With over 140 million people aged 60 and above, and projections suggesting this number will almost double by 2050, we are facing a quiet, yet important demographic shift. Despite this, our medical training institutions continue to give limited attention to geriatrics, often leaving it out altogether. This raises an important question: can we honestly expect our future doctors to fully care for older adults if they graduate without a foundational understanding of ageing processes, multi-morbidity, or elder-specific ethical considerations?
A few years ago, I was working at a well-known government hospital, when a worried son brought in his frail 82-year-old mother to the emergency room. She had become increasingly confused over the past two days and had stopped eating. The young resident on duty, new out of medical school, quickly ordered a CT scan of her brain and called for a neurology consult, thinking it might be a stroke or some form of neurological decline. But as I watched her, something about her dry tongue, sunken eyes, and crumpled hospital gown made me pause. I asked, “Did she have a fever recently?” The son shook his head. “Any new medications?” He thought for a moment. “Just a new tablet (an antihistamine) for her itching.”
A quick bedside check showed that the patient was severely dehydrated. It turned out that she had developed acute delirium, because of a simple urinary tract infection, made worse by the sedating antihistamine. No strokes, no complicated tests were needed in this case — it was just an older person presenting in a way that was easy to miss if one was not aware that in senior citizens, infections often do not cause fevers, and confusion is often the first sign. Within 48 hours of IV fluids administration and antibiotics, she was back to normal. But I could not shake the image of the resident’s face. Months later, he told me, “We were not taught any of this in medical school. I did not even realise that confusion could be the first clue of an infection in older adults.”
Neglected area
Having spent years in the geriatrics department across both government and private setups in India, I have seen, firsthand, how neglected elder care training remains. Many young doctors graduate with a solid knowledge of paediatrics or obstetrics, yet they are often unprepared to handle complex issues common in older patients, such as delirium, medication management, or frailty. Ironically, the very population that consumes most healthcare services has the least representation in our medical education system. This needs to change — and it needs to happen fast. Geriatrics should not be treated as just a small chapter in community medicine or an optional internship. Instead, it must be a core component of both undergraduate and postgraduate training, with assessments reflecting its importance.
To make this a reality, I am proposing 10 practical, evidence-based policy steps drawn from successful practices around the world, customised to fit India’s unique context.
But before that, let us understand why including geriatrics in the medical curriculum matters. Older adults are the norm, not the exception in healthcare settings. In many outpatient clinics, 30 to 50% of patients are over 60. Yet our MBBS graduates are not equipped to perform a Comprehensive Geriatric Assessment (CGA), a globally-recognised tool proven to reduce hospital admissions and improve patient outcomes. Geriatric syndromes are often overlooked. Conditions including falls, dementia, frailty, incontinence, elder abuse, and polypharmacy frequently go unnoticed or are misdiagnosed. Since our internal medicine training does not delve deeply into these issues, many doctors miss important signs, resulting in inappropriate treatments and poorer health outcomes for older adults.
Countries such as the U.K., Australia, and Canada have embedded geriatrics into their core medical curricula. The British Geriatrics Society, for example, mandates geriatric rotations during medical school years. There is no reason India cannot adopt similar approaches to enhance elder care training.
Failing to equip doctors with elder-specific skills indirectly denies older Indians access to quality care. Our medical education system must adapt to meet the demographic realities we face, ensuring health equity across all age groups.
To close these gaps, here are 10 policy solutions that could create a major impact:
1.Mandatory geriatric clerkship with CGA certification: Just as paediatrics and obstetrics are core parts of the MBBS curriculum, a four-week rotation in geriatric medicine should be made compulsory by the National Medical Commission. Every student needs to undergo training and earn a certification in Comprehensive Geriatric Assessment (CGA), which is the gold standard in elder care. For example, the Kerala University of Health Sciences introduced geriatrics as a dedicated subject within the MBBS curriculum back in 2023 — an approach that could serve as a model for the entire country.
2.Increasing postgraduate geriatrics intake through smart incentives: Currently, India trains fewer than 100 MD Geriatrics specialists each year, which is nowhere near enough. Turning one in every 10 MD general medicine seats into geriatrics could add over 150 seats annually. Besides, providing 200% funding for infrastructure in both public and private hospitals to support DNB (Diplomate of the National Board) Geriatrics would make a big difference. The goal is to reach at least 50 new DNB Geriatrics seats by 2026.
3.Developing geriatric faculty: A major challenge is the shortage of trained professors. Launching fellowships through the Ministry of Health and Family Welfare to send 100 Indian geriatricians abroad each year — particularly to the U.K. and Australia — for structured training would help build capacity. Requiring a bonded service period of five years in Indian colleges ensures the investment pays off. Offering a 30% salary premium, comparable to cardiology, could attract more specialists into geriatrics.
4.Involving the private sector: National Accreditation Board for Hospitals & Healthcare Providers (NABH)-accredited hospitals with over 500 beds should be required to either start DNB Geriatrics programmes or partner with medical colleges to provide training in elder care. Successful public-private partnerships like those already seen in Tamil Nadu and Karnataka can be scaled nation-wide to widen access.
5. State-level initiatives:States such as Bihar, Odisha, and many in Northeast India lack MD Geriatrics programmes. Providing grants of ₹10 crore along with mentorship models like AIIMS Delhi–Patna could help establish these programmes. Without addressing regional disparities, elderly populations in underserved areas will remain doubly marginalised.
6.Updating curriculum for allied health workers: Incorporate geriatric pharmacology modules into PharmD, nursing, and BSc Allied Health programmes. Data shows that 63% of prescriptions for elderly patients in India are potentially inappropriate, representing a serious patient safety issue that better pharmacological training can mitigate.
7. Financial support via PM-JAY: Dedicate 1% of the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) budget — around ₹800 crore — to: establishing geriatric outpatient departments in district hospitals, reimbursing Comprehensive Geriatric Assessment (CGA) for eligible older patients and training general practitioners in elder care.
8.Using data to guide policy: Implement a National Geriatric Registry to track the number of geriatricians, their geographical distribution, and service coverage, similar to the U.K.’s Geriatric Workforce Census. Also, reduce accreditation scores for colleges that lack geriatric faculty or departments — what gets measured tends to get prioritised and funded.
9.Legislative action: A Geriatric Care Bill – support a bill proposing that all medical colleges establish dedicated geriatrics departments by 2030 and at least 5% of the national health budget should be allocated to geriatrics education and services. This Bill would be both a symbolic and strategic move to embed accountability and drive priority.
10.Raising awareness and reforming exams: Include geriatrics explicitly in the syllabus in both formative and summative assessments during MBBS. Run nation-wide campaigns to challenge the misconception that geriatrics is simply a retirement niche and instead, emphasise its role as a critical, intellectually demanding frontline specialty.
A turning point
India is approaching a critical demographic turning point. We have roughly 25 years before the growing number of older adults begins to strain our healthcare systems beyond their limits. The way we prepare our doctors today will determine whether our health infrastructure buckles under preventable age-related illnesses, or advances to become a leading example of age-sensitive care.
Integrating geriatrics into medical education is not just about updating curricula —it is about justice, strengthening public health, and shaping a stronger nation. As a geriatrician, I see this as not only necessary but urgent. We should not wait for our system to falter before taking action.
It is time to develop a training approach that equips doctors not only to treat illnesses, but to genuinely care for people throughout their lives.
(Dr. Priyanka Rana Patgiri is a consultant in geriatrics at Apollo Hospitals, Chennai. priyanka.rana.patgiri@gmail.com)
This article was first published in The Hindu’s e-book Shades of Grey: Geriatric Care and its Social and Economic Facets
