BackgroundThe aim of the present study was to determine the factors affecting the abuse of the elderly by family caregivers among the elderly with hemodialysis (HD) using structural equation modeling.MethodThe study is descriptive-cross sectional, which is conducted in 2018 in Iran. The sample size was 367 in both groups (the elderly and their family caregivers). Data collection was done using an individual-social information questionnaire for the older adults under hemodialysis and their family caregivers, the questionnaire of elder abuse by family caregivers to the older people under hemodialysis, Zarit Burden Interview and the scale of instrumental activities of Daily Living (IADL). Data were analyzed by the SEM method. The Fitness of proposed pattern was measured using the following indexes: Chi-squared degree of freedom ratio (CMIN/DF), Parsimonious Normed Fit Index (PNFI), Comparative Fit Index (CFI), Parsimonious Comparative Fit Index (PCFI), Incremental fit index (IFI), Goodness of Fit Index (GFI) and Root Mean Square Error of Approximation (RMSEA). The significant level in this study was considered p <0.05.ResultsThe results of the present study showed that more than 70% of the elderly suffer from elder abuse by family caregivers on average. The highest median elder abuse was related to emotional misbehavior (21.46±6.09) and financial misbehavior (19.07±5.33), respectively. 63.2% of caregivers have experienced moderate care burden. 81.4% of women and 80.5% of older men needed help with daily activities. The results showed that the caregivers’ level of education and care burden with standard beta coefficient of -0.251 and 0.200 and the level of elderly’s education and IADL with the best beta coefficient of -0.299 and -0.234, had the highest regression effect on elder abuse respectively. According to the results, the model-fit indices of the hypothesized model was meet the criteria, with the PNFI= 0.746, PCFI= 0.796, IFI= 0.963, GFI=0.970, CFI=0.967, and RMSEA= 0.075. The outcome was suitable for the recommended level, so the hypothetical model appeared to fit the data.ConclusionProviding psychological interventions for family caregivers can reduce the burden when the elderly suffers from other chronic illnesses.