RESEARCH AND PRACTICE Domestic Elder Abuse and the Law | Gerald J. Jogerst, MD, Jeanette M. Daly, RN, PhD, Margaret F. Brinig, JD, MA, PhD, Jeffrey D. Dawson, ScD, Gretchen A. Schmuch, MSW, and Jerry G. Ingram, MSW The best national estimate is that approxi- mately 550000 persons aged 60 years or older experienced abuse or neglect, or both, in domestic settings in 1996.1 After adjusting for other factors that might affect mortality, Lachs and Pillemer2 found increased mortality rates among physically abused or neglected elders. Although abuse affects many elders and is associated with increased mortality, there are no clear case-finding guidelines, di- agnostic tests, or ideal legal or medical system interventions in the area of elder abuse.3,4 Be- cause of poor public awareness and lack of clear public health or practice guidelines, among other factors, only 21% of the esti- mated 550000 cases of abuse occurring in 1996 were reported to and substantiated by adult protective services (APS).1 Since the recognition of elder abuse as a sig- nificant social and public health problem,5-7 there have been an array of legislative re- sponses. By 1985, every state had instituted some type of adult protection program, and as of 1993 all states had enacted laws addressing elder abuse in domestic and institutional set- tings.8 State laws related to elder abuse are ex- tremely diverse,9 containing multiple sections regarding, for example, who is protected, who must report, definitions of reportable behavior, requirements for investigation of reports, penal- ties, and guardianship.9,10 The effectiveness of abuse reporting and in- vestigation depends, in large part, on the ability of reporters and investigators to recognize mis- treatment. However, the ambiguity of relevant protective statutes raises doubt that health care providers, other reporters, and state investiga- tors can identify abuse or neglect.8,9 To date there has been no systematic inquiry regarding elder abuse legislation to determine whether variations in state statutes and regulations re- late to differences in reporting and investigation activities. The purpose of this study was to eval- uate the impact of state APS legislation on rates of reported, investigated, and substantiated do- mestic elder abuse. Objectives. The authors evaluated the impact of state adult protective service legisla- tion on rates of investigated and substantiated domestic elder abuse. Methods. Data were collected on all domestic elder abuse reports, investigations, and substantiations for each US state and the District of Columbia for 1999. State statutes and regulations pertaining to adult protective services were reviewed. Results. There were 190005 domestic elder abuse reports from 17 states, a rate of 8.6 per 1000 elders; 242 430 domestic elder abuse investigations from 47 states, a rate of 5.9; and 102879 substantiations from 35 states, a rate of 2.7. Significantly higher investigation rates were found for states requiring mandatory reporting and track- ing of numbers of reports. Conclusions. Domestic elder abuse documentation among states shows substantial dif- ferences related to specific aspects of state laws. (Am J Public Health. 2003;93:2131-2136) METHODS Two sources of data were used in this