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When compared with other age groups, fatal drowning rates among seniors have stayed static. This study identifies causal factors in unintentional bathtub drowning deaths among people aged 65 years and over. This study is a 10-year (2003-2012) total population retrospective survey of all unintentional bathtub (baths, spa baths and showers) drowning deaths afflicting people aged 65 years and over. Data were sourced from the Australian National Coronial Information System. Risk factors and circumstantial variables were analysed including sex, age, activity prior to drowning, alcohol, drugs, pre-existing medical conditions, living circumstances, time until found, and performance of cardio-pulmonary resuscitation (CPR). There were 32 fatalities (20 females, 12 males); 41% drowned after a fall into the bath. High blood alcohol (≥0.05%) was disproportionately represented. Twenty-six people (81%) had a pre-existing medical condition, deemed contributory in 19 cases including cardiac (n=9) and sarcopenia or frailty (n=5). Of those with medical conditions, 69% had blood levels of prescribed drugs, commonly analgesics (n=10). Seven cases recorded both drugs and alcohol. In half of all fatalities (50%), the person resided alone. In ten cases (31%) the person was not found for one or more days. Bathtub drowning afflicting the elderly poses an unmet challenge. This study has identified five areas for targeted prevention: Pre-existing medical conditions, alcohol, falls in the bath, review of medications; and if practical, advising family members of bathing. Increased awareness of drowning among this age group (and carers) is required as the aged population increases.