Dimensions of Loneliness Among Older Adults in Osijek-Baranja County: Associations with Sociodemographic, Family, and Social Characteristics

1. Introduction

Population ageing has turned loneliness among older adults into a pressing public health issue. When the WHO Commission on Social Connection released its landmark report in 2025, it estimated that around one in ten older people worldwide experience loneliness, while a further quarter are socially isolated, representing related but distinct conditions [1]. The prevalence of loneliness appears to be considerably higher in high-income countries, where Chawla et al. [2] found that approximately one in four older adults reported feeling lonely, although estimates vary substantially across European Union countries [3].

The consequences of loneliness extend well beyond emotional distress. Loneliness has been associated with a 26% higher risk of all-cause mortality [4], and, together with social isolation, with increased cardiovascular morbidity [5,6]. Loneliness has also been associated with cerebrovascular and Alzheimer’s disease pathology [7], and, together with social isolation, with sarcopenia [8]. Social isolation, which is closely related to loneliness, is listed by the WHO as a modifiable risk factor for dementia. More broadly, up to 45% of dementia cases may be attributable to potentially modifiable risk factors [9]. Therefore, loneliness is not merely an unpleasant subjective experience, as it is associated with measurable effects on physical and mental health in later life.

1.1. Factors Associated with Loneliness in Older Adults

Several factors have consistently been linked to loneliness among older adults. Partnership status is among the most important: a meta-analysis of the correlates of loneliness in late adulthood found that married individuals and those living with a partner reported lower levels of loneliness than those who were widowed, divorced, or had never married [10]. Living alone has also been associated with greater loneliness, although the quality of household relationships may be more important than the number of people living in the household [11,12]. Findings on sex differences in loneliness are mixed, with several studies reporting higher loneliness among women [13,14,15].

Participation in community organizations has likewise been associated with lower levels of loneliness. Shimoda et al. [16] and Nakahara and Yokoi [17] found that several factors including community involvement, hobbies, and leisure activities, were associated with lower odds of loneliness. However, whether the frequency of engagement contributes independently of membership itself remains an open question [17].

Evidence on urban–rural differences in loneliness specifically is still limited, but a recent scoping review points out that older adults in rural areas face geographic and infrastructural barriers to social participation that likely shape their experience of loneliness in ways urban-based research has not captured [18].

1.2. Croatian Context and Study Rationale

Research addressing loneliness among older adults in Croatia remains limited. A cross-sectional study in northern Croatia examined social and emotional loneliness directly [15], while broader research from eastern Croatia has looked at successful ageing together with social connectedness [19] and subjective well-being [20], with loneliness appearing only as a single item within the wider ageing scale used in at least one of these studies [20], rather than as a primary outcome. Croatian studies conducted in specific institutional and clinical populations have also linked loneliness with lower perceived social support and lower life satisfaction [21,22]. Among nursing home residents during the COVID-19 pandemic, older adults without a partner reported greater loneliness, while greater perceived social support was associated with lower loneliness [21]. However, evidence concerning the distinct dimensions of loneliness among community-dwelling older adults in Croatia remains limited. Evidence specific to Osijek-Baranja County is lacking, although approximately one in four older adults in the County lives alone [23], a living arrangement consistently associated with an increased risk of loneliness.

Community and public health nurses are often in regular contact with older adults and may therefore be well positioned to identify those experiencing loneliness and facilitate appropriate assessment, support, or referral [24]. Understanding the prevalence and correlates of loneliness among community-dwelling older adults is therefore directly relevant to nursing practice, supporting the inclusion of a nursing perspective in research on loneliness at the community level.

1.3. Study Aims

The primary aim of this study was to examine social loneliness, family loneliness, and loneliness in romantic relationships among adults aged 65 years and older in Osijek-Baranja County and to assess their associations with participants’ sociodemographic, family, and social characteristics. Specifically, the study aimed to:

(1) examine the levels of social loneliness, family loneliness, and loneliness in romantic relationships;

(2) examine differences in these dimensions of loneliness according to selected sociodemographic, family, and social characteristics;

(3) assess the associations between age and each dimension of loneliness;

(4) among members of community organizations, examine the associations between the frequency of participation in organizational activities and each dimension of loneliness; and

(5) determine the independent contributions of selected sociodemographic, family, and social characteristics to social loneliness, family loneliness, and loneliness in romantic relationships.

2. Materials and Methods

2.1. Study Design

This quantitative, cross-sectional study was conducted between January and April 2025 in Osijek-Baranja County, Croatia.

2.2. Participants

The study included 431 community-dwelling adults aged 65 years and older who resided in Osijek-Baranja County and were able to provide informed consent. Individuals with diagnosed dementia, those residing in nursing homes, and those unable to provide informed consent were not eligible for inclusion. A non-probability convenience sampling method was used to recruit participants who met the eligibility criteria. A minimum sample size of 382 participants was estimated assuming a population of 56,734, a 95% confidence level, a 5% margin of error, and a 50% response distribution [25].

During data screening, 22 respondents younger than 65 years, five respondents whose age was not reported and whose eligibility therefore could not be confirmed, one nursing home resident, and 32 respondents whose missing responses prevented the calculation of one or more loneliness subscale scores were excluded from the analysis. In total, 60 respondents were excluded, resulting in a final analytical sample of 431 participants.

2.3. Instruments

Data were collected in person using an anonymous questionnaire consisting of two components.

The first component was the Croatian version of the Social and Emotional Loneliness Scale adapted into Croatian by Vera Ćubela Adorić and Marina Nekić. The instrument was obtained from the Collection of Psychological Scales and Questionnaires [26], and permission to use it was granted by Vera Ćubela Adorić.

The Social and Emotional Loneliness Scale comprises 36 items distributed across three subscales: social loneliness (14 items), family loneliness (11 items), and loneliness in romantic relationships (11 items). The term “loneliness” is not explicitly mentioned in the items, which include both positively and negatively worded statements. The subscale labels are not presented to respondents. Items assessing social loneliness are grouped together, whereas items assessing family loneliness and loneliness in romantic relationships are presented alternately, reflecting the conceptualization of the latter two domains as components of emotional loneliness. Respondents indicate their level of agreement with each statement on a seven-point Likert-type scale ranging from 1 (“strongly disagree”) to 7 (“strongly agree”). According to the scoring instructions, 23 items require reverse scoring so that higher scores consistently indicate greater loneliness. Each subscale score is calculated by summing the responses to its corresponding items, with higher scores indicating greater loneliness in that domain. Possible scores range from 14 to 98 for social loneliness and from 11 to 77 for both family loneliness and loneliness in romantic relationships. In the present study, ordinal McDonald’s omega coefficients were 0.919 for social loneliness, 0.917 for family loneliness, and 0.863 for loneliness in romantic relationships.

The second component comprised questions on sociodemographic, family, and social characteristics, including age, sex, marital status, household composition, place of residence, frequency and perceived quality of family contact, membership in a community organization, and, among members, the frequency of participation in organizational activities.

2.4. Data Collection Procedure

Before the data collection phase began, the research staff received targeted training in communication strategies and psychological approaches relevant to working with older adults. Data were collected in person in participants’ homes to provide privacy and a familiar and comfortable setting for questionnaire completion. During participant recruitment, potential participants received written and verbal information about the purpose and procedures of the study, the voluntary nature of participation, the confidentiality of the collected data, and their right to withdraw at any time without consequences. Participants were given an opportunity to ask questions, and written informed consent was obtained before questionnaire administration.

Participants completed the anonymous questionnaire using the paper-and-pencil method. They first completed the self-administered Croatian version of the Social and Emotional Loneliness Scale. Sociodemographic, family, and social information was collected afterward to minimize the possibility that personal questions could influence responses to the loneliness scale [27]. During questionnaire completion, researchers remained available to clarify the instructions or the meaning of individual questions when necessary. Clarifications were provided in a neutral manner without suggesting or directing participants’ responses. No personally identifiable information was entered into the research database. Completion time was not limited. The average time required to complete the questionnaire was ten minutes per participant, ranging from eight to twelve minutes.

2.5. Ethical Considerations

The study was conducted in accordance with the ethical principles of the Declaration of Helsinki [28] and approved by the Committee for Ethical and Professional Affairs of Nurses and Nursing Technicians of University Hospital Centre Osijek (approval No. R1-96-7/2025; 3 January 2025). All potential participants received written information through a research notice form and were also informed verbally about the purpose of the study, the data collection procedures, the voluntary nature of participation, the confidentiality of the collected data, and their right to withdraw from the study at any time without providing a reason or experiencing any consequences.

Participants were given an opportunity to ask questions and clarify any uncertainties before deciding whether to participate. Written informed consent was obtained from all participants before questionnaire administration. To protect participants’ anonymity, the questionnaires did not contain personally identifying information and were stored separately from the signed informed consent forms.

2.6. Data Analysis

Descriptive statistical methods were used to summarize the distribution of the study variables. Categorical variables were presented as absolute and relative frequencies. Participants’ age and, among members of community organizations, the frequency of participation in organizational activities were presented as the median and interquartile range, Mdn (Q1–Q3). Scores on the social loneliness, family loneliness, and loneliness in romantic relationships subscales were presented as the mean and standard deviation and as the median and interquartile range.

The internal consistency of the subscales was assessed using ordinal McDonald’s omega coefficients calculated from polychoric correlations. Normality was evaluated using the Shapiro–Wilk test. Because the scores on all three subscales deviated significantly from a normal distribution, nonparametric tests were used in the bivariate inferential analyses.

Differences in loneliness subscale scores between two independent groups were examined using the Mann–Whitney U test whereas differences among three or more groups were examined using the Kruskal–Wallis test. Statistically significant Kruskal–Wallis tests were followed by Dunn’s post hoc pairwise comparisons with Holm adjustment for multiple testing. Effect sizes were expressed as the rank-biserial correlation coefficient (r_rb) for Mann–Whitney U tests, epsilon-squared (ε²) for overall Kruskal–Wallis tests, and the rank-biserial correlation coefficient for the corresponding pairwise group contrasts.

Associations between age and the three loneliness dimensions were examined using Spearman’s rank correlation coefficient. Among participants who were members of community organizations, Spearman’s rank correlation coefficient was also used to assess the association between the frequency of participation in organizational activities and each loneliness dimension.

The social loneliness model included age, sex, residence, marital status, household composition, family-contact frequency and quality, and community-organization membership. The family loneliness model included age, marital status, household composition, and family-contact frequency and quality, whereas the romantic loneliness model included age and marital status. Categorical predictors were indicator-coded, and their overall effects were assessed using robust Wald F-tests.

Regression assumptions and model diagnostics, including linearity, residual distribution, homoscedasticity, multicollinearity, model specification, and influential observations, were examined before interpretation. Because heteroscedasticity was identified in some models, HC3 robust standard errors were applied in all regression analyses. Results are presented as unstandardized regression coefficients (B), HC3 robust standard errors, 95% confidence intervals, and p-values. Model performance was assessed using the adjusted coefficient of determination (adjusted R²). Missing data were not imputed. Statistical significance was set at p < 0.05.

Statistical analyses were performed using R, version 4.6.1 (R Foundation for Statistical Computing, Vienna, Austria), through RStudio Desktop, version 2026.07.1 (Posit Software, PBC, Boston, MA, USA). The following R packages were used: haven, dplyr, tidyr, tibble, purrr, stringr, psych, FSA, car, lmtest, sandwich, MASS, and writexl.

3. Results

A total of 431 participants were included in the study. Most were women, 272 (63.1%), and lived in urban areas, 250 (58.0%). The median age was 72 years (Q1–Q3: 68–77). Among members of community organizations, the median frequency of participation in organizational activities was 3 (Q1–Q3: 2–5) (Table 1).

The highest median score was observed for loneliness in romantic relationships, Mdn = 41 (Q1–Q3: 27–50), whereas the lowest median score was observed for family loneliness, Mdn = 20 (Q1–Q3: 14–29). Scores on all three subscales deviated significantly from a normal distribution (Table 2).

Regarding social loneliness, men had significantly higher scores than women (U = 24,545; p = 0.019). Social loneliness differed significantly by place of residence (H(2) = 6.59; p = 0.037). Dunn’s post hoc test with Holm adjustment showed that participants from suburban areas had higher social loneliness than those from urban areas (p = 0.033; r_rb = 0.209).

Social loneliness also differed significantly according to the perceived quality of family contact (H(2) = 28.23; p < 0.001). Dunn’s post hoc test with Holm adjustment showed that participants who rated their family contact as partly good had higher social loneliness than those who rated it as good (p = 0.001; r_rb = 0.257). Participants who rated their family contact as poor had higher social loneliness than those who rated it as good (p < 0.001; r_rb = 0.642), as well as those who rated it as partly good (p = 0.016; r_rb = 0.372). The effect size was small for sex (r_rb = 0.135) and place of residence (ε² = 0.011), whereas it was moderate for the perceived quality of family contact (ε² = 0.062) (Table 3).

Family loneliness did not differ significantly according to marital status or household composition. Family loneliness differed significantly according to the frequency of family contact (H(3) = 14.36; p = 0.002). Dunn’s post hoc test with Holm adjustment showed that participants who had contact with their family once a year or less often had higher family loneliness than those who had daily contact (p = 0.026; r_rb = 0.248) and those who had contact once or several times a week (p = 0.008; r_rb = 0.277). Family loneliness also differed significantly according to the perceived quality of family contact (H(2) = 69.69; p < 0.001). Dunn’s post hoc test with Holm adjustment showed that participants who rated their family contact as partly good had higher family loneliness than those who rated it as good (p < 0.001; r_rb = 0.424). Participants who rated their family contact as poor had higher family loneliness than those who rated it as good (p < 0.001; r_rb = 0.943), as well as those who rated it as partly good (p < 0.001; r_rb = 0.746). The effect size was small for the frequency of family contact (ε² = 0.028), whereas it was large for the perceived quality of family contact (ε² = 0.161) (Table 4).

Loneliness in romantic relationships differed significantly according to marital status (H(4) = 165.40; p < 0.001). Dunn’s post hoc test with Holm adjustment showed that married participants had significantly lower loneliness in romantic relationships than never-married participants (p = 0.002; r_rb = 0.628), divorced participants (p < 0.001; r_rb = 0.746), and widowed participants (p < 0.001; r_rb = 0.715). Cohabiting participants had lower loneliness in romantic relationships than never-married participants (p = 0.017; r_rb = 0.719), divorced participants (p < 0.001; r_rb = 0.816), and widowed participants (p < 0.001; r_rb = 0.813). The effect size was large (ε² = 0.390) (Table 5).

A weak positive association was observed between age and social loneliness (ρ = 0.148; p = 0.002) and between age and loneliness in romantic relationships (ρ = 0.194; p < 0.001) (Table 6).

The social loneliness model was statistically significant (FHC3(16, 379) = 4.49; p < 0.001) and explained 13.0% of the variance in social loneliness (adjusted R² = 0.130). Older age was associated with significantly higher social loneliness (B = 0.37; p = 0.014). Marital status was statistically significant as an overall predictor of social loneliness (FHC3(4, 379) = 5.73; p < 0.001). Compared with married participants as the reference category, cohabiting participants had significantly lower social loneliness (B = −9.83; p < 0.001), as did never-married participants (B = −9.63; p = 0.008), after adjustment for all other predictors included in the model.

The perceived quality of family contact was also statistically significant as an overall predictor of social loneliness (FHC3(2, 379) = 12.66; p < 0.001). Compared with participants who rated their family contact as good, participants who rated it as partly good had significantly higher social loneliness (B = 7.38; p < 0.001), as did participants who rated it as poor (B = 19.66; p < 0.001), after adjustment for all other predictors included in the model. Although the coefficient for contact once a year or less often, relative to daily contact, reached statistical significance (B = −5.06; p = 0.049), frequency of family contact was not statistically significant as an overall predictor (FHC3(3, 379) = 1.83; p = 0.142) (Table 7).

The family loneliness model was statistically significant (FHC3(12, 383) = 10.65; p < 0.001) and explained 27.0% of the variance in family loneliness (adjusted R² = 0.270). The perceived quality of family contact was the only statistically significant overall predictor of family loneliness (FHC3(2, 383) = 44.18; p < 0.001). Compared with participants who rated their family contact as good, those who rated it as partly good had significantly higher family loneliness (B = 7.17; p < 0.001), as did those who rated it as poor (B = 25.52; p < 0.001), after adjustment for all other predictors included in the model.

Although never-married participants had significantly lower family loneliness than married participants as the reference category (B = −6.82; p = 0.018), marital status was not statistically significant as an overall predictor (FHC3(4, 383) = 1.45; p = 0.216) (Table 8).

The loneliness in romantic relationships model was statistically significant (FHC3(5, 413) = 54.73; p < 0.001) and explained 38.5% of the variance in loneliness in romantic relationships (adjusted R² = 0.385). Older age was associated with significantly higher loneliness in romantic relationships (B = 0.24; p = 0.005). Marital status was statistically significant as an overall predictor of loneliness in romantic relationships (FHC3(4, 413) = 53.50; p < 0.001). Compared with married participants as the reference category, never-married participants had significantly higher loneliness in romantic relationships (B = 14.66; p < 0.001), as did divorced participants (B = 21.55; p < 0.001) and widowed participants (B = 15.58; p < 0.001), after adjustment for age (Table 9).

4. Discussion

This study examined social, family, and romantic loneliness among community-dwelling adults aged 65 years and older in Osijek-Baranja County, Croatia. Loneliness in romantic relationships had the highest median raw score, whereas family loneliness had the lowest. Because the three subscales differ in the number of items and in their possible score ranges, these raw scores should not be interpreted as directly comparable indicators of the severity of loneliness across domains. Among the variables included in the adjusted models, perceived family-contact quality was associated with both social and family loneliness, whereas marital status showed the clearest pattern of group differences in loneliness in romantic relationships.

In the bivariate analysis, men reported higher social loneliness than women, although the effect size was small. However, sex was not independently associated with social loneliness after adjustment for the other variables included in the regression model. This finding contrasts with much of the existing literature. Neuberg et al. [15], using the same instrument in a sample of older adults from northern Croatia, found that women reported higher levels of loneliness. Pagan and Malo [13] similarly reported higher loneliness among older women in a European sample, and Ratcliffe et al. [29], drawing on data from the English Longitudinal Study of Ageing, found that women scored higher on the UCLA Loneliness Scale, although men were less likely to directly acknowledge feeling lonely. One possible explanation for this discrepancy lies in the dimension-specific nature of the present finding: the observed sex difference concerned social loneliness, which captures the adequacy of friendships and broader social networks. Ratcliffe et al. [29] reported that older men had poorer-quality friendships and fewer close relationships outside of their partnership, which may make them particularly vulnerable to social loneliness even when overall loneliness scores appear lower on global measures. Cultural expectations around masculinity and reluctance to disclose emotional distress may further suppress self-reported loneliness on direct questions while leaving dimension-specific scores unaffected [29]. Pagan and Malo [13] also noted that sex differences in loneliness vary with age and measurement approach.

In a Turkish sample of 610 older adults, Gümüş Demir and Yılmaz [30] found that participants living in villages or towns had higher loneliness and depression scores than urban residents. In the present study, participants from suburban areas reported higher social loneliness than those from urban areas, whereas no significant difference was found between rural and urban participants. This finding should be interpreted cautiously because the suburban subgroup was relatively small (n = 61), and the study did not measure local availability of services, transport, mobility, neighborhood cohesion, or opportunities for social participation. The observed difference may reflect characteristics of the sample or unmeasured contextual factors rather than a general suburban pattern. Further studies using larger samples and direct measures of neighborhood and community resources are needed. Older adults in suburban areas may have more limited mobility and fewer opportunities for regular social participation, which could contribute to higher social loneliness. Irwin et al. [18] noted in their scoping review that older adults in rural areas face geographic and infrastructural barriers including limited transport, workforce shortages, and scarce community-based programs that can hinder social participation, suggesting that the rural context shapes social isolation in ways that warrant greater research attention.

Perceived family-contact quality was associated with both social and family loneliness in the respective adjusted models. Compared with participants who rated their family contact as good, those who rated it as poor had estimated social-loneliness scores that were 19.66 points higher and family-loneliness scores that were 25.52 points higher. This pattern is consistent with the findings of Norlin et al. [31], who studied 474 adults aged 77 years and older in Sweden and reported that relationship quality and quantity were both associated with loneliness. Models incorporating relationship quality, assessed through closeness, conflict, and perceived social support, explained more variance and showed better fit than the model based on relationship quantity. Their findings support the relevance of relationship quality, although differences in study design, measurement, and population limit direct comparison with the present study. Norlin et al. [31] also reported associations between partnership status, relationship conflict, relationships with children, and loneliness.

Wilson et al. [32] similarly found that perceived social support was associated with loneliness across two independent samples, whereas social network size and received emotional or instrumental support were not consistently associated with loneliness. Contact frequency was associated with loneliness in both samples, while network closeness was associated with loneliness in one sample. In the present study, family-contact frequency was associated with family loneliness in the bivariate analysis but was not statistically significant as an overall predictor in the adjusted model, whereas perceived family-contact quality remained statistically significant.

Family loneliness was not significantly associated with marital status or household composition in the bivariate analyses, and these variables did not show significant overall associations in the adjusted model. This finding is consistent with Neuberg et al. [15], who similarly reported that marital status was not associated with family loneliness. By contrast, perceived family-contact quality was associated with family loneliness and showed a relatively large bivariate effect size. These findings suggest that perceived family-contact quality was more closely associated with family loneliness than marital status or household composition in this sample, but the cross-sectional design does not allow conclusions about which factors cause or determine family loneliness.

Loneliness in romantic relationships showed a clear association with marital status, and the adjusted model explained 38.5% of the variance in this outcome. Compared with married participants, divorced and widowed participants had higher loneliness scores in romantic relationships, while the estimate for cohabiting participants did not differ significantly from that for married participants in the adjusted model. These findings describe differences between marital-status groups and do not establish that marital status itself causes romantic loneliness. These group differences are broadly consistent with previous studies reporting higher loneliness among widowed and divorced older adults. Liu et al. [33], analyzing data from the National Health and Aging Trends Study, found that divorced and widowed older adults reported higher loneliness than their married counterparts during the COVID-19 pandemic, and that these differences were not explained by changes in social participation or contact frequency. Vedder et al. [34], in a systematic review of 38 studies, confirmed that widowhood was associated with greater loneliness than other marital statuses, with the widowed being lonelier on average than divorced individuals. Kapelle and Monden [35] further demonstrated that loneliness increased in the year before widowhood or separation and that widowed men were more strongly affected than widowed women, although sex differences were negligible for separation. Because of its cross-sectional design, the present study could not examine the temporal dynamics that Kapelle and Monden [35] identified as central to understanding how loneliness evolves over marital transitions.

Older age showed weak positive cross-sectional associations with social loneliness and loneliness in romantic relationships, but not with family loneliness. Given the small correlation coefficients, these associations should be interpreted as modest in magnitude. Neuberg et al. [15] found that participants aged 85 years and older had higher scores for loneliness in romantic relationships than participants aged 65–84 years, whereas no statistically significant age-group differences were observed for social or family loneliness. The present study used age as a continuous variable and found weak positive associations with social loneliness and loneliness in romantic relationships. These findings are not directly comparable because the two studies operationalized age differently. The divergence in the social loneliness–age association between the two studies may reflect differences in sample composition: Neuberg et al. [15] included both institutionalized and community-dwelling older adults, whereas the present study was limited to community-dwelling individuals. Di Gessa et al. [14], using a 10-year English panel, identified heterogeneous loneliness trajectories in later life, suggesting that age-related increases in loneliness are not universal but depend on individual and contextual factors that accumulate over time.

Community-organization membership was not associated with social loneliness, and participation frequency among organization members was not associated with any of the three loneliness dimensions. These findings differ from studies that used broader or more detailed measures of social participation. Chu et al. [36], in a Chinese sample of 629 older adults, found that social participation was significantly and negatively correlated with loneliness after adjusting for demographic and health variables. Shimoda et al. [16] identified distinct patterns of social participation that were differentially associated with loneliness in Japanese older adults. However, Nakahara and Yokoi [17] observed that while meaningful social participation was associated with lower loneliness and reduced cognitive decline, the frequency of engagement did not independently predict these outcomes, raising the question of whether it is the act of participation itself, its subjective meaning, or the social connections it fosters that matters most. The present study measured frequency of participation rather than its perceived meaningfulness, which may explain the null finding. It is also possible that the types of community organizations available in Osijek-Baranja County, and the roles available to older adults within them, do not provide the depth of social connection needed to influence loneliness, or that self-selection into organizational membership is itself driven by factors associated with loneliness in ways that obscure a protective effect.

One finding requiring caution is the lower adjusted social-loneliness score observed among cohabiting and never-married participants compared with married participants. These estimates were based on very small subgroups, eight cohabiting and twelve never-married participants, and should therefore be regarded as imprecise and hypothesis-generating. Findings involving cohabiting and never-married participants should be considered exploratory. The direction of these adjusted associations was not consistent with the corresponding descriptive pattern and may reflect sparse categories, sampling variability, residual confounding, or model instability. Because the study was not designed to investigate these subgroup differences, no substantive interpretation is offered. Larger studies with sufficient numbers in each marital-status category are needed to determine whether these associations are reproducible.

This study has several strengths, including the use of a multidimensional loneliness instrument distinguishing between social, family, and romantic loneliness, the inclusion of effect-size estimates, and the use of heteroscedasticity-consistent standard errors. The study also has limitations. Its cross-sectional design precludes causal inference, and the non-probability convenience sampling method limits the generalizability of the findings. Data were self-reported, and reporting tendencies may have influenced responses. Previous research has shown that older men may be less likely than older women to disclose loneliness in response to direct questions [29]. Because the present study did not assess social desirability or reluctance to disclose loneliness, the extent of such bias in the current sample is unknown. The study was conducted in a single county in eastern Croatia, and the findings may not be generalizable to other regions or countries. Cognitive function was not formally assessed, and although participants with diagnosed dementia were excluded, undiagnosed cognitive impairment may have affected questionnaire responses. Finally, the small number of participants in certain marital status categories (e.g., cohabiting, never-married) limited the precision of some regression estimates. In addition, the small number of participants in some exposure categories may have produced unstable estimates and limited the reliability of subgroup-specific comparisons. Findings involving cohabiting and never-married participants should therefore be considered exploratory.

Future research should employ longitudinal designs to disentangle the temporal relationships between social contact quality, marital transitions, and loneliness trajectories. Intervention studies are needed to test whether strategies focused on improving the quality and emotional depth of family and social relationships are more effective than those that simply increase the frequency of contact or the number of social activities. Qualitative research could provide valuable insight into how older adults themselves define and experience relationship quality, and how community nursing services might be structured to address loneliness in ways that are acceptable and meaningful to this population. Larger national samples, including both urban and rural areas, would help clarify the geographic patterns identified in this study and the present null finding regarding community participation.

5. Conclusions

This cross-sectional study examined three dimensions of loneliness among community-dwelling older adults in Osijek-Baranja County, Croatia. Loneliness in romantic relationships had the highest median raw score, whereas family loneliness had the lowest; because the three subscales differ in the number of items and in their possible score ranges, these raw scores should not be interpreted as directly comparable indicators of the severity of loneliness across domains. Perceived family-contact quality was associated with social and family loneliness in the adjusted models, while marital status showed the clearest pattern of group differences in loneliness in romantic relationships. Family-contact frequency, community-organization membership, and participation frequency did not show consistent adjusted associations with the loneliness dimensions examined. These findings suggest that perceived relationship quality should be considered alongside structural and frequency-based indicators of social connection, but they do not establish causality or relative importance among these indicators. Future longitudinal and intervention studies should determine whether changes in relationship quality or social contact are followed by changes in loneliness and whether relationship-focused interventions are effective.