BACKGROUND: Limited attention is given on illicit substance use among the elderly & pattern of substance use in elderly is different from younger age group. AIM: To study substance use in geriatric patients admitted for medical illness. METHODS: 150 elderly patients admitted in general medicine ward were interviewed using a specially designed proforma, DSM–IV TR criteria & URICA Scale. RESULTS: Substance use was found in majority of the participants. Nicotine & alcohol dependence were predominant substance use disorders. Major depressive disorder & somatoform disorder was also found. Statistically significant associations were noted between gender, presence of icterus and peri knuckle pigmentation with presence of substance use. CONCLUSION: It is important to prevent substance use disorders in elderly. Psychiatric interventions should be practised in other wards of hospitals and primary health care centres for improving awareness of patients as well as their caregivers.