The typical victim of elder abuse is very old, frail, female, multiply dependent, and with health problems. Five major theories of causation have been advanced. These attribute the abuse to severe physical and/or mental impairment that increase vulnerability to abuse, psychopathology of the abuser, a pattern of learned transgenerational violence, caregiver stresses, or the dynamics of the abused-abuser relationship. Police, social services, and hospitals are most likely to identify cases of elder abuse. At Beth Israel Hospital in Boston, emergency unit nurses are trained in elder abuse screening and detection. Suspected cases are referred to an elder abuse assessment team for verification. A multidisciplinary evaluation is conducted by medicine, nursing, and social services; and the nature of the problem is explored in the context of the patient's medical history, functional abilities, and support systems. If abuse is substantiated, the hospital administration makes a formal report to the designated State agency. Identification and reporting of elder abuse is a sensitive process with many areas for conflict and limited viable options for care. However, as the number of frail elderly increases, so does the need for creative and compassionate solutions to this problem. 10 references.