Elder abuse, defined as “harm inflicted on an older person in a relationship where there is an expectation of trust, and/or when the person is targeted based on age or disability,” can be challenging for clinicians to identify. Radiologists can help raise appropriate suspicion for elder abuse based on a patient’s imaging. This article reviews common distributions and radiographic patterns of injury sustained in physical elder abuse. It also discusses limitations and unique challenges to the radiologic assessment of elder abuse, including issues of communication with frontline providers, and broad overlap in the appearance of abusive and accidental injuries in the setting of old age and deconditioning.