Emerging Medical,Social,and Technological Challenges in Home Health Care for Older Adults

Abstract

Background:

The rapid growth of the geriatric population and the rising prevalence of chronic diseases have made home health care (HHC) an essential component of modern health systems. Despite its importance, fragmented services, underfunding, and inequitable access undermine quality and safety, leading to preventable complications and hospital use.

Objective:

This narrative review evaluates the evolving medical, social, and technological needs of older adults receiving home-based care, highlighting persistent gaps and potential strategies to strengthen care delivery.

Methods:

Literature was searched in PubMed, Scopus, and Google Scholar for studies published between January 2020 and June 2025, complemented by WHO policy reports. Peer-reviewed articles, systematic reviews, meta-analyses, and policy documents in English were included. Data were synthesized thematically across 3 domains: medical, social, and technological/environmental needs.

Findings:

Medical challenges included multimorbidity, polypharmacy, poor medication adherence, inadequate wound and pain management, and delayed recognition of acute deterioration. Social aspects were dominated by loneliness, caregiver burden, financial inequities, and insufficient cultural sensitivity in care models. Technological and environmental barriers encompassed limited access to assistive devices, housing inaccessibility, transportation gaps, and low digital literacy. Although telehealth and assistive innovations provide opportunities, their adoption is inconsistent and inequitable.

Conclusions:

Improving geriatric and home health care requires multidisciplinary collaboration, caregiver training, supportive policy frameworks, and equity-focused integration of digital and assistive technologies. Strengthening these strategies can enhance patient safety, reduce preventable hospitalizations, and promote independence and quality of life for older adults.

Keywords

home health care geriatric care multimorbidity caregiver burden digital health health policy assistive technology

Introduction

As the global population ages and the prevalence of chronic diseases rises, home health care (HHC) has become a cornerstone of modern healthcare delivery. According to the World Health Organization (WHO), by 2030 1 in 6 people worldwide will be aged 60 years or older, and by 2050 the number of people aged 80 years or more will triple to 426 million.¹ Nearly two-thirds of older adults require some form of long-term support to perform daily activities, yet systems of care and support remain fragmented, underfunded, and insufficiently prepared to meet this demand.¹ WHO defines quality health services as those that are safe, effective, people-centered, timely, equitable, and integrated.² However, home health services often fall short of these standards, leading to multiple and interrelated challenges beyond clinical management.

The proportion of older people receiving long-term care—either in residential facilities or at home—varies greatly across countries, with many low- and middle-income regions lacking accessible services.³ Inadequate provision of home-based care contributes to increased hospital admissions, avoidable complications, and rising caregiver burden. These challenges are a major factor in patients’ hospital and emergency department visits and also raise critical concerns about the quality of services delivered in home settings.^4,5

From a medical perspective, older adults receiving HHC frequently face multimorbidity, polypharmacy, and complications such as falls, wounds, and infections.⁶ These clinical challenges require continuous monitoring, medication management, and tailored interventions that can be effectively provided in home-based settings.

From a social perspective, older adults receiving home health care face significant challenges. Social isolation and loneliness are prevalent, negatively impacting overall health and well-being.⁷ Alongside this, caregiver burden places significant physical, emotional, and financial burdens on families, often disrupting their own lives.⁸ Furthermore, barriers to health, social, and long-term care access, including financial inequities, limit care quality and availability, particularly for vulnerable populations.⁹

From a technological perspective, advances in telehealth, remote monitoring, and assistive devices have transformed the delivery of home health care. However, disparities in digital literacy and access to these innovations continue to create gaps in equitable care.¹⁰

Given these evolving medical, social, and technological challenges, a comprehensive synthesis of the literature is urgently needed.

This review article synthesizes recent literature to examine the evolving medical, social, and technological needs of older adults receiving home health care (HHC). By identifying persistent gaps and potential solutions, it aims to provide insights for developing more equitable, patient-centered, and sustainable home health care models.

Methods

This study was designed as a narrative review, which is considered appropriate for synthesizing heterogeneous evidence across clinical, social, and technological domains. Unlike systematic reviews or meta-analyses, which follow rigid, protocol-driven approaches, narrative reviews allow for a broader interpretive synthesis of diverse study types, policy documents, and contextual evidence. This approach was chosen because the purpose of this work was to provide an integrative overview of the evolving medical, social, and technological needs of older adults receiving home-based care, rather than to calculate pooled effect sizes.¹¹

Search Strategy

A structured literature search was conducted in PubMed, Scopus, and Google Scholar for studies published between January 2020 and June 2025. This 5-year timeframe was selected because most contemporary research and policy in home health care has emerged during this period. In recent years, technological innovations, evolving models of home-based care, and updated therapeutic approaches have rapidly reshaped the needs of older adults, making evidence from the last 5 years particularly relevant. Older studies were less reflective of these changes and were therefore excluded.

The searches were carried out independently by the authors. No automation software was used; instead, manual screening and cross-referencing were performed to ensure comprehensiveness. In addition, official reports and data from the World Health Organization (WHO) and the National Academies of Sciences were reviewvance.

Search strings combined keywords with Boolean operators, for example:

(“home health care” OR “home care services” OR “geriatric care” OR “older adults”) AND (“patient needs” OR “caregiver burden” OR “social support”)

(“multimorbidity” OR “polypharmacy” OR “chronic disease management” OR “wound care” OR “medication adherence”) AND (“home health care” OR “geriatric care” OR “older adults”)

(“telehealth” OR “remote monitoring” OR “assistive technology”) AND (“accessibility” OR “digital literacy” OR “older adults”)

Eligibility Criteria

Studies were included if they were peer-reviewed articles, systematic reviews, meta-analyses, or policy reports written in English. Gray literature, non-English publications, and conference abstracts without full texts were excluded. In addition, key reports from international organizations (WHO, NASEM) were included for contextual relevance.

The eligibility criteria were defined using the PCC framework (Population, Concept, Context), which is recommended for narrative and scoping reviews¹²:

Population (P): Older adults (≥60 years) receiving home health care

Concept (C): Medical, social, and technological needs in home-based care

Context (C): Home health care settings (community, home health services, non-institutional long-term care)

Selection Process

All records retrieved from the databases were imported into Excel for manual management. Two reviewers screened titles and abstracts independently, with disagreements resolved by discussion. Full texts were then assessed for eligibility according to the PCC criteria, resulting in the final set of included studies.

Data Extraction

From each included study, the following data were extracted: author, year, country/region, study design, population characteristics, type of intervention or focus, and main findings relevant to medical, social, or technological/environmental needs.

Data Synthesis

Findings were analyzed thematically and synthesized across 3 domains: medical needs, social needs, and technological/environmental needs. The thematic synthesis was conducted independently by 2 reviewers, and final themes were refined through consensus.

Results (Findings)

The included studies encompassed diverse designs and contexts, and were carefully analyzed to identify the needs of older adults receiving home health care. These needs were classified into 3 main domains—medical, social, and technological/environmental—and are presented in detail in the following sections. The detailed characteristics and main findings of the analyzed studies are summarized in Appendix Table 1.

Medical Needs

Chronic Disease Management

Effective management of chronic diseases is one of the most pressing challenges in home health care (HHC). Patients living with conditions such as chronic obstructive pulmonary disease (COPD), heart failure, and diabetes require structured follow-up, individualized care plans, and regular monitoring. Inadequate systems of home-based management frequently contribute to disease exacerbations and preventable hospital admissions.¹³

Wound and Pain Care

Wound and pain management represents another critical area. Pressure ulcers, diabetic foot lesions, and chronic pain are common among home care patients, yet evidence indicates that these conditions are often insufficiently managed outside of clinical settings.¹⁴ Studies suggest that targeted caregiver education and nurse-led wound care programs can substantially reduce complications and improve patient outcomes.¹⁵ However, such programs remain inconsistently implemented across regions.

Medication Adherence

Medication adherence is a further concern. Many older adults receiving HHC live with multimorbidity and polypharmacy, which increases the risk of confusion, dosing errors, and adverse drug interactions. Simplified packaging, digital reminder systems, and pharmacist- or nurse-led interventions have been shown to improve adherence, but their integration into routine home care remains limited.^16,17

Recognition of Acute Deterioration

Finally, recognition of acute deterioration is a persistent gap. Families and informal caregivers often lack the skills to identify early warning signs such as worsening dyspnea, chest pain, or altered mental status. Delayed recognition frequently results in late hospital presentation and poorer outcomes. Strengthening caregiver training and implementing remote monitoring technologies may help address this unmet need.¹⁸

Social Needs

Isolation and loneliness are highly prevalent among older adults receiving home-based care and are strongly linked to depression, cognitive decline, and poor adherence to treatment. For instance, a recent systematic review reported that nearly 1 in 3 older adults experience loneliness, with prevalence exceeding 50% in some care-dependent populations.¹⁹ Another study found that the use of home and community-based services was associated with lower levels of loneliness, underscoring the importance of social support programs in mitigating these risks.²⁰ Evidence suggests that community-based engagement initiatives, such as group activities and peer support networks, can reduce isolation and improve overall well-being.

Caregiving-related problems are a major component of the social needs of home health care (HHC) patients. Families often struggle to secure reliable caregivers, and in many cases relatives must leave employment to provide care, creating both financial strain and interruptions in patient support.²¹ Limited professional support, caregiver fatigue, and lack of training frequently result in insufficient attention to patients’ needs.^22,23 There are also risks of neglect and abuse, as highlighted by recent evidence linking ageism to increased elder mistreatment in both community and institutional care settings.²⁴ These challenges directly compromise patient safety and quality of life, underscoring the need for stronger caregiver support and oversight within HHC systems.

Financial inequities exacerbate the social challenges faced by HHC patients. Many older adults are unable to afford essential assistive devices, home modifications, or additional supportive services, creating barriers to safe and effective care. Financial pressures are particularly pronounced in patients with high long-term care needs, many of whom incur substantial out-of-pocket costs for home-based care and related services, leaving limited resources for other essentials.²⁵ Rural populations are disproportionately affected: in a randomized controlled trial, rural family caregivers and care recipients incurred significantly higher healthcare use and out-of-pocket costs compared to their urban counterparts.²⁶ These financial pressures restrict access to adequate home-based care and deepen existing health inequities.

Cultural sensitivity remains an underexplored dimension of HHC. Effective care must reflect cultural norms, health beliefs, and communication styles that shape how patients and families perceive illness and interact with providers. Evidence shows that culturally tailored approaches improve trust and engagement, while their absence often leads to miscommunication and lower use of home-based services.^27,28

Technological and Environmental Needs

Accessibility barriers remain a persistent challenge in HHC. Many patients live in homes lacking elevators, ramps, or accessible bathrooms, significantly increasing their fall risk. Systematic reviews confirm that targeted home modifications and assistive technologies—such as grab bars and mobility aids—can reduce falls and related injuries among older adults.²⁹

Access to assistive devices—including wheelchairs, walkers, hospital beds, and oxygen concentrators—is highly uneven, particularly in low- and middle-income countries (LMICs) where resource constraints limit availability. Access to assistive devices remains highly uneven worldwide, with stark disparities between low- and high-income regions.³⁰

Transportation difficulties further complicate HHC. Many patients face missed appointments, delayed care, or emergency hospital visits due to lack of appropriate transport or trained personnel available to assist immobile individuals.³¹

Digital health solutions, such as telehealth platforms, can support patient monitoring, continuity of care, and education by allowing timely communication, medication reminders, and easier access to health information from home. However, their use is often limited by low digital literacy, poor internet connections, and high costs—especially in LMICs.³² A recent review showed that electronic health literacy remains low among older adults worldwide.³³ In addition, a population-based study of 5.4 million older adults found that 14% have hearing impairment, 7% vision impairment, and nearly 7% both, which makes it harder for many to use smartphones, tablets, or remote monitoring tools.³⁴ Unless these barriers are addressed with simpler design, larger fonts, audio support, and caregiver help, digital technologies may end up excluding rather than supporting geriatric patients.

Discussion

The evolving needs of geriatric and home care patients span medical, social, and technological domains. While clinical challenges such as multimorbidity, chronic disease management, and wound care are well recognized, social and environmental factors—including loneliness, caregiver burden, transportation difficulties, and lack of assistive devices—are often underestimated. Addressing these interconnected issues is essential for improving the quality of care, supporting patient independence, and reducing preventable hospital admissions.

Clinical Implications

Effective care for older adults requires a truly multidisciplinary approach. Physicians and nurses remain central to clinical management, but they should be supported by social workers to address psychosocial needs, physical therapists to improve mobility and prevent falls, dieticians to optimize nutrition, and psychologists to manage depression and anxiety.³⁵ In addition, pharmacists and geriatric specialists can play a key role in minimizing the risks of multimorbidity, polypharmacy, and adverse drug interactions, which are highly prevalent in this population.^36,37 Cognitive impairment and dementia add further complexity, making structured routines and caregiver supervision essential for safe care delivery.

Caregiver education is equally important. Training should include early recognition of clinical deterioration, safe medication administration, and wound care techniques, as well as strategies for managing behavioral and cognitive symptoms. Evidence indicates that stronger state and institutional support for family caregivers is associated with lower hospitalization rates among older adults with dementia.³⁸ Together, these measures not only reduce complications but also enhance quality of life and preserve independence for older adults living at home. These concerns are also reflected in global estimates, with WHO reporting that 1 in 6 adults aged 60 and older experience mistreatment in community settings each year.³⁹

Policy Implications

Health systems must recognize that unmet environmental needs directly affect patient safety, independence, and equity. Subsidizing home modifications—such as ramps, elevators, and accessible bathrooms—reduces fall risk and supports aging in place.⁴⁰ Assistive technology and housing modifications are also being evaluated as additional strategies to lower injury risk among community-dwelling older adults.²⁹ Despite this, access to essential devices—including wheelchairs, walkers, and oxygen concentrators—remains highly unequal. A joint WHO–UNICEF report highlighted that in low-income countries, fewer than 5% of people in need can obtain such devices, compared with over 90% in high-income regions.⁴¹ Recent National Academies reports on long-term care quality have also underscored the urgency of strengthening home- and community-based models, highlighting systemic reforms needed to improve equity and sustainability in aging care.⁴²

Rural and remote populations face additional barriers. Older adults frequently report that transportation problems limit their access to timely care, with rural users experiencing disproportionate delays and unmet needs.⁴³ Broader analyses of healthcare accessibility confirm that transport and infrastructure challenges persist in both rural and urban settings, requiring more targeted policy interventions.⁴⁴ The OECD has similarly emphasized that in several countries, individuals with moderate to severe long-term care needs must allocate more than half of their income to care, underscoring the systemic nature of these financial pressures.⁴⁵ Finally, stronger state and insurance support for family caregivers is critical. Evidence indicates that caregiver training and respite services reduce hospitalizations and institutionalization among older adults living with dementia.³⁸

Although this review focused on older adults receiving home-based care, many of the identified needs—such as loneliness, caregiver burden, and access to assistive devices—are also common in the general elderly population, underscoring the broader relevance of these findings for aging policy and practice.¹⁹

Together, these measures—home modifications, assistive device reimbursement, improved transportation, and caregiver support—represent essential policy priorities for building more equitable and sustainable models of home and geriatric care.

Digital Health and Equity

Digital health can play a complementary role in home and geriatric care if tailored solutions are implemented. To improve usability, platforms should adopt simplified interfaces, larger fonts, audio support, and options for voice commands, which have shown potential in telehealth training programs using voice-assistive technologies.⁴⁶ Caregiver-assisted use and structured training initiatives are also important to help older adults overcome digital literacy gaps.³³ For those with sensory impairments, targeted health education interventions can improve engagement and self-management.³⁴ In parallel, digital tools have been shown to empower informal caregivers by improving health literacy and supporting active participation in care.⁴⁷ Beyond digital platforms, assistive innovations such as modern air mattresses or pressure-relief beds for bedridden patients can reduce complications and improve comfort, provided that adequate funding and caregiver training are in place. Integrating these strategies into health policy would ensure that technology serves as an enabler rather than a barrier for equitable care.

The main needs, challenges, and potential solutions identified in this review are summarized in Table 1.

Table 1.

Main Needs, Challenges, and Strategies in Geriatric and Home Health Care.

Domain	Main needs	Key challenges	Strategies/solutions
Medical	Safe management of chronic diseases, appropriate medication use, effective wound and pain care, early recognition of deterioration	Multimorbidity, polypharmacy, poor adherence, delayed detection of acute symptoms	Multidisciplinary care teams, caregiver training, structured follow-up, pharmacist and nurse support
Social	Social connection, caregiver support, financial protection, culturally sensitive care	Loneliness, caregiver burden, financial strain, risk of neglect or abuse, limited cultural adaptation	Community engagement, caregiver respite and education, financial subsidies, culturally tailored services
Technological/environmental	Access to assistive devices, safe and adapted housing, reliable transportation, digital inclusion	Limited device availability, unsafe housing, transport barriers, low digital literacy, sensory impairments	Home modifications, equitable provision of devices, improved transport, user-friendly telehealth with caregiver assistance

Table 1 summarizes the main needs, challenges, and potential solutions in geriatric and home health care, providing an overall synthesis of the review findings.

Limitations

This review is narrative in nature and does not provide a systematic evaluation of all available studies, which may introduce selection bias. The inclusion of primarily English-language publications may also have excluded relevant evidence published in other languages. In addition, evidence from low- and middle-income countries remains limited, restricting the generalizability of some findings to high-income settings. Furthermore, the review was limited to studies published from 2020 onward; while this ensured a focus on the most recent evidence, the exclusion of earlier relevant studies may be considered a limitation. Despite these limitations, the review synthesizes recent data across medical, social, and technological domains, highlighting critical gaps and offering practical directions to improve care for older adults living at home.

Conclusion

Home health care (HHC) and geriatric care are becoming increasingly vital as populations age and the burden of chronic disease rises. Yet significant gaps remain in addressing the medical, social, and technological needs of older adults receiving care at home. This review shows that multidisciplinary teams, caregiver education, supportive policies, and the appropriate use of digital and assistive technologies are essential to improving quality of life, reducing preventable hospital and emergency department visits, and promoting independence. Addressing these needs requires sustained investment, equity-focused policy reforms, and the integration of innovative solutions into routine practice. By prioritizing these strategies, health systems can create more resilient and patient-centered models of care for both geriatric and home health care populations.

Footnotes

Appendix

Technological and Environmental Needs.

Author (year)	Country/region	Study design	Population/setting	Main focus	Key findings
Crosby et al.²⁹ (2023)	Global	Systematic review protocol	Older adults	Falls prevention	Home modifications & assistive devices reduce falls
Zotcheva & Langballe³⁰ (2024)	Global	Commentary (Lancet)	Older adults	Assistive devices	Global disparities in access
Remillard et al.³¹ (2022)	USA	Qualitative	Older adults with mobility disability	Transport barriers	Lack of transport limits access
Denecke et al.³² (2023)	Global	Commentary	Hospital@home models	Digital health	Digital platforms can support but adoption limited
Jiang et al.³³ (2024)	Global	Systematic review & meta-analysis	Older adults	e-Health literacy	Low literacy among older adults worldwide
Fuller-Thomson et al.³⁴ (2022)	Canada	Population-based	5.4 million older adults	Sensory impairment	Sensory loss linked to cognitive impairment; affects digital use

ORCID iDs

Mehmet Gün

Salih Güntuğ Özaytürk

Yusuf Aktaş

Ethics Considerations

This article is a narrative review based on previously published studies and official reports. No human participants, patient data, or animal subjects were involved; therefore, ethical approval and informed consent were not required.

Author Contributions

Mehmet Gün: Conceptualization, methodology, literature review, manuscript drafting, critical revision, and final approval.

Salih Güntuğ Özaytürk: Medical content expertise, contribution to literature synthesis, and manuscript editing.

Yusuf Aktaş: Contribution to geriatric and palliative care perspectives, manuscript review, and editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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