Background: The geriatric age group, defined as any individual above the age of 60 years, is expected to double from 7.7% in 2001 to 12.30% in 2025.,1 Altered mental status is a challenging entity, where atypical manifestations poses greater challenge for diagnosis and treatment Aims: To analyze the clinical profile and etiology of elderly patients presenting with altered mental status A prospective, descriptive study of 247 elderly patients who presented with altered mental status were admitted to the wards/ICU. Detailed history was obtained from the attender, including comorbid conditions, activities of daily living, polypharmacy, physical disabilities. Comprehensive geriatric assessment, MMSE, GCS was performed and documented. Laboratory, radiological and other investigations were reviewed in order to make a conclusive diagnosis and care plan and patients were followed up, until discharge from the hospital Results: 247 elderly patients were included with a mean age was 71 years out of which 86.4% had comorbidities and 14.17% had psychiatric illness. 37% consumed alcohol and 33.19% were on medication with probable cause delirium. (78.3%). The mean GCs was 9.68. The most common etiology were metabolic disturbances (60.7%), followed by septic etiology (30.7%), cerebrovascular disease (12.55%), delirium (10%) The mortality rate in this study was 13.9% Conclusion: Majority patients had one or more comorbid conditions, drowsiness being the most common (68.01%). 14.5% had focal neurological deficits. Metabolic and septic encephalopathy were the most common. 20.6% had multiple causes of altered mental status. Septic encephalopathy with a worst outcome (23.07%) deaths.80.5% of patients were discharged.