Loneliness Among Older Indian Workers: Findings From the Longitudinal Ageing Study in India

Applications of study findings

• Job-training or skills training needs to be made available to older adults

Introduction

Adults aged 60 years and over currently comprise around 10% of India’s population, and this is projected to increase to 19% by 2050 (Chanda & Mishra, 2019; NSO, 2021). Around 47% of adults aged 60 years and over in India are completely economically dependent on others, with a further 25% in rural areas and 20% in urban areas partially dependent on others. The numbers also reveal a marked gender divide, with around two-thirds of women lacking economic independence when compared with around a quarter of men (NSO, 2021). Findings from the first wave of the Longitudinal Ageing Study in India (2017–18) indicate that over a third of individuals aged 60 years and over in India are working (International Institute for Population Sciences (IIPS) et al., 2020). While individuals over the age of retirement might wish to continue working, this may vary considerably by factors such as the profession the individual is currently in, education, and health status. Indeed, research by the Centre for Equity Studies on older adults aged 55 years and over in Rajasthan who lacked income security found that nearly half would work less or stop working completely if they had access to an adequate pension (Sampat & Dey, 2017). A recent review on extending working lives suggests poor outcomes for individuals in demanding or poorly paid jobs, and the widening of health inequalities for those who need to continue working when compared with those who are able to retire (Baxter et al., 2021). The state of older adults in India who continue to work and their well-being has received limited attention in the literature.

Loneliness or “perceived social isolation” refers to the discrepancy between an individual’s actual and desired social connections, leading to feelings of dissatisfaction with one’s social network (Peplau & Perlman, 1982). Feelings of loneliness can be useful as they may prompt an individual to establish social relationships (Qualter et al., 2015). However, there is considerable research indicating that sustained loneliness is associated with poor physical and mental health as well as an increased risk of mortality (Leigh-Hunt et al., 2017). Being employed is typically associated with lower levels of loneliness, with studies suggesting a potential bi-directional relationship, particularly in working-age samples (Morrish & Medina-Lara, 2021). Given that older adults may work for different reasons when compared with younger groups, we need to better understand factors that affect wellbeing in older workers. Indeed, there is some evidence to suggest no significant benefits to wellbeing or depression associated with continued employment among over-65s in Sweden (Anxo et al., 2019).

Financial insecurity in later life, including post-retirement, has been associated with greater feelings of loneliness (Cruwys et al., 2019; Loibl et al., 2022). There is strong evidence to indicate a marked socioeconomic gradient in loneliness with levels of loneliness higher among those who are more disadvantaged (Madani et al., 2022). One such indicator of disadvantage may be food security. The World Bank (1996) defines food security as “when all people, at all times, have physical and economic access to sufficient safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” While a significant issue in low- and middle-income countries such as India (George & McKay, 2019), food security is also a problem for many high-income countries (Loopstra, 2018). Loneliness has also been related to food insecurity at different ages (Guzman et al., 2022; Howe-Burris et al., 2022), with home food delivery programs such as Meals on Wheels in the US being associated with decreases in loneliness among older adults (Ross et al., 2022; Thomas et al., 2016; Wright et al., 2015). Poverty among those who work is high in several parts of Asia, including India and this is likely to be heightened in the case of older adults (Economic and Social Commission for Asia and the Pacific, 2022). Our analysis uses food security as a marker of disadvantage among individuals who are working in later life, and assesses its role as a predictor of loneliness.

Occupational characteristics may also play an important role in determining loneliness. Psychosocial stressors such as job demands, autonomy, and bullying have been found to be associated with poor mental health, but there has been relatively little consideration of the role of physical working conditions in mental health (Theorell et al., 2015). The limited evidence available also shows mixed findings. For instance, in a study on a working-age French cohort, working conditions that included exposure to noise, vibrations, chemicals, etc. were not associated with depressive symptoms (Niedhammer et al., 2020). However, such conditions were associated with greater depressive symptoms in a Korean sample (Stahl et al., 2016). Work from the US indicates that older workers prefer jobs that allow for more autonomy, greater flexibility, lower physical demands, and lower levels of stress (Acemoglu et al., 2022). Such work may not, however, always be available to this group. When considering the Indian context, workers aged over 60 years are mainly based in rural areas, and are predominantly involved in agricultural and allied activities (International Institute for Population Sciences (IIPS) et al., 2020). Many of these jobs are part of the informal economy, lacking adequate regulation and characterized by high levels of precarity (Agarwala, 2009; Government of India, 2015). Hence, it is important that the role of working conditions is assessed in the Indian context. The role of working conditions, including types of effort required or exposure to unpleasant conditions, has also received little attention in the literature on loneliness. Given that loneliness is closely related to depression and indeed may predict depressive symptoms (Cacioppo et al., 2010; Erzen & Çikrikci, 2018), and that the nature of work in later life may be different for older adults in India, it is important that we address this gap in the literature.

Thus, the present analysis examined the role of work-related factors and food security on loneliness among employed Indians aged 60 years and over, using data from a nationally representative cohort study. We hypothesized that poorer working conditions and greater food insecurity will be associated with higher levels of loneliness in this group.

Methods

Results

The mean age of participants was nearly 66 years, just over 68% were men and nearly 80% were partnered (see Table 1). Over a third of participants reported being in poor health. Nearly two-thirds of participants reported working in the primary sector. The average score for working conditions requiring physical effort was above the mid-point of the scale, while that for experiencing unpleasant conditions at work was quite low. Scores for working conditions requiring mental effort were slightly below the mid-point of the scale. While nearly two-fifths of participants reported not being able to eat food of their choice in the past 12 months, the proportion of participants who reported having to reduce their food intake (6.3%), going hungry (5.3%), not being able to eat for a whole day (4.0%), and having lost weight due to inadequate food intake (4.7%) was lower. Over two-third of participants reported never/rarely feeling lonely and over 20% reported feeling lonely some of the time, while 11.1% reported feeling lonely all of the time.

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Table 1.

Participant Characteristics (N = 9035).

Variable	Analytical Sample
Age in years—mean (SD)	65.9 (5.4)
Male (%)	68.1
Poor self-rated health (%)	37.4
Single(%)	21.8
Subjective social status—mean (SD)	4.2 (1.9)
Occupational sector (%)
Primary	64.5
Secondary	4.2
Tertiary	30.0
Other/missing	1.3
Physical effort required at work—mean (SD)	5.3 (2.5)
Mental effort required at work—mean (SD)	3.9 (1.8)
Exposed to unpleasant conditions at work—mean (SD)	1.2 (1.7)
Food security scale—mean (SD)
Reduced the size of meals (%)	6.3
Did not eat enough food of one’s choice (%)	38.6
Hungry but did not eat because of insufficient food (%)	5.3
Did not eat for a whole day because of insufficient food (%)	4.0
Lost weight because of insufficient food (%)	4.7
Lonely (%)
Rarely/never	67.5
Sometimes	21.4
Often/always	11.1

The test of parallel lines was found to be non-significant (χ²(19) = 26.71, p = .112), indicating that the assumption of proportion odds was met and that it was appropriate to carry out an ordinal regression. Results of the ordinal regression are presented in Table 2. Age, sex, occupational sector, and self-rated health were not significantly associated with loneliness. The estimated odds ratio indicated that marital status was associated with an increase in the outcome variable, specifically being single was associated with a two-fold increase in the odds of being lonely. Both total household wealth and subjective social status showed an inverse association with odds of loneliness. Several dimensions of food security were associated with increased odds of loneliness. In particular, not being able to eat enough food of one’s choice, going hungry because of insufficient food, and losing weight because of insufficient food indicated a positive relationship with loneliness. However, reducing the size of one’s meals or not eating for a whole day were not associated with greater food insecurity. Being in an occupation that required physical effort was not associated with loneliness. However, being in an occupation that exposes one to unpleasant working conditions was associated with higher odds of loneliness, while being in an occupation that requires mental effort was associated with lower odds of reporting loneliness.

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Table 2.

Ordinal Regression of Loneliness Categories (N = 9035).

Variable	OR (95% CI)	p-Value
Age	.99 (.99–1.00)	.144
Male	1.03 (.93–1.14)	.563
Poor self-rated health	1.01 (.92–1.11)	.800
Wealth
Second quartile	.84 (.75–.96)	.009
Third quartile	.92 (.81–1.05)	.224
Fourth quartile (wealthiest)	.79 (.69–.91)	<.001
Single	2.29 (2.05–2.55)	<.001
Subjective social status	.96 (.93–.98)	<.001
Occupational sector (reference = primary)
Secondary	1.09 (.88–1.38)	.409
Tertiary	1.09 (.98–1.21)	.118
Unclassified/missing	.87 (.58–1.31)	.507
Physical effort required at work	.98 (.96–1.00)	.173
Exposed to unpleasant conditions at work	1.09 (1.06–1.12)	<.001
Mental effort required at work	.93 (.91–.96)	<.001
Food security scale
Reduced the size of meals	1.13 (.89–1.42)	.292
Did not eat enough food of one’s choice	1.27 (1.16–1.39)	<.001
Hungry but did not eat because of insufficient food	1.49 (1.13–1.95)	.004
Did not eat for a whole day because of insufficient food	.97 (.73–1.31)	.864
Lost weight because of insufficient food	1.89 (1.50–2.39)	<.001

The pattern of results remained identical when the analysis was repeated using the summed score for food security. Using participants with no food insecurity as the reference good, those with mild food insecurity (score of 1) reported an increase in the odds of loneliness (OR: 1.38, 95% CI: 1.25–1.51), while those with higher levels of food insecurity (scores of 2 or higher on the summed score) had over a two-fold increase in the odds of reporting loneliness (OR: 2.38, 95% CI: 2.03–2.80).

Discussion

The present analyses aimed to assess the role of work-related factors and food security on older adults’ levels of loneliness. While there is a growing body of research focusing on the prevalence, correlates, and effects of loneliness, much of the research has focused on the Global North (Surkalim et al., 2022). Given marked social, economic, and demographic differences, more needs to be done to better understand loneliness in countries like India. Over 11% of participants in our analysis reported being lonely most or all of the time, which is slightly lower than in the total LASI sample where over 13% reported severe loneliness (Pengpid & Peltzer, 2021). We found that while work that exposed participants to unpleasant conditions was associated with higher levels of loneliness, work that required more mental effort such as high levels of concentration or skills in dealing with others was associated with lower levels of loneliness. Multiple aspects of food security were associated with increased levels of loneliness.

Our findings align with previous research indicating higher levels of loneliness among those who are more deprived (Madani et al., 2022) and those who perceive themselves as being less well-off when compared with others (Ayalon, 2019). Our analysis also demonstrated that food security persists as an issue among older Indians who work, with proportions of those reporting food insecurity comparable to those in all over-60s (Muhammad et al., 2022b). Previous research using the LASI data has indicated that measures of food security are associated with measures of depression (Muhammad et al., 2022b; Patel et al., 2022), cognitive function (Kumar et al., 2021), and frailty (Muhammad et al., 2022a) in later life. In our analysis, we find that a lack of food choice and a lack of food availability, including weight loss due to inadequate food consumption are associated with greater feelings of loneliness among those who work. While related to measures of socioeconomic position such income or education (Foley et al., 2009), food security may reflect certain aspects of social networks. Previous research has indicated that strong social bonds including greater community and social cohesion in more deprived groups may actually help in reducing food insecurity through sharing of resources including food (DiFiore et al., 2022; Nagata et al., 2015). Individuals who are food-insecure may lack these bonds, and hence experience higher levels of loneliness. Some items on the food security scale were not associated with loneliness in the multivariable analyses; however, when analyzed independently (adjusted for other variables in the model) each item measuring food security was associated with the outcome (all p’s < .001; data not presented here). When analyzed jointly, it may be that items indicating greater severity are more closely associated with loneliness.

India’s two existing national policies dealing with older adults are the National Policy on Older Persons 1999 (Government of India, 1999) and the more recent National Policy for Senior Citizens 2011 (Government of India, 2011). The National Policy on Older Persons, dealing with people above the age of 60, mentions the word loneliness once in the entire policy document and that too in the context of volunteers being encouraged to assist older adults who are confined to their homes, with particular reference to older women who may be frail and lonely. While financial security and food-related recommendations are individually recognized as factors necessary for the wellbeing of older adults, they are not understood as having any direct implications for loneliness. Similarly, the National Policy for Senior Citizens 2011 (Government of India, 2011) also mentions loneliness only once in the context of loneliness being higher among older women when compared with men. Again, while financial insecurity and the two-thirds of the older adults being below the poverty line are cited as reasons for a “major intervention,” the policy does not adequately reckon with food insecurity except for promising assistance through the public distribution system for those below the poverty line. Consequently, it does not take a holistic view of the implications of such insecurity for levels of loneliness. Our findings on the increase in levels of loneliness for food-insecure older adults may have implications in terms of expansion of the scope of policies beyond the “below poverty line” cohort to a broader cohort of those who are working but still food-insecure. This expansion in policy scope may in turn have implications for the formulation and implementation of schemes with increased budgetary allocations and expanded scope of food security (free foodgrains, highly subsidized rations, etc.). The paper’s findings on the connection between lack of food diversity and increase in levels of loneliness may also have implications for the programmatic design of these schemes to allow for greater diversity in allocated rations.

Working conditions have received limited attention as a correlate of loneliness. Work that requires concentration or skills places significant cognitive demands on an individual. The association between better cognitive functioning and lower levels of loneliness in later life is well-established (Cohen-Mansfield et al., 2016). Our findings offer additional support for these associations. Indeed, work that is challenging and offers the opportunity to maintain social contacts has been identified as a reason why people may choose not to retire (Proper et al., 2009). However, adverse working conditions such as exposure to noxious substances or odors were associated with higher levels of loneliness. Continued exposure to such conditions in later life may contribute to increased feelings of stress which in turn lead to feelings of loneliness (Laustsen et al., 2023). The correlation between working conditions and loneliness also has implications for policy that is not sufficiently recognized by current Indian policies. The National Policy for Older Persons recognizes older adults above 60 as a “huge untapped resource” (p. 8) and broadly commits to support organizations which provide training, career guidance, and orientation. However, the policy does not commit to specific job-training programs that can transition working older adults from arduous and adverse job environments to more convenient, stimulating ones (Government of India, 1999). The National Policy for Senior Citizens (Government of India, 2011) commits to provide “employment in income-generating activities after superannuation” (p. 5) and the setting up of a Directorate of Employment to help adults aged over 60 find re-employment opportunities. However, it too does not focus on orienting job-training programs in a manner that helps in transitioning this group from labor-intensive and physically demanding occupations to ones that are more cognitively demanding and stimulating, but physically convenient.

Conclusions

This study identified the role of poor working conditions and food insecurity in predicting loneliness among older adults who work. The analysis also identified how work that allows a greater degree of mental and social engagement may be protective against loneliness. Our findings highlight the need for skills training in later life as well as policies that ensure food availability in this group. Future research could consider additional variables such as the role of psychosocial demands, autonomy, and the experience of ageism.