How the COST Action is transforming geriatric medicine across Europe

Europe is getting older. People are living longer than ever before, but a longer life does not always mean a healthier life. Chronic illness and disability often come with ageing, creating a burden not only for families but also for healthcare systems and society.

Recognising this, the World Health Organisation launched the Decade of Healthy Ageing (2021–2030), calling for global action to improve the lives of older people around the world.
The challenge is not simply helping people live longer, but helping them live better. According to studies, a large part of poor quality of life in later years can be prevented or delayed with the right care at the right time.
This is where geriatric medicine becomes essential. Unlike traditional medical approaches that often focus on a single disease, geriatric medicine considers a person’s physical health, mental well-being, daily functioning, medications, and social environment.

However, access to this specialised care remains unequal across Europe. In many countries, especially in parts of Southern and Eastern Europe, geriatric medicine is still emerging, and only a few Balkan countries officially recognise it as a medical specialisation. As a result, many older people do not receive the care they need, and many healthcare professionals lack the training to provide it.

This is the gap that COST Action Promoting geriatric medicine in countries where it is still emerging (PROGRAMMING) set out to close.

Watch the Action video ‘PROGRAMMING in 90 seconds’

As Action Chair Dr Marina Kotsani explains, the network “decided to work together to produce meaningful outputs and to strive for changes that create impact for local communities, for Europe, and for the older people whose care we aim to improve.”

Listening to the whole orchestra

For Assoc. Prof. Karolina Piotrowicz, the Science Communication Coordinator of the Action, explaining geriatric medicine to non-specialists begins with a simple analogy.
“I often use the analogy of an orchestra to explain geriatric medicine,” Karolina says. “In younger people, each medical condition can sometimes be treated like a single instrument playing its own part. In older adults, however, many ‘instruments’ are playing at the same time — multiple diseases, medications, physical and social factors. Geriatric medicine is about understanding how all these elements interact and making sure the entire orchestra works in harmony.”

This is why older people often need a different medical approach.

“Caring for older adults requires a well-coordinated team of professionals… Just like musicians in an orchestra, they need to listen to each other, understand their roles, and work together in harmony.”
Assoc. Prof. Karolina Piotrowicz, the Science Communication Coordinator of the Action

“One unexpected fact is that older adults often do not present diseases and problems in the same way as younger people,” she continues. “For example, a serious infection in an older person may appear not as a fever, but as confusion or a sudden decline in function.”

Another often overlooked reality is that many older adults live with several chronic conditions at once. “This means that treating one disease in isolation is often not enough,” she explains.
She also points to another surprising fact: “The ability to perform activities of daily living and physical capacity are strongly related to longevity, sometimes more than the diseases themselves.”
Even medication requires careful balance. As Karolina notes, “taking multiple medications may sometimes be more harmful than beneficial.”

The orchestra analogy works on another level too. “Caring for older adults also requires a well-coordinated team of professionals: geriatricians, nurses, physiotherapists, pharmacists, social workers, and many others. Just like musicians in an orchestra, they need to listen to each other, understand their roles, and work together in harmony.”
“When this interdisciplinary team is well tuned,” she adds, “it can provide truly comprehensive and person-centred care for older patients.”

Building a European community

One of the strongest achievements of PROGRAMMING has been creating that harmony across borders.
The Action has brought together nearly 450 researchers and clinicians from 46 countries, including many where geriatric medicine is still not fully implemented.

Experts from different disciplines and healthcare systems who might never have met are now working side by side, sharing knowledge, comparing national realities, and building common solutions.
Another major success has been the involvement of young researchers and clinicians. Through COST networking activities and grants, young professionals have been able to develop research skills, build international collaborations, and take active roles in scientific work.

For Dr Kotsani, these personal stories are among the most meaningful results of the Action.
“Among the most rewarding moments,” Marina shares, “have been those when participants come back to us and tell us how a Short-Term Scientific Mission has boosted their career, giving them the confidence and tools to take the lead in new initiatives within their own institutions or countries.”
She has also watched younger colleagues grow into leaders. “They got empowered, took over initiatives, developed leadership and delivered outcomes,” she says.

An important part of the Action has also been the development of educational frameworks for non-specialists. Many general practitioners, nurses, therapists, and other healthcare workers caring for older adults often have no formal training in geriatrics.

By creating structured educational resources and policy briefs for clinicians, educators, and policymakers, PROGRAMMING is helping improve awareness and support better health policies for ageing populations.
“Leading a COST Action is truly a unique experience. If I could turn back time, I would absolutely do it again.”
Dr Marina Kotsani, Chair of PROGRAMMING

Greece: where change became visible

For Dr Evrydiki Kravvariti, leader of the Action working group at the National and Kapodistrian University of Athens, the impact of the Action has been both tangible and deeply personal.

“The years since 2022, when I joined the PROGRAMMING COST Action, have been transformative both for my professional development and for academic geriatrics in Greece,” she says.
“Through a series of webinars, focus groups, surveys and hybrid events organised by PROGRAMMING, we involved local policymakers and stakeholders in clinical practice and academia, and managed to draw attention to the lack of geriatric specialisation and the unmet educational needs of health professionals caring for older people.”
The results followed quickly. During the first year of the Action, her team helped pilot the first outpatient geriatric clinic in the Greek public healthcare system.

“We continue to expand its patient panel,” Evrydiki explains. “A second geriatric clinic was created by another young Greek PROGRAMMING collaborator the following year.”
The second year brought progress at the policy level. “We participated in a task force for postgraduate training in geriatrics,” she continues, “which led to the proposal of a training model for geriatrics as a medical subspecialty. This is currently under consideration by the Greek Ministry of Health.”

Then came a major milestone in her own career.

“During the third year of the Action,” Dr Kravvariti recalls, “I was elected Assistant Professor of geriatrics in the School of Medicine, National and Kapodistrian University of Athens. This was the first formal academic appointment for geriatrics in Greece.”

She sees a direct connection between that achievement and her role in the Action. “My experience as a PROGRAMMING working group co-leader was important to gain leadership skills, collaborative spirit, and international outlook,” she says.

“The years since I joined the PROGRAMMING COST Action have been transformative both for my professional development and for academic geriatrics in Greece.”
Dr Evrydiki Kravvariti, Action Working Group Leader

The next steps were the creation of a university-based one-year clinical fellowship in geriatrics for specialised physicians and an elective course in geriatrics for undergraduate students.

“This is the first time our discipline, geriatrics, is included in the medical school’s undergraduate curriculum as a stand-alone course,” she says proudly.
Her conclusion is simple and powerful: “At this rate of events, it wouldn’t be unrealistic to hope for formal recognition of geriatrics as a subspecialty during the fourth and final year of the Action. Thank you, PROGRAMMING, for major contributions to the advancement of geriatrics in Greece!”

The moments that stay with people

For Karolina Piotrowicz and Sofia Duque, Leaders of the Action working group ‘Communication, Dissemination and Impact Maximisation’, the most meaningful achievements are often the most human ones.
They both remember one particularly emotional moment during a PROGRAMMING meeting in Brussels, when “a representative of the older adults’ community presented a very personal speech from the perspective of older people.”

“They spoke very openly about their individual needs, the limitations they often face, and their expectations toward geriatric care,” Karolina recalls. “Listening to this perspective was very powerful. It reminded us that beyond research, guidelines, and training programmes, our work is ultimately about improving the lives of older people.”
“The most meaningful achievements are often the most human ones.”
Dr Ana Sofia Duque, Action Working Group Leader

For Marina Kotsani, chairing the Action itself has been equally memorable.
“Leading a COST Action is truly a unique experience, perhaps even once in a lifetime,” she says.
“I could not have anticipated the extent of the opportunities that would emerge, nor the beauty and power of bringing together such a diverse and extensive network of collaborators, all working towards a common purpose.”
Although, as she admits, she initially underestimated the amount of work the role would require, her conclusion is clear: “If I could turn back time, I would absolutely do it again.”

As the Action approaches its conclusion, Marina does not see an ending.
“We have a strong feeling that this is not the end of the journey, but rather the beginning of the next chapter of the story,” she says. “The vibrant community that emerged through this Action will continue to collaborate through new research initiatives, educational activities, and future European projects.”

Additional information

Action website
Network website
Publications – PROGRAMMING
PROGRAMMING in videos – PROGRAMMING