This systematic review with meta-analysis by Gellert et al aimed to provide an overview on the empirical evidence of the association of smoking with all-cause mortality in people 60 years and older. Seventeen studies from 7 countries were identified after a systematic literature search. Current smoking was associated with increased all-cause mortality in all studies; relative mortality (RM) of current smokers compared with never smokers was 1.83 (95% CI, 1.65-2.03) in meta-analysis. A moderate decrease of RM with increasing age was observed, but mortality remained increased up to the highest ages. Furthermore, a dose-response relationship of the amount of smoked cigarettes and premature death was found. Former smokers also showed increased mortality (meta-analysis: RM, 1.34; 95% CI, 1.28-1.40), but excess mortality compared with never smokers clearly decreased with duration of cessation. Smoking remains a strong risk factor for premature mortality also at older age.