Substance abuse is a growing problem among older Americans, and the nation's health care system is not prepared to adequately address the need, according to a report by the Institute of Medicine (IOM).

Up to one-fifth of Americans over age 65 have substance abuse or mental health conditions, according to the report by the IOM, an independent government advisory group.

Substance abuse appears to be increasing among this group, according to Dr. Dan Blazer, who headed the IOM committee that issued the report. Accidental and intentional misuse of prescription medications among the elderly is a particular concern, the report notes.

"The burden of mental health and substance use is large and will get larger," Blazer told The Wall Street Journal. The report calls on the government to redesign Medicare and Medicaid payment rules to address the problem. These programs should guarantee coverage of counseling, care management, and other types of services needed to treat substance use and mental health problems, so that clinicians are willing to provide this care, the IOM stated. The report also called on organizations that accredit health and social service professional schools and license providers to ensure that clinicians who see older patients can recognize signs and symptoms of substance misuse and mental health conditions, and provide at least basic care.

The Department of Health and Human Services must call attention to the need to build a sufficiently sized work force that is trained in geriatric substance abuse and mental health care, the IOM noted.

"There is a conspicuous lack of national attention to ensuring that there is a large enough health care work force trained to care for older adults with mental health and substance use conditions," Dr. Blazer said in a news release. "These conditions are relatively common, they can be costly, and they can have profound negative impacts on people's health and well-being. This report is a wake-up call that we need to prepare now or our older population and their extended families will suffer the consequences."