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Loneliness and social isolation among older adults are often treated as private struggles. A new commentary from Duke researchers argues that North Carolina should view them as public health issues shaped by infrastructure, health care access, caregiving pressures and demographic change.
The commentary, “Loneliness as a Public Health Imperative: Reframing Social Disconnection in Aging North Carolina,” was published in the Spring 2026 issue of the North Carolina Medical Journal. The authors are Sierra J. Kaplan, a Duke Master of Public Policy candidate set to graduate in 2027, and Dr. Nathan Boucher, an associate research professor in the Sanford School of Public Policy and associate professor of nursing and medicine.
Kaplan and Boucher argue that loneliness and social isolation among older adults should not be understood only as individual problems. Instead, they write, these challenges often grow from larger conditions, including rural transportation gaps, limited broadband, caregiving demands, health workforce shortages and uneven access to community-based services.
In North Carolina, those pressures carry particular weight. The commentary notes that older adults now outnumber children in 88 of the state’s 100 counties. More than one-quarter of North Carolina’s older adult population lives alone, one-third live either below or just above the poverty line, and one-third live with at least one disability.
The authors also cite state Behavioral Risk Factor Surveillance System data showing that about 439,000 older adults in North Carolina report feeling lonely, while about 268,000 report social isolation.
"Too often, loneliness and social isolation are dismissed as inevitable aspects of aging that older adults must navigate on their own, viewed in isolation rather than as deeply interconnected drivers of health that demand a coordinated public health response in North Carolina,” said Kaplan.
The commentary distinguishes between loneliness and social isolation, a difference the authors say matters for policy and practice. Social isolation refers to objective conditions, such as few relationships, limited social roles or infrequent interaction. Loneliness refers to the distress someone feels when their desired level of connection does not match their actual relationships.
That distinction can shape intervention. An older adult who lives alone may still feel supported and connected. Another older adult may have regular contact with others but still feel lonely because those relationships lack depth, meaning or emotional support.
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For North Carolina, Kaplan and Boucher argue, this means programs need to do more than increase the number of social contacts. Effective strategies should improve the quality of connection, bring services to people facing transportation or mobility barriers, and work through trusted local institutions such as senior centers, faith organizations, libraries, cooperative extensions and community nonprofits.
Boucher reiterates the need for collaboration. “No one organization can sufficiently tackle the intersection of aging, mounting disease burden and disability, social isolation, and loneliness – it takes collaboration across sectors and practitioners to serve older North Carolinians adequately.”
The commentary points to existing assets in North Carolina, including the state’s Division of Aging, Area Agencies on Aging, senior centers and the Social Bridging NC program. The authors also note North Carolina’s 2023 investment of $835 million in behavioral health as a potential foundation for strengthening early intervention and healthy aging supports.
But Kaplan and Boucher caution that programs will only work if older adults can access them. Rural communities, older adults living with disabilities, caregivers, and people without reliable transportation or broadband may face the greatest risk of falling through the cracks.
The authors call for a statewide approach that connects clinical care, community organizations and aging services. They also recommend better measurement of outcomes, including loneliness prevalence, social isolation prevalence, access to programs, referral success, sense of belonging, perceived support, depression symptoms, emergency department use and avoidable hospitalizations.
Key Takeaways
- Loneliness and social isolation among older adults should be treated as public health issues, not just private or personal concerns.
- North Carolina faces a growing challenge as its population ages, especially in rural communities with limited transportation, broadband and health care access.
- Loneliness and social isolation are related but different. Programs need to identify both the size of someone’s social network and the quality of their relationships.
- Effective interventions should focus on meaningful connection, trusted local institutions and practical access barriers.
- Health systems, aging services and community organizations can work together to identify older adults at risk and connect them with support.
- Better measurement can help North Carolina track progress and make social connection a stronger part of healthy aging policy.
The article is available in the North Carolina Medical Journal:
Media Contact
Matt LoJacono
Public Relations Manager, Sanford School of Public Policy
Email: matt.lojacono@duke.edu
Phone: 703-740-7871