How The Elderly Keep Mentally Strong: Lessons On Resilience

Kamakshi Narayanan (82) was looking forward to mornings of day dreaming. Advanced arthritis had severely impaired her mobility, although she is always seen hobbling around her home or garden in Kodaikanal, getting things done, or doing them herself. “It’s delightful to stay in bed in the morning, just dreaming of what is going to happen or what should be done that day,” she says. “But I know that unless I get up now, it’s going to be delayed every ten minutes or so, and it’s going to snowball through the day. So I get up and get on with it.” As a primary carer for her husband Narayanan, who is recovering from a hip replacement surgery, her work is cut out. Outsourcing caregiving is an option in theory, but getting a trained person to commit to look after an octogenarian in the hills is a challenge. Since Narayanan’s discharge from the hospital, as many as seven carers have come and gone.

Kamakshi is a trained homeopath, gardener, Tamil writer and translator, and social work enthusiast. But of all the by-products that come with ageing, including social isolation, health and caregiving challenges, what stands out for her is “the physical inability to go ahead with what I am doing. Walking is an effort. Getting up is an effort...” she says.

The sort of solitude or alienation from one’s own body is also commonly interpreted as loneliness. One of the most pressing issues faced by the elderly, loneliness is said to be a quiet epidemic that accompanies ageing. But many, like Kamakshi, have found unique ways to cope. Through routines, humour, caregiving, faith, or simply the will to get through the day, they make meaning of their life.

Loneliness is often looked at as the default companion of ageing. As social beings, it is our connection to others that helps us thrive. Sometimes this connection is lost because one has lost friends and family. More often than not, your children (if you have any) may have moved to other cities or countries in pursuit of their careers or family life. Sometimes one is displaced geographically and has acquired a new habitat, like a senior citizens’ home, because one of the two in a couple needs specialised caregiving. Sometimes you may have moved to a smaller town after retirement in search of more space or cleaner air.

While old age shifts the focus to physical parameters of health—markers for BP, thyroid, cholesterol, sugar, etc. are routinely in place and updated at every hospital visit—it is mental health that often goes unmonitored.

When cognition and personal autonomy are compromised, ageing becomes a different battle, because it impairs your ability to engage in social activities. At times, withdrawal, health-related anxiety and sadness mimic and mask the symptoms of loneliness.

For those in conventional job scenarios, retirement age (anywhere between 55 and 60) marks the end of a whole ecosphere called the workplace. Retirement brings about further isolation, and a feeling of anxiety that comes with a loss of income—added to this are physical restrictions, loss of a spouse or friends and the social networks they are part of in their cities of origin. But everyone makes peace with their new normal; some just do a better job of it than others. For those who have a purpose outside of their families, retirement age is just a number, but for those who feel they still have years of productivity left in them, it’s harder to reconcile. VS Ramachandran, a longtime Mumbai resident now settled in Coimbatore, felt let down by the system. “When I retired from my job in Mumbai in 1996, I wanted a few more years to work and earn. My son was still in college in Pune, studying for his engineering degree.” He looked for jobs in some small companies, but the computer era had just begun and he lacked those skills, so no one wanted to hire him. “I was somewhat disappointed that my working days were over.” he says. “I was already experiencing some form of anxiety and depression while I was still working, and it became worse. My interest and enthusiasm were at an all-time low. We soon moved to Pune around 1998 and I got a job with a travel and tourism company.”

Ramachandran eventually built his retirement home and moved to Coimbatore but soon after that, his wife suffered a stroke and he was her primary carer for 20 years until she passed away earlier this year. 

Living in your own home also comes with the motions of running a home—something that gives you a rhythm but is accorded only if you have financial security and are in a state of health which would still qualify as old age and not bed-ridden.

“Running my house keeps my mind busy and active,” says S Amba (79), of Chennai origin who also moved to Coimbatore soon after she and her husband R. Sanjeevi (79) retired from CSIR in 2006. They chose to remain child-free but have a huge family network of cousins, nieces and nephews who form the fabric of their social life.

“Both of us haven’t been in great health, and I’m often asked if we will move to a senior citizens’ home, but I think we’ll wait till there is no other option,” says Amba. The two of them have had several surgeries in the past decade and are now very organised about their routine, exercise and diet. Her husband, who is a science and tech aficionado enjoys conversations with kids in their building, “They know so much, this generation, it is thrilling to talk to them!” he says.

An avid reader and a library enthusiast, Amba misses the social interactions with young people from her earlier life. “Sometimes I wish I could use my brain more,” she says.

But even when the mind is fruitfully engaged, as in the case of Padmini Mani (81) who runs a holistically themed school for the underprivileged in the Atuvampatty Valley of the Palani Hills in Tamil Nadu, a decline in health with age is par for the course. “I have various neurological problems due to my tinnitis—so on any given day, my BP either drops suddenly or shoots up…” says Mani, as she is advising her house help on how to make a sauce to garnish a cake, and instructing the supervisor at the school on the importance of documentation of their sewing project and dental camp. “We didn’t realise that our little passion project—something my husband Ram and I built bit by bit—would live for so long. On a daily basis, for the past 20 years, a miracle is manifested here,” she adds.

With declining social connections as one ages, asking for help is something that doesn’t come easy. Eighty-four-year-old Sudesh Khera, a resident of Telco Colony in Pimpri, Pune, had one such moment when her 93-year-old husband had a fall at home. She realised she couldn’t pick him up, but didn’t want to bother her children who live in Mumbai, Delhi and Mathura. She stepped out and just stood by the gate. When two boys drove by on a motor cycle, she stopped them and asked if they could help. “With their help, we took him to the hospital where they treated his fractured wrist,” she says. Sudesh wouldn’t change anything about her life though. “If I manage my home and cook myself, my body parts will remain active,” she says. “I have to look after myself so I can look after him. I have learned to trust my instincts.”

Chennai resident Uma Maheshwari (66), also listened to her instincts in her early sixties when she gave up her apartment in the heart of town to move to Brindavan, a senior citizens’ facility in Coimbatore. Her only daughter lives in Fremont, USA. Her husband passed away in 2012 and she feared that as she aged, she would find it harder to navigate the busy city.

The living arrangements of the elderly are a primary determinant of their levels of satisfaction and their psycho-social well-being. Living with family is no guarantee for well-being. Often, a visit to or from a neighbour or someone from their own age group can be far more enjoyable as it doesn’t come with an obligation. May be this is the basis for how senior-citizen’s facilities operate. 

Beating loneliness by getting a headstart is an act of initiative. But then it’s also a privilege as these homes cost a packet. Maheshwari paid Rs 58 lakh for a two-bedroom unit at Brindavan Arcade in 2020, and has maintenance and food bills to pay every month. “If you come with the right mindset, you will be happy. Someone is there to cook for you, you don’t have to buy groceries, worry about meal prep—haven’t we done enough of that?” says Maheshwari, who has adjusted well to the assisted living lifestyle.  Her move was catalysed by COVID-19 and her brother moving there.  

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Covid also did one more thing—it made the urban homeless elderly more visible, says Ganesh M., an MNC employee and a part-time philanthropist who used to volunteer at old-age homes as a student in 2009. He started Helping Hearts, a series of shelters for the homeless elderly in 2016. Ganesh and his associates, around 30 MSW graduates, now run 11 centres in Coimbatore with new shelters at Pollachi, Mettupalayam and Dindigul. Each year, Helping Hearts takes in over 200 elderly people through their outreach programmes that rescue people from streets, government hospitals, etc. The first resident, Indhrani (79), still lives at the shelter, and helps with kitchen work and cleaning. They also have specialised centres for those affected by HIV, mental illness and the terminally ill. These are people who often lack documentation, hence private old-age homes and shelters cannot take them in. Helping Hearts has tied up with the government to create paperwork for the homeless.

Most of those rescued have been daily wage workers, street vendors, etc. Vasant Kumar (75), one of the residents, who has worked abroad in his youth, was rescued by his friends at a bus stand opposite the Kidney Centre. Another resident, Thangamani (75), was rescued from a government hospital as there was no one to care for him after a surgery, and he has been at the Pudur shelter since 2016.

But Ganesh’s goal is to go beyond providing the homeless elderly food and shelter. “We want their living years to count,” he says. “We’d like them to move beyond restricted living. We want to create new families.”

This is where ‘Home Again’, one of Chennai-based NGO The Banyan’s models, comes in. A housing intervention with supportive services, it is a cost-effective and sustainable option for addressing long-term mental healthcare. It aims to provide pathways for rehabilitation of people in institutional spaces, improve their quality of life, mental health outcomes and community functioning, while promoting human rights. One such model has taken off successfully in Mettupalayam, where a group of women rent a home together and run an Aavin Milk parlour.

The model has been adopted as a scheme by the Disability Department of the Government of Tamil Nadu and piloted now in five districts with The Banyan as technical partner and a local civil society organisation implementing the scheme with funds from the Department. The model was first tested in 2014, inspired by service users who had made this choice earlier to rent homes in the community and live as affinity groups.

Lalita Iyer is an Associate Editor at Outlook and the author of Sridevi: Queen of Hearts, The Whole Shebang, Raising Mamma and other books.

In its August 21 issue Every Day I Pray For Love, Outlook collaborated with The Banyan India to take a hard look at the community and care provided to those with mental health disorders in India. From the inmates in mental health facilities across India—Ranchi to Lucknow—to the mental health impact of conflict journalism, to the chronic stress caused by the caste system, our reporters and columnists shed light on and questioned the stigma weighing down the vulnerable communities where mental health disorders are prevalent. This copy appeared in print as 'Autumn’