Care of Older Adults as Nursing's Defining Ground: Leading the Transformation Toward Prevention‐Focused and Autonomy‐Promoting Healthcare Systems

摘要

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, medicat