The health practices and needs of two samples of older individuals with mental retardation were examined and contrasted over a period of 5 years. Their health status varied markedly, but most had poor health maintenance practices, and almost all had difficulty communicating with health care providers. Those who lived in community residential facilities or relatives' homes usually had adequate health care provided for them, whereas individuals who lived more independently had difficulty accessing health care. There is a pressing need for health care advocacy programs to help prevent chronic disability.