Objective This study aimed to assess the pattern of disease and predictors of mortality among critically ill geriatric patients admitted to the intensive care unit at a teaching hospital. Design A single-centre retrospective cohort study. Setting Medical-surgical intensive care unit of Tibebe Ghion Specialized Hospital, Bahir Dar, Ethiopia. Participants We enrolled 296 critically ill patients (age 60+) admitted to the intensive care unit who stayed for more than 2 hours. Those patients with missing or incomplete records were excluded. Primary outcome measure The primary outcome of this study was the time to death within 30 days following intensive care unit admission. Results In this cohort, the overall mortality rate of geriatric patients in the intensive care unit was found to be 42.9%. The incidence rate of mortality was 6.3 deaths per 100 person-days observation. Acute kidney injury (adjusted HR=2.36, 95% CI: 1.16, 3.68), coexisting diseases (adjusted HR=1.66, 95% CI: 1.13, 2.42), the presence of shock (adjusted HR=2.27, 95% CI: 1.66, 4.53) and mechanical ventilation (adjusted HR=1.82, 95% CI: 1.14, 2.89) were predictors of mortality in the intensive care unit. Conclusions The mortality rate in the intensive care unit among geriatric patients was high. Predictors of mortality in this population of critically ill geriatric patients included acute kidney injury, the presence of shock, coexisting diseases and mechanical ventilation in the intensive care unit.