Geriatric Medicine Matters

The added value for Healthcare systems
and Policymakers

Current demographic challenges due to population ageing result in an unprecedented pressure on healthcare systems, in terms of workforce tension, social impact and financial sustainability.

Geriatric Medicine [1] is a specialty of medicine [2] concerned with physical, mental, functional and social conditions in acute, chronic, rehabilitative, preventive, and end of life care in older patients. It focuses on individuals living with frailty and multimorbidity, whose needs extend beyond traditional organ-based paradigms of care and demand multidisciplinary, holistic management aimed at preserving function, autonomy, and quality of life.

Beyond being a medical specialty, Geriatric Medicine also exemplifies a clinical approach tailored for older people, while encompassing age-attuned aspects of healthcare. This approach can be perceived as an additional key skill for healthcare providers, granting a unique competence-based framework for managing frailty, multimorbidity, cognitive impairment, polypharmacy and functional decline - conditions that increasingly dominate healthcare utilization and expenditures in ageing societies.

Establishing Geriatric Medicine successfully in healthcare systems is a cost-effective [3], system-level solution to population ageing that improves functional outcomes [3], reduces hospital burden [4], and strengthens health system sustainability [5].

Geriatric Medicine is not an optional specialty—it is the core component of health systems required to deliver effective, person-centered and sustainable care in modern European societies. It can lead the transformation to a healthcare environment more attuned to older people’s needs. No European citizen should be deprived of the equity in quality healthcare.

Key messages

Healthcare systems are challenged by the specific needs of a continuously growing and heterogenous ageing population.
Geriatric Medicine is essential for sustainable health systems especially in societies with a growing share of older people, reducing costly healthcare and hospital use and institutionalization.
Geriatric Medicine also improves outcomes that matter to the older person and society: namely functional ability and quality of life.
Policies promoting education of the health workforce, establishment of adequate geriatric structures and services and integration of care have the potential to enhance care for older people.
Investment now prevents system overload later.

Presenter showing healthcare data to a meeting

This publication is based upon work from COST Action PROGRAMMING 21122, supported by COST (European Cooperation in Science and Technology). COST is a funding agency for research and innovation networks. Our Actions help connect research initiatives across Europe and enable scientists to grow their ideas by sharing them with their peers. This boosts their research, career and innovation. The present document is a tool designed to engage healthcare policymakers and managers to the integration of principles of Geriatric Medicine in the systems they manage, highlighting systemic and economic benefits. It was generated by a multiple step co-creation and review process by researchers engaged. The content is structured around three core questions: Why geriatric medicine is important for healthcare managers and policymakers, What policy changes are required, and How to implement them.

I. Why Geriatric Medicine matters

SYSTEMIC MISMATCHCurrent systems, primarily designed around single-organ diseases rather than adopting a holistic approach, need to evolve to respond to the needs of older adults with complex overall health needs, as dramatically revealed during the COVID-19 pandemic.

QUALITY OF CARE IMPROVEMENT AND SOCIETAL APPRAISALFragmented and poorly coordinated care fuel increased costs, inefficiency, inequity and user dissatisfaction. The holistic approach exemplified by Geriatric Medicine enables integrated care [6] and improves patient-relevant outcomes [7] such as quality of life and disability-free longevity [8], providing service satisfaction to the biggest share of healthcare users [3].

FINANCIAL EFFICIENCYGeriatric Medicine, as a clinical approach, can be a high-return investment that saves money by preventing unhealthy ageing trajectories in late life [5], reducing inappropriate polypharmacy, reducing outpatient [8] and emergency department [9] visits, shortening lengths of hospital stay by 4.1 days [10], saving a mean of €620 per fragility fracture admission and up to €1,320 per patient in perioperative care [11,12], reducing up to 51% hospital readmissions [13], preventing costly complications, such as functional decline [13,14] and nursing home admissions by 22% [15], and alleviating end-life disability [16].

ENHANCED PRODUCTIVITYGeriatric Medicine-aligned systems extend independent living, supporting longer active lives, while reducing long-term care expenditure, as well as the major social and financial burden of informal caregiving [17], which can reduce family income by up to 45%.

POLICY ALIGNMENT AND INTERNATIONAL ACCOUNTABILITYImplementation of policies targeting older adults’ healthcare aligns national health plans with international standards, such as the United Nations Decade of Healthy Ageing and World Health Organization (WHO) priorities. [18]

Better care, lower costs.

Health systems need geriatric expertise to function effectively.

II. What policy changes are needed to achieve meaningful impact

Healthy Ageing as
a Policy Priority

Moving from a disease-centered model to one that prioritizes functional ability and independence in self-care in older age and promotes preventive public health policies for healthy longevity. [3]

System
Integration

Ensuring access to high-quality, integrated and continuous care [19,20] for older people across healthcare services, in line with the WHO ICOPE (Integrated Care for Older People) framework. [6]

Workforce
Optimization

Addressing the workforce challenge by training healthcare professionals on basic skills of older adult care, developing a critical mass of specialized professionals and creating frameworks to promote interprofessional teamwork and professional skill-mix. [21]

III. The “How”: Implementation aspects

Depending on the baseline status of each system and the strategic priorities locally defined, different implementation actions need to be selected and adapted. [22]

1. CONTEXT-SENSITIVE IMPLEMENTATION AND GOVERNANCE

Conduct country-specific gap analyses to map existing resources, identify needs and prioritize domains to guide investment.
Develop National Frameworks adapted to local contexts and aligned with European and international standards [18], to deal with the multi-dimensional challenges of ageing and related health and social issues.
Promote co-creation with stakeholders (health professionals, policymakers, academia, civil society) and support implementation research to ensure scalability and sustainability.
Create the framework for providing independent scientific input to policymakers for evidence-informed decision-making.
Implement national benchmarking, audit systems, and accreditation mechanisms supported by real-world data to monitor quality, cost-effectiveness and system performance and scale up effective practices.

2. REFORMING AND STRENGTHENING HEALTH SYSTEMS AND SERVICE DELIVERY

Establish minimum standards and quality criteria for geriatric structures and services, including workforce requirements.
Develop centres of excellence in Geriatric Medicine with regional coordination, training, research and innovation roles, connected to community services.
Deploy mobile multidisciplinary geriatric teams across hospitals and community care to improve access and continuity of care.
Support primary care and enable the assessment of older people’s overall health and functional ability [6], and the early identification and management of common age-related conditions.
Leverage digital tools and innovative technologies (telemedicine, electronic health records, artificial intelligence-AI) to optimize resources, enhance integration and reach and promote gerotechnology and digital health solutions to support independent living and monitoring. [3]
Reform financial models that incentivize protocol and procedure implementation and reward functional outcomes and prevention (e.g. pay-for-performance, adapted nomenclature, Patient-Reported Outcomes Measures and Patient-Reported Experience Measures) [23].

3. CAPACITY BUILDING THROUGH EDUCATION AND TRAINING

Recognize Geriatric Medicine as a specialty or subspecialty across all countries and strengthen the role of geriatricians [2] as a multifaceted asset for healthcare systems (clinical, educational, research, policy advisory).
Create the basis for multidisciplinary teamwork by:
a) building a critical mass of trained healthcare professionals through targeted investment, including vocational training, “train-the-trainer” models and international twinning programs;

b) establishing mandatory core competencies and facilitating continuous professional development in the care of older adults for all health workers;

c) integrating basic geriatrics into undergraduate education for all healthcare professionals and providing opportunities for postgraduate education.
Strengthen the role and leverage the outputs of universities, scientific societies, and European networks (such as PROGRAMMING COST Action 21122) in education, research, and knowledge dissemination. Leverage national and international expertise, including advisory groups and scientific networks, to support strategic planning and implementation.

4. PUBLIC AWARENESS AND SOCIETAL ENGAGEMENT

Implement national healthy ageing campaigns to raise awareness, empower older people and combat ageism. [24]
Improve access to reliable health information, including health and digital literacy initiatives (e.g. seminars, hotlines, community information centers).
Engage citizens and caregivers as active partners in care design, delivery and quality evaluation.

Key Conclusions

Effective implementation of Geriatric Medicine requires coordinated action across the spheres of policy, financing, workforce, and service delivery, adapted to national contexts and focused on measurable improvements in functional outcomes and quality of life for older people.

Without structural implementation of Geriatric Medicine principles, healthcare systems risk becoming increasingly inefficient, fragmented and economically unsustainable under the pressure of demographic ageing.

Investment in Geriatric Medicine should therefore not be viewed as an additional healthcare expense, but rather as a strategic societal investment in sustainability, functionality and dignity across the life course.

Transparency statement: Generative AI was used solely to assist with editorial revision of an initial human-authored manuscript, including improving language, shortening text, and synthesizing complex ideas into concise wording. AI also assisted in identifying potentially relevant literature, whereas, all references were independently verified, critically appraised, and selected by the authors. The evidence base, policy recommendations, interpretation, and final content were developed, critically reviewed, and approved by the authors, who retain full responsibility for the document.

MORE RESOURCES (available at www.cost-programming.eu/):

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REFERENCES:

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MAIN COORDINATORS’ TEAM (in alphabetical order):

Rui Buzaco Family Unit, Clínica CUF Estádio José de Alvalade, Lisbon, Portugal Monserrat Conde Nuffield Department of Primary Care Health Sciences, University of Oxford; Cochrane Global Ageing, UK Sofia Duque Internal Medicine Department, Hospital Cuf Descobertas, Lisboa; Nova Medical School, Lisboa. Portugal Anne Wissendorff Ekdahl Department of Clinical Sciences, Helsingborg Hospital, Faculty of Medicine, Lund University, Lund, Sweden Meltem Koca Department of Geriatric Medicine, Etlik City Hospital, Ankara, Türkiye Marina Kotsani Hellenic Society for the Study and Research of Ageing, Athens, Greece Serdar Ozkok Department of Internal Medicine, Division of Geriatrics, Istanbul University, Istanbul, Türkiye Karolina Piotrowicz Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland Maria Tampaki Athens Chest Hospital 'Sotiria' and National and Kapodistrian University of Athens, Greece.

TASK & FINISH WORKING GROUP:
Additionally to the main coordinators (in alphabetical order)

Athanase Benetos University of Nancy, INSERM u1116, Nancy, France Nenad Bogdanovic Karolinska Institutet, Stockholm, Sweden Sylvie Bonin-Guillaume Aix Marseille University, University hospital of Marseille, France Tahir Masud Nottingham University Hospitals NHS Trust, UK Ian Perera Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland (proofreading) Mirko Petrovic Ghent University, Ghent, Belgium Maria Cristina Polidori University Hospital of Cologne, Germany Roman Romero-Ortuno Trinity College Dublin, Ireland Tamar Yellon Hebrew University of Jerusalem, Israel.