Introduction: Older adults experienced disproportionate levels of morbidity and mortality during the COVID-19 pandemic, driven by physiological senescence and multi-morbidity. This research evaluates the clinical features, biochemical markers, and survival outcomes of elderly patients within a tertiary care environment in Kerala. Methods: We conducted a retrospective, record-oriented analysis of 626 COVID-19-positive individuals (age ≥60) admitted to T.D. Medical College Hospital, Alappuzha, between June 2020 and January 2021. Statistical associations between demographics, laboratory indices, and clinical outcomes were determined using IBM SPSS version 25. Results: The study population was mostly male (57.7%), with the majority falling in the 60–70 age bracket. Fatigue (58.6%) was the primary clinical complaint, whereas pyrexia was notably absent in many cases. Hypertension (67.3%) was the most prevalent underlying condition. A significant mortality risk was identified in Category C patients (33.9%), those with an admission SpO₂ below 90% (46.0%), and individuals with pre-existing cardiac disease. High ESR, D-dimer, and ferritin levels, along with sodium and potassium imbalances, served as robust predictors of mortality. Conversely, standard antiviral and corticosteroid therapies did not show a correlation with improved survival in this specific cohort. Conclusion: COVID-19 in the elderly frequently presents with non-classical symptoms, complicating early detection. Management should prioritize the monitoring of inflammatory markers and electrolyte levels, as conventional pharmacotherapy demonstrated limited benefit in this demographic.