Spinal muscular atrophy (SMA) is a rare genetic disease characterized by degeneration of motor neurons resulting in severe progressive muscular weakness and atrophy. Limited information is available on healthcare resource utilization (HRU) over time among older SMA patients, particularly adults. In this study, HRU and disease progression were characterized for older patients in U.S. hospital settings over three years. The study population included patients with inpatient or hospital outpatient discharge encounters and ≥2 primary or secondary SMA ICD-9 codes ≥30 days apart in the Premier Healthcare Database (2007–2014). Index date was the date of the first SMA ICD-9 code. Three cohorts, grouped by age at index, were included: later childhood (4-12 years), adolescent (13-17 years), adult (≥18 years). HRU (including number and proportion of inpatient, outpatient emergency department [ED]), and outpatient non-ED visits) was assessed for each group 12 months pre- through 24 months post-index. Analyses included 144 later childhood, 69 adolescent, and 446 adult patients from 337 hospitals. Overall, HRU increased from the pre-index to post-index period for each age group across all examined service types. The largest three-year increases were found for mean outpatient non-ED visits (later childhood: 0.65 to 5.69, adolescents: 0.88 to 4.78, adults: 1.51 to 4.53), followed by outpatient ED visits, and inpatient stays. For adults at two years post-index, 71% of visits were outpatient non-ED, 16% were outpatient ED, and 14% were for inpatient care. Similar proportions were observed for other age groups. Findings illustrate increasing HRU over a relatively short time interval for older SMA patients, including adults. Approximately one-third of visits among adults occurred in inpatient and outpatient ED settings.