BACKGROUND Old age is considered a risk factor; however, its effect on the prognosis of injured elderly patients remains uncertain. OBJECTIVE To find the effect of old age on final outcome of elderly patients withmultiple trauma and to determine whether a different therapeutic approach is needed. METHODS All patients with at least two injured body regions, as defined by the ISS, of grade 4 in AIS, were included. RESULTS We studied 165 patients up to 64 years (Y) of age and 56 patients older than 65 years (E) in a 10-year period. On presentation 21.2% of Y and 25% of E, were hypovolemic (p = NS). No significant difference in number of injuries/patient was noted between Y and E patients, hemodynamically stable (HS) and unstable (HU) - (3.0 vs. 2.9 and 3.9 vs. 3.6). An increased relative frequency of chest and abdomen injuries was noted in Y and E, who died or were HU on presentation. A higher relative frequency of long bone and pelvis fractures was noted in the E. The ISS was not different among HS and HU, Y and E. Hospitalization in ICU was more common in E than in Y (69.6 vs. 47.3%), but there was no difference in the final outcome: overall mortality was 10.3% in Y versus 16.1% in E (p = NS), mortality in HU was 42.9% in Y versus 50% in E (p = NS). ISS was not associated with mortality in either group. CONCLUSIONS Old age has no influence on final outcome of E multi trauma patients; hence, the therapeutic approach of these patients should be the same in Y.