This week’s New England Journal of Medicine (NEJM) focuses on the realities of elder abuse. Elder abuse includes physical abuse, verbal or psychological abuse, sexual abuse, financial abuse and neglect. The rate of elder abuse has been estimated to be between 7.6% – 10%. The article discusses strategies that can be used by the medical profession when there is a suspicion of elder abuse. With our growing elderly population, it appears that elder abuse will be an ongoing problem. One particular concern is the fact that elder abuse can occur in nursing homes. The Omnibus Budget Reconciliation Act of 1987 was supposed to create a framework that would heighten awareness and reporting of elder abuse. However, family and friends always need to a keep a watchful eye to make sure their loved ones who reside in nursing homes are being taken care of properly. Nursing home residents always need advocates especially if they suffer from any type of dementia. Never be afraid to speak up and complain.