Background: Population aging and mobility have increased the exposure of elderly individuals to dengue. This study evaluated the clinical features of dengue in the elderly during the epidemic (2008 and 2012) and interepidemic (2009 and 2010) periods. Methods: This cross-sectional study was based on dengue surveillance data from Rio de Janeiro, Brazil: 2008 (n=31,210), 2009‒2010 (n=2,884), and 2012 (n=30,773). The analysis was stratified by age group (<60 and ≥60 years). Results: Case-fatality rates were higher in the elderly. In 2008, elderly individuals were found to be more prone to hematuria and thrombocytopenia. Conclusions: These results can improve the understanding of dengue in elderly individuals who live in or travel to tropical regions.