Although patients aged 65 years or older represent only 10% of all patients with traumatic brain injury (TBI), they account for 50% of all TBI-related deaths. Among patients older than 65 years, the mortality rate associated with TBI is double that in patients 20 to 44 years old, and among patients older than 75 years, the rate is tripled. Medical evidence indicates that elders who experience a TBI will likely have a poor outcome despite maximal medical and surgical care, and with the US population older than 65 years expected to double by 2050 and healthcare funds becoming increasingly more limited, TBI represents a major healthcare problem in elders, yet it has received little attention from clinicians and researchers. Scientifically, medically, economically, and ethically sound standards for the treatment of TBI in elders must be established to guide healthcare providers, patients, and their families. This article reviews the impact of age on outcomes after TBI and offers possible explanations as to why trauma-related morbidity and mortality are increased in elders. Clinicians’ attitudes and trends regarding treatment for elderly patients with TBI are also reviewed.