Caring Amid Challenges: Social Determinants of Health and Homecare Nursing for Older People

Background: Homecare nurses provide care for older people living with complex health and social needs. Social determinants of health (SDoH) – the conditions in which people are born, grow, live, work, and age - shape older people’s health and influence their ability to benefit from healthcare. Caring in this context is challenging, as nurses must navigate both structural inequities and the demands of an increasingly complex healthcare system. This study explores how SDoH affects older people’s health and homecare nursing practices.
Methods: An interpretive phenomenological approach informed by Patricia Benner guided the study. Data were generated through 68 spot observations with situational interviews and six small group interviews involving twelve homecare nurses. Analysis combined paradigm cases, exemplars, and thematic analysis, supplemented by collaborative data analysis with representatives of older people and civil society stakeholders.
Results: Five key SDoH were found to have the largest impact on older people’s health and homecare nursing: digitalization, social networks, transport, financial insecurity, and healthcare access. Generally, the growing complexity of the healthcare system and its demands often conflicted with older people’s capabilities and resources. Nurses responded by bridging gaps between patients and the system, providing practical assistance, digital support, and continuous coordination of care.
Conclusions: SDoH significantly shape older people’s health and the conditions under which homecare nurses deliver care. Addressing these challenges calls for holistic, equity-oriented caring practices that actively mitigate structural barriers influencing patients’ lives.
Ethical considerations: The study was approved by the Research Ethics Committee at UCL University College, Denmark, and conducted in accordance with the Declaration of Helsinki.