In faded trousers and plaid
shirts they came,
tired and worn,
common in their fame,
each one the others only
Life starts out as a newborn baby
and slowly becomes old men.
(From the poem Old men in the park by John Malcolm Pouch)
All poetry about old age conjures up a vivid image of being — of growing up and growing old. We are made acutely aware of the inevitability of the process. We cannot escape growing old, yet society places little emphasis on our emotional, psychological, and social well-being in the later years. In fact, in many cases, depression in older adults goes undiagnosed1. Instead, it is often brushed off as a natural by-product of ageing or confused with other illnesses.
Today, as we slowly break the stigma around mental well-being, mental illness and the like, the young receive a fair share of advocacy. But when it comes to the mental health of the elderly, the public discourse seems to be limited to cognitive and intellectual impairments like dementia and Alzheimer’s disease. What can we do to make it more inclusive? And what may be holding us back? Let’s see.
Elderly Mental Health: Putting together the words
Currently, 600 million people around the world belong to the 60+ age group. This number will double in the next five years. By 2050, the population of older adults is likely to hit the two-billion mark, with developing countries accounting for a majority share2.
The WHO estimates that depression affects around 7 per cent3 of the global elderly population today. What further compounds the issue is the fact that the aged are more susceptible to other physical and cognitive disabilities. So, the slope is rapidly rising without adequate preparedness to handle the disease magnitude on many fronts.
It does not help that several misconceptions and stereotypes have marred our perception of the ageing process. Everywhere, we portray growing old as an expected sadness or as an everyday ennui. More often than not, we assume ageing would bring an unnecessary crankiness. Considering that depression is the most common mental health disorder affecting the elderly, this narrative ought to take a sharp u-turn. Instead of viewing older people as the ‘other’ and assuming that they are alien to us, adopting the approach of ‘bridging and belonging’4 could do wonders in shaping the conversation and creating adequate mental health interventions.
‘Othering’ on ageist Grounds
everyone is susceptible to experience ageism if they live long enough
In sociology, we understand othering as a process of stigmatisation or objectification of another person or group in a negative light. This comparison or exclusion is usually made to justify one’s own positive identity. Of course, no one is comfortable acknowledging their privilege. In this case, however, the impact is seen across ages. How? Negative societal views and stereotypical representations of old age affect people across the age continuum. The elderly end up feeling alienated, while the younger people internalise these ageist attitudes. The result? It hampers their self-perception as they themselves grow older.
Research suggests that ageism may even be the most pervasive of the “isms,” surpassing sexism and racism. According to Ayalon and Tesch-Römer (2017), “Age changes with time and people are likely to change age group affiliation, with the passage of time. Hence, in contrast to the other two isms, everyone is susceptible to experience ageism if they live long enough.” And it can take many shapes, such as prejudicial viewpoints, discriminatory practices, and institutional policies that perpetuate negative beliefs5.
Moreover, the current narrative expects older adults to fade into the background upon retiring. Why? They are no longer the members of the so-called productive workforce. Such perceptions, policy neglect, and the consequent marginalisation could prove to be more unsettling in a country like India, which loves to turn the spotlight on its demographic dividend. This ‘us versus them’ thinking pervades the mental health landscape and policies and creates a seemingly irreparable rift.
Figure: Levy’s PEACE Model6
The Indian context
India is home to 104 million older adults, who represent 8 per cent of the country’s total population. The figure is expected to reach 20 per cent by the end of 20507.
In the traditional joint family structure, both young and old were absorbed with mutual harmony. But as Indian families undergo the process of nuclearisation with limited outlets to absorb the old parents, the feelings of loneliness, rejection, and social isolation also come to the fore. As a matter of fact, even in residential and community care institutions, senior citizens face disrespect and are habitually treated as a burden.
At the same time, being with the family does not guarantee emotional support or social security. The elderly can also face many forms of exploitation and abuse from their near and dear ones.
The bigger picture, The Way Out
We need to adopt a multi-faceted approach to promote the general mental health and quality of life of the seniors. The presence of older people and the problems they encounter in their daily life have far-reaching impacts on the structure and functions of the economy and society. Also, “old people” are who we all will become, which further reinstates that elderly mental health is a psychosocial and structural problem. So, how can we address it?
Medical research is an integral part of the solution architecture, but we also need interventions that go beyond just psychopathology. Our respect for the elderly should translate into their representation across popular culture and the media. Sometimes, even the most well-intentioned advocates can further negative generalisations, and positive messaging is inherent to creating greater awareness around this issue.
Therefore, we need to question the depiction of the elderly as helpless victims.
Tweaking the existing systems
We need to come up with innovative solutions to combat elderly loneliness. For example, Age UK runs a unique Befriending Service that pairs older adults with a friend who visits them once or twice a week for a cup of tea, a recreational activity, or an outing. Alternatively, the local centres can arrange such friendly conversations over the phone or online. Of course, we will need to consider the fabric of Indian family systems and adapt the idea, but it is a good starting point nevertheless.
Another example of a successful social integration programme in the UK is the University of Third Age (U3A). It organizes learning and development courses specifically for older adults who want to pick up a new skill or simply share their knowledge with others. Technological advancement has made possible the creation of a nationwide network and discussion forums where they can exchange ideas about arts, crafts, gardening, literature, computers, or anything else of their interest. We could learn from these programmes and come up with initiatives that address the Indian context.
After all, this is stating the obvious: we need improved access to personal and psychological counselling services. Talking to trained therapists can provide a judgement-free environment and help us find ways of dealing with our emotional issues.
Our solutions should embody the values of compassion, company and care to make room for everyone’s struggles.
After all, we all deserve to live with dignity and assert our right to holistic care, irrespective of our age and other biological or social labels.
If you or someone you know is dealing with depression, suicidal ideation or similar symptoms, please reach out to iCall helpline at 022-25521111 (available 8 am – 10 pm, Monday to Saturday in India), The Samaritans. (116 123 Or email firstname.lastname@example.org) in the UK.