Elder abuse, also referred to as elder mistreatment, is any abuse or neglect of a person aged 60 or older by a caregiver or another person in a relationship involving an expectation of trust that threatens his or her health or safety. It is difficult to determine the prevalence of elder abuse because many times cases are not reported. A 2003 National Research Council report estimated that there are between 1 million and 2 million cases of elder abuse and neglect in the United States every year. Family members, adult children, or spouses are implicated in 90% of the cases of elder abuse. Those affected are usually elderly people who are cognitively or physically frail, depressed, lonely, or lacking social support. The August 5, 2009, issue of JAMA is a theme issue on violence and human rights that includes an article reporting that both elder abuse and self-neglect in a community-dwelling population are associated with an increased risk of death.