The elderly population is fast growing due to recent development of diagnosis, treatment and prevention of disease. Advances in healthcare have allowed for healthier and more active life styles, thus increasing head injury. The injuries sustained by elderly are not different from those sustained by younger adults. However, mortality and complication is more severe compared to younger adults in equal injury. In this review, we provide the physiologic changes, mechanism of injury, clinical characteristics, surgical treatment and ethical problems of the geriatric head injured patient