Background: Trauma remains a leading cause of death and disability. With the rapidly growing aging population, geriatric patients face heightened trauma risks due to physiological decline and comorbidities. Despite the growing burden, data on the clinical characteristics, injury mechanisms, patterns, and healthcare utilization in this group remain limited. This study analyzed trauma outcomes and associated factors in geriatric patients. Methods: We conducted a retrospective cohort study using data from a Level I trauma center. Patients aged ≥65 years were compared with younger adults (<65 years). Variables included demographics, injury mechanism, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score, clinical outcomes, and medical costs. Multivariate logistic regression identified mortality predictors. Results: Among 10,358 trauma patients with mean age of 54.2 years, 61.9% of younger patients were male, compared to 37.7% in the geriatric group (p<0.001). Geriatric patients exhibited lower male predominance, higher costs, and greater mortality (p<0.001). Multivariable analysis revealed that, among geriatric groups, male sex, older age, lower GCS, lower RTS, burns injuries, and severe injuries (AIS ≥3) to head, thoracic, extremity, and appearance were significant mortality predictors. Undergoing orthopedic and thoracic surgeries was associated with lower mortality in geriatric patients. Conclusion Geriatric trauma patients experience higher mortality risks and demands. Timely interventions, critical care management, appropriate triage, and age-adapted assessment tools are essential for improving clinical outcomes. These findings underscore the importance of interdisciplinary care strategies to optimize geriatric trauma management and resource utilization.