Background: Tuberculosis (TB) in the elderly poses significant diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and atypical clinical presentation. This study evaluates the epidemiological and clinical characteristics of TB in patients aged ≥65 years. Methods: A retrospective descriptive study was conducted including all TB cases reported between 2020 and 2024. Data from the National Tuberculosis Program were analyzed for demographic characteristics, clinical form, bacteriological confirmation, comorbidities, and treatment outcomes. Results: Of 1,335 TB cases, 352 (26.4%) occurred in individuals aged ≥65 years. Pulmonary TB accounted for 80.7% of cases. Men represented 63.4% of patients, and 56.8% lived in urban areas. Bacteriological confirmation was achieved in 82% of pulmonary cases, and treatment success exceeded 85%. Diabetes mellitus (26.5%) and arterial hypertension (31%) were the most common comorbidities. An increase in TB cases was observed in the post-COVID-19 period. A significant association was found between age and clinical form of TB (p < 0.001). Conclusions: Elderly individuals constitute a substantial proportion of TB cases and frequently present with chronic comorbidities. Despite diagnostic challenges, favorable treatment outcomes were achieved, highlighting the need for integrated and early management strategies in this population.