Traumatic brain injury (TBI) is a major public health problem, affecting millions of people each year worldwide. Elderly patients are at particularly high risk after sustaining a TBI due to higher degrees of mortality and functional disability compared with younger patients. In addition, the causative mechanisms of TBI in the elderly are shifting from motor vehicle collisions to falls. In this article, we will review the risk factors and mechanisms that predispose elderly patients to sustain a TBI. We will conclude by using a "Haddon's Matrix" approach to review current evidence-based prevention strategies directed at reducing the burden of TBI in the elderly.