Recognition and identification of elder abuse and neglect within the Accident and Emergency (A & E) department currently appears less evident than recognition of child abuse and domestic violence. As the population of older people increases, it is likely that there will be an increased usage of the A & E department by older people, some of whome may have been subject to abuse or neglect. Elder abuse and neglect constitute potentially serious health and social problems. The need for the A & E nurse to identify and respond to elder abuse and neglect is therefore a professional responsibility. The nursing profession is clearly in a position to contribute to the recognition of elder abuse and neglect, and A & E nurses are in a unique position to assist this process. This paper seeks to assist nurses with this task by arguing for a 'higher index of suspicion', allied to a sound knowledge base of the circumstances surrounding elder abuse, signs and symptoms and known risk factors. Finally, practical suggestions are offered to assist in the assessment and intervention with suspected or known cases of elder abuse and neglect.