Abstract: The health of the neuromuscular system is critical in maintaining physical activity and self-care ability in older adults. Delaying the natural aging of the neuromuscular system to enhance life quality has become a key focus in the area of elderly rehabilitation. Strength training is the most widely adopted strategy in delaying neuromuscular aging. Over the past three decades, with the application of new technologies and methodologies, studies provided more evidences in deepening our understanding of the mechanisms through which strength training counters age-related declines. This study reviews the progress in neuromuscular adaptation to strength training in older adults, and the results show: 1) Age-related degeneration in older adults leads to a decline in neuromuscular adaptation, the elderly individuals exhibit extended neural adaptation and delayed muscular adaptation. 2) In the long term, the benefits of neuromuscular adaptations to strength training are primarily observed in the supraspinal level, neuromuscular junctions, and muscle fibers. However, these adaptations are constrained by the irreversible nature of age-related decline. 3) From a neuromuscular adaptation perspective, very elderly adults (≥80 years) can still benefit from strength training. 4) A relatively low load in the initial phase of strength training can induce optimal neuromuscular adaptation, while higher training load offers no additional benefit. 5) Current research on the effects and mechanisms of strength training in the elderly is limited, with findings often affected by research methods, experimental tasks, target muscles, and contraction intensities, which highlighting the need for more studies to explore neuromuscular adaptation in older adults by using new technologies and methods.