José Manuel Hernández‐Padilla
The care of older adults has become the defining ground on which nursing's future will be shaped. In aging populations, multimorbidity, cognitive change, social vulnerability, and long-term relational practice converge (Fernández-Fernández et al. 2025). It is here where nursing's distinctive contributions are most visible and most necessary yet also where the profession's identity is most at risk of being misunderstood. When nursing is framed as task-based support rather than autonomous, knowledge-driven practice, its central role in sustaining function, adaptation, and meaningful living is obscured. In aging societies, the primary challenge is not episodic disease treatment but the ongoing cultivation of capacity, participation, and continuity over time. The nursing profession is uniquely positioned to undertake this work and must therefore assert its authority to lead health systems' shift toward prevention and long-term support. Across the past five decades, practice with older adults has been a key area in the professional maturation of nursing. The design and widespread implementation of functional and comprehensive assessments, the expansion of aging-focused content in curricula, the development of advanced practice roles coordinating complex care, and the impact of nursing-led interventions on functional outcomes and quality of life have moved nursing beyond procedural caregiving. These advances have defined nursing as an autonomous, relational, and socially responsive discipline with the capacity to lead care. Looking ahead, growing aging populations, digital transformation, and persistent inequities require a profession that is confident in its identity and prepared to shape the priorities of healthcare systems. The task at hand is not only to expand capacity but to reassert nursing as the central actor in promoting autonomy, preventing decline, and supporting sustained well-being. Claiming the care of older adults as nursing's defining ground could therefore be essential to resolving the profession's identity crisis and positioning nurses as leaders in building health-promoting systems for an aging world. The purpose of this commentary is to examine how the care of older adults has shaped the evolution of nursing over the past 50 years and to argue that this field constitutes the defining ground upon which the profession must build its future. Drawing on historical developments and emerging trends, the commentary highlights key milestones that have advanced nursing knowledge, practice, and leadership in aging care. It also identifies pressing challenges and strategic priorities that must be addressed for nurses to lead the transformation toward prevention-focused, autonomy-promoting, and health-enabling systems capable of supporting an aging global population. The introduction of standardised functional assessment tools and subsequently, the Comprehensive Geriatric Assessment (CGA), has been one of the most consequential shifts in nursing practice with older adults over the past five decades. Instruments such as the Katz Index, Barthel Index, and Lawton IADL Scale have redirected clinical attention from the presence of disease to the capacities and everyday activities that shape autonomy and lived experience (Kim and Lee 2025). Prior to their use, the assessments of older adults were often based on generalised assumptions about age or subjective impressions, obscuring the nuanced variations in independence, vulnerability, and support needs. Functional assessment tools offer reliable, validated indicators of an individual's ability to perform daily tasks, enabling nurses to identify early functional decline, tailor interventions, and strengthen continuity of care (Kim and Lee 2025). Building upon this foundation, the emergence of the CGA expanded the scope of assessment from functional status alone to the full multidimensional reality of aging, incorporating medical conditions, cognition, emotional well-being, medication management, social support, and environmental context. This shift established a coordinated, person-centred model of practice in which nurses became central actors in interdisciplinary teams, responsible for synthesising assessment findings, coordinating individualised care plans, and promoting long-term independence and quality of life. Evidence suggests that CGA could improve survival, reduce institutionalisation, and promote aging in place (Kumlehn et al. 2025), marking a decisive transformation in the aims and identity of nursing practice. The recognition of the unique and interconnected needs of older adults has been instrumental in consolidating expertise and reshaping the identity of nursing practice. As increased longevity and multimorbidity revealed the limitations of episodic, disease-oriented models, it became evident that older adults require sustained, relational, and context-sensitive forms of care that address physical, cognitive, emotional, and social dimensions simultaneously. This recognition catalysed the development of specific gerontological competencies, standards of practice, and structured educational pathways, thus establishing a coherent foundation for advanced nursing roles in aging care (Tate et al. 2024). The formalisation of these roles—whether in community-based coordination, long-term care leadership, or complex chronic illness management—has not only expanded the scope of nursing practice, but clarified its intellectual and clinical distinctiveness. Evidence suggests that advanced and nurse-led models improve functional capacity, reduce avoidable hospitalisation, enhance continuity, and promote aging in place while upholding dignity, autonomy, and personhood (Htay and Whitehead 2021; Rahmat et al. 2025; Ruksakulpiwat et al. 2025). These outcomes reflect more than the success of specific interventions; they signify the maturation of nursing as a discipline capable of leading healthcare systems toward health-promoting, autonomy-sustaining modes of support. The recognition of health and self-care promotion as a core nursing competence represents a pivotal transformation in the care of older adults, altering both the goals and methods of practice. Earlier models of nursing in aging contexts were predominantly custodial in nature, centred on comfort, physical support, and symptom management. However, as longer life spans converged with the growing prevalence of chronic illness, it became evident that sustaining well-being over time required more than episodic treatment; it called for active participation, capacity-building, and behavioural adaptation. From the late twentieth century onward, international clinical standards and policy directives began to define nurses as educators and coaches, responsible for strengthening health literacy, supporting lifestyle modification, and equipping older adults to interpret and respond to changes in their own health (Horta Reis Da Silva 2024). In fact, nurse-led self-care and health promotion interventions enhance mobility, self-efficacy, medication adherence, symptom control, and psychosocial well-being, while reducing dependency, hospitalisation, and premature institutionalisation (Rahmat et al. 2025; Ruksakulpiwat et al. 2025; Zheng et al. 2024). This paradigm shift not only improved outcomes in aging populations; it reshaped the professional scope of nursing, affirming nurses as central agents in fostering autonomy and promoting sustained healthy living. The development and integration of digital and assistive technologies to support autonomy has marked a defining advancement in nursing care for older adults in the past few decades, signifying a shift from reactive, institution-centred models toward proactive, personalised, and community-based support. Early telemedicine and electronic health record systems, followed by contemporary wearable sensors, telemonitoring platforms, and smart home technologies, have expanded the possibilities for older adults to manage chronic conditions and sustain independence within their chosen living environments. These innovations have simultaneously reshaped nursing roles. Nurses now act as facilitators of digital engagement, educators in self-care, coordinators of remote care, and intermediaries between older adults and increasingly complex technological infrastructures. Nurse-enabled technology use can enhance medication adherence, mobility, cognitive engagement, and perceived safety, while reducing hospital readmissions, caregiver burden, and premature institutionalisation (Albarqi 2024). By integrating digital health competencies, nursing has positioned itself as a central force in advancing autonomy-focused, person-centred aging care. Workforce sustainability and retention have emerged as central challenges in nursing roles focused on supporting older adults, particularly in settings where complexity, relational care, and continuity are integral to practice. The demographic aging of the nursing workforce parallels broader population trends: a considerable proportion of highly experienced nurses are approaching retirement, while fewer early-career nurses choose to work in aging-focused contexts. This generational shift risks the loss of advanced clinical reasoning, relational expertise, and tacit knowledge essential for caring for individuals with multimorbidity, cognitive decline, and interdependent social needs. At the same time, long-term care environments—where the need for skilled nursing is most pronounced—are marked by high rates of burnout, emotional strain, and turnover, driven by demanding workloads, limited professional advancement, and comparatively lower compensation (Lim 2021). The COVID-19 pandemic intensified these pressures, amplifying moral distress and accelerating workforce departures. Persistent societal undervaluation of nursing roles in aging could further diminish recruitment and retention, as ageist assumptions continue to frame this work as less prestigious. The resulting instability could undermine continuity of care, weaken interdisciplinary collaboration, and jeopardise outcomes for older adults. Sustaining this workforce is therefore not a peripheral concern but a defining determinant of how effectively healthcare systems will meet the needs of aging populations. The rising prevalence of complexity and frailty in aging populations has fundamentally reshaped the clinical and relational demands of nursing practice. Older adults are increasingly affected by multimorbidity, in which multiple chronic conditions intersect and evolve dynamically, often compounded by polypharmacy that heightens susceptibility to adverse drug events, delirium, falls, accelerated functional or cognitive decline, and even increased mortality (Kılınçarslan et al. 2025; Nwadiugwu 2021). Cognitive impairment can further complicate decision-making, daily activities, and medication management, requiring nurses to integrate clinical expertise with sustained relational sensitivity. Frailty intensifies vulnerability: diminished physiological reserve means that even minor stressors can trigger acute destabilisation, making timely assessment, nuanced judgement, and vigilant continuity of care essential. These realities place nurses at the centre of navigating fluctuating health states, coordinating across settings, and balancing risks and priorities in ways that are both clinically complex and emotionally demanding. As a result, complexity, frailty and multimorbidity represent enduring challenges that test the depth of nursing knowledge, the continuity of the workforce, and the capacity of healthcare systems to uphold dignified, person-centred care. Technological transformation and ethical integration have become defining challenges in nursing practice within aging societies, as AI-assisted decision systems, robotics, telemonitoring, and digital care platforms increasingly reshape clinical relationships and caregiving practices. While these technologies may enhance health-promoting behaviours and self-care (Park et al. 2025), they also risk depersonalisation and diminished relational presence—concerns that are particularly acute when supporting frail, cognitively impaired, or socially vulnerable older adults. Research indicates that many older individuals fear that technologically-mediated care may prioritise operational performance over dignity, empathy, and human connection (Raja and Uhrenfeldt 2024). For nurses, whose professional identity is grounded in person-centred practice, these shifts require careful ethical discernment, as digital systems can unintentionally redirect clinical judgement and reduce moral agency. Additionally, unequal access and digital literacy disparities threaten to exacerbate exclusion, while data-driven care raises concerns about privacy, surveillance, and trust. Global inequity and structural ageism remain entrenched challenges in nursing practice, profoundly influencing who receives care, how care is delivered, and whose needs are prioritised within healthcare systems. and disparities lead many older in or experience limited access to care, and for sustained support. 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