INTRODUCTION
The focus of mental health care is undergoing a paradigm shift over the past few decades, with an emphasis on promoting mental health and well-being apart from the treatment and care of people with mental disorders. Recognition of mental health conditions as a public health problem, the development of community-based interventions, and the acceptance of a public health approach toward mental health care have contributed to this transformation. The public health model for mental health care includes a complete spectrum of mental health interventions ranging from prevention, promotion, early diagnosis, intervention for acute care, and maintaining treatment and support as part of chronic care and rehabilitation. Mental health care in older adults requires a public health approach with a focus on promoting the mental health and well-being through a comprehensive and multi-sectoral intervention.[1] Mental health problems in older adults have several biological and psychosocial determinants, including important factors, such as social isolation and loneliness.[2]
This clinical practice guideline will focus on interventions to promote mental health and well-being of older adults. The basic concepts related to mental health and well-being [Table 1] are addressed in the initial article of this supplement. Some of the issues relevant to mental health and well-being in older adults, such as interventions to promote mental well-being in those with medical comorbidity, are addressed as a separate article in this supplement. These issues will be addressed briefly in this article. The scope of this clinical practice guideline will predominantly include the interventions that are likely to be implemented through the health system in general with a specific focus on the role of mental healthcare services. These interventions will be relevant for health professionals from general health care and multidisciplinary fields related to mental health. Promoting mental health and well-being in older adults requires a multi-sectoral approach through the involvement of services from the departments of health, social care, finance, revenue, transport, housing, police, skill development, labor, urban development, rural development, nongovernmental organizations, etc., The role of the psychiatrist in these aspects will include the promotion of advocacy, contribution to the organization of these services, and promoting access to these interventions.
Table 1.
Recent understanding of mental health and well-being
| • Ensuring good mental health is considered a human right • Mental health is not just restricted to the absence of mental disorders • Good mental health should enable adequate coping with usual stressors in life • Ability to make decisions, maintain relationships, and contribute to community • Promoting mental well-being is important for even those with mental disorders |
MENTAL HEALTH AND WELL-BEING IN OLDER ADULTS
The biological and psychosocial factors influencing mental health and well-being of older adults aged 60 years and above include specific factors relevant to this age group in addition to the general factors influencing mental health across the lifespan [Table 2].
Table 2.
Factors important for mental health and well-being in older adults
| • Social isolation • Loneliness • Mental health disorders • Physical health conditions • Frailty • Retirement • Bereavement • Hearing impairment • Vision impairment • Family support |
• Agism • Elder abuse • Age-friendly environment • Health care • Social care • Financial stressors and poverty • Old age dependency • Active engagement and sense of purpose • Spirituality • Resilience |
POPULATION AGING AND MENTAL HEALTH
The increase in life expectancy and decline in the fertility rate have contributed to the increase in the proportion of older adults aged 60 years and above globally. The decline in the proportion of the younger population, along with the increase in the population of older adults, contributes to population aging [Table 3]. This demographic change is occurring at a faster rate in low- and middle-income countries, such as India. Many European and North American countries have taken more than 50 to 100 years for the increase in the proportion of older adults from 10% to 20%.[3] In India, this change is projected to happen rapidly over 20 to 30 years. Hence, the economic development in India during this period of demographic transition is likely to be inadequate to provide adequate health and social care support required to ensure the mental health and well-being of older adults, which is equivalent to the standards in some of the developed countries.
Table 3.
Challenges due to population aging
| • Increase in the prevalence of depression, anxiety, dementia, and other mental disorders • Increase in old age dependency • Decline in family and social support • Increase in caregiver burden • Increase in the prevalence of disability and need for social care and related economic cost • Increase in the prevalence of elder abuse • Increase in the prevalence of chronic medical disorders • Increase in older adults living alone |
LIFE COURSE PERSPECTIVE FOR MENTAL HEALTH AND WELL-BEING IN OLDER ADULTS
The determinants of mental health and well-being in older adults are not restricted only to old age.[4] It extends over the complete lifespan. This understanding is essential to focus on promoting interventions across the lifespan. Even if the interventions are initiated at a later age, it will be helpful to address some of the risk factors and contribute to the promotion of mental health and well-being [Table 4]. However, it is preferable to start these interventions as early as possible.
Table 4.
Factors promoting mental health and well-being of older adults over the lifespan
| Good education Optimal nutrition |
Maintaining good physical and mental health at younger age |
| Regular physical exercise | Minimizing exposure to an adverse environment and pollution |
| Avoiding nicotine use | Good interpersonal relationships with family and friends |
| Avoiding alcohol use | Financial planning and savings for supporting retirement Learning hobbies |
PROMOTING WELL-BEING ACROSS THE SPECTRUM OF INTRINSIC CAPACITY AND FUNCTIONING
Intrinsic capacity refers to the composite of the physical and mental capacity of an individual.[5] Aging is associated with a decline in intrinsic capacity. Old age is often considered synonymous with poor health due to significant limitations in physical and mental capacity, contributing to dependency on the working adult population. However, there are significant heterogeneity and diversity in the profile of intrinsic capacity across the spectrum of older adults.[6] One-third of older adults have preserved intrinsic capacity with adequate functioning. One-third of older adults in the middle of the spectrum may have a decline in capacity, but they may have preserved functioning with appropriate care and treatment for the physical and mental health issues. The older adults in the lower third of the spectrum have a significant loss of capacity due to a decline in physical or mental health. They may have health conditions, such as dementia and stroke associated with significant disability. Promoting well-being and healthy aging is applicable to all older adults in the complete spectrum of intrinsic capacity and functioning. The nature of the interventions and the requirement for environmental support will vary according to the level of intrinsic capacity and functioning [Table 5].
Table 5.
Approach to interventions for promoting well-being based on the level of intrinsic capacity
| Stage of intrinsic capacity | Target for interventions |
|---|---|
| No decline in intrinsic capacity | Health promotion and prevention of chronic health conditions |
| Some decline in intrinsic capacity | Stabilization of the intrinsic capacity through control of physical and mental health conditions Prevention of decline in functioning and disability |
| Significant loss of intrinsic capacity | Supportive interventions to limit the disability and improve functioning through environmental support Rehabilitation and palliative care |
TARGET GROUP FOR INTERVENTIONS TO PROMOTE MENTAL HEALTH AND WELL-BEING IN OLDER ADULTS
The predominant target group for the intervention will be older adults, as their participation and involvement are very important for the success of any intervention to promote mental health and well-being in older adults. However, the mental health and well-being of older adults are influenced by several factors that extend beyond the older adults themselves [Table 6].
Table 6.
Examples of interventions with different stakeholders to promote mental health and well-being in older adults
| Target group | Examples of interventions |
|---|---|
| Older adults | Self-care interventions Cognitive training Physical exercise Psychotherapy |
| Family caregivers | Psychoeducation Family therapy Caregiver training Support group for caregivers Prevention of elder abuse |
| Professional caregivers | Stress management for caregivers Training of caregivers in institutional care |
| School children | Promoting intergenerational bonding |
| Professionals in health and social care | Person-centered care Integrated care for older people Training in geriatric mental health care |
| Community | Age-friendly environment Reduction in agism Elder abuse |
Some of the important stakeholders determining the mental health and well-being of older adults include family members, caregivers, neighborhood, and environment. Family support and the role of an age-friendly environment are very important in promoting well-being and healthy aging.[7] Older adults with severe sensory impairment and mental disability may not be able to have active engagement in the interventions to promote well-being. In this context, interventions with other stakeholders can be very helpful.
TASK-SHARING APPROACH
The older adult population is growing rapidly across the globe and in India due to the increase in life expectancy, reduction in mortality, and improvement in the health system. The population of older adults aged 60 years and above in India is more than 13 crores. A significant proportion of the population seeking health care across all levels of the health system and those living in institutional care are older adults. A specialized workforce for the care of older adults is very limited even in developed countries. It will be very difficult to implement interventions for promoting mental health and well-being in older adults only through the professional workforce. A task-sharing approach by training other stakeholders, including lay people involved in the care of older adults, is an important strategy to address the shortage of specialized workforce.[1] Collaborative care interventions using the task-sharing approach have been implemented in primary care for the management and prevention of depression, suicide risk, etc.[8] The task-sharing approach is essential for scaling up the interventions for promoting mental health and well-being in older adults.
TECHNOLOGY-ASSISTED INTERVENTIONS
The use of technology is emerging as an important strategy for effective implementation and scaling up of services to promote mental health and well-being.[9] It is useful to minimize the human resource requirement and improve access for interventions to those having difficulty due to limitations in mobility, lack of access to safe transport, etc., Restrictions for personal contact during the coronavirus disease 2019 (COVID-19) pandemic contributed to the growth of acceptance of technology-assisted interventions. Many interventions to promote mental health and well-being in older adults have been implemented with the assistance of technology. The older adult population has several challenges with the use of technology-assisted interventions. Limitations in literacy, familiarity with the use of technology, sensory impairment, etc., are barriers for utilizing technology-assisted interventions. Older adults can improve in digital literacy with the provision of training and support.[10] Tele-mental health services have gained importance with the launching of “National Tele-Mental Health Programme (TELE-MANAS)” in India. It is essential to use this effectively for the older adult population.
INDIVIDUAL VS GROUP INTERVENTIONS
Interventions to promote mental health and well-being in older adults have been delivered individually or as a group intervention to patients, caregivers, or other stakeholders.[11] Both of these approaches have specific advantages or disadvantages. Individual interventions will be helpful for facilitating a personalized care plan. It will be useful in outpatient settings with significant heterogeneity in the profile of patients. However, individual interventions are more resource intensive and challenging to ensure access to a large number of patients.
Group interventions are more feasible in institutional settings, such as daycare or residential care. It is also likely to be more cost-effective. Group interventions provide the opportunity for learning from the experience of the peer group. The design of the group intervention itself provides an opportunity to address the issue of social isolation.
PUBLIC HEALTH APPROACH TO PROMOTE MENTAL HEALTH AND WELL-BEING IN OLDER ADULTS
Mental health issues in older adults are an important public health problem requiring a systematic intervention using a public health approach.[12] Promoting awareness about mental health and well-being of older adults among all stakeholders is essential. Ageism, mentalism, and ableism are important biases contributing to the neglect of this issue.[13] Many older adults, family caregivers, and health professionals consider mental health issues in older adults as normal for aging and do not seek help.
Public health systems at the level of Health and Wellness Centers and primary health centers have an important role in promoting mental health and well-being as they have closer access to the community. Public health programs, such as National Program for Health Care of the Elderly (NPHCE), National Mental Health Program (NMHP), National Program for the Control of Non-Communicable Diseases, and National Palliative Care Program, have an important role in the promotion of mental health and well-being in older adults.[14]
SOCIAL ISOLATION AND LONELINESS
Social isolation is the lack of an adequate number of contacts with other individuals either in person or through other means. Loneliness is a perceived emotional state regarding the adequacy of interpersonal contact. Some of the individuals having social isolation may not perceive loneliness. Individuals having multiple social relationships within the family and outside may still have perceived loneliness if they are not satisfied with the level of relationship.[15] Older adults have increased vulnerability to both social isolation and loneliness. More than 50% of older adults are reported to have social isolation. One-third of older adults are reported to have significant loneliness. Social isolation and loneliness are important factors influencing the mental health and well-being of older adults.[16]
Loneliness is a complex phenomenon that extends beyond the mere sensation of solitude. It encompasses a personal perception of social detachment or an absence of significant interpersonal relationships. The state of experiencing prolonged loneliness can result in a range of adverse outcomes, such as depression, anxiety, cognitive decline, heightened susceptibility to chronic ailments, general decline in the standard of living, and increased risk of mortality. Furthermore, the management of loneliness is closely intertwined with the mental health and well-being of elderly individuals.[16] The psychological, emotional, and physical well-being of older adults can be significantly influenced by loneliness. To adequately tackle and mitigate loneliness among the elderly population, it is imperative to comprehend its consequences for their psychological state and holistic welfare. Hence, it is imperative to prioritize strategies to foster psychological well-being and promote a state of being comfortable, healthy, and happy, while simultaneously tackling the problem of social isolation. The following are various strategies that can be employed to manage loneliness in older adults, with the ultimate goal of enhancing their overall well-being and mental health [Table 7].
Table 7.
Strategies to manage issues around loneliness
Strategies to manage issues around loneliness
|
Social support: The establishment of a robust social support system is crucial in addressing feelings of loneliness. Seniors can engage in various activities to sustain their social networks, including upholding preexisting relationships with loved ones, cultivating fresh connections through social events, and taking part in community initiatives tailored to their interest. A dependable and empathetic support network can offer psychological solace, camaraderie, and a feeling of inclusion.
Develop social bonds: Facilitating significant social and interpersonal associations can serve as a strategy to mitigate the effects of social isolation. Facilitating social interaction and bonding among elderly individuals is crucial and can be achieved through various means, such as joining clubs or interest groups, volunteering, or participating in shared hobbies. Significant associations offer a feeling of direction, comprehension, and the chance to exchange experiences with individuals who share similar interests.
Strengthen Networking: The integration of technology in communication can serve as a beneficial mechanism in mitigating feelings of loneliness. Instructing senior citizens on the operation of smartphones, computers, and social media applications has the potential to facilitate their ability to maintain social connections with loved ones, despite geographical separation. The utilization of video conferencing, messaging applications, and social media platforms can facilitate consistent communication, mitigate sentiments of seclusion, and foster engagement in online communities.
Accessible, affordable mental health resources, and facilities: The provision of mental health support is of paramount importance in addressing the mental health requirements of the elderly population. The experience of loneliness has the potential to play a role in the onset or escalation of various mental health disorders, including but not limited to depression and anxiety. Facilitating access to mental health resources, such as counseling or therapy, can furnish assistance, direction, and techniques for coping with loneliness and its related emotional difficulties.
Ensure involvement and participation in meaningful and fulfilling activities: Encouraging participation in meaningful and fulfilling activities has been shown to mitigate feelings of loneliness. It is advisable to motivate senior citizens to engage in hobbies, pursuits, and undertakings that elicit pleasure and a feeling of achievement. This may encompass artistic pursuits, physical activities, scholarly endeavors, or participation in community undertakings. Participating in stimulating activities has the potential to cultivate a sense of direction, enhance emotional well-being, and facilitate social engagement.
Develop an inclusive and supportive (age-friendly) environment: Establishing an inclusive and supportive environment is a crucial factor in promoting the mental health and overall well-being of elderly individuals within their home and community setting. This may entail the implementation of measures to guarantee the availability of community areas that are easily reachable, advocating for initiatives that cater to the needs of older adults, and furnishing various modes of transportation. Moreover, promoting intergenerational linkages by stimulating engagements with younger cohorts via mentorship initiatives or intergenerational events can counteract sentiments of seclusion and solitude.
Supporting caregivers: The provision of support to carers is essential in promoting the mental health and overall well-being of older adults. Ensuring that carers are equipped with sufficient resources, education, and support is crucial in enabling them to effectively tackle the issue of loneliness among older adults. The aforementioned services encompass respite care, support groups, and communication skill training, which are aimed at effectively addressing emotional needs.
The provision of an inclusive environment and system can aid in the effective management of loneliness among the elderly population. To effectively manage and address loneliness among the elderly, it is necessary to adopt a comprehensive approach that takes into account various aspects, such as social, emotional, and environmental factors. The mental well-being and overall quality of life of elderly individuals can be improved through the implementation of strategies that prioritize mental health support, promote meaningful engagement, and foster social connections.
RETIREMENT AND VOLUNTEERING INITIATIVES
Countries, such as India, have a fixed age for retirement in most of the formal employment positions. Many older adults are healthy after the usual retirement age of 60 years, and they have a further life expectancy of around 20 years. Older adults with adequate financial protection during retirement may not require gainful employment after retirement. Individuals engaged in agricultural work, business, and other self-employment may not have a specific retirement age, but they may discontinue regular work due to physical and mental health issues or frailty. Ensuring meaningful engagement for older adults in the postretirement period has an important role in promoting mental health and well-being. Volunteering initiatives across many areas have expanded significantly through many nongovernmental organizations. Older adults participating in volunteering initiatives for healthy aging will enable peer support interventions. Participation in any volunteering activity of their interest will be helpful to reduce social isolation and loneliness and promote well-being. Some government and non-governmental organizations have initiated regular and periodic educational sessions for retirement planning, including aspects of mental health and well-being.
HEARING AND VISION IMPAIRMENT
Older adults have a high prevalence of hearing and vision impairment. Awareness about treatable cause of vision impairment, such as cataract, has improved significantly, and services to treat vision impairment have expanded significantly over the last few decades. In contrast to this, most of the hearing impairment in older adults remain undiagnosed and untreated. High level of stigma, difficulty in affording good-quality hearing aids, and low level of awareness are some of the factors contributing to this. Hearing and vision impairment have a significant influence on social isolation, loneliness, and poor quality of life with an adverse impact on the mental health and well-being of older adults.
STRESS MANAGEMENT
Older adults are vulnerable to being exposed to multiple stressors that are common in old age. Maintaining mental health and well-being requires older adults to have adequate coping skills to manage these stressors. Common stressors faced by older adults include bereavement, diagnosis of health conditions, retirement, financial stressors due to catastrophic health expenditures, and disability. Many older adults are resilient and manage these stressors effectively without developing decompensation in their mental health. However, a significant proportion of older adults develop mental health issues related to these stressors. Promoting effective stress management through supportive psychosocial interventions and lifestyle interventions, such as exercise and yoga therapy, is helpful.
INTEGRATED HEALTH CARE FOR OLDER ADULTS
Older adults have a high prevalence of chronic physical health conditions, such as hypertension, diabetes, heart disease, and stroke. They also have a high prevalence of depression, anxiety, cognitive impairment, sleep disorders, substance abuse, etc., The presence of multiple physical and mental health conditions, including frailty, is common in older adults. The provision of integrated health care close to the community at the level of primary health care is required to improve access to health care, reduce the treatment gap, and promote healthy aging.
ROLE OF NON-PHARMACOLOGICAL INTERVENTIONS AND REDUCTION IN IATROGENIC EFFECTS
Older adults with physical and mental health conditions are often exposed to polypharmacy, contributing to a significant risk for drug interactions and iatrogenic adverse effects. Older adults are sensitive to medications and have a high risk for drug-induced adverse effects even with therapeutic doses of medications due to pharmacodynamic and pharmacokinetic changes. There is a requirement for the effective use of non-pharmacological interventions, such as psychotherapy, psychosocial interventions, and lifestyle interventions for those with milder mental health issues and those who are not responding to pharmacotherapy alone. Regular monitoring of adverse effects is essential to limit any adverse consequences of medications on mental health and well-being of older adults.
AYURVEDA, YOGA, UNANI, SIDDHA, AND HOMEOPATHY (AYUSH) INTERVENTIONS
Many older adults seek treatment from traditional systems of medicine, such as AYUSH. The government of India has advocated the integrated delivery of AYUSH and allopathic health services as part of these integrated health services. Yoga therapy has an important role in promoting mental health and well-being as it has shown effectiveness in the treatment of depression, anxiety, insomnia, etc.
HEALTH AND WELLNESS CENTRES
The government of India has introduced the Ayushman Bharat Initiative with the development of “Health and Wellness Centres” as an important component. These centers in the primary health system envisage the provision of integrated health care with significant emphasis on the component of preventive and promotive interventions to improve the mental health and well-being. Older adults will be one of the important beneficiaries of this initiative as services for non-communicable diseases and lifestyle interventions to promote mental health and well-being will be available in these centers. The availability of group intervention sessions to promote awareness, physical activity, and yoga therapy will be helpful to reduce social isolation and loneliness in rural areas.
SOCIAL CARE SERVICES
Older adults with chronic conditions, such as stroke, dementia, Parkinson's disease, and frailty, may have significant physical and mental disability requiring assistance for daily activities. A complete range of social care services, including home-based care, day care, residential long-term care, and palliative care services, are required to promote mental health and well-being of older adults with significant disability. Many of these services are not available and accessible easily to older adults. The development of these services to cater to the needs of older adults from low-income groups is essential to promote inclusive and equitable services for promoting mental health and well-being. Training in geriatric mental health and dementia care is essential for caregivers involved in providing social care services. Guidance for accessing welfare benefits through disability certification is also likely to enhance the well-being of older adults with disability.
ADVOCACY
Health professionals and other individuals with an interest to promote the mental health and well-being of older adults have the responsibility to promote advocacy on this issue. Advocacy on this issue with the government and nongovernmental organizations will be helpful to promote adequate human resources and services in this field. Promoting awareness about legal support available through “The Maintenance and Welfare of Parents and Senior Citizens Act, 2007” and guidance to access “Elderline” services (National Helpline for Elderly 14567) can promote the safety and well-being of older adults.
SPIRITUALITY AND RESILIENCE
Many older adults engage in spiritual activities to cope with significant physical and mental health challenges and promote resilience. Despite the decline in physical and mental capacity with aging, older adults are shown to have more resilience and they are able to face adversities using wisdom and resilience. Recent studies have demonstrated that cognitive and behavioral interventions can promote wisdom and resilience in older adults, enhancing the scope for positive and healthy aging.
CONCLUSION
Promoting mental health and well-being in older adults is gaining public health importance due to the population aging and the rapid increase in the prevalence of mental health problems in this population. Social isolation and loneliness are important factors contributing to the adverse impact on the mental health and well-being in older adults. A public health approach to address this issue requires multi-sectoral intervention. Health professionals, including those working in the field of mental health, have the responsibility to promote awareness, identify mental health conditions early, and implement comprehensive interventions toward healthy aging. The entire spectrum of intervention, including prevention, promotion, acute care, chronic care, rehabilitation, and palliative care, is required. Personalizing the intervention to promote person-centered care will be preferable to promote the mental health and well-being of older adults. Several evidence-based interventions are available, but there is a requirement for scaling up the implementation and developing more evidence through implementation research.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Rangarajan SK, Sivakumar PT, Manjunatha N, Kumar CN, Math SB. Public health perspectives of geriatric mental health care. Indian J Psychol Med. 2021;43(5 Suppl):S1–7. doi: 10.1177/02537176211047963. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Fakoya OA, McCorry NK, Donnelly M. Loneliness and social isolation interventions for older adults: A scoping review of reviews. BMC Public Health. 2020;20:129. doi: 10.1186/s12889-020-8251-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Divo MJ, Martinez CH, Mannino DM. Ageing and the epidemiology of multimorbidity. Eur Respir J. 2014;44:1055–68. doi: 10.1183/09031936.00059814. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Alegria M, NeMoyer A, Falgàs Bagué I, Wang Y, Alvarez K. Social determinants of mental health: Where we are and where we need to go. Curr Psychiatry Rep. 2018;20:95. doi: 10.1007/s11920-018-0969-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Zhou Y, Ma L. Intrinsic capacity in older adults: Recent advances. Aging Dis. 2022;13:353–9. doi: 10.14336/AD.2021.0818. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Ferrucci L, Kuchel GA. Heterogeneity of aging: Individual risk factors, mechanisms, patient priorities, and outcomes. J Am Geriatr Soc. 2021;69:610–2. doi: 10.1111/jgs.17011. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Avasthi A. Preserve and strengthen family to promote mental health. Indian J Psychiatry. 2010;52:113–26. doi: 10.4103/0019-5545.64582. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Kemp CG, Petersen I, Bhana A, Rao D. Supervision of task-shared mental health care in low-resource settings: A commentary on programmatic experience. Glob Health Sci Pract. 2019;7:150–9. doi: 10.9745/GHSP-D-18-00337. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Li J, Brar A. The use and impact of digital technologies for and on the mental health and wellbeing of Indigenous people: A systematic review of empirical studies. Comput Hum Behav. 2022;126:106988. doi: 10.1016/j.chb. 2021.106988. [Google Scholar]
- 10.Martínez-Alcalá CI, Rosales-Lagarde A, Pérez-Pérez YM, Lopez-Noguerola JS, Bautista-Díaz ML, Agis-Juarez RA. Frontiers in Education. Vol. 6. Frontiers; 2021. The effects of Covid-19 on the digital literacy of the elderly: norms for digital inclusion; p. 245. [Google Scholar]
- 11.Bar-Tur L. Fostering well-being in the elderly: Translating theories on positive aging to practical approaches. Front Med (Lausanne) 2021;8:517226. doi: 10.3389/fmed.2021.517226. doi: 10.3389/fmed. 2021.517226. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Jeste DV, Blazer DG, Buckwalter KC, Cassidy KK, Fishman L, Gwyther LP, et al. Age-friendly communities initiative: Public health approach to promoting successful aging. Am J Geriatr Psychiatry. 2016;24:1158–70. doi: 10.1016/j.jagp.2016.07.021. [DOI] [PubMed] [Google Scholar]
- 13.Rabheru K, Gillis M. Navigating the perfect storm of ageism, mentalism, and ableism: A prevention model. Am J Geriatr Psychiatry. 2021;29:1058–61. doi: 10.1016/j.jagp.2021.06.018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Ved RR, Gupta G, Singh S. India's health and wellness centres: Realizing universal health coverage through comprehensive primary health care. WHO South East Asia J Public Health. 2019;8:18–20. doi: 10.4103/2224-3151.255344. [DOI] [PubMed] [Google Scholar]
- 15.Holt-Lunstad J. The potential public health relevance of social isolation and loneliness: Prevalence, epidemiology, and risk factors. Public Policy Aging Rep. 2018;27:127–30. [Google Scholar]
- 16.Donovan NJ, Blazer D. Social isolation and loneliness in older adults: Review and commentary of a national academies report. Am J Geriatr Psychiatry. 2020;28:1233–44. doi: 10.1016/j.jagp.2020.08.005. [DOI] [PMC free article] [PubMed] [Google Scholar]