The development and preliminary validation of a multidimensional assessment scale for loneliness in nursing homes

Loneliness among nursing home residents is a multidimensional and subjective experience associated with adverse health outcomes. Existing instruments often fail to capture this complexity and are poorly adapted to cognitively impaired populations in institutional care settings.

To create a multidimensional, cognitively accessible assessment scale for loneliness in nursing home residents, grounded in residents' experiences and suitable for use in routine care.

Sequential multi method study following the initial stages of scale development as outlined by Boateng et al. (2018).

Multiple nursing home settings in the Netherlands represent long-term care environments for frail older adults.

Nursing home residents were purposively selected to reflect variation in cognitive functioning, including individuals with no cognitive impairment, mild cognitive impairment, and moderate to severe cognitive impairment. Participants were included if they could engage in an interview to some extent; residents with acute distress or an inability to participate in any form of communication were excluded.

Item development followed three steps: (1) generation of items and recommendations based on literature and residents' experiences; (2) expert consultation to establish content validity and refine wording; and (3) pre-testing through semi-structured cognitive interviews (Willis, 2004) to assess comprehension and feasibility.

The final scale comprises 14 items selected from an initial pool of 22. The instrument captures social, emotional, existential, and institution-specific dimensions of loneliness. Although comprehension was lower among residents with severe cognitive impairment, overall understanding across participants was sufficient to retain all items. Cognitive testing demonstrated that residents, including those with moderate to severe dementia, were able to meaningfully reflect on the items when appropriately supported. The assessment procedure was found to be practical, inclusive, and minimally burdensome, and facilitated discussion of residents lived experiences.