The geriatric population represents the largest reservoir of Mycobacterium tuberculosis infection in developed nations, including the United States. Tuberculosis (TB) case rates in the United States are highest for this age group compared with other age categories. The subtle clinical manifestations of TB in the elderly often can pose potential diagnostic dilemmas and therapeutic challenges, resulting in increased morbidity and mortality in this age group; this treatable infection unfortunately often is detected only at autopsy. Compared with their community-dwelling counterparts, the institutionalized elderly are at a greater risk both for reactivation of latent TB and for the acquisition of new TB infection. Prevention and control of TB in facilities providing long-term care to the elderly thus cannot be overemphasized.