Abstract Background: The proportion of elderly population is increasing globally. Very little information is available on the presentation and clinical outcome of elderly patients at the Emergency Department (ED) in Bangladesh. This study was carried out to assess the pattern of elderly patients (65 years and more) who visited the ED of 250 Bedded General Hospital, Pabna (GHP). Methods: A retrospective observational study was conducted on patients aged 65 years or more at GHP from 2017 through 2021. Patients’ demographic information, symptoms, diagnoses and outcome following attendance were studied. Statistical analyses were done using SPSS version 23. Results: 20.7% (n = 94,905) of all adults (n = 4,57,549) presenting to the ED were aged e” 65 years. A greater number of elderly patients (58%) required hospitalization than nonelderly adults (37%). The 3 most common symptoms were breathlessness (9.9%), dizziness (9.0%) and abdominal pain (5.3%). The symptoms were mainly acute (< 24 hours, 42%) or less than a week (28.9%). The 3 most common diagnoses were Respiratory tract infections (7.8%), Cerebro-vascular diseases (Stroke/Transient ischaemic attack, 7.6%) and heart failure (7.4%). Conclusion: Elderly people constituted 20.7% of emergency attendance but 32.5% of admissions in adults. They differ significantly from younger adults in presentation and outcome. A better understanding of this issue will help doctors at the ED provide better management.