INTRODUCTION: With Singapore's ageing population, there are increasing numbers of elderly cyclists and motorcyclists. Compared to younger riders, this cohort sustains more injuries and has poorer outcomes. This study aimed to describe and compare patient demographics, injury patterns and outcomes among elderly cyclists and motorcyclists at a Level 1 trauma centre. METHODS: Data of all cyclists, motorcyclists and pillion riders aged 65 years and above who presented to the emergency department after accidents from 1 January 2013 to 31 December 2017 was extracted from the hospital's trauma registry and reviewed. RESULTS: Cyclists and motorcyclists formed 42.0% and 58.0%, respectively, of 157 recruited patients. At the time of the accident, 40.8% of the patients were employed. The mean age of the patients was 71.6 ± 5.8 years. Extremities and pelvic girdle injuries (61.1%) were the most frequent, followed by chest injuries (48.4%), and head and neck injuries (40.1%). Among severe injuries (defined as Abbreviated Injury Scale score ≥ 3), chest injuries (39.5%) were the most common, followed by head and neck injuries (36.3%). The overall mortality rate was 9.6%, with cyclists at nearly three times the risk compared to motorcyclists. More cyclists than motorcyclists (18.2% vs. 11.0%) required intensive care. There were no significant differences in the length of hospital stay between cyclists and motorcyclists. CONCLUSION Elderly riders have unique injury patterns and consume significant healthcare resources. Trauma systems need to acknowledge this changing injury epidemiology and equip trauma centres with the necessary resources targeted at elderly patients. Future work should focus on strategies to minimise extremity and chest injuries.