Thanks to improvements in healthcare, nutrition and living conditions people are living longer than ever before, which means aged care providers are supporting residents in their late nineties and beyond. This demographic shift is changing the profile of residents entering aged care. The group often referred to as the “oldest old” – typically people aged 90 years and older – has individual health and care needs that differ significantly from younger seniors.

In Australia, the likelihood of disability rises with age. Data from the Australian Bureau of Statistics shows that more than 83% of Australians aged 90 and over live with some form of disability, which adds to the challenging health needs within this group.

At the same time, dementia becomes common in later life. According to the Australian Government Department of Health, around two in five people aged 90 and over are living with dementia, making cognitive impairment an essential part of care planning.

Along with this, residents in their nineties often experience physiological changes that affect how they respond to illness, medication and physical stress. Compared with younger older adults, residents in this age group are more likely to experience:

• Frailty and reduced muscle mass
• Multiple chronic conditions
• Slower recovery from illness or injury
• Increased sensitivity to medications
• Higher risk of falls and mobility issues

Many also live with a combination of conditions such as dementia, cardiovascular disease, arthritis and sensory impairment. As the Australian Institute of Health and Welfare notes, increasing longevity has led to a rise in chronic disease and neurodegenerative conditions. This means traditional medical models that focus heavily on disease treatment may not always be the best option for the oldest residents.

Priorities often shift away from aggressive medical intervention and toward quality of life, comfort and dignity. In practical terms, this means adapting clinical practices, the environment and daily routines to better support older residents.

Frailty-Focused Care Planning
Frailty is one of the defining characteristics of people aged 90 and over. It makes individuals more vulnerable to illness, falls and sudden health deterioration. 

Frailty-informed care planning emphasises:

• Early identification of frailty
• Preventing avoidable hospital admissions
• Supporting mobility and physical strength
• Monitoring nutrition and hydration
• Adjusting medication regimens carefully

Medication Management and Polypharmacy
Residents aged 90 and above are particularly sensitive to medications due to physiological changes such as reduced kidney function and slower metabolism.

Polypharmacy – the use of multiple medications at the same time – is common in aged care and can increase risks such as falls, confusion and hospitalisation.

The Australian Commission on Safety and Quality in Health Care highlights the importance of regular medication reviews in aged care to reduce unnecessary prescriptions and improve safety.

For the oldest residents, clinicians often focus on:

• Simplifying medication regimens
• Reviewing long-term preventative medications
• Monitoring for side effects
• Prioritising relief and comfort

Preventing Falls and Maintaining Mobility
Falls remain one of the leading causes of injury among older Australians. According to the Australian Institute of Health and Welfare, falls account for a large proportion of injury-related hospitalisations among people aged 85 and older.

To reduce these risks, many aged care homes now implement targeted fall-prevention strategies. These may include:

• Physiotherapy-led strength and balance exercises
• Environmental modifications such as improved lighting and handrails
• Appropriate footwear and mobility aids
• Regular vision and hearing assessments

Even small improvements in mobility can make a meaningful difference in maintaining independence and reducing injury risk.

Supporting Emotional Wellbeing and Social Connection
Loneliness and social isolation are common concerns for residents in their nineties. Many have experienced the loss of spouses, siblings and friends, which can significantly affect emotional wellbeing.

For aged care providers, this means creating opportunities for residents to remain connected and engaged. Strategies may include:

• Small group activities rather than large gatherings
• Reminiscence therapy and storytelling
• Music and sensory programs
• Visits from family, volunteers or therapy animals
• Opportunities to participate in familiar daily tasks

Integrating Palliative Care Earlier
Another important shift in caring for the oldest residents is the earlier integration of palliative care. Palliative care is not just about the final days of life. Instead, it focuses on relieving symptoms and improving quality of life for people with serious illness.

For residents aged 90 and over, this may involve:

• Early conversations about goals of care
• Advance care planning
• Managing pain and discomfort effectively
• Supporting emotional and spiritual wellbeing
• Involving families in decision-making

Australia’s population is ageing rapidly, and the number of people living into their nineties is expected to continue increasing in the coming decades. Aged-care providers will need to adapt clinical models, workforce training and facility design to better support residents with complex needs. At the same time, the growing focus on person-centred care, frailty management and quality of life offers an opportunity to create more compassionate and responsive care.