The review of abuse of elderly persons by Lachs and Pillemer (Feb. 16 issue)1 was timely, accurate, and comprehensive. We think, however, that it runs the risk of excessively portraying elderly patients as victims of malign outside influences and thus distracting readers from realizing that mentally competent older people may share responsibility for their own circumstances and must consequently be directly involved in their management and resolution. For example, we recently encountered a patient who has lived in great pain for nine years because of a neglected invasive basal-cell carcinoma that has metastasized to lung and bone.