The impact of tuberculosis (TB) on older adults in Southern Africa is rarely emphasised. The case notification rate in 2004 among the elderly in Soweto was 262 per 100 000 population. The elderly comprised 5.8% of adults and 1.6% of adults notified. Among 110 elderly patients studied, 50% had pulmonary TB, 37% had extra-pulmonary TB (EPTB) and 13% had both. A predisposing disease occurred in 46%. TB was microbiologically proven in 77%. Human immunodeficiency virus (HIV) status was known for 25 (23%) patients, with 10 (9% of the cohort) being HIV-infected. HIV-infected adults had more EPTB, anaemia and hyponatraemia. Older adults in Soweto bear a high burden of TB.