Elder neglect and abuse represent a widespread, largely undiagnosed problem in the United States. Factors contributing to misdiagnosis and underreporting include denial by both the victim and the perpetrator, clinicians' reluctance to report victims, disbelief by medical providers, and clinicians' lack of awareness of warning signs. Physical abuse is most recognizable, yet neglect is most common. Psychological and financial abuse may be more easily missed. Elder neglect and abuse have many clinical presentations, ranging from the overt appearance of bruises and fractures, to the subtle appearance of dehydration, depression, and apathy. Risk factors are varied and may be categorized by victim or perpetrator. Dependency, on the part of the victim or perpetrator, and caregiver stress are frequent common denominators in abusive situations. Increasingly, Institutionalization is recognized as a risk factor for neglect and abuse. Most states require primary care providers to report suspected elder abuse. Awareness of the risk factors and clinical manifestations allows primary care physicians to provide early detection and intervention for elder neglect and abuse.