Helping the elderly in India feel less lonely

In the small village of Mandwa, in central India, roughly 30 seniors and several of their grandchildren gathered in a one-room community center for a weekly meeting in late September. They began as they always do, with a nondenominational prayer, followed by songs. Then they spent a few hours connecting with each other and working on their own health.

They are part of a public health project called Sahjevanwhich aims to reduce loneliness among rural seniors. The effort is led by community medicine physicians at the Mahatma Gandhi Institute of Medical Sciences — the first rural hospital in India, started by Gandhi himself.

Although India is the most populous country in the world, rapid urbanization and the decline of traditional joint family structures have amplified a sense of isolation among seniors in rural areas. Now, projects like Sahjeevan aim to foster community as part of an effort to help the elderly lead healthier and happier lives.

The Sahjeevan model

India’s population is aging fast. From 2011 to 2036, the number of seniors is expected to jump from 100 million to 230 million. At the same time, many young people are leaving villages to find higher-paying jobs in cities, disrupting traditional extended family structures.

Against this backdrop, the Sahjeevan project was initially launched in 18 villages around Wardha, in the state of Maharashtra. In 2024, with help from a government grant, it was expanded to 100 villages across the region.

Dr. Arjunkumar Jakasania, a public health expert and one of the leaders of the Sahjeevan initiative, said the goal is “to make aging happier, healthier, more dignified.”

Through their model, several people from each village are trained on topics like how to mentor young people, care for their own health as they age and integrate themselves into the community. Then, they use games and activities to teach other seniors these strategies.

In Mandwa, the trainer is a local senior named Sudhir Rambhau Bawane. Initially, he said it was difficult to get people to attend their weekly meetings, but now, “more people keep joining. It’s like a type of magic.”

Nearby, elderly men and women sat together on the floor, coloring in coloring books, listening to stories being read aloud, teaching children new skills and doing exercises to improve their shoulder mobility and grip strength. They also commemorate birthdays, but with a unique twist. Since few older people there know their official date of birth, the group celebrates a different person each week.

That day, Bawane and another senior, Gopal Watkar, also went across the street to a primary school. Sitting outside with roosters crowing in the background, Watkar taught the children the basics of playing the harmonium.

“Anyone interested in learning is welcome to come join us,” he said, sharing that Sahjeevan holds weekly gatherings that the students can attend.

Of the seniors, Jakasania said, “When such activities started, they started finding company, and they started finding people who were in the same boat of loneliness and living alone,” which strengthened their bond.

And these bonds also can improve physical health.

Studies show that loneliness can lead to higher rates of cognitive decline, cardiovascular disease and depression. Jakasania has seen this firsthand. While discussing ways of preventing common diseases in India, such as hypertension and diabetes, seniors would question the value of extending their lives: “What will we do after living so long? Because there is no one with us.”

In addition to giving the elderly a greater sense of purpose, the program has benefited young people, as well.

One 18-year-old, Payal Ashok Raut, said her grandfather used to be “irritable at home. He wouldn’t talk to us or to anyone else.” Then, his son died, and he withdrew even further. Now, after joining the group, Raut said he’s learned how to better communicate with her.

Also, since she has started attending meetings, her own insecurity about public speaking has diminished.

“I got the confidence to sing and to talk in public,” she said.

Summing up their work, Jakasania said, “Health is embedded in relationships and the society we live in.”

Focusing on loneliness

While Sahjeevan has helped improve social ties in many of these rural communities, villagers often continue to lead challenging lives.

Yenubai Narayanrao Deshmukh lives in Dahegaon village. In her 70s, she beamed even as she recounted her hardships. Deshmukh’s parents died when she was young, and she often went without food while growing up. She was married at age 11 and now, as a widow, struggles to make ends meet.

“There’s been sadness throughout my life,” she said. “Maybe I’ll find happiness in the afterlife.”

Still, Deshmukh is thankful for the Sahjeevan center in Dahegaon. “Attending the meetings makes me feel peaceful, and I forget my problems for a while,” she said. In particular, she enjoys singing songs with everyone, although she doesn’t always know the words, “so I hum along.”

At least 40% of seniors live in the poorest economic bracket, like Deshmukh. But in the face of other public health challenges, such as high rates of diabetes and cardiovascular disease, loneliness often takes a backseat in India.

That is slowly starting to change.

Dr. Vijayaprasad Gopichandran, a community medicine physician, has been investigating different modes of reducing loneliness in Tamil Nadu, a state with one of the highest populations of seniors.

As part of his research, he brought seniors together once per month at his facility, where they socialized, ate meals and discussed ways of improving their health. To his surprise, a large number of seniors dropped out of the program.

“Many of the elders felt that this was not their priority,” Gopichandran said. “They were extremely lonely, but they could not perceive that socializing with others [and] having fun would actually make them feel better.”

Similarly, in the state of Maharashtra, about 25% of villages in the Sahjeevan project struggle with attendance and holding regular meetings. Mobility challenges could be one reason why.

However, Gopichandran would like to further explore factors that prevent lonely seniors in India from connecting. This topic has not been extensively studied, and he said common metrics like the UCLA Loneliness Scale might not capture the nuances of India’s cultural context.

“Even understanding how to talk about loneliness in a typical Tamil rural context is something we’re trying to work out,” Gopichandran said. “What is loneliness? What are the words they use to describe it?”

Gopichandran hopes that by studying the structures of loneliness in India, he can better shape future projects. One thing most experts agree on is that tailoring solutions to the local culture is essential for bringing people together.

For Sahjeevan, that has meant tailoring activities specific to each community’s culture, such as a festive project in which young and old residents worked together to sculpt religious idols of elephants before the holiday of Ganapati. It has also meant using region-specific language to frame their events.

For example, in the village of Karanji Kaji, people gathered recently for a traditional community fair called a “Mela.” Sahjeevan used it to foster intergenerational relationships. As seniors entered, they were encouraged to pin a paper mango to a large cardboard tree with their wishes for the next generation. Alongside children and teens, they competed in games, sang songs and worked on art projects together.

This project comes to an end in 2027 due to funding constraints. But Jakasania hopes to expand it across India. Several of the villages they supported are already running independently.

“We need to start working for an Indian solution for the Indian problem,” he said. “Our department is really hoping and dreaming that something should happen at a large scale.”