Loneliness among Older People in Hospitals: A Comparative Study between Single Rooms and Multi- Bedded Wards to Evaluate Current Health Service within the Same Organisation

Research Article

Gerontol Geriatr Res. 2016; 2(3): 1015.

Loneliness among Older People in Hospitals: A Comparative Study between Single Rooms and Multi- Bedded Wards to Evaluate Current Health Service within the Same Organisation

Singh I¹*, Subhan Z¹, Krishnan M², Edwards C³ and Okeke J¹

²Department of Geriatric Medicine, Aneurin Bevan University Health Board, UK

²Consultant Stroke Physician, Abertawe Bro Morgannwg University Health Board, Wales UK

³Consultant Clinical Scientist, Academic Dermatologist, Aneurin Bevan University Health Board, UK

*Corresponding author: Inderpal Singh, Consultant Geriatrician, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales. UK

Received: April 24, 2016; Accepted: May 24, 2016; Published: May 25, 2016


Background: Healthcare design professionals and new hospital design policies favor single rooms over traditional Multi-Bedded Wards (MB-W) for greater dignity, personalized care and infection control. Higher incidence of inpatient falls has been reported in single rooms but an impact on the perceived isolation and loneliness is not very well studied.

Objective: To compare perceived loneliness among older people treated in single rooms and Multi-Bedded Wards (MB-W) within the same organization.

Design: A semi-structured interview was conducted to measure medical comorbidities, functional status, social activity and cognitive function. Validated scales: Hospital Anxiety Depression Scale (HADS) were used to measure anxiety/depression in the both the hospital sites and perceived loneliness was measured using validated three-point loneliness scale both as in-patient and in the community before admission to the hospital.

Setting: Ysbyty Ystrad Fawr (YYF), a hospital with 100% single rooms, and the Royal Gwent Hospital (RGH), with MB-W. Both are under the Aneurin Bevan University Health Board (ABUHB).

50 patients aged 65 and over admitted to each site with an acute medical illness, recovering and able to give informed consent were included. Only patients with severe dementia, delirium or receiving palliative treatment were excluded.

Results: There was no significant difference in the 3-point loneliness score in the community (MB-W=4.16±1.55; single-rooms=3.66±1.39, p=0.9). But patients felt more lonely in single rooms (4.48±2.10) as compared to MB-W (3.72±1.14) and this was significantly higher (p=0.02). Furthermore, following the hospital admission, older people felt less isolated and lonely in MB-W and felt lonelier in single rooms and this was significantly different.

Conclusion: In this study, patients admitted to single-rooms reported significantly higher loneliness as compared to MB-W. Loneliness increased significantly following the admission to single room as compared to the preadmission level. We recommend that impact of isolation in older people should be taken into consideration in deciding the percentage of single rooms in the new hospital design.

Keywords: Loneliness; Ageing; Older people; Single-rooms; New hospital design


Worldwide populations are ageing and hospitals are admitting increasingly older people [1]. There has been an emphasis on maintaining dignity for older patients in the hospital, but older people often do not receive the dignified care in the hospitals. Multi- Bedded Wards (MB-W) wards are poorly designed, confusing and inaccessible for older people [2]. Older people were bored through lack of communal spaces and activities. Furthermore, concerns have been raised about the close proximity of patients of the opposite sex [2]. Healthcare design professionals favor single rooms over traditional MB-W for greater dignity and personalized care. This is supported by the new hospital design policies which tend to favor the construction of the single rooms for new acute care hospital designs in many parts of the world including the United States and the United Kingdom [3-5]. Single rooms do not only reduce the risk of hospitalacquired infection but also facilitate staff efficiency.

At present just under one-third (30.7%) of NHS beds in England are single rooms [6] while in Scotland’s 218 hospitals, 32% of the total beds are now single rooms and the proportion of single-occupancy rooms in NHS hospitals is rising steadily [7].

The aim of single rooms is to deliver a high level of dignity and minimizing hospital acquired infections. Despite the assumption that privacy, dignity and high levels of patient care are achieved by 100% single rooms, there is currently no hard evidence to support and justify these statements [8]. There is a lack of good quality evidence on the impact of this new service provision (single rooms) on the perceived loneliness [9]. Loneliness has been associated with depression [10], increased mortality risk [11], worse health behaviors and poorer health [12].

In 2011, Aneurin Bevan University Health board in Wales opened a new hospital, Ysbyty Ystrad Fawr (YYF) which has 100% single rooms with en-suite facility. This replaced two older hospitals with MB-W.

The new hospital admits a larger proportion of older people. The same health board also has another site, the Royal Gwent Hospital (RGH) in Newport, which is a traditional MB-W district general hospital. Both sites admit acute and subacute patients. The objective of this study was to compare perceived loneliness among older people treated in two different hospital environments: single rooms and MB-W within the same Health Board.


Study design and setting

This study was designed to measure patient’s perceived loneliness using validated scales in the community and as an inpatient in two different hospital sites: a hospital (YYF) with 100% single rooms or a hospital (RGH) which has MB-W, both under the same Health Board.


The sample consisted of 100 older patients aged 65 years and over, admitted to YYF or RGH, who were stable and recovering from an acute medical illness and able to give informed consent. The study was conducted between November 2013 and August 2014. Those who were unable to give informed consent due to acute confusion, delirium or dementia, or were receiving palliative treatment were excluded from the study. Patients whose hospital stay is less than 3 days were also excluded. To ensure that the sample was obtained correctly, medical teams in each setting were involved and informed of the inclusion and exclusion criteria. The participation in the study was completely on the voluntary basis and no patient was persuaded by any means to participate in the study. In case the patient has refused or agreed to participate in the study, patients were thanked and reassured that this will not affect current treatment.


Information was collated onto a standardized data collection form for each patient, allowing reproducibility. Individual patient characteristics were recorded from clinical notes or through a semistructured interview following recovery from the acute illness. This included age, sex, Abbreviated Mental Test (AMT) score, Activities of Daily Living (ADLs) on admission measured by Barthel Index (BI), co-morbidity burden measured by Charlson Comorbidity Index (CCI), social activity such as going out more than 3 times/week; living alone or with partner, support with shopping and medications. Validated scale: Hospital Anxiety Depression Scale (HADS) was used to measure anxiety/depression in both the hospital sites [13].

We found four validated scales to measure loneliness in the literature. The University of California, Los Angeles (UCLA) Loneliness Scale was designed to be self-administered; it has 20 items with four response categories each and is a commonly used measure of loneliness [14]. However, the scale is too long and complex to use. Therefore, we used the shorter, 3-item questionnaire version which has not only been widely used (original paper has been cited over 1,500 times) but also has been found to be accurate when it is part of a self-completed questionnaire and has been tested with older people [15].

The UCLA 3-item Loneliness scale comprises 3 questions that measure three dimensions of loneliness: relational connectedness, social connectedness and self-perceived isolation [15]. The scale generally uses three response categories: Hardly ever / some of the time / often. The scores for each individual question can be added together to give you a possible range of scores from 3 to 9.

The questions are:

1. How often do you feel that you lack companionship?

2. How often do you feel left out?

3. How often do you feel isolated from others?

The perceived loneliness was measured using validated UCLA 3-item Loneliness scale both in the community and following admission to the hospital.

Data and statistical analysis

Data were anonymised and recorded onto a password protected Microsoft Excel spreadsheet to protect patient confidentiality. Data analysis was performed using IBM SPSS 20 and STATISTICA Stat Soft data analysis software system, version 9.1 (Statistica Inc., 2010). Data are presented as means ± Standard Deviation (SD). In addition to descriptive analysis, loneliness was compared between two different hospital settings and sub-analysis was performed for the change in the loneliness following hospital admission. The level of statistical significance at which the null hypothesis was rejected was chosen as 0.05.

This study was to evaluate the impact of new service provision (100 % single-rooms) as compared to the existing service (multibedded wards), provided by the same Health Board. However, all questions and forms required to carry out the study were sent to the Research and Development (R&D) department at ABUHB, to assess risks to patient identification and the health board. R&D approved the study with no further need for ethical approval. The R&D decision was justified on the basis that this observational study was to evaluate current service and no personal information other than hospital identification number, date of birth and sex will be recorded for service evaluation purpose only and no personal identifiable information will be shared or published. Consent was still taken for this service evaluation in case patients need to be contacted or interviewed to complete any missing clinical data.


Patients admitted to single rooms were frailer as suggested by multiple co-morbidities and functional dependence. A significantly higher number of patients in single rooms were living alone. The description of two cohorts studied is shown in (Table 1).

Citation: Singh I, Subhan Z, Krishnan M, Edwards C and Okeke J. Loneliness among Older People in Hospitals: A Comparative Study between Single Rooms and Multi-Bedded Wards to Evaluate Current Health Service within the Same Organisation. Gerontol Geriatr Res. 2016; 2(3): 1015.