IntroductionCriminality has become of increasing concern in the practice of psychiatry. However, violence among elderly psychiatric patients is an underestimated and understudied phenomenon.ObjectivesThe aim of the study is to identify differences in the socio-demographic, clinical and criminological profiles between elderly criminals under treatment for psychiatric disorders and those not known to have mental disorders prior to the criminal offense in Tunisia.MethodsWe present a retrospective study on twenty male criminal mental patients, aged sixty years or older, who were hospitalized in the Forensic Psychiatry Department of Razi Hospital during 18 years, following a dismissal for insanity under Article 38 of the Penal Code and Article 29 of Law 92/83 on Mental Health.ResultsPrevalence was higher among elderly criminals without a known psychiatric history (2.42% versus 1.98%). The average age was roughly the same, around 73 years old.Neurological and cardiovascular histories were the most common in both groups. The criminal act was indicative of dementia in 8 cases. Criminal history was more frequent in elderly patients with a personal psychiatric history (55.5% versus 18.2%). Patients whose act was revelatory of their mental disorder committed more violent crimes (63.7% versus 44.4%) using blunt objects (71.4% versus 0%).The victim most often belonged to the aggressor’s family, particularly the spouse (87.5%).ConclusionsScreening for criminal risk factors in the elderly, early diagnosis of mental disorders and a comprehensive therapeutic project are necessary to prevent the risk of violent behaviour.