As the result of the strengthening of TB-control programs nationwide, a decline in the overall number of reported TB cases in the United States has been observed within the last 10 years. Despite these declines in absolute numbers, the elderly continue to account for a disproportionate share of the cases. The high number of cases diagnosed at autopsy among the elderly suggests that this condition often remains unrecognized, possibly due to the subtle clinical manifestations in this age group. Evidence suggests that, compared with their community-dwelling counterparts, the institutionalized elderly are at a greater risk for re-activation of latent TB and for the acquisition of new TB infection. More studies are needed to make final conclusions. New guidelines for the treatment of LTBI emphasize targeted TST among persons at high risk for development of active TB and no longer use age as an exclusionary condition. All nursing home residents must therefore be regularly screened for LTBI and treated if necessary. Even though elderly persons are at greater risk for hepatic toxicity from TB treatment, the poor outcome of untreated TB in this age group warrants more aggressive treatment of this condition.