Geriatrism: A Novel Concept

The world is undergoing a profound demographic transformation. Advances in public health, nutrition, and medicine have led to unprecedented increases in life expectancy. By 2050, the number of people aged 65 years and older is projected to more than double, reaching 1.6 billion globally.[1] This “silver tsunami” presents both an opportunity and an immense challenge for societies and, most acutely, for their healthcare systems. The demand for medical care tailored to the unique physiological and social complexities of older adults is surging. Yet, paradoxically, the supply of healthcare professionals willing and able to provide this care is critically lacking. This gap is not merely a logistical problem of workforce planning; it is symptomatic of a deeper, more insidious issue. For decades, we have recognized and studied “ageism” – the stereotyping, prejudice, and discrimination directed against individuals based on their age. Ageism manifests in social exclusion, workplace discrimination, and patronizing attitudes. However, within the medical and therapeutic professions, another, more specific form of bias has emerged. This phenomenon, recently termed “geriatrism,” is defined as a negative attitude and bias not necessarily toward older people themselves, but toward the study and practice of geriatrics.[2] It represents a systemic devaluing of the medical specialty dedicated to the care of older adults, a professional aversion that deters bright, compassionate students and doctors from entering the field. While fueled by societal ageism, geriatrism is a distinct concept with its own drivers and consequences. It is a reluctance among nurses, physicians, physiotherapists, and other allied health professionals to specialize in treating individuals aged 65 years and older. This editorial will define and explore this novel concept, differentiating it from the broader construct of ageism. The editorial will also examine its manifestations within healthcare education and professional practice, analyze its societal and systemic roots, and propose a multifaceted strategy to counteract its damaging effects on our collective ability to provide dignified, high-quality care to our aging population. To understand geriatrism, one must first distinguish it from ageism.[2] Ageism is a broad social prejudice. It is rooted in negative and often inaccurate stereotypes that cast older adults as frail, cognitively impaired, unproductive, and a burden on society. Psychological frameworks, such as intergroup threat theory, suggest that ageism can arise from the perception that older adults consume a disproportionate share of health care and welfare resources, posing a threat to younger groups. This prejudice can lead to overt discrimination, such as, being denied opportunities, or subtle microaggressions that undermine an older person’s autonomy and worth. Geriatrism, in contrast, is a professional and institutional bias. It is the active or passive aversion to the field of geriatrics as a career path. An individual can hold positive, respectful views of older adults – cherishing their own grandparents, for instance – while still exhibiting geriatrism by viewing the medical specialty as unglamorous, frustrating, or professionally unrewarding. Geriatrism is less about personal animus toward the elderly and more about a collective professional judgment on the perceived merits of their care. It thrives in the lecture halls of medical schools, the corridors of hospitals, and the policy rooms where healthcare priorities are set. Table 1 illustrates the key distinctions between these two concepts.Table 1: Comparison of ageism and geriatrismThe interplay between these two phenomena is undeniable. Pervasive societal ageism creates a fertile ground for geriatrism to grow. When a culture relentlessly celebrates youth and bombards its members with messages that equate aging with decline and dependency, it is hardly surprising that medical students would internalize the idea that specializing in the care of older adults is a career dead end. The ageist caricature of the “difficult” or “declining” older patient makes the entire specialty seem emotionally draining and devoid of the satisfying, curative victories glorified in other medical fields.[3] The impact of geriatrism is most visible in the dual arenas of healthcare education and professional practice, where it creates a self-perpetuating cycle of neglect and workforce shortage. The seeds of geriatrism are often sown early in medical and therapeutic training. A comprehensive scoping review of undergraduate medical education found that while nearly every future doctor will treat older adults, the geriatric content in curricula is often minimal, fragmented, or relegated to an afterthought. When a subject is given little curricular time, it sends a powerful message to students about its relative importance.[4] This lack of focus translates directly into a staggering lack of interest. Studies consistently show that only a small fraction of medical students – often as low as 3%–4% – express a strong interest in pursuing geriatrics as a career. This is not limited to physicians. A study of rehabilitation students in China, for example, found that while they held generally positive personal attitudes toward older people, fewer than 42% were willing to engage in geriatric rehabilitation after graduation. This highlights the core of geriatrism: the disconnect between liking older people and wanting to dedicate one’s professional life to their care. The reasons cited for this reluctance are telling: students perceive the work as too hard, the pay as too low, communication as too difficult, and the field as being disrespected. The educational pipeline’s failure to produce geriatric specialists creates a significant workforce crisis. This reluctance to specialize is not limited to a few fields but is seen across nursing, physiotherapy, psychology, and medicine. The result is a system where the vast majority of older adults are cared for by professionals with little to no specialized training in the complexities of aging. For those who do consider the specialty, a number of perceived barriers, rooted in geriatric thinking, stand in the way. These include the intellectual challenge of managing complex multimorbidity being overshadowed by the perception of futility; the emotional weight of dealing with chronic illness, cognitive decline, and end-of-life issues; and the time-consuming nature of comprehensive geriatric assessments in a system that incentivizes speed and patient turnover. Compounding this are systemic disincentives, including lower financial remuneration compared to procedural specialties and a perceived lower status within the medical hierarchy. This leads to a vicious cycle: the field is seen as undesirable, so few enter it, leading to a shortage of mentors and advocates, which further reinforces its marginalization.[1,5] Geriatrism is not a spontaneous phenomenon; it is the product of deeply ingrained societal values, reinforced by educational and systemic structures. First, modern society, particularly in the Western world, is overwhelmingly focused on youth. Media, marketing, and popular culture are saturated with images of vitality and vigor, while aging is often portrayed as something to be fought, delayed, or hidden. The medical field itself is not immune to this bias. The “heroic” narrative in medicine is often centered on dramatic interventions, technological marvels, and definitive cures. Geriatric medicine, with its focus on managing chronic conditions, preserving function, and optimizing quality of life rather than chasing cures, fits poorly into this narrative. It requires a different kind of heroism – one of patience, holistic understanding, and compassionate collaboration – that is often undervalued. Second, educational deficiencies are both a symptom and a cause of geriatrism. Students who receive inadequate or uninspiring training in geriatrics are unlikely to develop a passion for it. Research has shown that many students enter their training with a low level of knowledge about the normal aging process, often conflating it with disease. This knowledge gap can breed a sense of anxiety and helplessness when faced with complex older patients, making the specialty seem intimidating rather than intellectually stimulating. Without exposure to positive role models and the deeply rewarding aspects of geriatric care, students are left with only the ageist stereotypes to inform their career choices. Finally, systemic and economic factors cement geriatrism’s place in the healthcare landscape. Healthcare systems are predominantly designed for acute, episodic illness, not the longitudinal, integrated, team-based care that older adults with multiple chronic conditions require. This structural mismatch makes the practice of geriatrics incredibly challenging. When combined with pay structures that reward procedural interventions far more generously than the cognitive, time-intensive work of geriatricians, the choice to enter the field becomes an act of financial and professional sacrifice for many. Dismantling geriatrism requires a concerted, multipronged effort focused on education, policy, and culture. The most critical front in this battle is educational reform. As Hayim Mizrahi and others have argued, comprehensive geriatric education must become a mandatory, core component of all therapeutic training programs. This cannot be a single, isolated course in the final years of study. Instead, principles of geriatric care must be vertically integrated throughout the curriculum, from foundational anatomy that discusses the changes of normal aging to clinical rotations in every specialty that highlight the unique presentations of disease in older adults. Young doctors in surgery, cardiology, and every other field must spend meaningful time in geriatric departments to understand how to provide effective care to the largest patient demographic they will encounter in their careers. Furthermore, teaching methods must evolve beyond traditional lectures to include experiential learning that fosters empathy, such as senior mentor programs, interprofessional team simulations, and clinical placements in diverse settings such as nursing homes and community clinics.[1,2,6] These educational changes must be supported by systemic and policy shifts. Healthcare systems must create and fund models of care that support best practices in geriatrics, such as interdisciplinary teams and adequate time for comprehensive assessments. Policymakers and healthcare leaders must address the remuneration gap, ensuring that the complex cognitive work of geriatric specialists is valued and compensated appropriately. As the population ages, dedicated funding must be allocated to establish hospitals and clinics specifically designed for older adults and to acquire the suitable equipment necessary for their treatment. Finally, we must work to shift the cultural narrative around aging and geriatric medicine. The intellectual sophistication required to manage the interplay of multiple diseases, the profound human connection forged with patients and their families, and the immense satisfaction derived from improving an individual’s quality of life are powerful stories that need to be told. By challenging societal ageism and highlighting the unique rewards of the specialty, we can begin to reframe geriatrics not as a lesser choice, but as one of the most complex, vital, and fulfilling callings in all of health care.[6] Geriatrism is a pervasive and damaging bias within the healthcare professions that threatens our capacity to care for a rapidly aging world. It is a concept distinct from ageism, representing a professional aversion to the specialty of geriatrics that is fueled by cultural values, educational deficits, and systemic disincentives. The consequences are stark: a critical and growing shortage of professionals with the skills and passion to care for older adults. Acknowledging and naming this phenomenon is the first essential step toward addressing it. Geriatrism is not an insurmountable problem, but it demands our urgent attention. Through comprehensive educational reform, strategic policy changes, and a deliberate effort to change the professional narrative, we can dismantle the biases that devalue the care of our elders. By doing so, we can ensure that geriatrics is recognized not as a career of last resort, but as a specialty of utmost importance – one that attracts the best and brightest to the noble work of helping people live not only longer, but better.