Purpose <p>Intussusception in adult and elderly patients is rare but potentially life-threatening, requiring high clinical suspicion for prompt diagnosis and management. This study aims to identify risk factors in these patients to improve management protocols and enhance clinician awareness.</p> Methods <p>Adult and elderly patients with intussusception (2005–2014) from the National Inpatient Sample, which provided data on demographics, comorbidities, outcomes, and operative management were analyzed. Logistic regressions assessed the relationships between mortality and patient characteristics.</p> Results <p>Among 4,432 patients, 82.3% were adults (57.1% females), and 17.7% were elderly (64.1% females). The elderly mortality rate was 2.8% versus 0.1% in adults. In non-operatively managed elderly patients, longer hospital length of stays (LOS) and older age increased mortality odds by 5.7% (<i>P</i> = 0.120) and 24.8% (<i>P</i> = 0.080). Operatively managed elderly patients with higher frailty scores had 34.0% greater mortality odds (<i>P</i> = 0.160), while female sex reduced odds by 69.8%. In operatively managed adults, each day of delayed surgery raised mortality odds by 26.7%, and each additional year of age increased odds by 21.0% (<i>P</i> = 0.053).</p> Conclusion <p>Longer hospital stays, advanced age, and higher frailty increase mortality risk in adult patients and elderly surgical patients. Female sex offers a protective effect. Non-operatively managed elderly patients are at high risk for mortality.</p>