Care System Fragility in Ageing Societies: A Nursing Perspective on Vulnerability, Dependency and Continuity of Care

ABSTRACT Population ageing has intensified the challenge of sustaining continuity of care as care needs become more prolonged and interdependent across health and social care systems. Existing perspectives illuminate individual vulnerability, system adaptation and care organisation, but provide less insight into how continuity is sustained when changing care needs become increasingly difficult to reconcile with the arrangements supporting them. This paper develops care system fragility as a nursing‐informed relational and sensitising concept for examining this problem. It directs attention to how responsibility and compensatory work may be redistributed across organisational and social boundaries when formal arrangements become less well aligned with practical care requirements. Continuity may remain apparently intact while becoming increasingly dependent on additional work by nurses, families and other actors. Nursing is central to this inquiry because nurses both participate in sustaining continuity and encounter the conditions under which additional coordination and compensation become necessary. This gives nursing an important epistemic position from which to distinguish sustainable adaptation from continuity that increasingly depends on redistributed and less visible compensatory work. Care system fragility therefore draws attention to the work required to maintain continuity, the people and organisations undertaking it and the conditions that enable them to continue doing so.