Instruments for Assessing Loneliness in Older People in Portugal: A Scoping Review

Portuguese Journal of Public Health Review Article Received: September 17, 2022 Accepted: January 2, 2023 Published online: April 28, 2023 Port J Public Health 2023;41:45–64 DOI: 10.1159/000529147 Instruments for Assessing Loneliness in Older People in Portugal: A Scoping Review a Department of Education and Psychology, University of Aveiro, Aveiro, Portugal; bCINTESIS@RISE, Porto, Portugal; cSchool of Health Sciences, University of Aveiro, Aveiro, Portugal Keywords Aging · Assessment · Measures · Lonely · Portuguese population the Portuguese older adults population, namely de Jong Gierveld and UCLA-R (most used internationally), as well as the ALONE scale (new and brief). © 2023 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health Abstract Background: Loneliness is a public health problem that affects many older adults. The subjective nature of loneliness challenges its assessment. Thus, assessing loneliness with valid and reliable instruments is crucial to characterizing the phenomenon and planning adequate interventions. Summary: This study mapped the instruments validated for the Portuguese older population that assess loneliness. A scoping review was performed. The search for studies was carried out in SciELO, PsycInfo, Scopus, MEDLINE, MedicLatina, Nursing & Allied Health Collection: Comprehensive, CINAHL, and Open Access Scientific Repositories of Portugal. The findings showed three instruments validated for the Portuguese older population: ULS-16, ULS-6, and SELSA-S. Key Messages: Future testing of those instruments is required to update and accumulate psychometric evidence. In addition, it is important to translate and validate other instruments to www.karger.com/pjp © 2023 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health This article is licensed under the Creative Commons AttributionNonCommercial 4.0 International License (CC BY-NC) (http://www. karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission. Instrumentos de avaliação da solidão em adultos mais velhos em Portugal: uma scoping review Palavras Chave Envelhecimento · Avaliação · Escalas · Solitário · População Portuguesa Resumo Contexto: A solidão é um problema de saúde pública que afeta muitos adultos mais velhos. A natureza subjetiva da solidão desafia a sua avaliação. Avaliar a solidão com instrumentos válidos e confiáveis é fundamental para caracterizar o fenómeno e planear intervenções adequadas. Resumo: Este estudo mapeou os instrumentos validados para os adultos portugueses mais velhos que avaliam a solidão. Foi realizada uma scoping review. A Correspondence to: Rita Silva Carvalho, rita.carvalho @ ua.pt Rita Carvalho a Liliana Sousa a, b João Tavares b, c pesquisa foi realizada no SciELO, PsycInfo, Scopus, MEDLINE, MedicLatina, Nursing & Allied Health Collection: Comprehensive, CINAHL e RCAAP. Os resultados mostram três instrumentos validados para a população idosa portuguesa: ULS-16, ULS-6 e SELSA-S. Mensagenschave: São necessários testes futuros desses instrumentos para atualizar e acumular evidências psicométricas. Adicionalmente, é importante traduzir e validar outros instrumentos para a população idosa portuguesa, nomeadamente as escalas de Jong Gierveld e a UCLA-R (mais utilizadas internacionalmente), bem como a escala ALONE (nova e sucinta). © 2023 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health The ageing of the population is a relevant issue for societies, demanding better strategies to guarantee the quality of life. Loneliness among older people is widespread [1], requiring prevention and intervention measures [2]. Loneliness has been widely studied, yielding several definitions. Overall, there are three points of agreement in the conceptualization. First, loneliness corresponds to the perception of a discrepancy between a person’s desired and actual networks of relationships; thus, it is not having few social contacts but perceiving that the relationships are not satisfying. Second, loneliness is a subjective experience; therefore, people can be alone without being lonely or might be lonely in a crowd. Third, loneliness is an unpleasant and distressing experience [3, 4]. Loneliness in older adults has been a major public health issue since before the COVID-19 pandemic, due to its negative impact on mental and physical health, and well-being [5, 6]. The prevalence of loneliness in older adults (≥60 years), assessed in 30 European countries, between 2000 and 2019 (before the COVID-19 pandemic), showed a high prevalence of loneliness among older adults in southern European countries (ranging from 15.7% to 18.7%); for Portugal, the prevalence based on single item was 14.9 (12.3–17.7) [7]. The COVID-19 pandemic has impacted the population worldwide, particularly due to social distancing measures, lockdowns, and quarantine. Older adults were especially impacted since they are more vulnerable to the virus due to comorbidities [8, 9]. Therefore, loneliness levels have increased since the start of the pandemic [10, 11]. In the 46 Port J Public Health 2023;41:45–64 DOI: 10.1159/000529147 Carvalho/Sousa/Tavares Introduction first few months, 25% of EU citizens reported feeling lonely more than half of the time, while in 2016, it was 12% [3]. Assessing loneliness with validated instruments is crucial for its surveillance, prevention, characterization, and intervention at individual and community levels [12]. Two main methods have been used to assess loneliness: (i) validated loneliness scales, which measure the intensity of loneliness rather than its frequency, and (ii) self-rating scales, where respondents report the frequency of loneliness through a single-item question. Regarding the validated scales of loneliness, some are unidimensional (measure how lonely a person feels), while others are multidimensional (measure how lonely a person feels and what kind of loneliness they are experiencing). Some of the best-known scales worldwide are the UCLA loneliness scale [13] and the different revisions of this scale (ULS4 [14], ULS-8 [15], ULS-6 [16], RULS-8 [17], and ULS-3 [18]); the social and emotional loneliness scale for adults (SELSA) [19] and the de Jong Gierveld scale [20]. Regarding self-rating scales, the Campaign to End Loneliness [21] suggests three single-item questions: (i) Are you lonely? (ii) How often do you feel lonely? and (iii) During the past week, have you felt lonely? Some research has suggested that single items are more appropriate for an older age group experiencing cognitive decline or communication difficulties [21]. Overall, as people age, they become more vulnerable to loneliness, mostly because opportunities to socially interact and form relationships tend to diminish [22, 23]. Some factors contribute to that decrease: (1) the retirement process, whi (...truncated)