Aims The elderly are an increasing proportion in society, they have associated hearing loss and benefit from a cochlear implant (CI). Elderly CI candidates often voice their concern that CI outcomes may not be as good as younger recipients. The aim of the study was to analyse speech perception outcomes of patients with CIs 65 years and older, compared with those younger than 65 years. The secondary aim was to analyse if preoperative hearing levels, severe compared with profound, influenced speech perception outcomes in senior citizens. Methodology Retrospective review of speech perception outcomes for 785 patients receiving a CI between 2009 and 2016 at Nextsense (SCIC). Speech perception outcomes, using City University of New York (CUNY) sentences and Consonant-Nucleus-Consonant (CNC) words were measured preoperatively and postoperatively at 3, 6 and 12 months for cohorts younger than 65 years and 65 years and older. Results There were 785 CI recipients (350 younger than 65 years, 435 who were 65 years and older). Recipients younger than 65 years compared with those 65 years and older had comparable outcomes for CUNY sentence scores outcomes (p = 0.11) and CNC word scores ( p = 0.69). The preoperative severe hearing loss (HL) cohort had significantly better outcomes compared with the profound cohort, for both the CUNY sentence (p < 0.001) and CNC word scores ( p < 0.0001). CONCLUSIONS: The elderly have similarly speech perception outcomes as adults younger than 65 years. These finds are reassuring when counselling older CI candidates.