Perhaps you suspect your elderly neighbor isn't caring for herself the way she needs to, but you aren't certain. Or maybe you wonder about some bruises you've seen on your aging uncle. You can't get rid of a nagging feeling that something's not right. But is it elder abuse? What should you look for, and what can you do?

A 1996 study conducted by the National Center on Elder Abuse estimates that approximately 550,000 U.S. adults over age 60 have experienced domestic abuse, neglect, self-neglect or all of these. People 80 and older, and women of all ages, are at greater risk. Older adults who are dependent on others for basic care are particularly vulnerable.

The abuser is typically a family member, spouse or caregiver. In institutions, such as nursing homes or group homes, professional caregivers also may be abusers. Situations in which an older person isn't adequately caring for him- or herself constitute elder abuse, as well. Unfortunately, abuse of older adults — who may be socially isolated — can be hard to detect and is often underreported. But knowing the signs of abuse and who to call on for help can help you to protect your loved ones.

Elder abuse takes many forms, including:

• Physical abuse. Physical abuse is the use of physical force, such as hitting, pushing, shaking or burning, with the intention of causing pain or injury.
• Sexual abuse. Sexual abuse involves any nonconsensual sexual contact, such as inappropriate touching, rape or pornographic photographing.
• Emotional abuse. Psychological or emotional abuse is the use of tactics, such as harassment, insults, intimidation or threats, that cause mental or emotional anguish.
• Financial abuse. Financial abuse or material exploitation involves improperly using an older person's resources for the benefit of another person, for example by stealing, trickery or inappropriate use of government checks.
• Neglect. Neglect occurs when a caregiver or the older person him- or herself (self-neglect) refuses or fails to provide the level of care necessary to avoid physical or mental harm. Some examples include refusal of water, food, shelter and personal hygiene. Self-neglect — a common type of neglect — often involves individuals who have physical or cognitive limitations.

Neglect accounts for about half of all reported elder abuse cases, according to research by the National Center on Elder Abuse. Emotional, physical and financial abuses constitute the majority of the remaining abuse reports.

If you're concerned an older adult might be abused, knowing the signs and symptoms of abuse can help you determine if there is a problem. These signs and symptoms may include:

• Physical injury. Examples of questionable injuries include bruises, cuts, burn or rope marks, and broken bones or sprains that can't be explained. Other signs of potential problems include sudden changes in behavior, comments about being battered or the refusal of the caregiver to allow you to visit the older person alone.
• Lack of physical care. Indications of substandard physical care include dehydration, malnourishment, weight loss and poor hygiene. Bed sores, soiled bedding, unmet medical needs and comments about being mistreated also may indicate a problem.
• Unusual behaviors. Changes in an older person's behavior or emotional state may suggest a problem. Examples include agitation, withdrawal, fear or anxiety, apathy or reports of being treated improperly.
• Changes in living arrangement. Unexplained changes in living arrangement, such as the appearance of previously uninvolved relatives or newly met strangers moving in, might suggest mistreatment.
• Unaccounted for financial changes. Some potentially problematic financial changes include missing money or valuables, unexplained financial transactions, unpaid bills despite available funds and sudden transfer of assets, as well as comments about being exploited.

Remember that to get help, you have to ask for it. Talking with the suspected abuser about the problem is not likely to help. Some of the reasons people may not report suspected abuse include:

• Uncertainty about who to talk to
• Uncertainty about what can be done
• Fear of not being believed
• Fear of getting involved

Don't let these reasons keep you from reporting suspected abuse. Officials and agencies that address this problem do exist. And the problem can't be remedied until it's reported.

In domestic situations, as with any form of domestic abuse, call the police if a person is in imminent danger. If you're not aware of immediate danger, but you suspect abuse, check with welfare and social service agencies. Most cities and counties, according to state law, will investigate and protect vulnerable adults from elder abuse through these agencies.

The Adult Protective Services agency — a component of the human service agency in most states — is typically responsible for investigating reports of domestic elder abuse and providing families with help and guidance. Other professionals who may be able to help include doctors or nurses, police officers, lawyers and social workers.

If you suspect elder abuse in an institutional setting, such as a nursing home, report concerns to your state long-term-care ombudsman. As a result of the 1975 Older Americans Act, each state has such an ombudsman program to investigate and address nursing home complaints.

The National Center on Elder Abuse Web site maintains a list of phone numbers, by state, which you can call for assistance if you suspect domestic or institutional elder abuse: