Current challenges of home care for very long-lived seniors

Introduction

The reality of today is population aging. According to current statistical data (In: Štatistický úrad Slovenskej republiky, 2025), the number of seniors is growing faster than any other age group. The oldest subgroup among older people are the oldest seniors (80 years and over). In 2000, their number reached 70 million, and it is expected to increase more than fivefold within the next 50 years (Mihalčová, Barkóciová, Gontkovičová, 2022). Slovakia currently ranks among European Union countries with the fastest increase in the share of people aged 65 and above (Fig. 1). Therefore, society, the health care system, and individual disciplines need to be prepared for this reality.

Figure 1 Population structure by age groups

(Mihalčová, Barkóciová, Gontkovičová, 2022, Eurostat, 2020)

In home care for seniors 80 or 85+, several factors and specificities must be considered. The most severe are:

• Generation characteristics.
• Changes resulting from the aging process.
• Different clinical course of diseases.
• Geriatric syndromes.
• Multimorbidity.
• Polypragmasia, polypharmacy.
• Specific geriatric complications.
• Different treatment strategy.

In the following text, we focus on their characteristics and on the areas that, according to international standards and guidelines, require the highest attention of professional caregivers and nurses.

Population characteristics

Among long-lived seniors, this population is mainly that known as the Silent Generation (Silence generation)—Fig. 2—born between 1928 and 1945, and to a smaller percentage also the Greatest Generation, born between 1901 and 1927.

Figure 2 Distribution by generation by birth year

(Geneosity, 2022)

The Silent Generation experienced childhood during an economic crisis, was shaped by authoritarian political regimes and the Second World War, and entered adulthood in the postwar period. Surviving economic hardship and wartime shortages strengthened thrift, risk aversion, and respect for work. Totalitarian regimes, postwar border changes, and collectivization in Central Europe created emphasis on conformity and cautious communication (Lissitsa, Zychlinski, Kagan, 2022).

Key values are discipline and industriousness, loyalty to institutions, modesty and reserve, and family cohesion. Typical are long careers with one employer, vocational training profiles, technical professions, and work in administration (Encyklopédia poznania, 2025).

In health and diseases, this population is dominated by cardiometabolic disorders, musculoskeletal problems, sensory deficits, and increasing importance of specialized geriatric teams (especially when geriatric syndromes such as frailty, sarcopenia, and immobility occur). High treatment adherence is also characteristic, but there is also a risk of polypragmasia; therefore deprescribing and support for functional independence are important (Heart of Gold Nursing, 2020, Zrubáková, 2023). They use health and social services. Family care is the priority; community and field services are also important. Digital skills are heterogeneous: part of the population is active online, while others need assistance. The most common barriers and risks are security concerns, non-intuitive interfaces, small font size, and motor limitations. They need protection from cybercrime and scams (Smatana et al., 2021).

Changes in the aging process

Aging affects all organs and systems. Changes primarily involve thinking, personality, alertness, emotional reactivity, adaptation, self-esteem, and overall physical and mental activity. The most significant changes are reduced function of the central nervous system, cognitive functions, heart, blood vessels, lungs, liver, kidneys, and skin (Olexa, 2022).

There is also a 15% decrease in total body water, up to a 35% decrease in skeletal muscle mass, and a 50–80% increase in fat tissue. In blood, albumin and hemoglobin concentrations decrease, and functional reserves in core organ systems also decline. Reducing the negative impact of these changes is supported by preventing dehydration, hypo- and hypernatremia, malnutrition, problems related to impaired thermoregulation, promoting physical and cognitive activation, and supporting immunization (Vágnerová, 2020). Care of the respiratory system is also essential because of increased risk of pneumonia, as well as support for use of compensatory aids. Skin care is likewise key (Poledníková et al., 2013).

Skin in advanced age is lax, dry, loses elasticity, is more prone to irritation, and becomes thinner, increasing the risk of injury and hematoma. The skin barrier weakens, and the skin tolerates aggressive products or environmental changes less well. In very old people, so-called parchment or “paper-like” skin may develop. We describe parchment skin as thin, fragile, vulnerable, and susceptible to mechanical injury. Seniors with chronic venous insufficiency are at risk. It is most common on the upper limbs. Their protection is important (Kožuchová et al., 2019).

The basis of care is:

• skin hydration. Use thick creams, hand creams, and specialized cosmetics for seniors.
• Adequate nutrition and fluid regimen.
• Physical activity.
• Protection from injury—long sleeves or long trousers; use of protective devices on extremities.
• Gentle care of skin defects with appropriate fixation (Saibertová et al., 2023).

Among long-lived seniors, we frequently see senile purpura. This is a benign condition characterized by recurrent purple ecchymoses (bruising) on extensor surfaces of the forearm after minor trauma. Risk factors include long-term sun exposure, use of oral or topical corticosteroids, and anticoagulants (Hegyi, Krajčík, 2015).

Skin tears are also common. They appear as skin lesions caused by blunt trauma, impact with an object, or even rough handling of the patient. Skin tears can occur anywhere on the body, but are most often found on the limbs and more often in women. Tears can arise from friction or shear forces, from non-gentle removal of adhesive dressings, or during care of an immobile patient (Nova Scotia Health, 2025).

A preventive measure is assessment of overall condition, mobility, and skin, as presented in Fig. 3.

Figure 3 Skin Tear Risk Assessment

(sourced from: Saibertová et al., 2023)

Note: when identifying risk factors, individualized preventive and treatment measures are set, targeting both skin changes and compensation for the overall health and functional condition of the long-lived senior. Interdisciplinary collaboration also plays a significant role here.

Different clinical course of disease

Many symptoms in acute and chronic disease in very old seniors are absent or subtle and poorly expressed. Most often, visceral pain is atypical or absent. A myocardial infarction may be painless or less painful, and pain may be only mildly and vaguely localized, which reduces the warning and diagnostic value of acute pain. In contrast, musculoskeletal pain is pronounced (Zrubáková, Magerčiaková, 2024).

Inflammatory diseases often run afebrile or subfebrile. Tachycardia may be absent, dysuria may be absent, and even the course of hyperthyroidism can be altered, presenting only with poor appetite and wasting. Acute illnesses have a longer course; a cascade-like, domino effect is typical (Bartošovič et al., 2025).

Dizziness → fall → femur fracture → immobility → hypoventilation → pneumonia → heart failure → hypotension → stroke → further decline in mobility → pressure injury →
↑ risk of death (Krajčík et al., 2022).

Geriatric syndromes

Their main characteristic is that they affect very old individuals with reduced ability to recover. They worsen with any change—an acute illness, loss of a close person, and so on. Common features are multicausality, chronic course, reduced independence in activities of daily living, reduced quality of life, inability to follow ordinary treatment, and only symptomatic relief. As a result of these syndromes, the risk of adverse drug effects and interactions increases, as does social isolation. There is an increased risk of institutionalization and risk of death (for people over 80 years, this is among the main causes).

Currently, geriatric syndromes are understood more comprehensively as complex symptom clusters, as shown in Table 1.

Table 1 Classification of geriatric syndromes by symptom clusters

(Summarized from: Vagnerová, 2020)

Geriatric syndromes can occur in isolation but can also combine. The care approach of nursing staff toward older patients is highly demanding and ethically complex. A drawback is that geriatric syndromes can accompany every acute condition. They can be prominent and often mask the underlying clinical picture of the original disease (Olexa, 2022).

In the home setting, early identification of these syndromes is very important, as is the purposeful use of screening tools and anthropometric assessments. Recommended are: Geriatric Frailty Scale, Barthel test (Activity of Daily Living—ADL), Instrumental Activities of Daily Living test (IADL), physical fitness test, nutritional assessment (Mini Nutritional Assessment MNA), cognitive function test (Mini Mental State Examination MMSE), shoulder and calf circumference measurement, and grip strength assessment (Zrubáková et al., 2025).

Polymorbidity

It is characterized by the presence of multiple diseases whose clinical picture overlaps or amplifies each other. It represents a significant risk in terms of organ failure during acute illness, complications, hospitalization, polypharmacy, and death. Changes in clinical presentation are expected (Krajčík et al., 2022). According to current standards for the Geriatrics specialty, polymorbidity, especially in long-lived seniors, requires regular monitoring even without troublesome symptoms; this is done by the general practitioner/geriatrist and a nurse from the home care agency (ADOS) (Hoozová, Németh, Leitmann, 2021).

Polypharmacy and polypragmasia

Polypharmacy is the use of more than five medications, and as the number of medications increases, so does the risk of adverse effects and interactions. In home care, we very often also encounter polypragmasia, which is the use of an excessive number of new methods or drugs at once or in quick succession. Nutritional supplements and phytotherapeutics are also risky. Therefore, in community care, education of seniors and family members is highly important (Hegyi, Krajčík, 2015).

Specifics of care and treatment

To ensure prevention of complications and timely initiation of treatment, continuous monitoring of health, functional status, and cognitive functions is important. Professionals (health and social workers) also need to pay attention to nonspecific symptoms, as already mentioned in the clinical presentation of diseases.

Key interventions include implementation of primary, secondary, and tertiary prevention, medication review, application of non-pharmacological treatment methods, support in using e-health services, collaboration with family, and interdisciplinary and cross-sector cooperation.

The main goal of care and treatment is to keep the senior in the home setting, because if this environment is safe for them, has appropriate quality of life, and avoids destabilization. We must always remember that long-lived seniors are highly vulnerable and have reduced adaptive capacity—maladaptation (Zrubáková, Bartošovič et al., 2025).

Conclusion

Each stage of human life has its own characteristics and specifics. Arguably the most specific stage is old age. This stage differs not only by changes that come with aging but also by changes triggered by lifestyle, environment, and comorbid conditions. The result is various problems, which were described in this article. It is therefore very important that in practice, information and recommendations from standards and professional literature are sufficiently used, and individualized, empathetic interdisciplinary care is implemented, enabling seniors to live out the autumn of life in a familiar home environment.

Authors: Katarína Zrubáková Katolícka univerzita v Ružomberku, Fakulta zdravotníctva, Katedra ošetrovateľstva Mariana Magerčiaková Katolícka univerzita v Ružomberku, Fakulta zdravotníctva, Katedra ošetrovateľstva Denisa Šarkóziová Slovenská komora sestier a pôrodných asistentiek, Sekcia sestier pracujúcich v geriatrii Libuša Repiská Vysoká škola zdravotníctva a sociálnej práce sv. Alžbety Bratislava

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