Recently one morning, a voluntary organization working for the welfare of senior citizens in New Delhi received a phone call from a distraught old woman. Refusing to identify herself,  the quavering voice on the line blurted out that she had dialed at random, just to hear a human voice.

After some persuasion, she disclosed that she lived alone; her children had moved away, leaving her to her own devices. Living as she did in a colony where the neighbors kept to themselves, she was virtually a prisoner within her home. And for days together, her only contact with the outside world was a voice - any voice - at the other end of the phone.

In another horrifying instance of gross neglect and apathy towards the elderly, the police had to break into the home of an old couple in west Delhi after neighbors complained of a foul smell emanating from there. They found that the couple, both over 80, had been dead for many days. The neighbors said they had died of starvation, probably because they were frail and unable to cook for themselves. The only edible substance found in their home was salt. Their only son, an affluent businessman, lives in London.

As traditional modes of family support decline, and more and more children abandon their old folk to migrate in search of better opportunities, a new and frightening social malaise is pervading Indian life � the social and emotional isolation of elderly people. Up to a point, both the government and private organizations have intervened by way of setting up old age homes in an effort to simulate the comforting environs of family life for senior citizens who live away from their families.

But while a few upscale old age homes - that cater exclusively to the affluent graying population - have been established by private parties, appropriate facilities for the middle and lower middle classes are far and few in between.

According to Nidhi Raj Kapoor of HelpAge India, the country's largest voluntary organization working for the care of disadvantaged older people, there are a total of 1,300 registered old age homes in the
country of which about 50 per cent are pay and stay. In Delhi, there are 18 homes for senior citizens of which 11 offer free board and lodging.

At the ground level however, the state of affairs is far from encouraging. Social worker Vimla Lal says that the Delhi administration has opened free of charge homes for the elderly at Kalkaji in South Delhi, and Narela in West Delhi. But such charitable homes are much below the desired standards. "There is one big dormitory and the quality of food and service in government-aided homes depends largely on external donations," she says grimly.

The feelings of abandonment and worthlessness engendered in elderly people who are forced to seek sanctuary in such homes is an important aspect of care which needs to be studied more sensitively and skillfully by care providers. A just-completed random 12-month study undertaken by HelpAge India (from June 2002) to gauge the effects of social and emotional isolation on the older population has yielded disturbing facts.

The survey reveals that the problem exists on a wide scale, and that there is a link between low income and poor health and the isolation and loneliness of many elderly people. Of the 500 respondents - 8 per cent women and 92 per cent men, contacted through telephone and a questionnaire - 26 per cent said loneliness sets in after retirement. While 41 per cent said they began to feel lonely after their spouse passed away, 33 per cent felt alone after their children became independent and moved away. In addition, half of the respondents said loneliness is related to age. Tellingly, 88 per cent think that loneliness can lead to physical and mental ailments like depression; and 61 per cent said older people are lonely when they live alone. Clearly, the findings reinforce the need for providing specialized holistic geriatric care at institutions and homes for the elderly.

The plight of neglected and homeless old women is even worse. In 2001, Lal started Aradhana, a 47-bed home for elderly women in distressed circumstances, at Bhagwan Das Road in New Delhi. Most of the inmates here suffer from health, emotional and financial problems. "Women from the lower classes worry about financial insecurities and indifferent health while emotional problems trouble those from the upper and middle classes," she discloses.

The biggest challenge facing social workers helping elderly women at such homes is counselling, which must take into account the psychological distress afflicting their wards. "Women by nature are very adjusting and they only leave their homes at the most extreme provocation. Most old age homes today do not have skilled counselors who can deal with the mental trauma, and the feeling of stigma women experience when they come here," says Lal.

Old age homes meant exclusively for women also tend to be more rigid and inflexible in structure than do those catering to both sexes. The Arya Mahila Ashram in New Rajinder Nagar, central Delhi, is one such example. Run by the Arya Samaj, a religious body, it accepts only widows or deserted women aged between 50-60 years.

They must first and foremost be religious and take part in the "satsang"*** (a gathering for religious discourse) thrice a day, states Dr Indira Sardana of the ashram. "We are a charitable institution, but we accept donations from residents at the time of admission. Some are rich widows who have given Rs 100,000 or Rs 50,000 (1US$=Rs 47). They are given accommodation accordingly and all women must do some kind of work in the ashram, either in our store or office. We do not take in ill women," she says.

The total capacity of the ashram is 110, and there is no vacancy at present. Though the picture painted here is one of duty and solemnity (which would be fine if it was voluntary and not enforced), ironically there is a long waiting list for admission into its strict environs.

According to Lal, more and more elderly people of the middle classes, especially men, are leaving their homes for stay and pay lodgings. The main reasons, she says, are limited space in houses or the fact that both husband and wife work and so are unable to look after their aged parents.

The HelpAge India survey, however, does provide us with clues on how to begin understanding, listening and finally meeting the needs of our senior citizens. One of questions (of the survey) to the respondents was - How would you deal with loneliness? An overwhelming 65 per cent said the way to tackle it was to maintain an active social circle. Twenty-six per cent thought the answer lay in acquiring membership of a club or a community-based organization, and 9 per cent felt that starting an enterprise after 60 could help ward off isolation.