The Health of the Nation Outcome Scales (HoNOS) family of measures is routinely used in mental health services in the New Zealand, Australia, and the United Kingdom. However, the psychometric properties of the HoNOS65+ for elderly people have not been extensively evaluated. The aim of the present study was to examine the validity, reliability, and sensitivity to change of the HoNOS65+. Routinely collected HoNOS65+ data from a psychiatric service for older people (n = 2065) were collated, and a subsample (n = 66) of older service users were assessed with an additional battery of established measures. The individual HoNOS65+ items generally showed adequate concurrent validity and sensitivity to change. Estimates of inter-rater reliability across settings indicated areas of concern however, and confirmatory factory analysis did not support models based on existing subscales. These findings indicate some limitations of the HoNOS65+ as an outcome scale for older people. (Contains 6 tables.)