ABSTRACT Population ageing is emerging as a critical determinant of substance use patterns worldwide. Aging, in general, has imminent public health implications for countries (such as India) that are undergoing rapid demographic transit. The elderly population represents a growing but under-examined group within substance use research and clinical practice globally. Age-related physiological changes alter the risk profile of substance use in older adults, resulting in larger negative effects even in lesser amounts. Clinical presentations are frequently atypical, contributing to underrecognition and delayed diagnosis. In primary care, substance use-related harms in the elderly are frequently overlooked or misattributed to comorbid medical or cognitive conditions. In India, this invisibility is compounded by the limited availability of age-specific epidemiological data and health systems that remain largely oriented toward the working-age population. This narrative review synthesizes available Indian and international literature on substance use and related disorders among older adults. We have discussed the current epidemiology, clinical presentation, and diagnostic dilemmas. Particular attention is given to elderly women, in whom substance use is often linked to heightened stigma and poor help-seeking. Management strategies, including pharmacological and psychosocial interventions, rehabilitation, and the role of primary care integration, are discussed. Emerging areas, such as digital health interventions, brain stimulation, and integrative medicine, are discussed, alongside their limited evidence base. In the end, key research priorities and policy directions are debated. This review underscores the need for more systematic research, age-sensitive clinical frameworks, and greater visibility of the elderly within substance use discussions in India.
Kololichalil et al. (Thu,) studied this question.