Combatting Social Isolation, Loneliness, and Elevated Suicide Risk Among Older Adults in North Carolina

Social isolation (the objective deficit in social relationships) and loneliness (the subjective deficit between an individual’s desired and actual social relationships) are public health issues that affect the health and well-being of many North Carolinians. The North Carolina Department of Health and Human Services (NC DHHS) seeks to develop a strategy to reduce social isolation, loneliness, and elevated suicide risk (SILES). Given the barriers to addressing SILES and the resources of NC DHHS, this strategy should include the formation of a task force, improved social isolation and loneliness screening, and support for community-based organizations. Social isolation and loneliness contribute to higher morbidity and mortality and are widespread. Social isolation and loneliness are associated with greater mortality and increased risk of stroke, heart disease, dementia, diabetes, high cholesterol, chronic conditions, anxiety, depression, and suicide. Prior to the COVID-19 pandemic, 43 percent of adults over age 60 in the United States reported feeling lonely and 25 percent of adults over age 65 were considered socially isolated. By the middle of the pandemic, almost two-thirds of people aged 50 and older in the nation reported social isolation.

NC DHHS recognizes the importance of social isolation and loneliness. The Division of Aging and Adult Services (DAAS) developed a SILES working group in April 2020 to begin working to address these key public health issues. Later, DAAS encouraged the North Carolina Area Agencies on Aging to use Older American Act 2021 and various COVID-19 funding to support social connection. The Division of Health Benefits (North Carolina Medicaid) plans to use American Rescue Plan Act funding to address social isolation, loneliness, and elevated suicide risk among home and community-based services beneficiaries.

The purpose of this report is to answer the following question: given the recent influx of funding to combat social isolation and loneliness, what strategy or strategies should the North Carolina Department of Health and Human Services pursue to combat these issues?

Based on an environmental scan, expert interviews, analysis of the recently conducted Social Isolation and Loneliness in North Carolina Survey, a landscape review of current screenings being used in North Carolina, interviews with other states and large cities, and a guided discussion with NC DHHS stakeholders, we recommend that North Carolina initially focus on coordinated existing efforts throughout the state that aim to improve social connection among older adults. In particular, we recommend NC DHHS:

1. Creates a SILES task force that includes NC DHHS Divisions, community-based organizations, older adult advocates, and researchers. The task force should be led by an individual at NC DHHS who reports directly to executive leadership and for whom SILES work is a top priority of their role.

2. Incorporate the UCLA 3-Item Loneliness Scale into existing Medicaid HCBS screening tools and NCCARE360 screenings. Incorporate referrals to existing SILES programs into the NCCARE360 referral network. Referral services should build over time to include more SILES programs occurring in North Carolina, in particular, those that are targeted toward specific communities of high need. Screening can help identify high-need communities and populations to prioritize for the development of SILES pilots and programs.

3. Fund existing community efforts and pilots through grants. Grants should be awarded in a way that prioritizes innovative programs that support high-need groups and support the state’s goal to create a comprehensive, person-centered SILES approach