Background <p>Using a validated tool, we explored the prevalence, risk factors, and predictors of longer hospitalization among hospitalized geriatric patients.</p> Methods <p>Retrospective and comparative analyses of age groups (55–64 vs. ≥ 65 years), gender, survival status, and frailty index categories were performed. The Modified 5-Item Frailty Index was assessed, and multivariable logistic regression analysis was performed to predict prolonged hospitalization (&gt; 7 days).</p> Results <p>There were 17,600 trauma hospitalizations with a mean age of 32 ± 15 years between 2010 and 2021; of them, 9.2% were geriatrics at ≥ 55–64 years (<i>n</i> = 935) and ≥ 65 years (<i>n</i> = 691). The female/male ratio was 17.5%/82.5%, and the mean injury severity score was 13 ± 9. The injury rate for age ≥ 65 was 24 per 10,000 compared to 10 per 10,000 in the younger group age (<b>≥</b> 55–64). 35% of injuries occurred at home due to falls. Overall mortality was 8%, with a higher rate among males than females (9% vs. 4%). The deceased were three years older at the time of death compared to the survivors. Higher frailty grades were associated with home-related falls and head injuries. Patients 65 years or older were likely to have higher frailty scores, as indicated by higher percentages in the mFI-5. Among the older group, 25% were moderately frail, and 18% severely frail. In the younger group, 50% were frail. Higher frailty scores correlated with increased acute kidney injury, pneumonia, urinary tract infections, and longer hospital stays. Severe frailty significantly predicted longer hospitalization (odds ratio 1.83, <i>p</i> = 0.007).</p> Conclusion <p>One out of eleven trauma admissions was aged &gt; 55. Head injury and bleeding were the leading causes of mortality in the study cohort. There was a significant decrease in the trend of geriatric trauma over the years. The modified FI-5 performs well as a predictive tool of prolonged hospitalizaion in trauma patients with different age groups.</p>