Barriers to Yoga as an Add-On Treatment for Common Mental Health Disorders in India.

Data from the Seventh National Population Census shows that the population aged 60 and above in China totaled 264 million at the end of 2020, constituting 18.7% of the overall population (). As population aging accelerates, the number of empty-nest elders—defined as older adults living alone or solely with a spouse after their children have left home—rose to 118 million in 2020 and are projected to encompass nearly 90% of the older adults population by 2030 (, ). Rooted in family life cycle theory (), the emergence of the “empty nest” household structure has introduced a range of psychosocial challenges. Empty-nest older adults individuals are particularly susceptible to “empty nest syndrome,” which is characterized by emotional distress, depressive symptoms, and profound loneliness arising from reduced social interaction (). The weakening of traditional family-based support systems and diminished social connectedness have further intensified the risk of social frailty, presenting a pressing public health concern. Fried et al. () formally conceptualized frailty as an aging-related clinical syndrome at the 1987 U.S. Federal Conference on Aging, characterized by reduced physiological reserves and heightened vulnerability to stressors resulting from accumulated health deficits. Frailty is commonly categorized into three domains: physical frailty, cognitive frailty, and social frailty. While physical and cognitive frailty have been widely examined in gerontological research, social frailty remains comparatively underexplored, particularly among empty-nest older adults individuals. Current literature establishes a significant association between social frailty in older populations and increased vulnerability to multiple detrimental outcomes, including loss of functional ability, impaired cognition, depressive disorders, and elevated mortality (). Epidemiological data estimate social frailty prevalence rates of 21–38.1% in this group (, ), with growing evidence supporting its potential role as both predictor and contributing factor to physical frailty onset (). However, owing to its subtle presentation and lack of specific clinical indicators, social frailty is often overlooked in both clinical practice and community-based assessments. Social frailty in empty-nest older adults individuals is a complex, multidimensional condition encompassing inadequate access to social resources, reduced participation in social activities, weakened interpersonal relationships, and declining self-management abilities. The absence of co-residing children may lead to difficulties in managing daily life and maintaining independence, ultimately compromising quality of life (). Additionally, a lack of emotional support and companionship exacerbates feelings of loneliness and social isolation (). Financial insecurity is another contributing factor, particularly for those who previously relied on financial assistance from their children. On an individual level, social frailty is closely linked with increased risks of depression (), anxiety (), and diminished self-worth. Deteriorating physical health may further aggravate these conditions. On a broader societal scale, the growing burden of social frailty among the older adults poses significant challenges to healthcare systems and social welfare infrastructures, underscoring the need for responsive policy and service frameworks.