Background: Knowledge about alcohol consumption patterns and alcohol problems among the Belgian elderly population is scarce. The aims of this study were to explore alcohol consumption patterns and alcohol problems among the Belgian elderly population aged ≥65 years living at home, and to determine their association with socio-demographic characteristics, health status and socio-economic status. Methods: In this cross-sectional study based on a representative sample of 4825 non-institutionalized Belgian elderly people (≥65 years) in the Belgian Health Interview Surveys 2001 and 2004, alcohol consumption patterns and alcohol problems were estimated according to age, gender, survey year, living situation, frequency of social contacts, smoking status, and socio-economic status. Results: In all, 50.4% of the sample were non- or occasional drinkers, 29.1% were moderate drinkers, 10.4% at-risk drinkers, 4.6% heavy drinkers and 5.5% problematic drinkers. In total, 20.5% of the Belgian elderly population drank in excess of the National Institute on Alcohol Abuse and Alcoholism guidelines, and 4.7% had an alcohol problem according to the CAGE. In addition, 81.3% of the elderly people who consume alcohol used prescribed medications in the past 2 weeks. After adjustment for risk factors we found that, compared with moderate drinking, unhealthy drinking was significantly associated with age, gender, frequency of social contacts, health status and socio-economic status. Conclusions: Belgian health policy should be aware of the high level of at-risk drinkers in the elderly population and the underdetection and misdiagnosis of alcohol problems in this age group. An increased attention in public health initiatives among the Belgian elderly population is needed.