Use of psychotropic medications with elders who are mentally retarded is a very common procedure. However, patterns of medication usage in this group are not easily determined. Objectives were to explore relationships between prescribed psychotropic treatments, the types of reported behavioral difficulties, and the size/type of living settings where these difficulties were exhibited. Subjects were moderately mentally retarded elders who were living in Congregate and Group care settings who were observed and rated by caretakers using a standard behavior rating instrument. Comprehensive medical (drug) and demographic data was obtained on each person. The study revealed that psychotropic use was more frequent in congregate care settings for these older clients. Those more elderly demonstrated a tendency toward higher utilization. Little differences were evident in the general characteristics (sex, IQ, reality orientation) of elders living in the two settings despite differences in drug use rates. Future research needs to focus on differences in behavior problems and setting factors to more fully understand drug utilization rates in elders with mental retardation.