Geriatricians reframed as lifelong leaders of resilient health systems

Geriatric medicine should stop being seen as a specialty confined to the final decades of life and instead be repositioned as a source of leadership for health systems facing unprecedented population ageing. That is the argument of a perspective article published in Aging Clinical and Experimental Research, in which an international group of geriatricians sets out a framework they call Lifelong Health Leadership. The authors argue that the longevity era requires geriatric care to evolve beyond the reactive management of late-life complexity toward anticipatory leadership of biological, functional, social, and organizational trajectories.

The perspective, authored by Virginia Boccardi, Mathias Schlögl, Ellen Vlaeyen, Jean-Pierre Michel and colleagues, begins from a stark statistical backdrop. Recent global analyses cited in the article estimate a mean gap between healthspan and lifespan of 9.6 years across 183 World Health Organization member states. In other words, people on average spend nearly a decade of their lives with multimorbidity, frailty, disability, cognitive vulnerability, loneliness, or dependency. At the same time, the population aged 60 years and older is projected to reach 1.4 billion by 2030 and 2.1 billion by 2050. The authors contend that gains in lifespan have not been matched by equivalent gains in healthspan, and that this widening gap is the central problem health systems must confront.

Population ageing is commonly framed in three ways, according to the authors: as a demographic challenge, as a biological frontier, or as an economic pressure. Each of these perspectives, they argue, remains incomplete unless longevity is also understood as a leadership challenge. The distinction matters because the response to ageing is usually organized around treating disease after it appears, whereas the framework proposed in the article is organized around preserving function before dependency becomes established. The authors draw on established concepts including healthy ageing, intrinsic capacity, integrated care, and health-system resilience to build their case.

Intrinsic capacity, a concept promoted by the World Health Organization, refers to the composite of physical and mental capacities that an individual can draw on, and functional ability describes what a person can actually do in their environment. The perspective argues that health systems should be designed to preserve these capacities across the entire life course rather than to recover them only after they have been lost. Geriatricians, in this framing, act as physicians of trajectories: clinicians who monitor and shape the long arc of a person’s biological, functional, and social circumstances instead of intervening only at moments of crisis.

A central and deliberately modest claim of the article is that such a transformation cannot be entrusted to geriatricians alone. The authors call for shared leadership across professions, organizations, communities, and policy systems. Geriatricians would work alongside nurses, allied health professionals, managers, policymakers, patients, and communities to develop adaptive systems that maintain autonomy and resilience. The framework explicitly aligns clinical practice with organizational governance, workforce sustainability, intergenerational collaboration, and public health strategy, treating these as interconnected components of a single system rather than separate domains.

The concept of health-system resilience underpins much of the argument. A resilient system, in this view, is one that can anticipate vulnerability rather than merely absorb shocks after they occur. The authors position geriatrics as a central contributor to systems that anticipate vulnerability, preserve function, and support healthy longevity across the life course. This anticipatory stance contrasts with the reactive model in which specialist geriatric expertise is summoned only when an older patient has already accumulated multiple conditions, lost independence, or become medically fragile.

Importantly, the authors state that the Lifelong Health Leadership framework is not intended to replace traditional geriatrics. Rather, it expands the discipline’s mandate. The traditional core of the specialty, the assessment and management of complex late-life illness, remains intact. What changes is the scope: the same knowledge base that geriatricians apply to frailty, multimorbidity, and dependency in older adults is redirected upstream, informing how systems plan care, organize workforces, and design public health strategy for populations that are ageing continuously from birth onward.

The article is published as an open access perspective, a format that presents an argument or viewpoint rather than reporting new experimental data. Its evidence base consists of published global analyses and established frameworks rather than a new clinical trial or cohort study, and its projections for the older population are drawn from existing estimates. Readers should therefore understand the piece as a strategic argument about how health systems should be organized, supported by cited statistics, rather than as a demonstration that the proposed model has been tested and shown to work. The authors themselves frame the work as an aim to redefine the contribution of geriatrics across the life course and to propose a framework in which geriatricians act as lifelong health advocates.

The significance of the argument lies in its timing. With the population aged 60 and over projected to grow from 1.4 billion in 2030 to 2.1 billion by 2050, and with a mean healthspan-lifespan gap of 9.6 years already recorded across 183 countries, the cost of continuing to treat ageing as a late-life emergency is measured in years of dependency and disability. The perspective proposes that the discipline best acquainted with those outcomes should help lead the systems that prevent them, working in collaboration with every other profession and policy actor involved in care.

Subject of Research: A perspective proposing a Lifelong Health Leadership framework that repositions geriatricians as anticipatory leaders of resilient, function-oriented health systems amid global population ageing.

Article Title: Lifelong health leadership: reframing geriatrics as a model of care for resilient health systems

Article References: Boccardi, V., Schlögl, M., Vlaeyen, E., & Michel, J.-P. (2026). Lifelong health leadership: reframing geriatrics as a model of care for resilient health systems. Aging Clinical and Experimental Research. https://doi.org/10.1007/s40520-026-03538-6

Image Credits: AI Generated

DOI: 10.1007/s40520-026-03538-6

Keywords: geriatrics, population ageing, healthspan, intrinsic capacity, health-system resilience, integrated care, healthy ageing, multimorbidity, frailty, lifelong health leadership, functional ability, public health strategy