Published in IJCP June 2024
Guest Editorial
Silver Stewardship
June 11, 2024 | Sanjay Kalra, Navneet Agrawal, Nitin Kapoor
Diabetes & Endocrinology

Humankind has been able, over the past century, to double its life expectancy1. This has increased not only our total population, but also the proportion of elderly persons in the population. Increasing longevity exposes individuals to the degenerative diseases of old age. These impact quality of life, and may lead to disability as well as dysfunction2.

This situation calls for enhanced focus on geriatric care. While geriatric medicine offers preventive and curative services to elderly persons, longevity and antiaging medicine (LAM) works to promote and preserve health. Emphasizing both esthetic and functional youthfulness, LAM complements and supports geriatric medicine by aiming to reduce the need for secondary and tertiary geriatric care services. LAM may also be viewed as a primary and secondary prevention strategy, designed to promote health and prevent complications of aging3.

The word stewardship has been used in multiple ways in medicine and health. Antibiotic stewardship, steroid stewardship, and insulin stewardship are notable examples4-6. The word silver, which alludes to ‘silver-haired’, denotes the elderly age group.

We use the term ‘Silver Stewardship’ to describe the practices and behaviors that help protect and promote health of elderly persons, while pre-empting and preventing disease and disability. Though there is no consensus on the age cut-off for geriatric and elderly persons, a threshold of 65 years is accepted by most researchers7. The physiological changes of aging, and their impact on health and function, however, begin much earlier. Silver stewardship, therefore, can be taken to mean care of all persons above the age of 40 years.

Silver stewardship is a multidimensional construct, which includes all aspects of health and happiness. These are listed in Table 1. The table also lists a few of the commonly encountered diseases that are the focus of silver stewardship.

Table 1. Domains of Silver Stewardship



Common conditions


Maintenance of bone, muscle, joint health

Osteoarthritis, osteoporosis, sarcopenia

Metabolic and endocrine

Management of metabolic/endocrine dysfunction

Diabetes, dyslipidemia, hypertension, obesity

Medical and surgical

Management of comorbid illness

Heart disease, kidney disease, urinary complaints


Optimization of dermatologic health, including hair nails, and esthetics

Hairloss, skin aging

Macho/maiden health

Optimization of genital gonadal and sexual health

Late-onset hypogonadism in men, menopause in women


Early detection, management and prevention of cancer

Common cancers


Mental emotional and cognitive health

Depression, dementia

Multi-personal (social health)

Ensurance and strengthening of social connections

Social withdrawal


Financial autonomy and stewardship

Financial ill health

As the world’s population ages, the need for silver stewardship is bound to increase. A multifaceted concept, silver stewardship should be practiced by policymakers and planners, physicians and paramedical staff, pharmaceutical researchers, and members of the public alike. Within the medical fraternity, geriatric medicine, along with longevity and antiaging medicine, as well as endocrinology and metabolism, should take the lead in strengthening and supporting silver stewardship.


  1. Schumacher AE, Kyu HH, Aali A, Abbafati C, Abbas J, Abbasgholizadeh R, et al; GBD 2021 Demographics Collaborators. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403(10440):1989-2056.
  2. Ayoubi-Mahani S, Eghbali-Babadi M, Farajzadegan Z, Keshvari M, Farokhzadian J. Active aging needs from the perspectives of older adults and geriatric experts: a qualitative study. Front Public Health. 2023;11:1121761.
  3. Liu JK. Antiaging agents: safe interventions to slow aging and healthy life span extension. Nat Prod Bioprospect. 2022;12(1):18.
  4. Glasziou P, Dartnell J, Biezen R, Morgan M, Manski-Nankervis JA. Antibiotic stewardship: A review of successful, evidence-based primary care strategies. Aust J Gen Pract. 2022;51(1-2):15-20.
  5. Kalra S, Kumar A, Sahay R. Steroid stewardship. Indian J Endocrinol Metab. 2022;26(1):13-6.
  6. Kalra S, Sahay R, Tiwaskar M. Need for insulin stewardship programmes. J Assoc Physicians India. 2018;66(7):83-4.
  7. Orimo H, Ito H, Suzuki T, Araki A, Hosoi T, Sawabe M. Reviewing the definition of “elderly”. Geriatr Gerontol Int. 2006;6(3):149-58.