Abstract
Background
Loneliness is common among older adults and linked to poor health outcomes. In the UK, around 1.4 million older people experience frequent loneliness, a number expected to rise. Despite its impact, loneliness is often unrecognized in acute hospitals. The UCLA Loneliness Scale Version 3 (UCLA-3) is a brief, validated 3-item tool with 77% sensitivity and 61% specificity, suitable for routine geriatric screening.
Objectives
· Assess feasibility of UCLA-3 for rapid loneliness screening
· Determine loneliness prevalence in older inpatients
· Explore integration of UCLA-3 into geriatric care pathways
Methods
A cross-sectional study of 50 randomly selected patients, aged 65 and over on geriatric wards at MMH, between,1st to 31st of May 2025 was conducted. The data which included UCLA-3 scores, completion time, demographics, and Clinical Frailty Scale (CFS) status was collected by the resident doctors.
Results
Of the 50 participants, 41/50 (82%) completed the UCLA-3 in under 5 minutes,7/50 (14%) between 5-15 minutes and 1/50(2%) took more than 15 minutes.
1/50(2%) patient’s questionnaire completion time was not recorded.
· Moderate to severe frailty (CFS scores 6–9) was observed in 24 /50 (48%) of the screened patients.
· Loneliness (UCLA score 6–9) was identified in 16/50 (32%), while 34/40 (68%) were classified as not lonely (UCLA score 3–5).
· Among those identified as lonely,8/16 (50%) were moderate to severely frail
Conclusion
The UCLA-3 is a quick, practical and reliable bedside screening tool for early detection of loneliness, which among frail older adults may be a modifiable risk factor.
Recommendations
· Screen all elderly patients for loneliness due to high prevalence
· Incorporate UCLA-3 scoring routinely into Comprehensive Geriatric Assessments and discuss high UCLA-3 (score 6-9) during MDT meetings
· Refer all lonely individuals to NHS loneliness support and involve local charities for additional help
Comments
Important work
Do you find a relationship between loneliness and sensory decline (hearing/vision loss)?
Screening for Loneliness in the Elderly with UCLA 3 scale
Thank you, Dr. Henshaw, for highlighting this critical issue.
There is a well-documented association between sensory decline—particularly hearing and vision impairment—and elevated levels of loneliness and social isolation among older adults. Although the UCLA 3-Item Loneliness Scale does not explicitly assess sensory deficits, it remains a validated instrument for capturing subjective experiences of loneliness. Specifically, it evaluates perceived lack of companionship, feelings of exclusion, and social isolation, irrespective of the underlying contributing factors such as sensory loss
Your recommendations for…
Your recommendations for loneliness screening and referrals are important, given that loneliness can have a significant impact on physical and mental health and can be screened using established tools, yet is often overlooked. It might be interesting to look at gender differences. It might also be interesting to carry out think aloud interviews with a small group of older adults to examine the acceptability of administering the UCLA-3, if this research hasn't been conducted elsewhere previously. The measure asks respondents about 'feeling left out,' which I think is more acceptable wording than 'feeling lonely' to older adults.
Dear Dr Heffernan
We are…
Dear Dr Heffernan
We are grateful for your review of our poster and for the thoughtful, practical insights you shared.
Loneliness is strongly associated with increased risks of depression, cognitive decline, chronic pain, cardiovascular disease, and premature mortality. Despite these serious health consequences, it is rarely included in routine healthcare screening, unlike depression or anxiety.
Gender differences are important to acknowledge. Men often underreport loneliness due to stigma, yet items such as “feeling left out” may capture experiences they are more willing to disclose. Women, by contrast, may be more open to reporting loneliness, but their responses are often shaped by social contexts such as caregiving responsibilities, widowhood, economic dependence, or cultural expectations. These systematic differences in UCLA‑3 item endorsement suggest that tailored interventions may be necessary.
Exploring think‑aloud interviews with older adults could provide valuable insights into how terms such as “lack of companionship,” “feeling left out,” and “feeling isolated” are interpreted. This approach may help identify barriers to honest reporting and enhance the acceptability of loneliness screening in both community and clinical settings.
We agree that “feeling left out” is likely less stigmatizing than directly asking about loneliness. However, there are currently no well‑documented studies examining the acceptability of administering the UCLA‑3, making this a promising area for future research
Once again, thank you for your thoughtful feedback.
Excellent and thought provoking
Thank you for this poster. I agree with others that this part of the CGA is the most neglected - certainly in secondary care - and all members of the MDT could be asking these questions. I wonder going forward if there are any measurable outcomes for those who received screening vs those who did not - did formally recognising the need to signpost them to additional community support services reduce readmissions/LOS/one year mortality for example. As you already have the dataset the extra information may prove powerful to influence local change.
Loneliness us a hidden stigma
A simple and easily administered 3 part tool offers scope for widespread screening. With social prescribing now embedded in primary care we are finally better able to consistently offer support to address this important factor that can impact so much on quality of life and future health care use
Loneliness screening UCLA 3 scale
Dear Dr Greenwood
We sincerely thank you for taking the time to review our medical poster and for your valuable feedback.
Currently to my knowledge, there is no strong evidence that loneliness screening with the UCLA‑3 scale, followed by signposting to community support services, has directly reduced hospital readmissions, length of stay (LOS), or one‑year mortality
Thankyou once again for your valuable insights
Loneliness screening UCLA 3 scale
Dear Dr Kingston
Thank you for your time in reviewing the poster and offering your valuable feedback
We totally agree with your viewpoint.
With social prescribing now embedded in primary care, we are better able to consistently offer support for individuals identified as 'at risk' through loneliness screening via this UCLA 3 scale.
Embedding this tool into routine practice ensures that loneliness is not only detected but also formally acknowledged, creating a pathway to targeted interventions. This integration has the potential to improve quality of life and, in the longer term, reduce healthcare utilization by addressing a factor that significantly influences future health outcomes.
Once again, we are thankful for your input