A review of the literature on physicians' perceptions of alcoholics and the elderly shows that scant professional or research attention has been given to the elderly alcoholic. Medical schools offer little training on alcoholism, fostering the impression that physicians do not have responsibility for treating alcoholic patients. An exploratory study of 26 physicians reaffirmed physicians' limited knowledge of, or interest in, addressing older patients' drinking problems, as assessed by physicians' responses to vignettes. These findings challenge the existing health care system, especially in light of the current demographic predictions that the proportion of the elderly population wilt increase substantially and the prevalence of alcohol-related problems in this age group. Strategies to address the drinking problems of the elderly are discussed.