Acute leukemia patients have a diminished survival inversely proportional to their age. 5-year overall survival in younger AML patients is 50%, however reduced to <10% if age >70. Factors contributing include poor performance status, decreased response to induction therapy, increased treatment related mortality, unfavorable cytogenetics and secondary leukemia. Report observed characteristics and outcomes of elderly leukemia patients. Retrospective chart review of newly diagnosed acute myeloid leukemia (AML) patients >65 admitted from 7/1/2015 through 6/30/2021. Demographic information, classification, duration of hospital stay, blood products administered, treatment, discharge condition, 3 and 6 month remission, and survival data collected. Academic medical center. 149 patients identified. AML[n=130], acute promyelocytic leukemia (APL)[n=9], and acute leukemia not otherwise specified (AML-NOS)[n=10]. 97 patients treated. AML treatment: Induction therapy, daunorubicin and cytarabine (liposomal), or hypomethylating agent +/-venetoclax. APL treatment: all-trans retinoic acid (ATRA) +/- arsenic trioxide (ATO). One patient with AML-NOS received hypomethylator. Patients separated into three groups: <70[n=55], 70 to 74[n=52], and >75[n=60]. Percent of patients who did not receive any therapy increased as age group increased (21.8%, 32.7%, and 41.7%). Length of hospital stay, reflective of treatment, was greatest in the younger population (28 days, 17.6 days, and 15.3 days). 6-month survival 51% younger, 42.3% middle and 23.4% for eldest cohort. Treatment related mortality (TRM) including transitioning to hospice care increased as age increased (29%, 34% and 50%). 25/130 patients received induction chemotherapy. Nineteen patients were <70. The expected TRM for the younger cohort was 10.68% (1 - 41%) and 10.1% (1-20%) for elder cohort. The observed TRM was 10.5% in the younger cohort and 50% in the older cohort. Most of the eldest AML patients received a hypomethylating mono- or combination therapy. Nearly 50% of all AML were discharged home. The 6-month survival was 50% for younger, 26.8% for middle and 13.3% for eldest cohort. Nine APL patients were identified with 5 being in the eldest cohort. Only 3(33.3%) survived 6 months. None of the patients with AML-NOS were alive at 6 months. Acute leukemia in the elderly population remains a challenge with poor outcomes despite considering patient's age and performance status.