Physical abuse was the primary form of mistreatment, accompanied by psychological abuse, although the latter was more difficult to substantiate. Neglect was also evident, perhaps more correctly defined as self-neglect, since the son could not be considered a caregiver. In fact, the son depended on the victim for the basic necessities of life and gave him nothing in the way of affection or companionship. Attributes associated with physical abuse cases are evident in the case study: poor emotional health of both victim and perpetrator, shared living arrangements, and mutual dependency. While there was no history of mental illness or alcohol abuse on the part of the perpetrator, his uncontrolled behavior, immaturity, dependency, and alcohol consumption suggest an unhealthy mental state. Case details fit the hypothetical causal model of Pillemer that links the abuser's mental and emotional difficulties, including alcohol abuse, with violence and dependency. The situation is exacerbated by the social isolation of the family. The case also illustrates the dilemma that professionals face in preserving the client's right to self-determination. The social worker arranged for and monitored an array of services that involved health care, social service, aging, and law enforcement agencies but only after considerable persuasion and negotiation with the victim. Treatment for elder abuse perhaps should include not only protection of the victim but also some of the responses used in cases of spouse abuse, such as legal sanctions and offender control. Prosecution may aid in therapy since it provides the leverage needed to bring the perpetrator into treatment and to acknowledge wrongdoing. Similarly, victim support groups that enable battered persons to gain self-esteem and courage to confront their abusers can be successfully used with older persons. 28 references