Modern care of patients with spinal cord injury is leading to greater numbers of individuals surviving into old age and the emergence of a cohort that has sustained injury at an advanced age. The clinical characteristics of either group of patients has not been well characterized. Analyses from the Aging with a Long-Term Disability Research Program database, which is enriched by the presence of a high quality Spinal Cord Injury Service, revealed a population of 510 recently assessed individuals with a mean age of 50 years, ranging from 16 to 84 years. Twenty-three percent of the patients were at least 65 years of age. Spinal cord injuries were usually the result of automobile accidents in individuals injured younger than 50 years of age and falls in individuals injured when older than 50 years of age. Patients surviving late life injury are much more likely to have incomplete injuries predominantly affecting the cervical spine. A number of conditions were found to be more prevalent in older patients. These included carpal tunnel syndrome, chronic obstructive pulmonary disease, myocardial infarction, diabetes, kidney stones, pressure ulcers and hypertension. The development of diabetes, kidney stones and perhaps pressure ulcers was directly related to aging with SCI, but not just to aging alone. The better functional outcomes in late life spinal cord injury may be secondary to selective survival. The excess morbidity associated with late life spinal cord injury has significance for future planning of healthcare needs for the spinal cord injured patient.