The epidemic of loneliness

“After my husband’s death, I need someone with me. I don’t like to live alone.” These words were spoken softly by an older woman suffering resentment and abandonment while I was interviewing her for the qualitative study in one of the shelter homes of Karachi.

These painful words capture the raw emotion behind an issue that Pakistan can no longer ignore. Loneliness and social isolation are two interrelated notions affecting the elderly population globally. The World Health Organization (WHO) recognises it as a global public health concern, stating its impact on mortality is comparable to smoking 15 cigarettes daily.

The WHO further estimates that approximately one in four older adults experience social isolation, and between 5.0 and 15 per cent of adolescents report feelings of loneliness. The WHO Commission on Social Connection (2024–2026) is now urging countries to recognise loneliness as a public health priority.

The United Nations Population Fund and HelpAge International highlight a remarkable fact: every second, two individuals around the world are turning 60. The global population is ageing at an unprecedented pace, with 80 per cent of older adults residing in lower-middle-income countries. The WHO estimates that by 2050, the number of people aged 60 and above will double, reaching approximately 2.1 billion. Pakistan’s elderly population is projected to surge from 11.3 million in 2017 to over 43.3 million by 2050.

Nothing is accidental. It is an outcome of a paradigm shift. Pakistan’s traditional narrative of the joint family system – where elders are valued, respected, and surrounded by children and grandchildren – is no longer a reality. Globalisation, economic migration, rising costs of living, nuclearisation of families, children leaving for better opportunities and promising to ‘send money’ but never returning, and evolving gender roles have weakened intergenerational bonds.

Other factors include the increasing number of women entering the workforce, leaving less time for traditional caregiving roles. Family conflicts, poverty, and shifting cultural priorities further widen the emotional gap. What’s left behind is a growing elderly population with no one to talk to, no one to touch, no one to care.

Loneliness is not simply about being alone. It is about feeling unseen, unheard, and unwanted. In my study, loneliness emerged as a purely genuine experience of life, along with helplessness and a lack of a support system. They spoke of sitting in silence for days, missing conversations with children, festivals and grandchildren’s laughter. This social and emotional isolation was profound and palpable. Some wept, recalling the moment they were told to “go make their own arrangements”.

The phenomenon of loneliness remains under-researched in developing countries like Pakistan. Loneliness and social isolation significantly affect physical and mental health and overall community well-being. Studies worldwide confirm that loneliness is a risk factor for depression, cognitive decline, heart disease, and even mortality. In Pakistan, nearly 50 per cent of older adults are at risk of loneliness, with one-third likely to face social isolation – especially older women, who are more vulnerable than men.

A recent study conducted in 2024 in Islamabad found a high prevalence of loneliness among geriatric patients, with 65 per cent experiencing moderate levels and males reporting more severe loneliness. Key contributing factors included a perceived lack of support (22 per cent) and social exclusion (12 per cent). As a nation, we cannot afford this neglect. The consequences of chronic loneliness – depression, anxiety, weakened immunity, higher rates of hospitalisation – are not only harmful but burdensome to the already stretched healthcare system.

What do we need to do? We need to treat loneliness as a national health priority. Train healthcare providers – including doctors, nurses and Lady Health Workers – to recognise signs of loneliness and refer individuals to social or psychological support services.

We also need to officially recognise loneliness in older adults as a health risk within the National Health Policy and integrate its assessment into routine health screenings and national surveys. Establish day centres, senior clubs, community hubs, and intergenerational social spaces in every district to foster inclusion, connection, and engagement. And launch a national awareness campaign to destigmatise loneliness and encourage families to stay connected with their elders through visits, calls, or simply listening.

Loneliness should no longer be seen as a personal issue but recognised as a collective public responsibility. As global efforts intensify to tackle this silent crisis, Pakistan must also act. Our older adults deserve to grow old with dignity, connection, and support – not in isolation or neglect.

It is a moral and national imperative that requires immediate action.

The writer is a senior instructor at the Aga Khan University School of Nursing and Midwifery.