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Geriatrics is the branch of medicine concerned with the health and care of older adults. A geriatrician is a physician who has completed training in internal medicine or family medicine and then additional training in geriatric medicine, and who diagnoses, treats and coordinates care for people in later life, particularly those living with several chronic conditions, changes in thinking or mobility, and complicated medication regimens. Geriatrics is a clinical discipline. It is closely related to, but not the same thing as, gerontology, the broader science of aging. This guide explains the difference, what geriatrics covers, the frameworks and tools clinicians use, why research involving older adults raises its own methodological and regulatory questions, who funds that research, and how people train in the field.
Geriatrics vs. Gerontology: The Core Distinction
The two words are often used interchangeably in everyday speech, but in research and education they describe different things:
- Geriatrics is a clinical specialty. Its object is the patient: assessing, treating and managing disease and function in an older person. It sits inside medicine, alongside nursing, pharmacy, rehabilitation and social work practice.
- Gerontology is the multidisciplinary study of aging itself, spanning biological, psychological and social questions. A gerontologist may be a cell biologist, a sociologist studying retirement, or a policy analyst, and may never see a patient. Our guide to what gerontology is covers that side of the field.
A useful shorthand is that gerontology produces much of the knowledge about how people age, and geriatrics applies knowledge from many sources to the care of individual older patients. The two overlap heavily in research: studies of how medications behave in older bodies, how frailty develops, or how hospital care affects cognition draw on both traditions. The National Institute on Aging reflects the overlap in its own organization, where its extramural program includes an area explicitly named geriatrics and clinical gerontology alongside the biology of aging, behavioral and social research, and neuroscience.
Where the Word Comes From: A Short History
The term “geriatrics” was coined by Ignatz Leo Nascher, a New York physician, in a 1909 article in the New York Medical Journal. He built it from Greek roots meaning old man and relating to the physician, by analogy with pediatrics. In 1914 he published a textbook titled Geriatrics: The Diseases of Old Age and Their Treatment. The American Geriatrics Society was founded on June 11, 1942, and Nascher was among its founding physicians. The National Institute on Aging was established in 1974 as part of the U.S. National Institutes of Health, giving aging research a dedicated federal home. Since then geriatrics has developed formal fellowship training, board certification pathways, validated assessment instruments and a research literature of its own.
What Geriatrics Covers
Geriatric care is organized less around single organ systems than around the combinations of problems that tend to occur together in later life. Common areas of focus include:
- Cognition and mood: dementia, delirium and depression, including screening and differentiating between them. Brief cognitive instruments such as the Mini-Cog and the Montreal Cognitive Assessment are widely used in clinical care and as research measures.
- Mobility, falls and function: balance, gait, fall prevention and the ability to carry out activities of daily living. Instruments such as the Timed Up and Go test and the Katz Index of Activities of Daily Living quantify function.
- Medications: adjusting, simplifying and deprescribing regimens, and avoiding drug choices that carry greater risk in older patients.
- Frailty and multimorbidity: recognizing reduced physiological reserve and planning care around several coexisting conditions rather than one.
- Care transitions and settings: hospital, post-acute care, home, assisted living and nursing homes, including medication reconciliation at each handoff.
- Goals of care: aligning treatment with what the patient values, including palliative and end-of-life planning.
The Geriatrics 5Ms
One widely used organizing framework is the Geriatrics 5Ms, developed in 2017 by Canadian and U.S. specialists in geriatric medicine. The five domains are Mind (cognition, dementia, delirium, depression), Mobility (movement, safe mobility and fall prevention), Medications (optimal prescribing, adherence and reducing unnecessary or harmful drugs), Multicomplexity (the whole person, including multiple conditions and complicated needs) and what Matters most (the patient’s own goals and care preferences). The framework is a teaching and care-planning aid, not a diagnostic standard, but it shows how geriatrics differs from organ-based specialties: the unit of analysis is the person and their goals.
Comprehensive Geriatric Assessment
Comprehensive geriatric assessment is a multidimensional, usually interdisciplinary process that evaluates medical conditions, cognition, mood, function, medications, nutrition, social support and environment, and then builds a coordinated care plan. It is a core clinical method of the specialty and also an intervention that is evaluated in trials, which makes its definition and delivery an important detail whenever a study reports on it.
Related Specialties and Professions
Geriatrics is team-based. Geriatric nursing, geriatric psychiatry, geriatric pharmacy, physical and occupational therapy, and social work all contribute. Geriatric psychiatry is a focus within psychiatry; the nursing research tradition is described in our guide to nursing science; and the study of cognition and neurodegenerative disease overlaps with neurology. Palliative medicine, rehabilitation medicine and primary care each share patients and questions with geriatrics.
Research on Older Adults: Why It Needs Its Own Methods
Older adults carry a disproportionate share of disease burden, yet they have historically been underrepresented in clinical research, partly because of age cut-offs and exclusions for comorbidity, disability or concurrent medication. The result is an evidence gap: treatments are often used in older patients who resemble few of the people in the pivotal trials. Geriatric research tries to close that gap and has developed methods suited to the population.
Inclusion Across the Lifespan
In the United States, Section 2038 of the 21st Century Cures Act, enacted December 13, 2016, directed NIH to address age as an inclusion variable in research involving human subjects. NIH’s response was the Inclusion Across the Lifespan policy (notice NOT-OD-18-116), which extended its earlier policy on the inclusion of children to people of all ages, including older adults. It took effect in January 2019. Under it, investigators must include participants of all ages unless there are scientific or ethical reasons not to, and age-based exclusions need to be justified rather than applied by default. Research administrators will recognize this as a human subjects and application-content requirement, covered alongside related policy in our dictionary entry on NIH inclusion policies.
Frailty
Frailty describes reduced physiological reserve and heightened vulnerability to stressors such as illness, surgery or a new medication. There is no single universally accepted definition; different instruments operationalize it as a phenotype or as an accumulation of deficits, and a study’s results can depend on which is used. Clinical tools such as the Clinical Frailty Scale are used both for bedside risk stratification and for describing study populations. Because frailty varies widely among people of the same chronological age, it is increasingly used as an eligibility criterion, a stratification factor or an outcome, and protocols need to state clearly how it is measured.
Polypharmacy and Medication Safety
Polypharmacy refers to the use of multiple medications at once. Definitions vary, and not every multi-drug regimen is inappropriate, so the research and clinical focus is on appropriateness rather than a drug count. Explicit criteria support that review. The American Geriatrics Society publishes the AGS Beers Criteria, a list of potentially inappropriate medications for older adults, and the STOPP/START criteria offer a complementary European approach that also flags potentially omitted beneficial treatment. Good medication histories and medication reconciliation at transitions of care are standard safeguards. For trials, polypharmacy complicates attribution of adverse events and creates interaction risks that narrow trial populations tend to miss.
Design Issues Common to Geriatric Studies
- Outcomes that matter to patients: function, independence, quality of life and cognition often matter more than a laboratory value or a single-disease endpoint.
- Competing risks and attrition: death and loss to follow-up are more common in older cohorts and can bias naive analyses.
- Capacity and consent: studies including people with cognitive impairment need a considered approach to assessing capacity, surrogate consent and assent, and IRB review.
- Participation barriers: transport, sensory impairment, caregiver involvement and visit burden can all limit enrolment and retention, so recruitment plans need to address them.
- Longitudinal design: many questions about aging require repeated measures over years; see our guide to longitudinal study design.
Funding for Geriatrics and Aging Research
The National Institute on Aging, part of NIH and established in 1974, is the lead U.S. federal funder of aging research, including clinical geriatrics research. Its mission covers biomedical, social and behavioral research and training related to the aging process and the diseases and special problems of older people. Applicants to NIA follow the standard NIH process: a funding opportunity, a peer-reviewed application, and a funding decision informed by the institute’s paylines and priorities. Our pages on the NIA payline and on NIH paylines across institutes explain how those thresholds work and how to read them. Because paylines and policies change from year to year, always check the current NIA website and the specific funding opportunity rather than relying on any summary. Other NIH institutes also fund work relevant to older adults, for example in cancer, cardiovascular disease and mental health, and private foundations and professional societies support training and demonstration projects. Outside the U.S., national research councils and health research agencies fund comparable programs.
Training and Career Paths
In the United States, the usual route to becoming a geriatrician is medical school, a residency in internal medicine or family medicine, and then a one-year geriatric medicine fellowship accredited by the ACGME. Graduates may seek subspecialty certification in geriatric medicine from the American Board of Internal Medicine or a certificate of added qualifications from the American Board of Family Medicine. Other routes include geriatric nursing and nurse practitioner tracks, geriatric pharmacy, physical and occupational therapy, and social work. Physician-scientists in geriatrics often combine fellowship with research training and early-career awards from NIA or other funders. Requirements differ by country, so consult the relevant licensing body for current rules.
Journals and Professional Societies
- American Geriatrics Society (AGS): a professional society founded in 1942 for health care professionals in geriatric medicine, which publishes the Journal of the American Geriatrics Society and the AGS Beers Criteria.
- Gerontological Society of America (GSA): a multidisciplinary society for the study of aging, publishing The Journals of Gerontology series, including a medical sciences series.
- British Geriatrics Society: the UK professional body for geriatric medicine, associated with the journal Age and Ageing.
Why Geriatrics Matters to Research Administration
For research offices, geriatric studies raise recurring compliance and operational questions: justifying age-based eligibility criteria under the NIH inclusion policy, IRB review of studies involving adults who may lack decision-making capacity, data and safety monitoring for populations at higher baseline risk of adverse events, and budgets that account for longer visits, caregiver involvement and home or facility-based data collection. Careful protocol language on frailty measurement and medication data prevents problems at review and at publication. The broader methods background is collected in the research methods hub.
Frequently Asked Questions
What is the difference between geriatrics and gerontology?
Geriatrics is the medical specialty that cares for older patients. Gerontology is the broader, multidisciplinary science of aging, covering biological, psychological and social aspects. Geriatrics draws on gerontology, and researchers in both fields often collaborate.
What does a geriatrician do?
A geriatrician is a physician trained to care for older adults, often those with several conditions and complex medication needs. Work typically includes comprehensive assessment, medication review, attention to cognition, mobility and function, and coordination with other clinicians and caregivers. This guide is educational and is not medical advice.
When is geriatrics a field of research as well as practice?
Whenever studies examine how best to diagnose, treat or organize care for older people, including trials of medications, falls prevention, delirium prevention, models of care and deprescribing. Geriatric research is funded mainly through NIA and other NIH institutes in the U.S.
Why are older adults often excluded from clinical trials?
Historically, trials used upper age limits and excluded people with multiple conditions, disabilities or many concurrent medications to simplify analysis. NIH’s Inclusion Across the Lifespan policy now expects scientific or ethical justification for age-based exclusions.
Is there one definition of frailty or polypharmacy?
No. Both are defined in several ways depending on the instrument or study, so papers and protocols should state exactly how each was measured.
How do you become a geriatrician in the United States?
Complete medical school, a residency in internal medicine or family medicine, and a one-year geriatric medicine fellowship, then pursue board certification through the relevant board.
Where can I read more?
Start with our guide to gerontology, then the guides on the Beers Criteria and the Clinical Frailty Scale.
