According to the World Health Organization (WHO), the global population aged 60 years and older is projected to reach 1.4 billion by 2030 and 2.1 billion by 2050 [1]. In South Korea, population aging has progressed at a faster rate than in other major member countries of the Organization for Economic Cooperation and Development (OECD), with the proportion of individuals aged 65 years and older exceeding 20% by 2025, signaling the nation’s entry into a super-aged society [2]. As the older population increases, the prevalence of chronic diseases and functional decline also increases, leading to a substantial escalation in medical and long-term care costs both at the individual and national levels. In response to this global aging phenomenon, the United Nations (UN) declared the period from 2021 to 2030 as the decade of healthy aging and requested that the WHO develop and lead strategies for healthy aging [3]. According to the WHO, healthy aging is defined as the process of developing and maintaining functional ability that enables well-being in older age, which is determined through the interaction of intrinsic capacity and external environmental factors that shape an individual’s life context. The WHO identifies the provision of person-centered integrated care for older people (ICOPE), which focuses on the needs and preferences of older adults, as one of the main strategies for the decade of healthy aging [3]. Therefore, the WHO has emphasized the need to reconsider and redefine the roles of healthcare and care personnel, such as nurses, and to adopt novel paradigms in practice [4,5].

Healthy aging requires a comprehensive approach that goes beyond the mere concepts of disease prevention and management [3]. Specifically, it encompasses providing a seamless system of healthcare, long-term care, and personalized support that allows older adults to age with dignity in their own communities as they transition from pre-frailty through frailty, disability, and, in some instances, being bedridden [3]. In Korea, initiatives, such as the 2019 pilot project for community-integrated care and the 2023 demonstration project for integrated medical care for older adults, have served as the foundation for establishing a community-based care system. Furthermore, the Act on Integrated Support for Local Care, enacted in 2024, is set for nationwide implementation in 2026 to integrate support across health, long-term care, and community care services [6]. However, existing legislation, such as the Medical Service Act and Nursing Care Act, primarily focuses on the delivery of healthcare services in medical institutions. Accordingly, clear guidelines on services associated with health promotion, disease prevention, chronic disease management, home-visit nursing, long-term care, and integrated care in communities are lacking. By contrast, nursing associations in countries that have experienced rapid population aging, including the United States, Australia, and Japan, emphasize that nurses play essential roles in promoting and supporting the healthy aging of older adults across diverse care settings, including community clinics, nursing homes, acute care hospitals, and long-term care facilities [7].

In the context of a rapidly aging population, the establishment of an integrated health management system that maintains and enhances the functional ability of older adults is indispensable for supporting them in living healthily in their communities for as long as possible. Nurses play a central role in this system. Professionals who closely observe the health status of older adults and sensitively respond to their daily changes are capable of integrating a wide range of responsibilities, including health monitoring, personalized care planning, emotional support, medication management, and the promotion of social interactions. Moreover, as older adults frequently present with complex health problems and multiple chronic conditions, effective coordination and linkages among various services are required. Nurses act as coordinators capable of managing such complexities and collaborating with multidisciplinary teams to provide continuous and integrated services [8]. This aligns with the WHO’s integrated care model for healthy aging (ICOPE), which strongly emphasizes the leading role of nurses. Therefore, nurses’ participation and leadership are imperative in policymaking, institutional planning, service design, and implementation to realize healthy aging. It is imperative to nurture a nursing workforce equipped with professional competence and a strong sense of responsibility to meet these demands.

Nursing competencies for supporting healthy aging should go beyond managing the health status of older adults; they must focus on maximizing the individual potential and ensuring a sustainable quality of life. Innovation is required in nursing education curricula to proactively address demographic aging and promote healthy aging [9]. The development and evaluation of nursing service models suitable for a super-aged society requires an enhanced understanding of gerontological nursing skills and the establishment of new practice models and strategies tailored to older adults with complex health needs. Additionally, nurses must be equipped with the competencies of coordinators and leaders capable of managing older adults interactively in multidisciplinary collaborative teams, which requires not only fragmented technical training but also comprehensive professional and leadership education to realize a genuinely human-centered and integrated approach encompassing mental well-being and social relationships. This implies the need for a structural transformation in nursing education and practice along with systematic competency development and the establishment of explicit clinical guidelines. Therefore, this study aimed to define the specific competencies required for nurses to effectively support healthy aging, thereby enhancing nursing expertise regarding healthy aging and ultimately contributing to the improvement of older adults’ quality of life.

This study aimed to define the specific competencies required for nurses to support healthy aging based on expert consensus using the Delphi method.

This study derived the core competencies of nurses supporting healthy aging in older adults through an integrative literature review and a subsequent Delphi survey to explore expert consensus on these competencies. The Delphi method systematically and repeatedly collects the opinions of multiple experts, allowing statistical analyses to arrive at more accurate estimates. This is based on the premise that a group’s collective judgment is likely to encompass the correct range of answers [10]. The Delphi survey is particularly well suited for problems requiring expert judgment or topics for which consensus among stakeholders is necessary [10]. In the present study, a Delphi survey was conducted regarding nursing competencies for healthy aging, which were identified through an integrative review to collect the opinions of experts. This study was performed in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE; http://www.strobe-statement.org).

To identify the nursing competencies required to support healthy aging, purposive sampling was used to recruit experts with academic and practical experience in age-related fields. An expert panel was selected based on their expertise in healthy aging, gerontological nursing, and older adult care. The panel comprised educators, researchers, and practitioners with at least five years of experience in relevant areas, such as gerontological nursing, psychiatric nursing, community health nursing, geriatric welfare, geriatric rehabilitation, geriatric health, and policy for older adults. Based on previous research [11] suggesting that a panel of 10 to 15 experts is appropriate when the panel characteristics are homogeneous, a panel of 10 experts was convened for this study. The response rates for the first and second rounds of the Delphi survey were 100%.

The study procedure comprised the following phases (Figure 1): first, to establish the foundation for the competency model, a conceptual framework was defined, the existing elements of nursing competency were reviewed, and the context was analyzed. This study referenced relevant theories and conceptual frameworks to develop nursing competencies for healthy aging. Specifically, the Framework of Competencies in Healthy Ageing [12] was analyzed to review the domains and key elements required for personnel supporting healthy aging, including collaboration, communication, advocacy, leadership, professionalism, and education as the six core domains that defined the direction for nursing competencies to support healthy aging. In addition, the age-friendly care model (4Ms framework) [13] established for the development of age-friendly healthcare systems was referenced to identify the essential elements for healthy aging. The 4Ms framework aims to establish a healthcare system in which all older adults receive optimal and satisfactory care without harm, structured around four key components: person-centered care that respects personal values and life goals (“what matters”); age-friendly medication management that does not impair health goals, mobility, or mental health (“medication”); cognitive health assessment and management across settings (“mentation”), and enhanced mobility ensuring autonomy and independence (“mobility”). Finally, the geriatric nursing competency framework [14], reorganized to encompass healthy aging, disease prevention, and the assessment and management of physical and psychological health issues in the context of population aging, was used to examine the practical and specific competencies required by nurses, which were incorporated into the conceptual framework of this study. This framework serves as a practical model for person-centered, tailored care and includes core domains, such as comprehensive assessment and individualized care planning for older adults, early screening and prevention of frailty, human-centered care, integration and management by multidisciplinary teams, continuity of care, and community linkage. By integrating these three theoretical frameworks, this study established a systematic and conceptual foundation for developing the nursing competencies needed for healthy aging to fulfill the study’s aims.

The second phase, the development of the competency model, involved drafting the domains, core competencies, and detailed competencies. For the first round of the Delphi survey, an email was sent to the participating experts to explain the nursing competencies for healthy aging developed through the integrative review as well as instructions for content validity, consensus, and convergence assessment. The survey used a five-point Likert scale for each item and allowed experts to provide open-ended feedback in each domain. Items that reached consensus according to preestablished criteria for the content validity ratio (CVR), consensus, and convergence were regarded as agreed upon by the expert panel and were excluded from the second round. The final model, including the domains, core competencies, and detailed competencies, was established based on consensus achieved using the expert Delphi process.

This study was approved by the Institutional Review Board (IRB No. 202405-SB-068-01) of Chungnam National University to which the researcher is affiliated. The researcher explained the purpose and methods of the study, anonymity of the collected data, voluntary participation, possibility of withdrawal, and confidentiality to prospective participants who met the inclusion criteria via both telephone and email communication. Written consent for participation was obtained before proceeding with the study after sending informed consent documents and explanatory statements via email. The first round of the Delphi survey was conducted for a two-week period on June 17~30, 2024. Following the collection of feedback from the expert panel, the second round of the Delphi survey was conducted between July 22 and August 4, 2024.

The general characteristics of the expert panel were analyzed using frequencies, percentages, means, and standard deviations. To verify content validity and assess the consensus and convergence of expert opinions on nursing competencies for healthy aging, the mean, standard deviation, quartile, median, CVR, degree of consensus, and degree of convergence were analyzed. For a panel of 10 experts, a CVR greater than 0.62 was considered indicative of content validity [15]. Items were considered to have achieved consensus if the consensus value was at least 0.75 and the convergence value fell within the range of 0 to 0.5 [16].

The expert panel consisted of 10 individuals: three specialized in gerontological nursing, one in psychiatric nursing, two in community health nursing, one in geriatric welfare, one in geriatric rehabilitation, one in geriatric health, and one in policies for older adults. The selected members were experts with a practical understanding of policies and systems associated with healthy aging, gerontological nursing, and older adult care, with experience in both education and research. The panel comprised six educators and four practitioners (nine=women, and one=man). Their average age was 46.4 years, and their mean length of experience in relevant fields was 23.2 years.

A comprehensive review of domestic and international literature was conducted to synthesize the nursing competencies for supporting healthy aging among older adults. Academic databases, including PubMed, CINAHL, Cochrane Library, and Google Scholar, were searched using key terms such as “healthy aging,” “older adults,” “nurses,” “competency,” and “competence” for literature published between 2000 and 2023. Of the 580 results, 32 studies were selected for final analysis after assessing their relevance to the topic. This review demonstrated that a diverse range of competencies was required for nurses to effectively support healthy aging. Essential nursing competencies include a comprehensive assessment of the determinants, barriers, and facilitators of healthy aging, considering the values and coping capacities of older adults, families, and stakeholders and identifying key health issues and modifiable factors through screening for physical, psychological, and social factors. Based on this assessment, nurses should demonstrate their ability to coordinate services and resources to meet the complex health needs of older adults [17]. Additionally, nurses play an important role in implementing interventions tailored to the individual characteristics of older adults to prevent decline in their intrinsic capacity, including physical and mental abilities, thereby upholding functional abilities [18]. Nurses also provide education and support to families and caregivers [19], facilitate collaboration and effective communication with multidisciplinary teams and older adults [20], exhibit leadership in guiding nursing teams and advocating for older adults’ rights [21], and resolve ethical dilemmas based on professional ethics [22]. Ongoing education and research are necessary to improve service quality continually [23]. These multifaceted nursing competencies are vital for promoting healthy aging and improving older adults’ health and quality of life.

From this integrative review, a comprehensive set of competencies for nursing in healthy aging was identified, comprising nine domains, 27 key competencies, and 134 enabling subcompetencies. The “healthy aging assessment” domain included one key competency with eight enabling competencies; “service coordination” comprised four key competencies with 15 enabling competencies; “prevention and management of decline in intrinsic capacity” included six key competencies with 36 enabling competencies; “support for caregivers and care personnel” comprised two key competencies with 18 enabling competencies; “collaboration” included two key competencies with 11 enabling competencies; “communication” included three key competencies with 16 enabling competencies; “leadership” included three key competencies with 11 enabling competencies; “professional ethics” included two key competencies with seven enabling competencies; and “education and research” included three key competencies with 10 enabling competencies.

In the first round of the Delphi survey, items were revised or supplemented if they did not meet the predetermined criteria [16] for content validity (CVR less than 0.62) [15], consensus (less than 0.75), or convergence (outside the range of 0–0.5) (Table 1).

In the “healthy aging assessment” domain, specific examples of determinants (e.g., genetic factors and lifestyle), barriers (e.g., lack of community resources), and facilitators (e.g., social support) to healthy aging were added. The definitions of “family” and “stakeholders” were clarified to ensure precise communication of these terms.

In the “service coordination” domain, the item “shared decision-making” was revised to “shared decision-making for healthy aging,” and a subcompetency, “respecting the self-determination of older adults,” was added to emphasize autonomy. Reflecting the importance of person-centered case management, relevant items were modified to “the nurse continuously evaluates and adjusts plans to provide person-centered case management” and “adjusts or modifies care plans when necessary.” The term “barriers to equity” was replaced with “barriers,” and “journalists and marketing specialists” (as communication professionals) were refined to “media professionals and public relations specialists.”

In the “prevention and management of decline in intrinsic capacity” domain, “inactive behavior” was revised to “inactive lifestyle.” Provision of exercise therapy was revised to “refer or connect to occupational/rehabilitation specialists.” The inclusion of “mobility support services” was added under age-friendly environments. “Malnutrition” became “poor nutrition (including obesity),” and “loneliness” was clarified as “social isolation.” Clearer descriptions were provided for vision and hearing support, including screening, provision of assistive devices, and preventive activities. Specific examples of vision and hearing aids were provided, and new subcompetencies were added to train recipients in the correct use and management of these aids. Emphasizing the increased fall risk from misuse of devices, “use assistive devices” was revised to “provide education on the correct use of assistive devices.” Pharmacological pain management, medication adjustment, and transitional care were clarified as being conducted “in collaboration with a multidisciplinary team.”

In the “support for caregivers and care personnel” domain, “malnutrition” was broadened to “poor nutrition (including obesity),” and subcompetencies associated with polypharmacy were amended to “provide education on precautions and management methods” beyond simply communicating warnings. In the “collaboration” domain, the term “negotiation” was replaced with “consult and coordinate with other professionals for shared or overlapping roles.” “Referral” was clarified as “facilitate transitions to other fields as needed.” Interaction with families was rephrased from “educate family” to “consult with family,” and “supporting family adaptation” became “supporting family participation in the process of healthy aging.”

In the “communication” domain, the item “promote self-management and resilience in older adults” was revised to “support improvement of self-management skills and resilience in older adults.” It was also refined to “provide and support information and opportunities for older adults to interact with various individuals and participate in community-based educational activities.” In “leadership,” the competencies for personal and shared vision in the context of healthy aging expertise were articulated in more detail. The “professional ethics” domain was revised from “provide equitable service and refuse age-based discrimination” to “provide equitable service and avoid age-based discrimination.”

Finally, in “education and research” domain, a shift was made from simply identifying appropriate media to focusing on the actual delivery of education, modifying “identify media for public education” to “educate the general public on healthy aging using effective media.”

Items that did not achieve consensus in the first round were revised and supplemented before the second round of the Delphi survey. The items assessed in the second round included subcompetencies 1.1.4 and 1.1.8 in Domain 1; 2.1.5, 2.2.4, 2.3.1, 2.3.3, and 2.4.5 in Domain 2; 3.1.4, 3.1.6, 3.2.1, 3.4.2, 3.4.4, 3.5.3, 3.5.4, 3.5.7, and 3.5.8 in Domain 3; 4.1.3 and 4.2.4 in Domain 4; 6.3.1 and 6.3.2 in Domain 6; and 9.3.2 in Domain 9. In the second Delphi survey, all items achieved a consensus value of 0.75 or higher and a convergence value within the range of 0–0.5, indicating that sufficient agreement was reached among the experts. Reflecting the results of the final expert Delphi survey, the nursing competencies for healthy aging were finalized as comprising nine domains, 26 key competencies, and 132 subcompetencies (Table 2, 3).