Cochlear implantation allows for improved communication and quality of life in elderly individuals with severe to profound sensorineural hearing loss and poor word discrimination. Medical and psychosocial factors, however, pose additional challenges that can impact desired cochlear implant outcomes. Risks associated with cochlear implantation are not significantly increased with age. Special consideration should, however, be given to the peri-operative needs of this population and added risks associated with the recovery process. A thorough multidisciplinary approach to candidacy evaluation is necessary to minimize intervention risks, and develop appropriate expectations by the patient and family members. Post-operative rehabilitation including the development of strategies for better communication in real world conditions is underutilized, but is likely to increase success with a cochlear implant. © 2010 Elsevier Inc.