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Measuring loneliness in later life: a comparison of differing

measures

Christina Victor, Linda Grenade and Duncan Boldy

Reviews in Clinical Gerontology / Volume 15 / Issue 01 / February 2005, pp 63 - 70

DOI: 10.1017/S0959259805001723, Published online: 14 February 2006

Link to this article: http://journals.cambridge.org/abstract_S0959259805001723

How to cite this article:

Christina Victor, Linda Grenade and Duncan Boldy (2005). Measuring loneliness in later life: a
comparison of differing measures. Reviews in Clinical Gerontology, 15, pp 63-70 doi:10.1017/
S0959259805001723

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Reviews in Clinical Gerontology 2005 15; 63–70

C 2006 Cambridge University Press Printed in the United Kingdom doi:10.1017/S0959259805001723

Measuring loneliness in later life: a comparison

of differing measures
Christina Victor
School of Health and Social Care, University of Reading, UK

Linda Grenade and Duncan Boldy

Division of Health Sciences, Curtin University of Technology, Perth, Western Australia

Introduction of life in old age, currently a key policy objective

for older people.3 There is concern to promote
The social environment is one of the key factors
social engagement amongst older people that is
determining the quality of life of older people. Re-
manifest in local, national and international policy-
search has consistently demonstrated a strong and
makers’ interest in ideas such as social capital
positive relationship between social engagement in
and social exclusion. However, like the concept
all forms but especially participation within kin
of community care, notions of social capital, social
and wider social networks, and a high quality of
engagement and social exclusion are described in
life.1 However, this recognition of the importance
many different ways4,5 Scharf and Smith6 have
of this relationship is not new. In the early 1960s,
proposed a model of social exclusion in later life,
the ‘activity theorists’ of aging posited that the
which consists of five domains: exclusion from
key to a good old age was the maintenance of
social relations, civic activities, material resources,
high levels of activity, including social participation
basic services and neighbourhood. This definition
and the maintenance of kin- and friendship-based
of social exclusion provides a theoretical and
relationships. This resonates with the ideas of
policy-related framework within which to locate
Rowe and Kahn2 who suggest that a high level of
the study of social engagement and indicators of
social engagement is a key factor in achieving the
social impoverishment in later life, loneliness and
individually and socially desired goal of ‘successful
isolation.
aging’. Furthermore, they argue that, with adva-
It is evident from the policy, theoretical and
nced age, the social context, in combination with
research literature that a variety of different terms
the physical environment, exerts a more potent
and concepts are being used interchangeably to
influence upon the experience of later life than
describe notions of social engagement, exclusion
either intrinsic genetic or biological factors. Whilst
and participation by older people. These largely
the prescriptive strictures of activity theory and
reflect the dynamic and varying nature of the
successful aging remain the subject of debate, there
broader theoretical and policy context. Social
seems little doubt that the social environment
engagement is a broad and diverse concept with
continues to exert both a powerful influence upon,
different sub-divisions relating to notions such as
and provides a context within which people ex-
social capital, social participation, as measured by
perience old age, both individually and collectively.
activity and contact rates, and social networks, in-
A key element of current thinking on the
cluding notions of exchange relationships, intimate
promotion of quality of life in old age relates to
ties and roles and relationships.7 The predominant
notions of social engagement and social inclusion.
conceptualization of exclusion from social
Manipulation of the social environment by, for
relationships has been in terms of investigating the
example, interventions to combat isolation and
pathological end of the distribution, with a specific
promote social engagement may offer pathways
concentration upon isolation and loneliness. This
for the improvement and enhancement of quality
largely reflects an approach to the investigation of
social relationships in later life influenced by the
Address for correspondence: CR Victor, School of
study of social problems and, perhaps, too ready
Health & Social Care, University of Reading, Bulmershe an acceptance of the stereotype that the normal
Court, Reading, RG6 1HY, UK. experience of old age is of social neglect, isolation
64 C Victor, L Grenade and D Boldy
and a reliance upon fragile social networks.8 There
has been a concentration in research upon peer-
group studies in terms of empirical investigations of
loneliness,9,10,11,12 social isolation and exclusion.6
By contrast, other perspectives such as describing
current experience within a life-course or bio-
graphical context have received relatively little
attention.
Perhaps the greatest emphasis in both research
and policy terms has been upon the examination
of loneliness in later life, although loneliness is es-
timated to be commoner and more intense in adol-
escence. Despite the extensive research literature,
however, there are still problems in defining and
measuring this concept13,14 reflecting the theoret-
ical diversity underpinning notions of loneliness. At
the fundamental level, loneliness is concerned with
how individuals evaluate their overall level of social
interaction, and describes a state in which there is
a deficit between the desired and actual quality
and quantity of social engagement. Loneliness
may thus be identified as the emotional response
to the discrepancy between desired and available
relationships and is described by Fees et al.15 as ‘a
concept that relies on comparisons’.
The development and acceptance of theories of
loneliness, and its measurement within populations
has been hampered by the fact that loneliness is
often masked by clinical syndromes: there is a
strong association between loneliness and depres-
sion.16 There is an obvious and consistent link
between loneliness and depression – indeed depres-
sion indices often used to include questions about
loneliness. Depression is a problem that often
accompanies loneliness, and depressive symptomo-
tology such as withdrawal, anxiety, lack of
motivation and sadness both mimic and mask
the manifestations of loneliness. In such cases,
people are often treated for depression without
consideration of the possibility that loneliness
may be a contributory and sustaining factor
in their condition. Consequently, loneliness has
often been subsumed under depression, anxiety or
social isolation, rather than being recognized as a
distinct problem. Thus loneliness and depression
are characteristics of people who have recently
suffered the death of a close family member or
friend.
There are two main approaches towards the
empirical measurement of this phenomenon; self-
report measures and the development of scales
or aggregate measures.13 These measures are
usually distinguished in terms of their differing
methodological approach and theoretical positions
concerning the nature of loneliness.
Cognitive theories of loneliness, based upon
personal assumptions, such as the discrepancy
between desired and available relationships, giving
rise to maladaptive patterns of thinking which
can generate feelings of loneliness, underpin the
self-rating scales approach to measurement. From
this perspective, loneliness is considered to be a
state that can be manipulated, hence the interest in
intervention studies.17
Self-report measures are simple to use, appear
highly acceptable to research participants and ask
directly about feelings of loneliness. This approach
presumes that loneliness is a unidimensional
concept, and that the primary variation between
individuals is in the intensity of the experience.
Such questions require respondents to rate their
levels of loneliness from ‘never’ to ‘always’ with
a variety of intermediate gradations of response.18
This simple scale has been found to adapt better
to the oldest age group, although it does not elicit
information about the amount, nature, value or
meaning of loneliness, nor about its causes or
consequences.15 However its simplicity has been
seen as a weakness, in that the question presumes a
common understanding of the concept by study
participants and, as such, is highly culturally
specific.19 More fundamentally, loneliness may be
seen as a stigmatizing concept compromising the
identity of individuals so that older people may
choose not to define themselves in this way and may
downshift their loneliness rating. Consequently,
study participants may express a ‘public account’
and present what they assume the interviewer may
want to hear, or not admit to feelings of loneliness,
for fear of compromising their autonomy and self-
identity.
A key objection to the use of direct questions to
measure the extent of loneliness is that they will
not elicit a true response: they will generate only
a publicly acceptable [socially desirable] response.
Hence a variety of scales have been developed
which approach the topic indirectly. One widely
used scale is the University of California, Los
Angeles (UCLA) Loneliness Scale,20 a 20-item
Likert scale. De Jong Gierveld12 has also developed
a scale for use with older people which meets
the criteria of the Rasch measurement model and
has both positive and negative dimensions. It also
reflects the de Jong Gierveld proposition14 that

loneliness can be perceived as a multidimensional
phenomenon comprising three distinct dimensions;
a deprivation component that relates to the loss
of an intimate attachment; a temporal perspective,
raising the question of the extent to which the
state of being lonely might be prone to change;
and a range of emotional aspects of loneliness,
such as sadness, guilt, frustration and desperation.
Wenger21 also developed an 8-item scale, which
views loneliness from the perspective of friendship
and family connections: here questions probe
the pervasiveness of loneliness in older people,
while only including the word ‘loneliness’ once.
However, all scales demonstrate cultural specificity
and rely upon measuring loneliness via indirect
questions relating to direct social engagement.
Hence they make theoretical assumptions about
the definition and meaning of loneliness and the
link between, in the case, for example, of
the Wenger index,13 social engagement and
loneliness. However the indirectness of these
measures offers a way of exploring the ‘private’
expressions of loneliness, in that they do not
directly ask about or require older people to
give direct responses to potentially stigmatizing or
compromising questions. In this paper we compare
the utility of the differing approaches towards
the measurement of loneliness, via the results
generated by two different measures of loneliness.
Sources of data
The data for this analysis is provided by two
surveys: one conducted in the UK and the second
in Perth, Western Australia. The two surveys
used different methods to determine the extent
of loneliness amongst older people and different
modes of data collection. The British survey took
the form of a face-to-face interview and employed
a direct question asking respondents to rate their
level of loneliness22 whilst the Perth study used
a postal questionnaire which included the same
direct question, as well as the indirect 11-item de
Jong Gierveld scale.23,24,25 The self-report question
and the de Jong scale that elicited the data reported
here are shown in Figure 1.
The British Survey
The first dataset is derived from a national survey
of households26 in Great Britain conducted using
the United Kingdom Office for National Statistics
Measuring loneliness in later life 65
(ONS) Omnibus Survey and funded by the ESRC
Growing Older Programme and Medical Research
Council Health Services Research Collaboration.
This is based on face-to-face interviews with
approximately 2000 adults aged 16 years and
over in their own home. Researchers can purchase
specific modules/questions on the survey, or use
the survey as a mechanism to identify eligible
research participants, as was the case in this study.
Respondents aged 65 and over participating in the
Omnibus Survey were invited to participate in a
Quality-of-life module that was administered at a
second interview.27,28,22 To control for seasonality
and to generate a sample of sufficient statistical
power, all 1598 participants aged 65 years and over
who were interviewed for the April, September,
November 2000 and January 2001 Omnibus
Surveys were invited to participate in the Quality-
of-Life survey and 1323 agreed to do so. At
follow-up, 24 of these addresses were subsequently
found to be ineligible, leaving a potential study
population of 1299. Of this number, 243 (19%)
declined to participate and 57 (4%) were not
contactable. This yielded a total study population
of 999 respondents, a response rate of 77% of
those identified as eligible for the study and 63%
of those who participated in the index waves of the
Omnibus Survey.
The Perth, Western Australia Study
This study was funded by ‘Healthway’ (the
Western Australia Health Promotion Foundation)
and was based in three districts of the Perth
metropolitan area and stratified to reflect different
socioeconomic levels: City of Melville (high SES),
Canning City Council (intermediate SES), and
City of Fremantle (low SES). Respondents were
identified from the electoral information data
provided by the Australian Electoral Commission
and consisted of people aged 65 years and over
living in the community. The sample was stratified
according to age and sex within five-year age
bands. Equal numbers of men and women were
sampled in each age group. The study used
a postal questionnaire supported by telephone
follow-up and support. Initially, 625 individuals
were identified but 78 (12.5%) were excluded
as no telephone number could be traced for
them. Questionnaires were sent to 547 potential
participants and 353 were returned: a response
rate of 65% (or 56% of the initial sample). The
66 C Victor, L Grenade and D Boldy

A. The self-rating scale

‘Would you say that you are’
Always lonely
Often lonely
Sometimes lonely
Never lonely

B. The items included in the de Jong Gierveld scale

There is always someone I can talk to about day-to-day problems
I miss having a really close friend
I experience a general sense of emptiness
There are plenty of people I can lean on when I have problems
I miss the pleasure of the company of others
I find my circle of friends and acquaintances too limited
There are many people I can trust completely
There are enough people I feel close to
I miss having people around
I often feel rejected
I can call on my friends whenever I need them

Figure 1 Methods of measuring loneliness used in the two studies

major reasons for non-response were: refusal (80),
ill-health (39), and problems with literacy (24).
Results
The results are presented in three sections, firstly,
description of the samples. We then examine the
public representation of loneliness as measured
by our direct self-rating question and then move
on to consider the private accounts of loneliness
produced by our study participants via the use of
the de Jong scale.
Sample description
The profile of the two samples is broadly similar
in terms of sex distribution, chronic illness and
household living arrangements. The Perth sample
is ‘older’ than the British sample, whilst the British
sample has a much larger percentage of widowed
respondents (Table 1).
Loneliness: the ‘public’ account
Both studies used a direct self-rating question,
which required study participants to rate their
current levels of loneliness on a four-point scale:
‘never’/ ‘sometimes’/ ‘often’/‘always’, in effect, a
public declaration of a negative and potentially
stigmatizing experience. All respondents in the
British survey and all but 10 in the Australian
sample answered the question. The results of the
two studies are remarkably similar (Table 2),
which is particularly interesting, considering that
the Perth study used a postal questionnaire and the
British survey a direct interview. The majority of
respondents in both studies, about 60%, reported
that they were never lonely. In both populations
a minority of respondents (8–9%) reported being
often or always lonely and approximately one-
third reported that they sometimes experienced
loneliness.
Loneliness: the ‘private’ experience
To explore the potentially unexplored (and
different) ‘private’ representation of loneliness,
we compared the levels of loneliness generated
from our direct question with those derived
from the use of the de Jong scale in the Perth
 Measuring loneliness in later life 67

Table 1. Key sociodemographic characteristics of were more likely to be female and older, but
the two samples (%) were similar in terms of marital status and
household composition. Table 2 illustrates that
Perth, WA Great Britain∗
the overall classification of respondents was
% %
remarkably similar in the de Jong scale and the self-
Age rating questionnaire, especially at the severe end
65–74 40 58
of the distribution, where the prevalence estimates
75–84 42 34
85+ 18 8 are broadly consistent at about 8–9%. The scale
Sex did, however, generate a higher percentage of
Male 51 47 participants in the intermediate loneliness category
Female 49 53 and a subsequent decrease in the ‘never’ lonely
Marital status group.
Single 2 7 For 293 participants in the Perth survey, we can
Married/cohabiting 65 46 directly compare their loneliness ratings (Table 3).
Widowed 26 39
This confirms the variability in the responses in the
Separated/divorced 7 8
Living arrangements ‘never’/intermediate loneliness category between
Lives alone 31 37 our two measures. Overall 63% of respondents
Lives with others 69 63 had the same classification on both measures. Of
Health status the 108 where there was a difference between
% reporting longstanding 57 62 measures, 74 were rated as more severe on the de
illness Jong measure and the majority of these were on the
% reporting limiting 37 ‘never’/intermediate loneliness boundary.
longstanding illness
∗ Source: Victor et al (2005) Discussion
Measuring loneliness is problematic.13 Two main
sample. As the scale is calculated on the basis approaches towards the empirical measurement of
of responses to 11 questions, because of missing loneliness may be identified: self-report measures
values to one or more, there were 53 respondents and the development of scales or aggregate
for whom we could not calculate a score: they measures. The use of a single-question self-rating

Table 2. Reported levels of loneliness in the two studies using differing methods of measurement (%)

Great Britain Perth, WA Perth, WA

% respondents % respondents % respondents
Self rating scale rated as rated as De Jong Gierveld Loneliness Scale classed
Do you feel lonely?
Never 61 62 Not lonely (score of 0–2) 52
Sometimes 32 32 Moderately lonely (score of 3–8) 39
Often 7 6 Severely lonely (score of 9–10) 7
Always 2 2 Very severely lonely (score of 11) 2

Table 3. Comparison of loneliness classification for individuals in the Perth study: cross-tabulation
of responses to the self-rating scale and classification on the de Jong scale

Self-rating loneliness scale responses

de Jong Never Sometimes Often Always Total

Not lonely (0–2) 125 25 1 0 151
Moderately lonely (3–8) 58 48 6 4 116
Severely lonely (9–10) 0 11 9 0 20
Very severely lonely (11) 0 3 2 1 6
Total 183 87 18 5 293
68 C Victor, L Grenade and D Boldy
scale to measure loneliness appears to have
been first reported by Sheldon29 and has
subsequently been widely used in Britain,30,31,21,
Continental Europe,11 and North America.32 Self-
report measures are simple to use, appear to
be highly acceptable to research participants,
in that they generate few ‘missing items’ either
in direct interviews or via postal surveys, and
ask directly about feelings of loneliness, which
is the specific area of interest. However their
use presupposes a common understanding of
the term ‘loneliness’ amongst respondents. In
research with older people, participants may
present to the survey interviewer only their ‘public’
accounts (Cornwell33 ) and fail to affirm the
existence of socially undesirable or stigmatizing
concepts such as loneliness in their lives. As
loneliness may be seen as a ‘stigmatizing’ concept
compromising the identity of individuals, these
measures may thus capture only the ‘public’,
socially desirable account. An alternative approach
to the measurement of loneliness has been the
development of specific scales such as those devised
by de Jong Gierveld12 and Wenger.13 These do not
ask directly about loneliness and, perhaps, offer
a way of capturing a ‘private’ account by asking
indirectly about loneliness via questions relating to
social networks and the availability of confiding
relationships. (All these scales have undergone
varying degrees of psychometric testing of validity
and reliability).
The ‘public’ account of loneliness articulated in
our studies falls within the pattern expected from
the published literature, as our prevalence of 8–9%
reporting that they were ‘often’/‘always’ lonely is
consistent with previous research.34 The similarity
of our responses is notable, given that the British
study used direct interview whilst the Australian
data was generated by a postal survey. However,
here we have had the opportunity to compare
both public and private accounts by comparing a
direct question and an indirect scale. Again, the
most immediate conclusion was in the similarity
of the overall estimates of loneliness generated by
the two methods, especially at the severe end of
the distribution Where there was variability, it
was on the ‘never lonely’/intermediate loneliness
boundary, with as many as 32% (58/183) of
those ‘publicly’ indicating that they were never
lonely, being ‘privately’ identified as ‘moderately’
lonely. Given that the rationale for the use of the
intervals for categories used in the scale is unclear,
this variability may reflect either statistical noise
in the scale, the inexact nature of the response
categories used in the rating scale or indeed, some
combination of the two.
Pepper35 reported that respondents’ interpreta-
tions of the term ‘sometimes’ are variable; with
many people understanding it to be about 20%
of the time, while others understood it to mean
about half the time. Schaeffer36 recommends that
the relative frequency responses currently used in
many scales be replaced by absolute frequency
response options, such as ‘every day’ or ‘once
a week’. By using absolute frequency response
options, the possibility that comparisons between
groups would be valid reflections of the concept,
and not caused by differences in how groups
interpret the response option terms may increase.
If, however, we wish to identify a wider group of
older people for whom low-level interventions may
be appropriate then it may be more desirable to
adopt a scale approach (perhaps in addition to a
direct question or questions with a less ambiguous
set of response options).
Loneliness is an intensely personal, subjective
feeling for which there are no observable signs
or symptoms. Due to the inherent problems
in defining loneliness, the discrepancies between
theoretical perspectives, and the problems of
distinguishing loneliness from related states such
as depression, the problem of trying to measure the
phenomenon is challenging. To measure loneliness,
researchers must rely on a person’s statement
about their internal experiences, and attempt to
‘diagnose’ loneliness from symptoms described
or from self-reported questionnaires. People are
‘labelled’ as lonely because they say they are,
or because they relate to the indirect indicators
of loneliness. It has been suggested37 that the
self-report measures are more appropriate for
use with older people than composite scales.
However, we would suggest that this conclusion
is premature. Our studies certainly suggest that
self-rated questions need to be modified to
include less ambiguous response categories, and
that more complex rating scales may be more
appropriate in screening-type studies of older
people.
There is clearly scope for further research
investigating the relationship between the different
ways of measuring loneliness and how older people
define and conceptualize this important aspect of
quality of life.

Acknowledgements
The British study was funded by the Economic and
Social Research Council as part of its Growing
Older Programme (award numbers L480254042
and L480254022). Relating to the Perth study,
LG and DB would like to acknowledge their co-
investigators Helena Iredell, Thérèse Shaw, Prof
Peter Howat and Dr Ros Morrow. The study was
funded by Healthway – the Western Australian
Health Promotion Foundation. We are all especi-
ally grateful to all those older people who gave so
freely of their time to participate in these studies.
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