AN EXPLORATORY STUDY OF ABUSIVE BEHAVIOR TO THE ELDERLY WAS CONDUCTED AT THE CHRONIC ILLNESS CENTER OF THE COUNTY HOSPITAL SYSTEM IN CLEVELAND, WHICH SERVES BOTH AGED AND CHRONICALLY ILL CLIENTS AND PROVIDES DIRECT SERVICE, PARTICULARLY IN THE AREA OF HOME CARE, TO THESE CLIENTS. THE STUDY WAS UNDERTAKEN TO DETERMINE THE INCIDENCE AND NATURE OF ABUSE SITUATIONS IN CASES ACCEPTED FOR SERVICE BY THE AGENCY. WORKERS AT THE AGENCY WERE ASKED TO REVIEW ALL CLIENTS OVER 60 ASSIGNED DURING A 12-MONTH PERIOD FOR INSTANCES OF PHYSICAL, PSYCHOLOGICAL, AND MATERIAL ABUSE. OUT OF 484 NEW CASES ACCEPTED BY THE CLINIC DURING THE REPORTING PERIOD, 404 CASES INVOLVED CLIENTS 60 YEARS OF AGE OR OLDER. A TOTAL OF 39 CASES OF ABUSE WERE IDENTIFIED, AND CASE RECORDS OF THESE CLIENTS WERE REVIEWED. ALL HAD PROBLEMS WHICH INTERFERED WITH DAILY LIVING ACTIVITIES OR COULD POTENTIALLY REQUIRE NEEDED CARE: 51 PERCENT COULD NOT WALK ALONE, 11 PERCENT HAD HEARING OR VISUAL PROBLEMS, 28 PERCENT WERE INCONTINENT, AND 41 PERCENT WERE CONFUSED OR SENILE. AT THE TIME OF REFERRAL TO THE CENTER, 87 PERCENT WERE LIVING AT HOME. FOUR SPECIFIC AREAS OF ABUSE WERE IDENTIFIED: PHYSICAL ABUSE, PSYCHOLOGICAL ABUSE, MATERIAL ABUSE, AND VIOLATION OF RIGHTS. ALMOST THREE-FOURTHS OF THE ABUSE CASES INVOLVED PHYSICAL ABUSE AND OVER HALF INVOLVED PSYCHOLOGICAL ABUSE. ONLY INFREQUENTLY WAS ABUSE OF THE AGED LIMITED TO ONE TYPE OF ABUSE. A TOTAL OF 49 DIFFERENT INDIVIDUALS WERE INVOLVED IN THE ABUSE OF THE 39 CLIENTS. IN ONLY 4 CASES, THE ABUSER WAS NOT A RELATIVE. THIRTEEN OF THE ABUSERS WERE DAUGHTERS OF CLIENTS AND SIX WERE SONS. REACTIONS OF THE ABUSED TO THE ABUSE WERE PREDOMINANTLY THOSE OF DENIAL, RESIGNATION, OR REFUSING TO ACKNOWLEDGE THE PROBLEM. EXPLANATIONS FOR ABUSE WERE (1) THE ABUSER PREVIOUSLY HAD SUFFERED MISTREATMENT BY THE PARENTS OR CAREGIVERS AND NOW REVERSES THE ROLE; (2) FAMILY PATTERNS OF VIOLENCE; (3) DEPENDENCE ISSUES; (4) FILIAL CRISIS; (5) PSYCHOTIC, ELDERLY, OR SENILE CAREGIVERS; AND (6) USE OF DRUGS OR ALCOHOL. BASED ON THE STUDY, OUTCOMES FROM INTERVENTIONS WERE CATEGORIZED INTO THREE GROUPS; INSTITUTIONALIZATION, PROBLEM CONTINUES, AND ASSISTANCE PROVIDED AND UTILIZED. OF THE 39 ABUSED ELDERLY STUDIED, 18 WERE EVENTUALLY INSTITUTIONALIZED IN NURSING HOMES. IN 10 CASES, THE ABUSE CONTINUTED BECAUSE ASSISTANCE AND INTERVENTION WERE REFUSED. IN 11 CASES, THE ABUSE CONTINUED BECAUSE ASSISTANCE AND INTERVENTION WERE REFUSED. IN 11 CASES, PROFESSIONAL ASSISTANCE WAS ACCEPTED. DISCUSSION COVERS PRACTICAL, LEGAL, AND POLICY IMPLICATIONS. A SYSTEMATIC PLAN FOR DATA COLLECTION AND CASE FINDING IS NEEDED ON A NATIONAL LEVEL, AS WELL AS EFFICIENT AND EFFECTIVE LAWS TO PROTECT THE ABUSED ELDERLY. TABLES AND REFERENCES ARE PROVIDED. (MJW)