The National Council on Aging reports that about one in ten Americans at or over the age of 60 have faced abuse in some form. This puts the estimate at as high as 5 million elderly people who face abuse each year. Another NCOA study estimates that only one in fourteen elder abuse cases are even reported to authorities. Since elders are vulnerable to abuse not only by nursing homes but also by family members, elder abuse occurs almost more often than not in any caretaker/elder relationship. The NCOA further states that in nearly 60% of elder abuse and neglect incidents, the perpetrator is typically a family member. The abuser can be of any gender, and two-thirds of perpetrators are adult children or spouses.