Nigeria experiences a major demographic transformation which accelerates at an increasing pace through its present elderly population of 9.4 million people aged 60 and above who represent the most extensive senior demographic across Africa and future estimates predict this number will reach three times its current size by the year 2050. The demographic transition creates significant obstacles for the healthcare system which already suffers from insufficient infrastructure and extreme shortages of medical personnel and inadequate social protection services and complete lack of geriatric care options in its public tertiary hospitals. Medical social workers (MSWs) serve as essential healthcare professionals who possess powerful capabilities to connect different care areas but face active underutilization in their work. This paper conducts an extensive integrative review of existing geriatric care practices in Nigeria’s public tertiary hospitals while it investigates how medical social workers execute multiple responsibilities that assist elderly patients through all stages of their treatment process and the study identifies all existing barriers which hinder the effective delivery of geriatric social work services. The paper shows that MSWs need professional development through recognition and training which leads to better integration into their work and the public health system because the country faces an upcoming crisis in geriatric care delivery. Key findings show that MSWs work in psychosocial assessment and discharge planning and caregiver support and financial advocacy and inter-professional coordination and ethical mediation to deliver essential services which operate under multiple constraints that stem from insufficient legal support and chronic understaffing and inadequate payments and poor recognition from other professionals and overall resource shortages. The paper ends with evidence-based recommendations which target essential areas requiring immediate policy changes and inter-professional training programs and workforce development initiatives and official acknowledgement of medical social work as a profession in Nigeria’s healthcare system.