Exploring the interplay of loneliness, depression, and frailty in Indonesian nursing homes: towards holistic care repositioning

Purpose This study aims to determine the prevalence and severity of loneliness among older adults in Indonesian nursing homes and examine its correlations with depression and frailty to inform holistic care. Design/methodology/approach A cross-sectional study was conducted across three government-run nursing homes (Panti Sosial Tresna Werdha) in Jakarta and Bekasi, Indonesia. Using consecutive sampling, 250 older adults (aged = 60 years) completed the University of California, Los Angeles (UCLA) Loneliness Scale Version 3, Geriatric Depression Scale-15 and FRAIL Scale. Spearman’s correlation and subgroup comparisons were performed. Findings Moderate-to-severe loneliness affected 82.0% of participants (moderate 44.0%, severe 38.0%). Depression was present in 78.0% and pre-frailty or frailty in 76.0%. Significant moderate positive correlations emerged between loneliness and depression (ρ = 0.48, p < 0.001) and loneliness and frailty (ρ = 0.39, p < 0.001). Longer institutional stay, widowed or never-married status, lower education and multimorbidity predicted higher loneliness scores. Research limitations/implications The cross-sectional design precludes causal inference. Generalizability is limited to government-run facilities in Java excluding residents with severe cognitive impairment. Longitudinal and multi-site research is warranted. Practical implications Loneliness should be systematically screened upon admission, integrated into individualized care plans and addressed through staff training in relationship-centered care, structured psychosocial interventions, facilitated family engagement and environmental redesign. Brief screeners are feasible in resource-limited settings. Social implications The high prevalence of loneliness among institutionalized older adults signals a societal failure to maintain social integration in later life. Repositioning loneliness as a standalone mental health priority can drive policy reforms that shift long-term care from custodial models toward community-connected, relationship-centered environments. Such change may reduce ageist stereotypes, encourage intergenerational solidarity and lessen the burden on healthcare systems by addressing loneliness before it exacerbates depression and physical decline. Ultimately, fostering belonging in nursing homes contributes to more inclusive, age-friendly societies. Originality/value This large-sample, multi-institutional study from an underrepresented low-middle-income context repositions loneliness as a primary mental health target distinct from depression, simultaneously examining the loneliness–depression–frailty triad to guide targeted, holistic interventions.