Elderly people in long-term care facilities (LTCFs) may be more vulnerable to infectious gastroenteritis and food-borne disease and more likely to experience serious outcomes. We review the epidemiology of gastroenteritis and food-borne diseases in elderly residents of LTCFs to inform measures aimed at preventing sporadic disease and outbreaks. Gastroenteritis in elderly people is primarily acquired from other infected persons and contaminated foods, although infections may also be acquired when residents have poor personal hygiene, have contaminated living environments or water, or have contact with infected pets. Early recognition of outbreaks and implementation of control measures is critical to reduce the effects on LTCF residents and staff members. Although outbreaks among LTCF residents are common, they are challenging to investigate, and there are still major gaps in our knowledge, particularly in regards to controlling noroviruses, the incidence and causes of specific infections, and sources of food-borne disease.