We report 281 consecutive admissions of head-injured patients over 65 years of age. 2/3 were males, as in younger age groups, despite the decreased activity and increased proportion of females among the elderly. The main causes of injury were falls (71.8%; mostly at home) and pedestrian accidents (20.6%). There was a high incidence of cardiovascular disease among the men. The unique set of causes and types of head injuries in this age group (1/3 chronic subdural hematomas, 1/3 cerebral contusions and 1/5 acute subdural hematomas), as well as the grim outcome, justify regarding head injury in the elderly as a special clinical entity. Its special medical, surgical, organizational and ethical aspects should be considered.