Advancing age is known to be a determinant of outcome in head injury. We have sought to discover whether there has been any change in the outcome of elderly patients with severe head injury in Newcastle, where these patients have continued to be treated with maximum intervention. A review of prospectively collected data from the Newcastle Head Injury Database for the period 1990 to 2000 was carried out. All patients aged 70 years and above who had sustained a severe head injury (Glasgow Coma Score of 8 or less from the outset) were included. The Glasgow Outcome Score (GOS) was determined at 6 months. Seventy-one patients were identified. Fifty-seven (80%) died and 2 (3%) were in a vegetative state, 11 (16%) had severe disability, 1 (1%) had moderate disability and no patients made a good recovery. The natural history of this condition remains unchanged and due consideration should be given to this when evaluating interventions for elderly patients with a severe head injury.