Towards Trustworthy AI Agents in Geriatric Medicine: A Secure and Assistive Architectural Blueprint

As artificial intelligence (AI) continues to expand across clinical environments, healthcare is transitioning from static decision-support tools to dynamic, autonomous agents capable of reasoning, coordination, and continuous interaction. In the context of geriatric medicine, a field characterized by multimorbidity, cognitive decline, and the need for long-term personalized care, this evolution opens new frontiers for delivering adaptive, assistive, and trustworthy digital support. However, the autonomy and interconnectivity of these systems introduce heightened cybersecurity and ethical challenges. This paper presents a Secure Agentic AI Architecture (SAAA) tailored to the unique demands of geriatric healthcare. The architecture is designed around seven layers, grouped into five functional domains (cognitive, coordination, security, oversight, governance) to ensure modularity, interoperability, explainability, and robust protection of sensitive health data. A review of current AI agent implementations highlights limitations in security, transparency, and regulatory alignment, especially in multi-agent clinical settings. The proposed framework is illustrated through a practical use case involving home-based care for elderly patients with chronic conditions, where AI agents manage medication adherence, monitor vital signs, and support clinician communication. The architecture’s flexibility is further demonstrated through its application in perioperative care coordination, underscoring its potential across diverse clinical domains. By embedding trust, accountability, and security into the design of agentic systems, this approach aims to advance the safe and ethical integration of AI into aging-focused healthcare environments.