Elder neglect, a form of elder abuse characterized by omission, results in irreparable physical and psychological harm to this vulnerable age group. One approach to address this phenomenon is the imposition of criminal sanctions for neglecting the duty of care toward the elderly, a strategy adopted in certain countries, including the United States. In modern criminal policy, elder abuse is recognized as a crime, and the criminal justice system acts as a key player in responding to this issue. This study examines how various forms of elder neglect have been criminalized and subjected to sanctions under the substantive criminal laws of the United States and Iran. The findings of this comparative study indicate that the U.S. states examined have provided comprehensive protection for the elderly against caregivers' omissions through the differential criminalization of elder neglect and failure to report it, a broad definition of the actus reus and mens rea of these crimes, and simultaneous attention to the physical and psychological harms caused by neglect. Additionally, by stipulating exceptions and defenses against such charges, they have avoided excessive stringency toward caregivers. A comparison of this differentiated supportive system with the general crimes in Iranian law—including the crime of failure to pay maintenance, inflicting bodily harm by omission, abandonment of individuals requiring care, and failure to assist injured persons—reveals disproportionate leniency or severity in certain instances and the exclusion of some forms of neglect. To achieve appropriate criminal protection for the elderly, it is beneficial and essential to consider the legislative advancements of other countries, such as the United States, which have implemented comprehensive protections against various forms of elder abuse.