Objectives-To examine the diagnosis of problem substance use in hospital inpatients aged 65 years and over and their referral to drug and alcohol services by medical staff Design-Questionnaire to registrars or house officers caring for patients 65 years of age and over with problem substance use.

Setting-3 hospitals in New South Wales, Australia.

Subject-Medical staff caring for 263 inpatients.

Result-Medical staff did not recognise substance misuse in older hospital patients and did not seem to be aware of current recommendations of the National Health and Medical Research Concil recommendations for safe use of alcohol and benzodiazepines.

Three out of 88 problem users of benodiazepines, 29 out of 76 smokers, and 33 out of 99 problem drivers were identified by medical staff.