The disease consequence of smoking occurs disproportionately among the elderly because of the long duration of cumulative injury or change that underlies the bulk of tobacco-caused disease. Older smokers are less likely than younger smokers to attempt quitting, but they are more likely to be successful in the attempts that they do make to quit. Excess absolute rates of disease incidence and mortality due to smoking increase steadily with increasing age and duration of smoking, and there is little evidence to suggest that the disease consequences of smoking diminish among the elderly. Although cardiovascular disease is the most common cause of excess mortality among younger smokers, lung cancer is the largest cause of excess smoking-related mortality over the age of 60 years; and at older ages the excess death rate from chronic obstructive lung disease equals that for cardiovascular disease. Because of the dramatic increases in smoking-related excess mortality with advancing age, approximately 70% of the 400,000 or more deaths occur among those over age 60 years. The benefits of cessation are proportionately somewhat less among the elderly and may manifest more slowly than among younger smokers, but cessation remains the most effective way of altering smoking-induced disease risks at all ages, including those over the age of 60 years.