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The purpose of this study was to determine hospital and postdischarge survival and functional status at follow-up in elderly patients receiving tracheostomy for respiratory failure and to determine if these outcomes differed between the younger elderly (65–74 years) and the older elderly (≥75 years). This was a retrospective chart review with prospective administration of the SF-36 conducted in 228 patients aged 65 years or older who had undergone tracheostomy to facilitate mechanical ventilation for respiratory failure at a tertiary care, university-affiliated urban medical center. Demographics, comorbidities, hospital survival, liberation from mechanical ventilation, long-term survival, and functional status were determined. Combined hospital and hospice mortality did not differ by age, being 34% and 26% in the 65- to 74-year and ≥75-year groups, respectively (P > .05). However, older patients (≥75 years old) were more likely to be discharged still requiring mechanical ventilation (62% vs 45%, P < .05). Only one half of hospital survivors survived for 1 additional year. Those discharged ventilator-dependent were more likely to die. Of the 20 participants in the SF-36 portion of the study, most had fair to good emotional and social functioning but were extremely limited physically.