Reframing Negative Understandings of Ageing Populations: Updating Our Nursing Perspective

Frail, vulnerable, a burden. This sequence of thoughts feels omnipresent as we consider older people and ageing populations. Many nurse researchers and their colleagues leverage frailty, vulnerability and interpersonal or societal burden in some combination to outline problem statements, frame studies and anchor programmes of research. Certainly, some use approaches like strength-based nursing that rebalance such negativistic language. But we are, in general, far more likely to see gerontological nursing research predicated on the problematic. Emphasising the negative and anticipating decline as the inevitable consequence of growing older is a proverbial slippery slope. When we gerontological nurses view growing older and ageing demography in the negative terms of loss and decline, we invest in a nihilistic perspective. That nihilism involves believing that older people and aged communities pose the eventual prospect of societal downfall. Diverse age demographics are, like all societal diversity, invaluable to individuals and communities alike. Thus, viewing ageing and older people foremost as problems needing to be managed by younger people is unrealistic, auguring deleterious consequences for people of all ages. Suggesting that older people are, as individuals and groups, needy and burdensome conflicts with our current global reality. A variety of indicators reflect that our older fellows contribute to our communities and societies in important and essential ways. Older people are involved in both paid and unpaid work in large numbers. Critically, older people often need to work for themselves and their families to subsist, a reality reflected in the high numbers of people aged 65 and older who work for pay in low- and middle-income societies (World Health Organization 2026). Older women frequently spend a sizeable portion of their days engaged in unpaid labour, most often caring for others (UN Women 2023). For example, huge numbers of older people now care for their own grandchildren is many societies around the world. The work of older people is broadly essential to intergenerational family well-being. The paid and unpaid work undertaken by older members of our societies offers vital support to families, helps secure younger people's employment and provides the older people themselves with key benefits like financial independence, social engagement and well-being. These benefits point out the strengths and advantages exhibited by older people. By contrast, a closer look at the ideas of frailty, vulnerability and burdensomeness reveals the full extent of our biases. When we believe these concepts define older people, instead of seeing the extent to which older individuals may experience one or more of them at different times in their lives, we miss the strengths and advantages that older people simultaneously possess at the same time that they are frail or vulnerable. Understanding frailty as an inevitable and permanent result of normal ageing is a ubiquitous bias. Strong evidence points to the extent to which people of any age may exhibit frailty. Children and adolescents living after cancer treatment, for instance, frequently become frail (Caruso and Magon 2025). Crucially, examinations of frailty in older populations suggest that suboptimal healthcare plays a role in expressing the frailty phenotype (Mallery and Shetty 2026). Even more importantly, both scientific evidence and clinical observation highlight that frailty is far from a permanent state (Kim Dae and Rockwood 2024). Regaining strength, function and ability are all possible with clearly conceived rehabilitative care. Yet, many nurses and their colleagues appear to persist in believing that frailty is a fixed state where strength cannot be regained and for which the main response must be more compensatory care. Thinking of older people as vulnerable is a long-standing and ever more popular belief. Universally applying this concept to older people disregards two key points. First, all human beings are vulnerable to varied forces at different times. Second, the planetary health crisis underscores that everyone is now critically vulnerable amidst this unprecedented global calamity, requiring our immediate and ongoing collective action in response. Vulnerability is an element of being human, whereas invulnerability is the stuff of fairy tales and superhero cartoons. Believing younger people invulnerable while people classed as different—older, or disabled, for example—carry the label of vulnerability risks untold damage to people of all ages through miscast support while needlessly disadvantaging those so labelled. A close examination of the notion of burden uncovers the true scope of our implicit discrimination when we apply frail, vulnerable and burden imprecisely. Here, chronological age defines our discrimination. Few speak about the burden of caring for children in the all-encompassing way in which the term is applied to caring for older people. We must ask ourselves why caring for the young is viewed as a joy or a privilege whereas caring for the old is burdensome. Further, assertions that defining burden helps project needs for workforce and other resource development end in disutility. Burden is so generally used that distinguishing resource needs as result of its application becomes impossible. Significantly, applying the language of vulnerable and burdensome to older people starkly others our future selves and our current patients, relatives, friends and neighbours. No human being or indeed any species is invulnerable, always making contributions without needing anything from others. All human beings at any age, like all life forms on our planet, are vulnerable and needful at any given time. Conversely, people of all ages possess the capacity to support and contribute to the welfare of others in varied ways at different points in time. Unrealistic appraisals of older people risk consequences that are often serious for individuals, families and communities. Spurring negative self-stereotyping about growing older is foremost among these risks. Fostering social discrimination across all levels of society from the family through the national and global levels is a spontaneous corollary of self-stereotyping. Unfavourable beliefs about and attitudes towards ageing and being old generate manifold effects on health and well-being (Chang et al. 2020). Similarly, we know from the World Health Organization and other sources that ageism more broadly worsens health, function, well-being and social engagement for people around the world (World Health Organization 2021). Critically, age-related discrimination, especially as it interacts with and promotes other forms of discrimination, entails marked financial as well as human costs. Believing that older people are, as a group, frail, vulnerable and burdensome limits their economic and social contributions while simultaneously being costly to societies and making health and social care more wasteful. In view of our discipline's principles of holism and person-centeredness, why do we persist in grounding our research as well as our education, practice and policies in ideas about older people's frailty, vulnerability and burdensomeness? We espouse the centrality of our role in promoting health and function through person- and family-centeredness. Underscoring our investment in notions of ageing as a state of decline, fragility and neediness contradicts our principles as nurses. Such investment further undermines any claims we might wish to make for fiscal responsibility and sustainability. Overemphasising the phenomena of functional decline and dependence results in enlarging needs for care while neglecting how to build on extant strengths and advantages. This overemphasis is both costly and wasteful. If the answer to my question of ‘why do we?’ is a shrug or bafflement, then our choice is clear. Adjusting our beliefs and changing our actions is the obvious choice. Almost 10 years ago, I wrote a clinical essay proposing an advantage inventory for use in nursing care (Kagan 2017). From what I can tell, my aim of shifting our perspective on caring for older people toward understanding advantages came to nothing. Only two papers cited the essay and just two nurse educators told me how they used the idea when teaching their students. Nevertheless, I find the idea of an advantage inventory more useful than ever. Transforming our negative attitudes and problem-seeking actions requires reframing. We can reframe our perspective by looking for the positive attributes of ageing and older people. We need to replace our fixed conceptions of frail, vulnerable and burdened with ideas that align with reality. Realistically, ageing is a phase of human development like any other. It brings different advantages and challenges. Old age offers manifold possibilities. We must be sensitive to restrictions imposed by social and commercial drivers of health and well-being like poverty and negative messages from social and news media. Likewise, population ageing poses possibilities and opportunities to communities and societies such as growth in prosperity and planetary health. Capitalising on these prospects requires clear vision and resources. Correcting our view of ageing and being old mandates replacing frail, vulnerable and burdensome as the only arbiters of what we see in later life. Advantages, strengths and value gracefully balance these negative specifications. The advantages of later life and of having an aged community within broader societies are sufficiently divergent that summing them up proves challenging. Among my favourite advantages are experience and common sense. Experience enables people who acquire it to learn patterns, sense probabilities and project what might come next. With support to manage emotional responses when what might come next is uncertain or undesirable, older people may leverage their experience to benefit from it as they continue to grow and develop. Unlike experience or perhaps because experience is often disregarded, common sense proves rare in today's world. That rarity makes it the uncommon sense. Common sense entails prudence and judgement, making sense of the everyday and choosing the sensible way forward. Common sense applies in most of daily life and becomes especially important when encountering changes in later life, helping to distinguish both causes and solutions. Strengths and values seen in later life, like advantages, are so varied that quickly summarising them is difficult to do. Strength is often stereotyped as existing in later life only emotional and spiritual domains. Physical and cognitive strength are presupposed to be the domains of youth. But how much of the weakness we see in other domains results from self-directed and external ageism? We cannot know until we dismantle our own and others' age discrimination. Likewise, older people add vast value to their own lives, to their families and to their communities and societies. While economic value may be easily estimated, interpersonal and social worth that older people create in the various aspects of their lives is both tangible and intangible, immediate and long-lasting. Completing the necessary shift in our perspective will come quickly as we curtail our overuse of frail, vulnerable and burdensome. That curtailment will allow us to focus our attention on advantages, strengths and values in how we see later life and older people. Such attention offers manifold value for gerontological nursing. It can drive new models for research, deepen nurse–patient–family engagement and display the social benefit of nursing through research and in nursing care that promotes health, function and well-being. The International Journal of Older People Nursing (IJOPN) has long invited and will continue to welcome manuscripts reporting research and synthesising evidence relevant to the fresh view on older individuals and populations laid out here. Commensurate with the specifications in our 2026 Style Brief (https://onlinelibrary.wiley.com/page/journal/17483743/homepage/forauthors.html#style-brief), we will always ask authors who frame their work in general terms of frailty, vulnerability and burden to reconsider their argument with attention to advantage, strength and value. They can look to some current papers in the journal for ideas about how to successfully reframe their own work. Prospective authors can learn from how the authors of ‘Live bedside music for hospitalized older adults: A qualitative descriptive interview study’ precisely defined vulnerability in relation to hospitalisation, for example (van der Wal-Huisman et al. 2023). As always, we invite our IJOPN community of readers, authors and reviewers to share their views on this editorial via social media. You can find IJOPN on LinkedIn! Just tag IJOPN with the hashtag #GeroNurses. The author has nothing to report. The author declares no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.