OBJECTIVES: Reportedly, suicide rates are highest among those aged 65 years and older (elderly) in the US. This study examines admissions resulting from suicide attempts by elderly persons and estimates the resulting hospital costs. METHODS: Cases of suicide attempts by elderly persons were identified using ICD-9 diagnosis and E-codes. Hospital costs were developed based on 2000 discharge data from 619 hospitals in seven states, supplemented with national fee schedules. Cost estimates include accommodation, ancillary and physician services, reported in 2003 US$. Charges were adjusted using a 0.61 cost-to-charge ratio and the annual medical care component of the U.S. Consumer Price Index. RESULTS: Of 2129 suicide attempts identified, 56% were female and 3% were admitted from residential, nursing or correctional facilities. The mean age was 76 years; 75% were admitted via Emergency Room and 41% spent time in ICU. Drug overdose was the method of self-inflicted injury in 71% of cases. Mean length of stay was 5.9 days (median: 3, range: 1-261). Mean cost per stay was $11,445 (median: $6005, range: $498 - $610,565). Cumulative cost for all cases was $29.7 million. The inpatient case fatality rate was significantly (p = 0.000) higher in males (12%) than females (4%). Of those discharged, 51% went home (6% with home care), 26% to sub-acute facilities, 20% to a mental health or residential care facility, and 1% returned to prison. Within 12 months following their index suicide attempt, 8% were readmitted for another attempt and survived. CONCLUSIONS: While most of the intentionally self-inflicted injuries by elderly persons who are admitted to hospital are not fatal, elderly males admitted for suicide attempts are three times more likely to succeed. Although suicide attempts by elderly persons generate substantial hospital costs, the estimates presented reflect only a portion of the economic consequences of this problem, as most require health services post-discharge.