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Summary:
Abuse and neglect of elderly people remain understated, although they affect 3 to 6 % of men and women aged 65 and over. While financial and psychological abuse are the most frequent forms encountered, neglect by lack of adequate care and physical abuse may be life threatening. Data about institutional abuse and neglect are still sparse. The complexity of the issue, the difficulty to establish the facts and to intervent efficiently makes the practical approach critical. This is especially true in community-dwelling, socially isolated subjects with poor informal and formal supportive network. Most victims are old, physically dependent women suffering from cognitive impairment and behavioral problems. The abuser, who may be a female, is often old as well. He/she lives with the victim and cares for her or him without adequate support and is financially dependent on the victim. Factors such as alcohol or drug abuse or health problems are known triggers of mistreatment. Fear of reprisals or of the loss of the only remaining affective link are clear obstacles to detection and intervention. Nevertheless, the law of silence has to be broken. The couple of abuser and victim should be considered in its affective and social context, but health and security of the victim remain a priority. Screening of abuse and neglect in the community and in nursing homes, education of health professionals and building up of medico-social network should be the basis of an efficient prevention.