ArticleBMC geriatrics2025
Psychometric evaluation of the UCLA-8 loneliness scale among structurally vulnerable older adults in rural India: implications for equity-oriented screening in primary health care.
Article in BMC geriatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLoneliness is recognized by the World Health Organization as a major global public health concern, with well-documented consequences for mental and physical health. Yet it remains under-prioritized in public health programs, particularly in low- and middle-income countries (LMICs). In rural India, intersecting vulnerabilities-caste, gender, and widowhood-exacerbate risks of social isolation and loneliness in later life. Despite commitments under the National Programme for Health Care of the Elderly (NPHCE), validated screening tools are lacking in primary care.
objectiveTo evaluate the psychometric properties of the 8-item UCLA Loneliness Scale (UCLA-8) among community-dwelling older adults in rural Tamil Nadu, using Classical Test Theory (CTT) and Item Response Theory (IRT).
methodsA cross-sectional survey of 413 older adults (≥ 60 years) was conducted across five villages. CTT analyses assessed internal consistency, item-total correlations, and factorial structure via exploratory and confirmatory factor analyses. IRT analyses applied a graded response model to estimate item discrimination, threshold parameters, and test information. Known-groups validity was examined by gender, age cohort, and living arrangement.
resultsThe UCLA-8 demonstrated acceptable internal consistency (α = 0.74) and a two-factor structure distinguishing emotional from social loneliness. Emotionally salient items (e.g., "I feel alone") showed high discrimination and strong factor loadings, whereas reverse-coded relational items (e.g., "I feel part of a group") underperformed. IRT findings indicated optimal precision for detecting moderate-to-high loneliness but weaker sensitivity at lower levels. Loneliness scores were significantly higher among widowed women, Scheduled Caste/Scheduled Tribe (SC/ST) elders, and those living alone.
conclusionsThe UCLA-8 shows robust psychometric validity and feasibility as a brief, equity-sensitive screening tool for rural Indian primary care. Cultural adaptation of weaker items and integration into NPHCE and Health and Wellness Centres could enable earlier detection and support for loneliness among structurally marginalized older adults.
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