Miranda and colleagues1 have performed a retrospective review of a series of 209 patients with chronic subdural hematoma (CSDH). What makes this article merit editorial comment is the nature of their population: the patients’ mean age was over 80 years. The authors’ conclusion is aptly presented in their headline: chronic subdural hematoma in the elderly may not be such a benign disease. No other series of patients with CSDHs has examined the long-term outcome from treatment in a group of this seniority. Some results were not surprising. The only factor they could identify that correlated with the in-hospital mortality rate was neurological status on admission. There was also a markedly increased postdischarge mortality rate among the CSDH group compared with actuarial norms. Other results were less predictable. The hazard ratios derived from their data show that their younger patients (age range 60–69 years) had the highest mortality rate, with the risk progressively diminishing in each successive decade to the tenth. They theorized that this paradoxical result might be explained if CSDH was, in fact, a “marker” for underlying disease, much in the way that hip fracture in the elderly has become a poor prognostic indicator that supersedes its significance as a solitary entity. If this is the case, then the younger a patient is when a CSDH develops, the sicker that patient is compared with his/her age-matched cohort, and the poorer is his/her agematched predicted survival. A surprising number of patients (125) were discharged to a skilled nursing facility, despite the fact that a large majority (166) of their population was admitted with a normal neurological status. This may, in part, be due to the advanced age of the patients or to local rehabilitation practices. There is no true correlate for comparison in the literature, but this exemplifies the complexity of managing these patients. One aspect of this series should be emphasized: of the 209 patients, 72 (35%) underwent no surgical procedure and were treated conservatively. The mortality rate was not influenced by whether surgery was even performed. Furthermore, the type of intervention, size of the CSDH, amount of shift, the presence of bilateral CSDHs, and anticoagulant use had no significant impact on the shortor long-term mortality. Aspects of this study will have to be replicated in future case series. Nevertheless, the authors are to be con gratulated on pointing out what might be potentially im portant implications of CSDH on both prognosis and life expectancy.