How shall we measure loneliness among older adults? Comparison of direct single-item and indirect multi-item measures of loneliness in a Swedish national study

Objectives There are several direct single-item and indirect multi-item measures of loneliness. This study compared four measures of loneliness in a sample of older adults, how they operated across subgroups, and their associations with health and psychosocial variables.Methods Participants in a Swedish national survey (ages 77+, N = 1599) completed a questionnaire containing two single-item measures of the frequency of a) “feeling lonely” and b) being “bothered by loneliness”, two versions of the 3-item UCLA Loneliness Scale, and seven health and psychosocial variables.Results More participants were categorised at low levels of loneliness by the single items (≈70%) than the UCLA scale (≈60%). The measures were strongly correlated, and had consistent associations across subgroups. Compared to the UCLA, the single items had low sensitivity (43-47%) for detecting loneliness. All measures were significantly correlated with all health and psychosocial variables (r = 0.14 to 0.46); even participants who responded Hardly ever feeling lonely had significantly poorer outcomes than those responding Never.Conclusion Single- and multi-item measures are not equivalent and are optimally used in combination. If this is not feasible, multi-item measures are preferred due to their greater capacity to distinguish degrees of loneliness. Measures are needed that can better discriminate between low levels of loneliness.