1. Measuring your impact on loneliness in later life
Dr. Kellie Payne
Learning and Research Manager at the Campaign to End Loneliness
@EndLonelinessUK

2. Loneliness Measurement – Tools & Scales
What is loneliness?
No agreed definition
Unwelcome, painful and unpleasant feeling
Both number and depth of relationships
Fluctuating, difficult to measure and identify
Why measure loneliness?
Lack of good quality evidence on ‘interventions’
Negative impact on mental and physical health
Understand how people feel about connections
It may surprise you to hear that I’m going to start this presentation by saying there is no agreed definition of loneliness – particularly in the research world. If you talk to people about what loneliness feels like, you’ll also get a range of adjectives, metaphors and stories.
However, whilst academics and people can have a different understanding about what loneliness is, and why people experience it, we don’t need to worry. For example, the three main theories that define loneliness all describe it as a negative, unwelcome and painful. They also all recognise that loneliness is not just caused by a lack of friends or acquaintances, but we also need quality or depth in our relationships and social networks if we are to prevent or alleviate it.
It’s also generally agreed that loneliness is not a static experience, we may feel loneliness non-stop for a week, or it may come and go over the course of a day, week, month or year. It’s therefore difficult to quantify and identify.
It’s important to remember from the outset that measuring loneliness is not always easy and that different scales used slightly different definitions of loneliness which does have an influence on the questions that are eventually written.
But that doesn’t mean that we shouldn’t try to measure loneliness. As our Promising Approaches report, published with Age UK in January, pointed out – there is a lack of robust evidence that demonstrates what services, activities or support can effectively address loneliness.
There is a growing awareness of the negative consequences of loneliness for our mental and physical health. Loneliness increases our chances of dying earlier, and is linked to chronic conditions including depression and dementia.
So by measuring the difference that your service or activity is having on loneliness in later life, you’ll be adding to the evidence base and helping others supporting older people. You’ll know that you’re improving people’s quality of life and health. But you’ll also gain a better understanding of how your service is improving the way people feel about their connections, and not just counting the number of people they meet in a given day.

3. Loneliness Measurement – Tools & Scales
Why not social isolation, or wellbeing?
Three distinct concepts
Social isolation = objective measure
Wellbeing = broader measure
What is a scale?
Consistent, numerical measurement of emotion
Show how much of a difference you’ve made
Compare the impact of different types of activities/services
Why not social isolation, or wellbeing?
Well I would say do include isolation or wellbeing measures in your evaluation – if you think you’re having a positive impact on them. But don’t assume that if you can demonstrate that someone’s isolation is decreasing, or wellbeing is improving, that you are also having an impact on their loneliness
Social isolation is objective state – it only measures the number or frequency of social contacts someone has. It doesn’t capture how people feel about that contact – you might have heard the saying that you can be lonely in a crowd, well this is particularly true for people who live in care homes, who are unpaid carers, maybe in an unhappy marriage or don’t like socialising with strangers
Wellbeing is a broader concept which looks at our psychological and physical state as well as social connections. So like isolation, it is related to loneliness – but it isn’t a proxy measure for loneliness.
At the Campaign, we feel that it is important to measure the difference a service is having specifically on loneliness – although of course that will often be part of of a larger evaluation of outcomes, which could include wellbeing and isolation.
Just briefly, I wanted to say a couple of words about scales. A scale is a consistent, numerical measurement – in this case, of a emotion. It should produce consistent and comparable results and – if used over a period of time – show any subtle changes in how someone is feeling. We’ll be discussing the pros and cons of using a scale in an hour’s time, but first we’ll cover 4 potential loneliness scales that you might like to use as part of your evaluation and monitoring.

4. They include a scale developed by the Campaign to End Loneliness in 2014, the De Jong Gierveld Scale – originally from the Netherlands and the UCLA scale – originally developed in the USA. We’ll also look briefly at a number of “single-item” scales – basically one question that asks directly about loneliness.

5. Definition of loneliness
Loneliness is the distressing feeling that people experience when the amount or type of friendships / relationships that they have are less than they would like to have.

6. Campaign to End Loneliness Measurement Tool
The tool contains the following statements:
I am content with my friendships and relationships
I have enough people I feel comfortable asking for help at any time
My relationships are as satisfying as I would want them to be

7. Answers Answers are as follows:
Strongly Disagree / Disagree / Neutral / Agree / Strongly Agree / Don’t Know
In order to avoid a ‘response set’ – where people give the same answer to a question almost by rote, it is important to alternate the direction of answers
Asking all three of these questions together produces the most reliable

8. Scoring
The scores for each individual question need to be added together. This gives a possible range of scores from 0 to 12

9. Campaign to End Loneliness Measurement Tool
I am content with my friendships and relationships
Strongly Disagree [4] Disagree [3] Neutral [2] Agree [1] Strongly Agree [0]
I have enough people I feel comfortable asking for help at any time
Strongly Agree [0] Agree [1] Neutral [2] Disagree [3] Strongly Disagree [4]
My relationships are as satisfying as I would want them to be

10. Strengths
Positive language about a tricky issue: written in language which is non-intrusive and unlikely to cause any embarrassment or distress.
Practical: very practical resource for organisations in the field to use in their face-to-face work with older people.
Co-designed: with a number of different people and organisations, to try and ensure it is appropriate for a ranges of contexts.
Length: kept as short as possible and is easy to score.
Validity: has undergone academic tests to ensure it is valid and reliable.

11. Limitations
Newness: not yet been used extensively by services, so we do not yet know how it picks up changes over time
Only using positive language: The use of only positive worded questions could lead to respondents under-reporting their loneliness
Not a screening tool: strongly advise organisations not to use these questions as a “screening tool” to establish eligibility to their services. It has not been designed for this purpose and may therefore give misleading results.

12. De Jong Gierveld Loneliness Scale
Definition based upon Weiss (1973) theory – emotional and social loneliness
Overall score of 0-6 (two 0-3 subscales)
Strengths
Different types of loneliness
Designing with and for older people
Extensively used and validated
Limitations
Length
Training/support needed for negative Qs

13. De Jong Gierveld Loneliness Scale
I experience a general sense of emptiness
Yes [1] More or less [1] No [0]
There are plenty of people I can rely on when I have problems
Yes [0] More or less [1] No [1]
There are many people I can trust completely
I miss having people around me
There are enough people I feel close to
I often feel rejected

14. De Jong Gierveld Loneliness Scale
Definition based upon Weiss (1973) theory – emotional and social loneliness
Overall score of 0-6 (two 0-3 subscales)
Strengths
Different types of loneliness
Designing with and for older people
Extensively used and validated
Limitations
Length
Training/support needed for negative Qs

15. UCLA Loneliness Scale Cognitive discrepancy – “mismatch”
Overall score of 3-9
Strengths
Widely used
Well tested and validated
Compare to national studies/data
Limitations
Originally developed with USA students
‘Response set’
Training/support needed for negative Qs

16. Hardly ever [1] Some of the time [2] Often [3]
UCLA Loneliness Scale
How often do you feel that you lack companionship?
Hardly ever [1] Some of the time [2] Often [3]
How often do you feel left out?
How often do you feel isolated from others?

17. Single questions Strengths Short – each to insert into M&E
Age-friendly – if communicating is difficult
Commonly used in research
Limitations
May not be reliable
May be too blunt
Limitations of time period
Challenges or ignores stigma?

18. Single questions How often do you feel lonely? Hardly ever or never
Some of the time
Often
During the past week, have you felt lonely:
Rarely or none of the time (e.g. less than 1 day)
Some or a little of the time (e.g. 1-2 days)
Occasionally or a moderate amount of time (e.g. 3-4 days)
All of the time (e.g. 5-7 days)
During the past week, have you felt lonely:
Rarely or none of the time (e.g. less than 1 day)
Some or a little of the time (e.g. 1-2 days)
Occasionally or a moderate amount of time (e.g. 3-4 days)
All of the time (e.g. 5-7 days)

20. Next steps… Read the guidance Let us know what does and doesn’t work
Share your findings: write us a case study

21. kellie@campaigntoendloneliness.org .uk
THANK YOU!
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