Background: Acute pancreatitis (AP) is a clinical condition that can range from mild inflammation to severe forms accompanied by multiorgan failure. It is linked to notable rates of illness and death. Older adults are particularly vulnerable due to reduced physiological reserve and the presence of multiple comorbidities. This study sought to examine how age influences comorbidities and clinical outcomes in patients with AP.Aim: This study's main goal was to identify the risk factors contributing to systemic complications and mortality among individuals aged 65 and over diagnosed with acute pancreatitis. In addition, the study aimed to assess the effectiveness of commonly used clinical severity scoring systems across different age groups.Materials and Methods: This retrospective cohort study evaluated 401 patients who presented with acute pancreatitis between January 2023 and May 2025. Participants were initially categorized according to age into those younger than 65 years and those aged 65 years or older, with additional age-stratified subgroup analyses performed within the elderly population. Clinical, laboratory, and demographic variables were systematically assessed and compared. To determine independent predictors of systemic complications, local complications, and in-hospital mortality, multivariate logistic regression analyses were applied.Results: Of the 401 patients included, 50.1% were aged 65 years or above. Comorbidities including diabetes mellitus (32.3% vs. 9.0%), hypertension (75.1% vs. 15.5%), and coronary artery disease (34.8% vs. 5.5%) were markedly more common among elderly patients (all p 0.05). Systemic complications were more commonly observed in elderly patients (39.3% vs. 25.5%, p = 0.003), whereas the incidence of local complications (23.5% vs. 17.4%) and in-hospital mortality (6.0% vs. 7.5%) showed no significant differences between the age groups (both p 0.05). In the multivariate analysis, age ≥65 years (aOR = 1.96, 95% CI: 1.20–3.18) and presence of diabetes (aOR = 2.48, 95% CI: 1.47–4.21) emerged as independent predictors for systemic complications. Regarding in-hospital mortality, systemic complications (aOR = 2.68, 95% CI: 1.07–6.69) and reduced serum albumin levels (aOR = 0.43 per g/dL, 95% CI: 0.19–0.96) were found to be significant risk factors.The predictive performance of current severity scores for mortality and complications was limited in elderly patients (AUC
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