Challenges in Home-Based Care for Older Adults: Physical, Psychological, Social, Economic, and Systemic Dimensions - A Narrative Review

Yıl 2026, Cilt: 2 Sayı: 1, 47 - 61, 24.01.2026

İnci Hazal Ayas

https://izlik.org/JA73TY37JH

Öz

The rapid global growth of the elderly population has caused an increasing demand for home-based care, together with the diverse challenges that accompany it. The aim of this review is to examine the physical, psychological, social, economic, and systemic challenges encountered in elderly care in light of current literature, and to evaluate their impacts on older individuals and caregivers. This narrative review synthesizes evidence from the current literature. According to the literature, physical problems such as limited mobility, chronic diseases, dependency in personal care, and feeding difficulties complicate the care process and place a significant burden on caregivers. From a psychological perspective, conditions such as depression, anxiety, social isolation, and dementia diminish the quality of life of older adults while increasing the emotional burden on caregivers. Furthermore, factors including low income, lack of social security, and limited access to health services contribute to economic and systemic instability in care provision. Caregivers frequently experience burnout, insufficient knowledge, and musculoskeletal disorders. In conclusion, home-based elderly care requires a comprehensive approach and support mechanisms at structural, educational, and policy levels that extend beyond individual efforts.

Anahtar Kelimeler

Home Care Services , Elderly , Caregivers , Psychosocial Factors , Health Services Accessibility

Etik Beyan

This study is a review based solely on existing literature, no data were collected from human participants, and therefore ethics committee/IRB approval was not required.

Destekleyen Kurum

None

Teşekkür

There are no contributions to this study that deserve to be acknowledged from any individual or institution that does not meet the authorship criteria.

Evde Yaşlı Bakımının Zorlukları: Fiziksel, Psikolojik, Sosyal, Ekonomik ve Sistemsel Boyutlar - Anlatısal Derleme

https://izlik.org/JA73TY37JH

Öz

Dünya genelinde yaşlı nüfusun hızla artması, yaşlı bireylerin ev ortamında bakım gereksinimlerini ve bu sürecin getirdiği çok yönlü zorlukları giderek daha görünür kılmaktadır. Bu derlemenin amacı, yaşlı bakımında karşılaşılan fiziksel, psikolojik, sosyal, ekonomik ve sistemsel zorlukları güncel literatür doğrultusunda incelemek ve bu zorlukların yaşlı bireyler ile bakım verenler üzerindeki etkilerini değerlendirmektir. Bu çalışma, mevcut literatüre dayalı anlatısal bir derlemedir. Literatür bulgularına göre; yaşlı bireylerde hareket kaybı, kronik hastalıklar, kişisel bakımda bağımlılık ve beslenme güçlükleri gibi fiziksel sorunlar, bakım sürecini zorlaştırmakta ve bakım veren üzerine fiziksel ve mental yük oluşturmaktadır. Psikolojik olarak depresyon, anksiyete, sosyal izolasyon ve demans gibi durumlar, yaşlının yaşam kalitesini düşürürken, bakım verenin duygusal yükünü artırmaktadır. Düşük gelir, sosyal güvence eksikliği ve sağlık hizmetlerine erişim zorlukları, süreci ekonomik ve sistemsel açıdan da kırılgan hâle getirmektedir. Ayrıca, bakım veren bireylerde tükenmişlik sendromu, bilgi eksikliği ve kas-iskelet sistemi rahatsızlıkları sıklıkla gözlenmektedir. Sonuç olarak, evde yaşlı bakım süreci çok boyutlu bir yaklaşım gerektirmekte olup, bireysel çabaların ötesinde yapısal, eğitsel ve politik destek mekanizmalarına ihtiyaç duyulmaktadır.

Anahtar Kelimeler

Evde bakım hizmetleri , Yaşlılar , Bakıcılar , Psikososyal Faktörler , Sağlık Hizmetlerine Erişilebilirlik

Etik Beyan

Bu çalışma, yalnızca mevcut literatürün incelendiği bir derleme çalışmasıdır, herhangi bir insan katılımcıdan veri toplanmamış olup etik kurul onayı gerektirmemektedir.

Destekleyen Kurum

YOK

Teşekkür

Bu çalışma kapsamında yazarlık kriterlerini karşılamayan herhangi bir kişi veya kuruma teşekkür edilmesini gerektirecek bir katkı bulunmamaktadır.

Kaynakça

• World Health Organization. Ageing and health [Internet]. Geneva: WHO; 2022 [cited 2025 Jul 30]. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
• Beard JR., Officer A, De Carvalho, IA, Sadana R, Pot AM, Michel JP. The World report on ageing and health: a policy framework for healthy ageing. The lancet. 2016; 387(10033), 2145-2154.
• Grube, M. M., Möhler, R., Fuchs, J., Gaertner, B., & Scheidt-Nave, C. Indicator-based public health monitoring in old age in OECD member countries: a scoping review. BMC Public Health. 2019;19(1), 1068.
• Türkiye İstatistik Kurumu (TÜİK). İstatistiklerle Yaşlılar, 2024 [Internet]. Ankara: TÜİK; 2025 Mar 13 [erişim 2025 Tem 30]. Erişim adresi: https://data.tuik.gov.tr/Bulten/Index?p=Istatistiklerle-Yaslilar-2024-54079.
• Shahriari M, Nia DH, Kalij F, Hashemi MS. Challenges of home care: a qualitative study. BMC Nurs. 2024;23(1):215.
• Johnson S, Bacsu J, Abeykoon H, McIntosh T, Jeffery B, Novik N. No place like home: a systematic review of home care for older adults in Canada. Can J Aging. 2018 Dec;37(4):400-419.
• Sabetsarvestani P, Mohammadi F, Tehranineshat B, Bijani M, Fereidouni Z. Barriers to efficient management of in‐home care: a qualitative content analysis. Nurs Open. 2022;9(2):1200-9.
• Bütünleşik Evde Sağlık ve Bakım Hizmetleri – Ulusal Model Önerileri (2024) STD Raporu yayımlandı” [Internet]. Ankara: T.C. Sağlık Bakanlığı; 2024 Kas 22 [erişim 2025 Eyl 10]. Erişim adresi: https://shgm.saglik.gov.tr/TR-106362/butunlesik-evde-saglik-ve-bakim-hizmetleri---ulusal-model-onerileri-2024-std-raporu-yayimlamistir.html.
• Aile ve Sosyal Hizmetler Bakanlığı (ASHB), Sosyal Yardımlar Genel Müdürlüğü. Sosyal yardım programlarının aylık ödemeleri artırıldı [Internet]. Ankara: T.C. Aile ve Sosyal Hizmetler Bakanlığı; 2025 Tem 09 [erişim 2025 Eyl 12]. Erişim adresi: https://www.aile.gov.tr/sygm/haberler/sosyal-yardim-programlarinin-aylik-odemeleri-artirildi/.
• Anadolu Ajansı. Evde sağlık hizmetinden yararlananların sayısı 1,5 milyonu aştı [Internet]. Ankara: Anadolu Ajansı; 2020 Eyl 23 [erişim 2025 Eyl 10]. Erişim adresi: https://www.aa.com.tr/tr/saglik/evde-saglik-hizmetinden-yararlananlarin-sayisi-1-5-milyonu-asti-/.
• Schulz R, Sherwood PR. Physical and mental health effects of family caregiving. Am J Nurs. 2008 Sep;108 (9 Suppl):23-27.
• Marengoni A, von Strauss E, Rizzuto D, Winblad B, Fratiglioni L. The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons: a community-based, longitudinal study. J Intern Med. 2009;265(2):288-95.
• Jaul E, Barron J, Rosenzweig JP, Menczel J. An overview of co-morbidities and the development of pressure ulcers among older adults. BMC Geriatr. 2018;18(1):305.
• Stubbs, B., Schofield, P., & Patchay, S. Mobility limitations and fall‐related factors contribute to the reduced health‐related quality of life in older adults with chronic musculoskeletal pain. Pain Practice. 2016; 16(1), 80-89.
• Okubo Y, Schoene D, Lord SR. Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis. Br J Sports Med. 2017;51(7):586-93.
• Hignett S, Otter ME, Keen C. Safety risks associated with physical interactions between patients and caregivers during treatment and care delivery in home care settings: a systematic review. Int J Nurs Stud. 2016; 59:1-14.
• Yusif S, Soar J, Hafeez-Baig A. Older people, assistive technologies, and the barriers to adoption: a systematic review. Int J Med Inform. 2016; 94:112-6.
• Choi UY, Patterson P, Chinho N. Reducing the burdens of paid caregivers of older adults by using assistive technology: a scoping review. West J Nurs Res. 2024;46(4):315-26.
• Marasinghe KM. Assistive technologies in reducing caregiver burden among informal caregivers of older adults: a systematic review. Disabil Rehabil Assist Technol. 2016;11(5):353-60.
• Shogenji M, Yoshida M, Kakuchi T, Hirako K. Physical, emotional, and financial burdens of toileting assistance for family caregivers in home care settings and factors associated with each burden: a cross-sectional study. Jpn J Nurs Sci. 2024;21(4):e12615.
• Sura L, Madhavan A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287-98.
• Namasivayam-MacDonald AM, Shune SE. The burden of dysphagia on family caregivers of the elderly: a systematic review. Geriatrics. 2018;3(2):30.
• Bruce ML, McAvay GJ, Raue PJ, Brown EL, Meyers BS, Keohane DJ, et al. Major depression in elderly home health care patients. Am J Psychiatry. 2002;159(8):1367-74.
• Jayasinghe N, Rocha LP, Sheeran T, Wyka K, Bruce ML. Anxiety symptoms in older home health care recipients: prevalence and associates. Home Health Care Serv Q. 2013;32(3):163-77.
• Büker N, Altuğ F, Kavlak E, Kitis A. Huzurevi ve Ev Ortamında Yaşayan Yaşlılarda Moral ve Depresyon Düzeyinin Fonksiyonel Durum Üzerine Etkisinin İncelenmesi. Yaşlı Sorunları Araştırma Dergisi / Elderly Issues Research Journal. 2010; (1):44-53.
• Tomstad S, Sundsli K, Sævareid HI, Söderhamn U. Loneliness among older home-dwelling persons: a challenge for home care nurses. J Multidiscip Healthc. 2021;14:435-45.
• Chiao C, Lin WH, Chen YH, Yi CC. Loneliness in older parents: marital transitions, family and social connections, and separate bedrooms for sleep. BMC Geriatr. 2021;21(1):590.
• Rautiainen LJ, Jansson AH, Knuutila M, Aalto UL, Kolster A, Kautiainen H, et al. Comparing loneliness, social inactivity, and social isolation: associations with health-related quality of life and mortality among home-dwelling older adults. Gerontology. 2024;70(10):1103-12.
• Hauger B, Martinsen R, Hestad K, Ødbehr LS. Nurses’ perspectives on clinical competence to identify loneliness and depression in older people in home care: a qualitative study. BMC Health Serv Res. 2025;25(1):1-14.
• Heaven B, Brown LJ, White M, Errington L, Mathers JC, Moffatt S. Supporting well-being in retirement through meaningful social roles: systematic review of intervention studies. Milbank Q. 2013;91(2):222-87.
• Siebert DC, Mutran EJ, Reitzes DC. Friendship and social support: the importance of role identity to aging adults. Soc Work. 1999;44(6):522-33.
• Kim B, Noh GO, Kim K. Behavioural and psychological symptoms of dementia in patients with Alzheimer’s disease and family caregiver burden: a path analysis. BMC Geriatr. 2021;21(1):160.
• Liu S, Jin Y, Shi Z, Huo YR, Guan Y, Liu M, et al. The effects of behavioral and psychological symptoms on caregiver burden in frontotemporal dementia, Lewy body dementia, and Alzheimer's disease: clinical experience in China. Aging Ment Health. 2017;21(6):651-7.
• Lizano-Díez I, Amaral-Rohter S, Pérez-Carbonell L, Aceituno S. Impact of home care services on patient and economic outcomes: a targeted review. Home Health Care Manag Pract. 2022;34(2):148-62.
• Mmopelwa G, Ngwenya BN, Sinha N, Sanders JBP. Caregiver characteristics and economic cost of home-based care: a case study of Maun and Gumare villages in North West District, Botswana. Chronic Illn. 2013;9(1):3-15.
• Wang SE, Haupt EC, Nau C, Werch H, McMullen C, Lynn J, et al. Association between financial distress with patient and caregiver outcomes in home-based palliative care: a secondary analysis of a clinical trial. J Gen Intern Med. 2022;37(12):3029-37.
• Siconolfi D, Shih RA, Friedman EM, Kotzias VI, Ahluwalia SC, Phillips JL, et al. Rural-urban disparities in access to home- and community-based services and supports: stakeholder perspectives from 14 states. J Am Med Dir Assoc. 2019;20(4):503-8.
• Norman GJ, Wade AJ, Morris AM, Slaboda JC. Home and community-based services coordination for homebound older adults in home-based primary care. BMC Geriatr. 2018;18(1):241.
• Henning-Smith C, Kozhimannil KB, Casey MM, Prasad S. Beyond clinical complexity: nonmedical barriers to nursing home care for rural residents. J Aging Soc Policy. 2018;30(2):109-26.
• Cerrah, L., Umar, E. K., Oral, M., Pak, M. Evde Bakim Hizmeti Alan Yaşli Bireylerin Ve Bakim Verenlerinin Karşilaştiklari Sosyal Sorunlar Üzerine Nitel Bir Çalişma: Oltu Örneği. Sosyal Politika Çalışmaları Dergisi,. 2024;24(62), 89-110.
• İpek L, Gunes Gencer GY. Dünya’da ve Türkiye’de Yaşlı İnformal Bakım Verenler: Geleneksel Derleme. JoGS. December 2024;7(3):256-256.
• Rachel H, Francesco S. Factors associated with and impact of burnout in nursing and residential home care workers for the elderly. Acta Biomed. 2018;89(Suppl 7):60.
• Çakır, G., Yaman, Ö. M. Yaşlilara Evde Bakim Veren Aile Üyelerinin Yaşadiklari Zorluklar Ve Etkileyen Unsurlar. Tıbbi Sosyal Hizmet Dergisi. 2021;(18), 104-124. https://doi.org/10.46218/tshd.983990
• Chen Q, Zhang H, Yuan S, Liu W, Lyu T. Perceived training needs of the informal caregivers of older adults: a cross-sectional study. Healthcare (Basel). 2024;12(23):2369.
• Darragh AR, Sommerich CM, Lavender SA, Tanner KJ, Vogel K, Campo M. Musculoskeletal discomfort, physical demand, and caregiving activities in informal caregivers. J Appl Gerontol. 2015;34(6):734-60.
• Caponecchia C, Coman RL, Gopaldasani V, Mayland EC, Campbell L. Musculoskeletal disorders in aged care workers: a systematic review of contributing factors and interventions. Int J Nurs Stud. 2020;110:103715