Q: I was very hesitant to write to you, but I cannot wait any longer. The problem I want your advice on is complicated. I may be out of my way here. I talked it over with my husband and we both think that something needs to be done.

I have this neighbor who must be in her late 80s, at least that is what she looks like. She has been living in the house next to us for more than 20 years. I think that her husband died more than 15 years ago. Initially, she was doing well. In the last two to three years, however, she is not. We see her sporadically and she looks thin and dirty when she emerges from her house. She no longer recognizes us. This would not be such an issue, after all there are people who keep to themselves, but there is more She has this family member who comes to visit, usually at the beginning of the month. We hear screaming and cries. We worry that this person may be harming this old lady. My husband tried to check on her many times, but she will not let him in. Is it the right thing to do to report this? Who should we report this to? Are we overeager to help this lady? Can we get in trouble if we are wrong? What do you think? — Donna and Mike

A: First of all, thank you for writing to me. Your concern is a valid one. We may be dealing here with a case of elderly abuse. This is a tough and complicated topic. I have to deal with it often in my daily professional life and it always leaves me distraught.

First, let's review the definition of abuse.

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Generally, it is believed that abuse is a willful infliction of pain, injury, and mental anguish, nonconsensual sex, or depravation of the basic care needed (neglect and abandonment) committed by a person in the position of trust.

Abuse may also be in the form of self-neglect when a given individual fails to take care of his or her needs. Quite commonly this is because of failing memory, mental illness or substance abuse. It may also take a form of financial exploitation, when unwarranted amounts of money are being taken away from a victim, sometimes under the pretense of "delivering care."

No one knows how common elderly abuse is. It is estimated that between 3 to 10 percent of people over 60 are abused. More than 75 percent of abused elderly are women, and most of them are over 75.

Abusers are usually adult children, spouses and relatives. There may also be paid caregivers and friends. Sometimes, abuse is a continuation of behavior happening throughout a person's life. It may also be related to caregiver stress and burnout. It is not easy to identify elderly abuse. The majority of times the affected person will not willingly report his/her oppressor. For medical professionals, abuse is a mandatory reportable event. Every state law is different.

Connecticut, for example, has a fine of up to $500 for failing to report an abuse. It is not clear, though, how this law can be fully executed. The emergency room is quite often a place where abuse is discovered. Doctors, nurses and social workers are all trained to recognize and act on suspicion of abuse. Unexplained injuries, conflicting stories, poor hygiene, malnutrition, bruises and suspicious marks will prompt professionals to inquire about the abuse. Depression, fear, and anxiety may also trigger questions. Another group of professionals that deals often with abuse are visiting nurses. Since they have access to a given person's home, they often discover situations no one may be suspecting.

All cases of potential abuse are referred to Adult Protective Services (APS), a state-funded agency. Its workers often have to deal with extremely complicated, unpleasant situations. Having met many of the local APS workers, I have the utmost respect for their work and dedication.

Anyone can report suspected abuse. It is confidential. One way is to call 211, which is a statewide number for services for the elderly. The direct local number is 1-888-385- 4225 or, out of state, 1-800-203-1234.

I would strongly advise NOT to confront the suspected abuser on your own. If you happen to know this person's physician, contacting that doctor may also help. The limited space here does not allow me to talk more about institutional abuse. If you suspect it, the best way to help is contact the state ombudsman. I wish you both courage and hope for the best for your neighbor.

Please keep us posted. Dr. Beata Skudlarska is a Bridgeport geriatrician. Send questions to Bridgeport Hospital Center for Geriatrics, 95 Armory Road, Stratford CT 06614 or geriatricmd@aol.com.