Physicians must expand their concept of clinical responsibility to include the safety and dignity of older adults and help prevent elder abuse and neglect. That was the message delivered recently to Kaiser Permanente Bernard J. Tyson School of Medicine (KPSOM) students and faculty by Julia Hiner, MD, Associate Professor of Geriatric and Palliative Medicine and Director of the Geriatric Medicine Fellowship program at McGovern Medical School at UTHealth Houston. Dr. Hiner’s talk, “Primary Care Primary Prevention,” was delivered virtually as part of the KPSOM Speaker Series on April 6.
Elder mistreatment, Dr. Hiner emphasized, is “out there whether we immediately see it or not,” and clinicians are often the only professionals in a position to recognize it early. Yet more than half of physicians never ask older patients about mistreatment, and fewer than 7 percent of Adult Protective Services (APS) reports come from physicians, she said.
“You have to shift how you view it,” Dr. Hiner said, “and if we don't, the consequences that are both expensive and life threatening will continue. And so, it is a medical problem. It is within our domain as clinicians. And we do really have an important role to play because we can prevent these harms. And we can do that by acting as an advocate for our patients.”
Dr. Hiner framed identifying and preventing elder mistreatment as core clinical work, not an optional add‑on to be delegated to social work or case management. “If you don’t identify it, you’re going to miss it 100 percent of the time,” she said, urging students to make mistreatment part of their diagnostic lens when they see older adults in clinic.
Elder mistreatment is common and often hidden, Dr. Hiner noted. About 1 in 10 adults over age 65 experience it, and among those with cognitive impairment the rate rises to roughly 50 percent. Despite its prevalence, most cases never reach authorities. Neglect, emotional abuse, exploitation, and self‑neglect are far more common than the dramatic physical or sexual abuse scenarios that attract media attention.
Elder mistreatment carries profound consequences for patients, caregivers, and health systems. It is associated with more emergency department visits, more acute exacerbations of chronic disease, new acute problems, and significantly increased morbidity, she added. Economically, estimates of its annual cost range from $3 billion to $36 billion, depending on how lost productivity and caregiver burden are calculated. Most strikingly, experiencing mistreatment is associated with a roughly threefold increase in mortality risk in the first year, and that risk never fully returns to baseline, Dr. Hiner said.
She also highlighted promising evidence that supporting caregivers can dramatically reduce mistreatment. A Kaiser Permanente-based study of the COACH intervention (Comprehensive Older Adult and Caregiver Health Help) provided 3 to 12 telephone sessions with a trained coach focused on self‑care, goal setting, and care mapping for caregivers of older adults with chronic illness, including dementia. In that study, elder mistreatment dropped from 23 percent in the control group to zero percent in the intervention group. “How we support the person caring for that older adult can make all the difference,” she said.
Dr. Hiner urged students to see elder mistreatment prevention as part of their broader commitment to primary care and whole person care. “If we don’t shift how we view it, the consequences that are both expensive and life‑threatening will continue,” she warned. By asking questions, advocating for patients, and supporting caregivers, she said physicians can prevent harm and help older adults live with safety, dignity, and respect.
The KPSOM Speaker Series is a monthly event featuring in-person and virtual presentations from recognized leaders in medical education, research, and healthcare. Recent guest speakers have included Wizdom Powell, PhD, Director of the Health Disparities Institute and Associate Professor of Psychiatry at UConn Health; Tony Ogburn, MD, Professor of Obstetrics and Gynecology at University of Texas Health Sciences Center in San Antonio; and Joann Elmore, MD, MPH, Professor of Health Policy and Management at UCLA Fielding School of Public Health.
(To report incidents of elder mistreatment, reach out to Adult Protective Services .)
