Background <p>Metabolic bariatric surgery leads to improved life expectancy in younger individuals, but whether older (&gt; 60&#xa0;years) individuals benefit from metabolic bariatric surgery is uncertain. This study examined mortality and causes of death in patients with metabolic bariatric surgery at age 60&#xa0;years or older.</p> Materials and Methods <p>This was a population-based matched cohort study based on all healthcare in Denmark, Finland, and Sweden between 1996 and 2024. All patients who had primary metabolic bariatric surgery at age &gt; 60&#xa0;years were included and exactly matched 1:5 to comparison individuals of the same age, sex, country, and calendar year with non-operative treatment for obesity. Cox regression provided hazard ratios with 95% confidence intervals for mortality adjusted for multiple obesity-related diseases and frailty.</p> Results <p>In total, 3879 (16.7%) patients with metabolic bariatric surgery and 19395 (83.3%) patients with non-operative treatment for obesity were included and followed for 176632 person-years. The cumulative mortality was 17.5% (<i>n</i> = 677) among operated patients compared to 23.5% (<i>n</i> = 4536) in the non-operated. In adjusted analyses, metabolic bariatric surgery was associated with 32% decreased mortality (HR 0.68, 95% CI 0.63–0.73). The results were consistent in patients of age &gt; 60–70&#xa0;years at the time of surgery, but there was no apparent benefit in patients operated at age &gt; 70&#xa0;years (HR 1.14, 95% CI 0.89–1.47). Operated patients were less likely to die from cardiovascular disease (57.6% versus 65.8%, <i>p</i> &lt; 0.001), but other causes of death were similarly distributed between the groups.</p> Conclusion <p>Metabolic bariatric surgery may decrease mortality in older patients with severe obesity.</p>