Team-Based Geriatric Care Supports Prevention, Identification, and Management of Elder Mistreatment

In recognition for World Elder Abuse Day, I am honored to highlight our specialty older-adult services at Swedish Family Medicine—First Hill and our interprofessional geriatric assessment clinic.  It’s a unique and wonderful opportunity for an older person to experience a comprehensive assessment and take advantage of multiple professionals working together to build a person-centered care plan. 

Swedish Family Medicine—First Hill is the home of the Swedish Geriatric Medicine Fellowship. For the last 22 years, we have had a special interest in caring for vulnerable and complex older adults. In addition to providing primary care for all ages, we have faculty physicians who are geriatric medicine board-certified and geriatric medicine fellows who have their own primary care practices. The geriatrics team at Swedish Family Medicine is also part of the King County Elder Abuse Multidisciplinary Team, serving as medical consultants. 

We also provide a unique specialty service at Swedish Family Medicine—First Hill, a team-based interprofessional comprehensive geriatric assessment clinic. The geriatric assessment at Swedish is a two-hour visit with a team of doctors, nurses, pharmacist, psychologist, and social workers. We have a particular focus on cognitive assessment, functional assessment and evaluation of social circumstances and resources.

Generally, this is a one-time visit, but it can be performed over two or more sessions for particularly complex situations. Geriatric assessment does not replace primary care; rather, it is intended to help the patient, the family and the primary care team develop a better understanding of the relevant issues, and a care plan to meet the needs of the individual patient and family. 

During our interprofessional comprehensive geriatric assessment, we utilize the Age-Friendly Health System Framework, which focuses on the 5Ms of Age-Friendly Care—Medications, Mentation, Malnutrition, Mobility and—most importantly—what Matters Most. This approach is an evidence-based way to assess and act on issues essential to all older adults, from the healthiest to the most complex and vulnerable. 

Our geriatric assessment clinic can play a role in both prevention and assessment/mitigation of elder mistreatment along the care continuum. From a prevention point of view, our geriatric assessment clinic is intended to build upon strengths of an individual in their aging process and address areas where they may need more support. We value an individual’s independence and work to identify their unique needs and preferences (especially in setting of cognitive and functional decline), matching that to the appropriate support and care settings. In doing so, I believe we can assist an individual in being less susceptible to elder mistreatment. 

From an assessment and mitigation perspective, elder mistreatment is often unseen and unaddressed. Using a comprehensive model which centers around building a care plan around what matters to an individual can help a care team identify someone who is at risk for elder mistreatment or may even be experiencing abuse. In eliciting what matters to an individual, it may be the first opportunity in an individual’s health care experience to share fears, insecurities, and concerns.

Our interprofessional clinic can play a role when understanding all aspects of an alleged victim’s situation. We delve deep into mood, cognition, mobility, social support, and medications during this visit. And while focusing on what matters most, we can help connect a person experiencing elder mistreatment to the appropriate resources for support and care that align with their needs, goals, and preferences. 

Geraldine’s story

Let me tell you the story of Geraldine (name and details changed for privacy). She is an older adult without a significant support system in Seattle. Her primary care provider referred her to us for an assessment of cognition and function and concern about self-neglect. An on-site resource coordinator helped bring her to our assessment clinic. While she was there, we noticed she had significant hearing loss, middle stage dementia based on her cognitive testing and functional abilities, and very poor balance with high fall risk.

Geraldine had previously been referred to Adult Protective Service (APS) for concern about neglect by a neighbor with an open APS case. She was seen by geriatrician, social worker, pharmacist, and psychologist. We built a care plan and reached out to her APS investigator. We recommended referrals to audiology and physical therapy and deprescribing some medications (two of which could be affecting her cognition and balance) to minimize her risks and simplify her daily responsibilities.

Geraldine was clear that maintaining her independence was the thing that mattered most to her. We built an Age-Friendly 5Ms care plan for her and scheduled to see her again in three months. While we may not be able to reverse some of the conditions that are impacting her ability to live independently, we can play a very important role in helping her live well. 

In the end, team care is always better care!

Contributor Carrie Rubenstein, MD directs the Geriatric Medicine Fellowship and Curriculum at Swedish Family Medicine—First Hill (1401 Madison St, Seattle). The clinic is held weekly on Thursday mornings. Referrals from the community are accepted. In-person, at-home (when appropriate and available), online, and phone options are available. To make an appointment, call 206-386-6111.