[Relationship between loneliness and fear of falling in community-dwelling older adults: Systematic scoping review]

The rising prevalence of unwanted loneliness and the fear of falling among older adults represents a significant challenge for contemporary public health. Understanding the relationship between these two variables is imperative for designing interventions that promote active and healthy aging. To this end, a scoping review was conducted following the PRISMA-ScR guidelines and the Arksey & O'Malley methodology, focusing on studies from the last five years across databases such as PubMed, Web of Science, Scopus, and the Virtual Health Library. The selection process, performed by peers using Rayyan software, began with an initial universe of 179,478 records, from which 26 articles in Spanish, English and Portuguese were ultimately selected, meeting the inclusion criteria for community-dwelling individuals aged 60 and over. The analysis of this evidence reveals a bidirectional and cyclical relationship: loneliness acts as a predictor for an increase in the fear of falling, while the latter intensifies loneliness by involving various proximal variables. Within this dynamic, depression emerges as a key mediator, as both loneliness and the fear of falling elevate the risk of developing depressive symptoms, creating a negative feedback loop that deteriorates overall well-being. This relationship is not universal and may be modulated by additional factors such as functional limitations, perceived self-efficacy, social support, and environmental risks. Despite these findings, limitations persist relating to conceptual heterogeneity between subjective loneliness and objective social isolation: most of the identified studies operationalize the variable as living alone or as objective social isolation rather than subjective loneliness, which limits the generalization of the findings to loneliness as an internal experience, as well as a scarcity of studies in populations with functional dependence. In conclusion, the multifaceted nature of this link demands a holistic public health approach that addresses both phenomena jointly to preserve autonomy, quality of life, and the well-being of older adults.