The physical abuse, psychological abuse, exploitation, and neglect of older
adults constitute a serious and under-recognized public health problem thr
ough out the world. Clinicians often misinterpret the health effects of eld
er mistreatment (EM) as caused by underlying disease or the aging process.
Clues to mistreatment include the patient's appearance, recurrent urgent-ca
re visits for the same diagnosis, missed appointments, suspicious physical
findings, and implausible explanations for injuries. Avoiding confrontation
and emphasizing treatment of abuse-related health conditions help the clin
ician maintain a therapeutic alliance with the victim and abuser. Victim sa
fety should be the paramount concern. Victims with decisional capacity shou
ld be apprised of the chronic, progressive nature of EM. Clinical strategie
s to stop abuse include hospitalization and closer monitoring through offic
e visits and home nursing. In most U.S. states, laws require that clinician
s report at least physical abuse to the local adult protective services age
ncy or to law enforcement. Mandated reporting, while offering potential soc
ial and legal remedies, raises ethical concerns regarding the physician-pat
ient relationship.