Photograph of an older adult playing a saxophone; photo source: Administration on Aging, DHHS Learning Activities

Optimal Aging Competency

Plan, implement, and evaluate care that promotes optimal aging.

Develop your Optimal Aging Competency by completing some or all of these learning activities. Choose the ones that are the most useful and appealing as you prepare to demonstrate your Optimal Aging Competency. You might want to explore them all, to see what resources are here for sharing with others in your work setting or community.

What is optimal aging? We define optimal aging as living at the highest potential that is possible, given each older adult's life pattern, physical and mental reserves, functional ability, social context, and environmental influences. Thus, optimal aging is possible for every older adult, whether living independently with excellent health, coping with chronic illness or disability, or receiving considerable assistance with activities of daily living in a skilled nursing facility. 

Three evidence-based ways to build the foundation for optimal aging are preventing or managing disease, maintaining or building physical and cognitive function, and continuing or renewing engagement with life.

Photograph of a box of items to assist with optimal aging: syringe for vaccination, exercise shoes, fruits and vegetables, etc.

Introductory Video for the Optimal Aging Competency

If you prefer, you can read a transcript of the video.

Overview of Learning Activities:  Learning Activities for the Optimal Aging Competency are divided into those three foundational areas of focus:

Preventing or Managing Disease

One of the foundations for optimal aging is disease prevention, which includes immunizations and risk factor reduction. Older adults who have chronic diseases such as Type II diabetes or hypertension engage in both disease management and prevention when they make lifestyle choices that reduce risk factors for progression, exacerbation, or complications of those diseases.

Drawing of a syringe Update Your Knowledge of Immunizations for Older Adults

Note: The internet links provided here were active at the time these Older Adult Focus materials were prepared. If a link is no longer active, try searching for the same or similar content using the name of the organization or the title provided.

CDC Recommended Adult Immunization Schedule

The annual Recommended Adult Immunization Schedule from the Centers for Disease Control and Prevention (CDC) applies from each October through the following September. Find and print the most recent version at http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm using the link to Adult Immunization Recommendations.

Online Vaccine Quiz

The National Immunization Program of the CDC has a online quiz to help people know which vaccines they may need. Take the What Vaccines Do You Need? quiz at http://www2.cdc.gov/nip/adultImmSched/default.asp to generate a list of the vaccines that you may need. Do you need to update your own vaccines?

Take a Whirlwind Tour of Resources for Risk Factor Reduction   Picture of the letters http:

Note: The internet links provided here were active at the time these Older Adult Focus materials were prepared. If a link is no longer active, try searching for the same or similar content using the name of the organization or the title provided.

Exercise is an excellent way to reduce risk factors for many conditions, including cardiovascular diseases, osteoporosis, and constipation. We shall discuss exercise in the Maintaining Function section of this Optimal Aging Competency. 

Drawing of a diseased heart with a bandage on it               

Heart Disease

Use the site search function to find the Learn and Live Quiz; take it to identify your own risk factors for heart disease. Follow through the results links to find information that is provided specifically for older adults.

Click the Caregiver tab and explore the resources provided to aid caregivers as they try to be heart healthy while caring for an older adult.

Drawing of a strong and healthy heart that is smiling

Guide to Quitting Smoking

Use the site search function to find the Guide to Quitting Smoking and you will find numerous smoking cessation resources. Click Tools and Calculators to find these additional resources:

Medicare Preventive Services

Click Manage Your Health - Preventive Services to find the answers to the following questions:

Risk Factors for Osteoporosis

The National Osteoporosis Foundation provides information about risk factors as well as preventive measures for those at risk. Assess your own risk of osteoporosis. Do you need to attend to prevention? If you work with any older adults who take glucocorticoids such as prednisone, be sure that they are also taking calcium and vitamin D supplements!


Managing Stress

The AARP website has stress management tips for older adults. Find them by using these words in the site search function: How to Manage Stress

Sleep Quiz

You learned about sleep disturbance and assessment of sleep in the Adapting Care Competency. Take the Sleep Quiz to remind yourself that adequate sleep is an important part of preventing and managing disease. The American Academy of Sleep Medicine provides this quiz.

  Drawing of a person sleeping

Drawing of the sun wearing sunglasses  


Sun Safety Quiz

Use the search function at the American Cancer Society website to find the Sun Safety Quiz. Although some of the questions pertain to younger people, older adults can learn from this quiz and then click related links to learn more about reducing risk and early detection of skin cancer. Annual screening for skin cancer is recommended for older adults.


You learned a simple nutrition assessment in the Assessment Competency. Now take a look at the DETERMINE Your Nutritional Health screen, distributed by the Nutrition Screening Initiative. What words are indicated by each of the letters in DETERMINE? Can you see a clinical use for this screening tool?

    Drawing of nutritious foods

Using the Nutrition Facts Label

Older adults who know how to read the nutrition information on food labels have an important tool for maintaining a healthful diet and adapting to dietary management of chronic diseases. The U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition provides this 2010 resource: Using the Nutrition Facts Label: A How To Guide for Older Adults.

Preventing Constipation in Older Adults

These Nursing Best Practice Guidelines are an excellent evidence-based resource for preventing constipation. You can download this document if you wish.

Solve a Drag-and-Drop Puzzle to Choose Medication Management Aids Drawing of a computer mouse
Photograph of three medication management boxes labeled A, B, and C.

Box A has four compartments per day, each over 1 cubic inch.

Box B has one compartment per day, each about 1 cubic inch.

Box C has four compartments per day, each about one-half cubic inch. 

Assistive Devices for Managing Medications help many older adults adhere to their medication schedules for optimal management of chronic disease. Many options are available. Here are some questions that will help you assist older adults to decide which device will be the best for their individual circumstances:
  • How many times per day does the person take medications?
    • Be sure there are enough compartments for the number of doses per day.
  • Is manual dexterity an issue?
    • Some boxes are difficult to open and close.
  • How many and what size medications does the person take?
    • Be sure the pills will fit in the compartments. For example, calcium supplements are usually quite large.
  • Will the person need to transport the box during the day?
    • Some boxes will fit in a pocket or purse. Others are quite large and unwieldy.
  • Does the box need a locking device?

Take a good look at the photograph of medication aids on the left. Then solve the Medication Management Aids Drag and Drop Puzzle to practice matching these devices with specific older adults. 


Picture of the letters http: Find Websites to Assist with Disease Management

International Bibliographic Information on Dietary Supplements Database

Many older adults take herbal and other dietary supplements in addition to over-the-counter and prescription medications. They use these supplements for disease management as well as health maintenance. Nurses and other professionals who work with older adults need a reputable source of information about these products. You can find information from scientific literature and fact sheets about many of these products in the International Bibliographic Information on Dietary Supplements Database, sponsored by the National Institutes of Health.



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Maintaining or Building Physical and Cognitive Function

Maintaining or building physical and cognitive function is another important part of the foundation for optimal aging. Research demonstrates that exercise helps older adults improve both physical and cognitive function as well as reduce functional decline.

We all have heard about the many benefits of regular exercise for prevention of various diseases and disabilities. Older adults who begin to exercise need guidance regarding the following aspects:

  • type of exercise appropriate to their physical condition and level of function
  • how vigorously to exercise (intensity)
  • how long each exercise session should last (duration)
  • how often to exercise (frequency)



View a Presentation on Exercise for Older Adults

The physical attributes of endurance, strength, balance, and flexibility are important determinants of an individual's function. Different types of exercise have different effects. View the presentation for an introduction to this topic.

Strength and Flexibility for Life

Now learn more with the exercise guide illustrated at the end of the presentation:

Picture of the letters http: Explore an Internet Exercise Guide for Older Adults

Note: The internet links provided here were active at the time these Older Adult Focus materials were prepared. If a link is no longer active, try searching for the same or similar content using the name of the organization or the title provided.

Exercise: A Guide from the National Institute on Aging and the National Aeronautics and Space Administration is accessible at http://weboflife.nasa.gov/exerciseandaging/home.html and was written for older adults. In addition to exploring barriers and benefits of exercise, it provides guidance and illustrated examples of specific exercises to gain endurance, strength, balance, and flexibility. Explore the site to become familiar with the wealth of information it provides.

Read Research Articles about Specific Aspects of Exercise for Older Adults Picture of two journal articles     

In this section, you will find research on specific aspects of exercise for older adults:

Exercise for People Who Have Various Chronic Diseases

In addition to being preventive for many chronic diseases, exercise has many benefits when prescribed for treating them. This review article summarizes much research on this subject.

Pedersen, B.K., & Saltin, B. (2006). Evidence for prescribing exercise as therapy in chronic disease. Scandinavian Journal of Medicine & Science in Sports, 16, (Suppl 1). 3-63.

Exercise for Frail Older Adults

If you work with frail older adults, read one or more of these articles.

Fiatarone, M.A., Marks E.C., Ryan, N.D., Meredith, C.N., Lipsitz, L.A., & Evans, W.J. (1990). High-intensity strength training in nonagenarians. Journal of the American Medical Association, 263, 3029-3034.

Wolf, S.L., Barnhart, H.X., Kutner, N.G., Mcneely, E., Coogler, C., Xu, T., & the Atlanta FICSIT Group. (2003). Selected as the best paper in the 1990s: Reducing frailty and falls in older persons: An investigation of tai chi and computerized balance training. Journal of the American Geriatrics Society, 51(12), 1794-1803.

Lord, S.R., Castell, S., Corcoran, J., Dayhew, J., Matters, B., Shan, A., et al. (2003). The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: A randomized, controlled trial. Journal of the American Geriatrics Society, 51(12), 1685-1692.

Exercise to Relieve Symptoms of Depression

Regular aerobic exercise such as brisk walking, jogging, or cycling has been shown to reduce depression in older adults. In some studies, aerobic exercise has been found to be as effective or more effective than antidepressant medication. Many health professionals recommend one or two brisk walks daily for depression prevention or management. Here are three studies on exercise and depression for you to explore, if this topic interests you.

Penninx, B., Rejeski, W.J., Pandya, J., Miller, M.E., DiBari, M., Applegate, W.B., et al. (2002). Exercise and depressive symptoms: A comparison of aerobic and resistance exercise efects on emotional and physical function in older persons with high and low depressive symptomatology. Journals of Gerontology Series B-Psychological Sciences, 57B(2), P124-P132.

Barbour, K.A., & Blumenthal, J.A. (2005). Exercise training and depression in older adults. Neurobiology of Aging, 26(Suppl 1), 119-123.

Rosenberg, D., Pepp, C.A., Vabia, I.V., Reichstaddt, J., Palmer, B.W., Kerr, J., Norman, G. & Jeste, D.V. (2010). Exergames for subsyndromal depression in older adults: A pilot study of a novel intervention. American Journal of Geriatric Psychiatry, 18(3), 221-226.

Exercise and Maintaining Cognitive Function

Regular aerobic exercise has been shown to promote growth of new neurons in the hippocampus, an area of the brain that is important in learning and memory. Increasingly, we are learning the importance of regular exercise in maintaining cognitive function.

Larson, E.B., Wang, L., McCormick, W.C., Teri, L., Crane, P., et al. (2006). Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Archives of Internal Medicine, 144, 73-81.

If you are interested in learning more about exercise and cognitive function, search a database of professional journal articles such as MEDLINE. Keywords to find pertinent articles include exercise, cognition, and dementia.

Picture of the letters http: Explore Internet Resources for Maintaining or Increasing Cognitive Function

Evidence-based ways to maintain or increase cognitive function are:

AARP Brain Health

Brain Resources for Seniors

The Dana Foundation is a private philanthropic foundation that focuses on neuroscience and brain health. See what is available for older adults on this website.

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Continuing or Renewing Engagement with Life

Engagement with life is the third part of the foundation for optimal aging. We shall focus on two aspects of engagement with life: relationships with other people and with animals, and meaningful activities.


Photograph of an older adult and a younger woman talking together over a book  

Focus on Relationships with Other People

Maintaining and building new relationships with other people are crucial components of engagement with life. Maintaining relationships may become a challenge due to sensory changes and difficulties with mobility. 

As friends and relatives age and die, an older adult who does not develop new relationships can become lonely, isolated, and depressed. 

Nurses and other professionals in the field of aging can assist older adults with maintaining and building relationships in multiple ways. Here are a few examples:

Photograph of an older adult smiling while talking on the telephone

If this woman develops hearing loss, what would you suggest to help her maintain relationships with her distant family members?


This man has expressive aphasia after a stroke, so he has difficulty talking with his grandson. Can you think of other ways to help them communicate?


  Photograph of an older man holding a small child on his lap
       Photograph of an older couple enjoying a photograph album together Explore the bereavement resources in your community that would be helpful for an older adult after the death of a spouse.

Can you find some reputable supportive internet resources for older adults who are grieving?


Photograph of Silverstreak the cat, courtesy of L. Felver Focus on Relationships with Animals

Florence Nightingale recommended that patients, especially those with chronic illness, have a pet. Today, the benefits of pet ownership by older adults and of animal-assisted therapy in hospitals and long-term care facilities are being documented through research.

Explore one or more of these resources to learn about the benefits of relationship with animals in various settings.

Animal-Assisted Therapy

Cangelosi, P. R. & Sorrell, J.M. (2010). Walking for therapy with manís best friend. Journal of Psychosocial Nursing, 48(3),19-22.

Animals and Loneliness

Banks, M.R., & Banks, W.A. (2002). The effects of animal-assisted therapy on loneliness in an elderly population in long-term care facilities. Journals of Gerontology Series A-Biological Sciences & Medical Sciences, 57(7), M428-M432.

Use of Aquariums

Edwards, N.E., & Beck, A.M.(2002). Animal-assisted therapy and nutrition in Alzheimer's disease. Western Journal of Nursing Research, 24(6), 697-712.

The Delta Society

The mission of the Delta Society is "improving human health through service and therapy animals."


Drawing of older adult fishing Focus on Meaningful Activities

Meaningful activities for older adults include such things as paid or volunteer work, religious observances, hobbies such as gardening, enjoying music, literature, and visual art, and a myriad of other activities that each individual finds important and a source of meaning and engagement with life. 

Drawing of an older adult in a wheelchair who is working with craft items

In this section, you will find some resources on horticultural therapy and music, literature, and visual art, to spark your thinking about how to incorporate these into your own setting. 


Many older adults find gardening an enjoyable, meaningful activity. The use of raised flower beds or modified garden tools enables older adults who have limited mobility to continue or begin gardening for the first time. 

The many benefits of gardening include: 

  • enjoyment of participation in a meaningful activity

  • connectedness with the natural world

  • physical activity that helps maintain muscle strength, range of motion, and flexibility

  • pleasure in sharing flowers or vegetables with others

  • Interview an older adult who enjoys gardening and see what additional benefits you could list here.

Drawing of older adult working in a garden

Horticultural Therapy

Horticultural therapy uses simple activities with plants to promote both simple physical activity and social interaction. Here are two examples of use of plants in inpatient settings.

Pachana, N. A., McWha, J.L., & Arathoon, M. (2003). Passive therapeutic gardens: A study on an inpatient geriatric ward. Journal of Gerontological Nursing, 29(5), 4-10.

Wichrowski, M., Whiteson, J., Haas, F., Mola, A., & Rey, M.J. (2005). Effects of horticultural therapy on mood and heart rate in patients participating in an inpatient cardiopulmonary rehabilitation program. Journal of Cardiopulmonary Rehabilitation, 25, 270-274.

  • How was the horticultural therapy used within the cardiopulmonary rehabilitation program?
  • What were the effects of the therapy on mood and heart rate?
  • How would you go explore incorporating some type of horticultural therapy into your clinical setting?
Music, Literature, and Visual Art

Music, literature, and visual art are meaningful activities that promote engagement with life for many older adults, whether they are creating or observing them. 

What forms of engagement with music, literature, or art do you see in the older adults in your clinical setting? How could you encourage this form of engagement with life for the older adults with whom you work? Here are two articles that may provide some new ideas.

Drawing of an older adult painting at an easel     

Skingley, A. & Bungay, H. (2010). The silver song club project: Singing to promote the health of older people. British Journal of Community Nursing, 15(3), 135-140.

  • What is the Silver Song Club Project?
  • What were some of the benefits to older adults who participated in this project?

Kramer, M.K. (2001). A trio to treasure: The elderly, the nurse, and music. Geriatric Nursing, 22(4), 191-197.

  • How do the authors describe music therapy?
  • What recommendations does this article provide for clinicians?

Wikstrom, B. (2004). Older adults and the arts: The importance of aesthetic forms of expression in later life. Journal of Gerontological Nursing, 30(9), 30-36.

  • Note the primary themes and subthemes from the interviews, as listed and illustrated in the box on page 33.
  • In what ways did the older adults indicate that music, literature, and visual art give life meaning?
  • In what ways did they view music, literature, and dance as initiators of activity?
  • What implications do these ideas have for older adults that you know?
  • How would you assess the music preferences of an older adult in your clinical setting? How would you go about making an older adult's preferred type of music available?

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After you have completed some or all of these Learning Activities, proceed to the Competency Demonstration.

Developed by L. Felver; Revised 2010