Low-grade gliomas (LGG) are increasingly being diagnosed in older patients (>or=60 years). The rising incidence is incompletely understood but demands an analysis of the natural history and prognostic factors to determine if there are differences compared to younger populations. We retrospectively review a consecutive series of 20 older patients who presented between 1991 and 2004 with LGG to characterize the presentation, management, outcomes, and prognostic factors in older patients with LGG. Median follow-up was 27.3 months. Thirty-five percent of patients harboured oligodendrogliomas. Patients presented in equal numbers with seizure, focal neurological deficit, and mental status change. Median overall survival (OS) was 27.3 months. Patients who survive beyond 2 years experience prolonged periods of progression-free survival. Younger age, seizure presentation, and radiation treatment were prognostic of OS on multivariate analysis. Similarities with previous reports of LGG suggest that age should not affect the management of LGG patients. Prospective studies of older patients with LGG are needed to further characterize the optimum management of these patients.