problem, osteoarthritis or knee pain, it will inevitably be linked with mental health conditions,” says Dr Debanjan Banerjee, geriatric psychiatrist at Apollo Multispeciality Hospitals in Kolkata and vice-chair of the Advocacy and Public Awareness Committee of the International Psychogeriatric Association (IPA).
The effects are compounded by the natural changes occurring in the brain as well. “In common terms, we can call it the shrinkage of the brain. This is age-related atrophy, similar to muscular atrophy,” explains Dr Rahul Chakravarty, a senior consultant with the Tele MANAS programme at the Post Graduate Institute of Medical Education & Research in Chandigarh.
That leads us to one of the most common mental health and neurological concerns among older persons, dementia, marked by a significant change in memory and cognitive functioning. It most commonly occurs due to neurodegenerative diseases like Alzheimer’s. “Starting from 60 years of age, the prevalence of dementia keeps doubling every 10 years,” says Dr Chakravarty.
According to Dr Banerjee, geriatric depression and sleep issues like insomnia are other causes of concern affecting mental health. Add social isolation to this and we start to see a fuller picture of why we need to pay attention to this demographic. “More than three-fourths of the sample did not attend social activities such as political/community/organization group meetings and cultural performances /shows/cinema. Almost half of the older adults (47%) did not attend religious functions /events such as bhajan/satsang/prayer,” said the paper published in BMC Psychiatry, noting that many of the study’s subjects reported receiving poorer services than other people at public places.
Take the example of 75-year-old Vatsala Balachandran from Bengaluru. Since her children live abroad, she and her husband don’t have much of a support system. A lack of physical infrastructure in public spaces that might have made them more accessible to her stops her from going out or even getting essential chores done, which leads to frustration and a feeling of helplessness. “Many banks and shops don’t have ramps or stair rails to hold on to while climbing up or down,” says Balachandran.
Dr Banerjee recalls how his organisation received calls from older folks during the covid-19 lockdowns in 2020 and 2021 as they could not access emergency services and faced harassment from the police when they went out. It can further take a dark turn with elder abuse. There is an urgent need to address the mental health concerns of older persons at the individual and policy levels, he says.
Both Dr Banerjee and Dr Chakravarty suggest that older folks maintain a proper routine of sleep, exercise, and getting adequate nutrition. “If you have a religious place nearby, go and sit there. That can help you relax. If you have kids in the neighbourhood, interact and play with them,” adds Dr Chakravarty. He also suggests gardening and adopting pets to boost your brain and mental health.
Similarly, Dr Banerjee suggests not missing doctor appointments and seeking help when needed. “If you keep your brain active, what cannot be possible? We always say ‘Use It or Lose It’ in terms of the brain,” he says while advocating for digital literacy that can help folk get online and interact with more people.
Staying connected and going online helped Alvares out of her cocoon as well. She joined the GetSetUp platform, a peer-to-peer learning community, that provides virtual classes on health and well-being and hosts socialisation events like in-person meetings and trips for older adults. When Alvares went to Sikkim recently through the platform, she found that her peers there had also lost their husbands. “We realised that we all came out of a sad and depressed mind. [But] we were all enjoying ourselves. We were so happy to know it was also a healing trip for us.”
Retired HR professional turned wellness coach Binda Kanayalkar, who takes some classes on the platform, says she has seen such transformations many times. “I have seen a great change in their personal well-being, mental health issues, and confidence levels. I have seen a transition in their personality,” says Kanayalkar.
Apart from such networking, caregivers can do their part as well. For instance, Dr Banerjee says they can provide an audience and listen to seniors in their families. Or check for any signs and symptoms of cognitive decline or other health issues.
Changes are needed at the policy level too. For dementia, it’s significant to train grassroots professionals and caregivers to care for a person living with it. “Public health training of the nurses in geriatric care, increasing the community and the district collaboration, creating better training and research in geriatric medicine and geriatric psychiatry is also important,” says Dr Banerjee.
Dr Chakravarty also advocates for geriatric care leave provision for caregivers, similar to childcare leaves, and a geriatric mental health policy.
To detect, prevent, and stop elder abuse, Dr Banerjee suggests training law enforcers, and for policymakers to implement strict laws and regulations against it. Also, create awareness campaigns for available policies. For example, “The Ministry of Social Justice and Empowerment has started a new helpline where elders can call and report abuse at 14567,” he adds.
As we counter these specific factors that impact their mental health, he further says we need to change perceptions of ageing and promote healthy ageing. “Our focus needs to be to create an age-friendly society we want to live in. We need to combat ageism with a no tolerance policy, sensitise older people to their rights and the social provisions, improve digital literacy, create a better support network, foster intergenerational solidarity, and respect and protect their human rights,” concludes Dr Banerjee.