Nepal’s ageing population is growing, but the mental health needs of older adults continue to be overlooked. Emotional difficulties such as sadness, worry, isolation, and neglect are often normalised as part of ageing, preventing timely support and understanding.

Psychologist Sunita Shrestha, who has spent over two decades working in Nepal’s mental health and psychosocial field, offers insights into the mental health of elderly individuals. Over the years, she has specialised in trauma counselling, family and relationship counselling.

What are the common mental health challenges for the elderly population?

Depression is one of the most common mental health concerns among elderly people, especially among those living in old-age homes or with limited family contact. Its causes often stem from social isolation, bereavement, chronic illnesses, and the painful feeling of being a burden to their family.

Anxiety is also widespread, driven by worries about health, financial security, and the well-being of children living far away—often showing up as restlessness, tension, excessive worry, or physical symptoms like headaches and digestive issues. Cognitive decline and dementia further add to these challenges, with memory loss and confusion becoming more pronounced when seniors lack mental stimulation or are dealing with chronic health conditions.

Additionally, grief and emotional burden from the loss of spouses, siblings, or peers, as well as responsibility for maintaining cultural and religious practices, can lead to chronic stress. Finally, risk of neglect or abuse—whether emotional, financial, or physical—can increase vulnerability to depression, anxiety, and reduced self-esteem.

How does loneliness or social isolation impact the mental well-being of older adults?

In Nepal, where family and social bonds have long served as emotional anchors, the absence of meaningful connection can be devastating. Many seniors find themselves increasingly alone—even within multi-generational homes—due to migration, urbanisation, and shifting social roles.

With no one to share daily experiences or emotions with, negative thoughts multiply, creating an emotional vacuum that can lead to clinical depression, irritability, and chronic anxiety. Adding to this, many elderly individuals hesitate to express their emotional pain for fear of “troubling” family members.

Prolonged social isolation also contributes to cognitive decline and memory problems. Human brains thrive on social interaction, and seniors who spend long hours alone without conversation or stimulation show weaker memory, slower decision-making, and an increased risk of dementia.

A community survey in Kavre District reported that the age and gender-adjusted prevalence of geriatric depression was 53.1 percent, highlighting the strong correlation between social isolation and mental health deterioration.

Loneliness additionally triggers physiological stress. A study in Tansen, Palpa, found that 30.6 percent of elderly participants had depressive symptoms, 2 percent had clinical depression, and 8.2 percent experienced severe anxiety, reflecting the interplay between emotional isolation and health outcomes.

As social roles shrink due to children moving abroad, reduced mobility, or fading networks, many elderly individuals begin to question their relevance, wondering, “Am I no longer needed by anyone?” or “What is my role now?” This loss of identity strongly predicts emotional distress.

How does children’s migration influence their emotional health?

When adult children move abroad, seniors lose primary sources of daily interaction, companionship, and emotional closeness. Many describe a painful silence at home: no one to share morning tea with, no one to share small joys, and no one to ask how they are doing. This vacuum intensifies loneliness and can quickly lead to sadness or clinical depression.

Elderly parents also carry persistent worry about children abroad, concerning their safety, health, work pressures, marital relationships, and finances. Even with frequent communication, seniors feel a gap between “hearing their voice” and “being physically present,” leading to ongoing anxiety.

Migration creates complex emotional landscapes. Parents feel proud of their children’s achievements but simultaneously hurt by distance. Financial support brings relief, but a lack of companionship generates sadness.

In Nepali society, mental health issues in older adults are often dismissed as “normal ageing”. How harmful is this misconception?

Labelling psychological distress as “normal ageing” silences suffering and blocks access to support. A parent losing interest in activities may be clinically depressed, someone with memory difficulties may need cognitive evaluation, and irritability or withdrawal can indicate stress, trauma, or loneliness. Yet normalisation delays intervention until conditions become severe.

Many elderly individuals internalise this message, silently enduring sadness, hopelessness, worry, sleep disturbances, unresolved grief, and emotional exhaustion.

Untreated mental health issues worsen physical conditions, including hypertension, diabetes, heart disease, pain disorders, sleep problems, and immunity. Emotional symptoms can mimic physical illness, leading to misdiagnosis, unnecessary tests, and over-medication.

What signs of depression or anxiety should families pay attention to in elderly members?

Depression and anxiety in older adults often present differently than in younger people, frequently showing through subtle behaviour or physical symptoms. Families should watch for noticeable changes in mood or personality, including withdrawal, irritability, tearfulness, or feelings of hopelessness.

• Noticeable changes in mood or personality, including withdrawal, irritability, tearfulness, and hopelessness.
  
  

• Loss of interest in hobbies, rituals, or social events.
  
  

• Sleep disturbances: insomnia, early waking, excessive sleep, nightmares.
  
  

• Physical complaints without clear medical cause: headaches, digestive issues, joint pain, fatigue.
  
  

• Changes in appetite and weight: loss of appetite, overeating, sudden weight change.
  
  

• Talking about death or feeling like a burden, “Why should I live?”
  
  

• Neglecting personal care: bathing, grooming, and medication adherence.
  
  

• Increased use of alcohol or pain medications to cope with emotional discomfort.