To determine the perceived magnitude of elder mistreatment, physician awareness of applicable state laws, and the barriers to reporting suspected cases, we surveyed a random sample of 3,000 members of the American College of Emergency Physicians in the United States. Survey questions included practice characteristics, number and type of suspected cases of elder mistreatment seen in the ED, number of cases actually reported, and reasons for not reporting abuse. Physicians were also asked about the availability of elder-mistreatment protocols and their familiarity with local laws and reporting requirements. We received 705 completed surveys, for a response rate of 24%. Most physicians (52%) described elder mistreatment as prevalent but less so than spouse or child abuse. The respondents had evaluated a mean of 4 +/- 8 (range, 0 to 93) suspected cases of elder mistreatment in the preceding 12 months; approximately 50% were reported. Only 31% of emergency physicians reported having a written protocol for the reporting of elder mistreatment, and physicians were generally not familiar with applicable state laws. Twenty-five percent were able to recall educational content pertaining to elder mistreatment during their emergency medicine residencies. Most physicians were not certain or did not believe that clear-cut medical definitions of elder abuse or neglect exist (74%); that emergency physicians can accurately identify cases of mistreatment (58%); or that their states had sufficient resources to meet the needs of victims (92%). These results suggest that practicing emergency physicians are not confident in identifying or reporting geriatric victims of abuse or neglect. This lack of confidence may reflect inadequacies of training, research, and continuing education with regard to mistreatment of older people.