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Several years ago, while attending a lunch meeting of health services researchers, I found myself sitting next to a prominent physician whose research I had long admired. As our conversation turned to my work on elder mistreatment (EM) prevalence and the millions of older adults who are abused, neglected, and exploited, he reflected that he could not think of a single older adult patient that he had suspected was a victim of abuse. Researchers generally agree that the annual rate of EM among community-residing adults aged 60 and older is about 10%. My lunch partner posited that, given these numbers, he had probably treated dozens of elder abuse victims. He was scarcely alone in failing to detect EM. The topic we did not discuss was what he should have done if he did suspect abuse. What programs, services, and tools does EM research offer physicians and other healthcare providers? What is the evidence for how, where, and to what end the tools should be used? In this issue, Rosen and colleagues provide a comprehensive review of programs designed to identify, treat, or prevent EM. The authors are to be commended for a well-documented, systematic examination of the peer-reviewed literature. To avoid missing promising or innovative approaches, they included all programs, whether or not they had been evaluated. They identified 115 programs that they categorized by each program’s primary focus: educational (53%), multidisciplinary team (21%), psychoeducational/therapy/counseling (15%), and legal services/support (8%). They also looked at whether each program was integrated into an acute-care hospital and the likelihood that the program could be implemented in a low-resource environment. For readers interested in specific approaches, they offer detailed information on each program in an online supplement. The article makes several key contributions to the field. The two most striking, but not surprising, are (1) none of the programs they reviewed had “an impact on the safety of older adults,” and (2) despite the important role of hospitals and emergency departments (EDs) as frontline settings for EM treatment, only about one-third involved acute-care hospitals (13% as a partner integrated into the intervention, 5% as a referral source, and 17% had one or more providers affiliated with the intervention). Why are these results not surprising? Like other types of family violence, EM is complex—difficult to detect and address, let alone prevent. Some would call it one of the “wicked problems,” which are challenging to remedy because they are imbedded in other complex issues (eg, poverty, violence, mental illness); they are prevalent, costly, and shaped by inadequate or conflicting information; and it is unclear who “owns” the solutions. As Rosen et al point out, EM is associated with a range of negative personal, mental health, and physical health costs as well as increased utilization of services (eg, hospitalizations, ED) and increased mortality. At the same time, older adults may be reluctant to acknowledge that they are victims because of embarrassment, fear of placement, or fear of retribution for and from family members. They may assume, often correctly, that the outcome will not change or could be worse. Because of the complexity of intransigent social problems, progress, when it happens, is often slow, painstaking, and incremental; Lindblom famously termed this “muddling through.” Breakthroughs will likely require sustained collaborative efforts to slowly chip away at the problem, and despite the lack of demonstrated outcomes, some solid chipping away in EM research has already occurred. Advances have been spurred by two seminal publications, the National Research Council Review and, more recently, the Elder Justice Roadmap. Most agree that EM encompasses physical assault, sexual abuse, psychological abuse, financial exploitation, and caregiver neglect or abandonment. The abuser is someone in a position of trust, which includes friends, family, providers, and caretakers, and excludes scams committed by predatory strangers (eg, telemarketing, sweepstakes, investment). Progress has also been made in screening/assessments, a conceptual framework that helps organize the complexity, and advances in forensic markers that, although not definitive, nonetheless help physicians and other providers detect or rule out abuse. Still, efforts to address EM remain fragmented in part because policies and program implementation reside at the state and local level with considerable variation in approaches. Conversely, we lack both a strong national policy and, until very recently, national data. Although the research focus has been on prevalence and interventions, the policy focus has DOI: 10.1111/jgs.15874