Severe Loneliness Among Community-Dwelling Older Adults at Risk of Falls in Andalusia: Epidemiological Determinants and Clinical Correlates of Pain and Sleep Quality

Background/Objectives: Loneliness is a relevant social determinant of health in older age and has been associated with adverse physical, psychological and social outcomes. This study aimed to estimate the prevalence of severe loneliness and to identify its epidemiological and clinical correlates among community-dwelling older adults at risk of falls in Andalusia, Spain. Methods: A cross-sectional analytical study was conducted with 237 adults aged 65 years and older living in private households. Loneliness was assessed using the 10-item version of the UCLA Loneliness Scale, which showed excellent internal consistency in this sample (Cronbach’s alpha = 0.900). After reviewing the scoring direction of the instrument, severe loneliness was operationally defined using the corrected UCLA total score, with higher scores indicating greater loneliness. Sociodemographic and clinical variables included age, sex, living arrangements, economic level, family relationships, pain, sleep quality, depression history, physical exercise, outings from home, polymedication and analgesic use. Bivariate analyses were performed to compare participants with and without severe loneliness, and logistic regression was used to examine independent correlates of severe loneliness. Results: Severe loneliness was identified in 51 participants, corresponding to 21.5% of the analytical sample. The corrected UCLA-10 loneliness burden score ranged from 0 to 30, with higher scores indicating greater loneliness. Participants with severe loneliness were more likely to report poorer sleep quality and severe pain. In the adjusted logistic regression model including age, sex, sleep quality and severe pain, better sleep quality was associated with lower odds of severe loneliness (OR = 0.46, 95% CI: 0.30–0.72, p = 0.001), while severe pain was associated with higher odds of severe loneliness (OR = 3.15, 95% CI: 1.56–6.35, p = 0.001). Age (OR = 1.03, 95% CI: 0.99–1.07, p = 0.184) and female sex (OR = 2.00, 95% CI: 0.83–4.81, p = 0.124) were not statistically significant in the fully adjusted model. Conclusions: Severe loneliness affected a clinically relevant proportion of community-dwelling older adults at risk of falls in Andalusia. The findings should be interpreted as cross-sectional associations and not as evidence of causal pathways. Sleep quality and severe pain emerged as the main independent clinical correlates of severe loneliness in the adjusted model, supporting the relevance of multidimensional assessment in frail older adults.