Objectives To investigate the association of chest CT findings with mortality in clinical management of older patients. Methods From January 21 to February 14, 2020, 98 older patients (>= 60 years) who had undergone chest CT scans ("initial CT") on admission were enrolled. Manifestation and CT score were compared between the death group and the survival group. In each group, patients were sub-grouped based on the time interval between symptom onset and the "initial CT" scan: subgroup1 (interval <= 5 days), subgroup2 (interval between 6 and 10 days), and subgroup3 (interval > 10 days). Adjusted ROC curve after adjustment for age and gender was applied. Results Consolidations on CT images were more common in the death group (n = 46) than in the survival group (n = 52) (53.2% vs 32.0%,p < 0.001). For subgroup1 and subgroup2, a higher mean CT score was found for the death group (33.0 +/- 17.1 vs 12.9 +/- 8.7,p < 0.001; 38.8 +/- 12.3 vs 24.3 +/- 11.9,p = 0.002, respectively) and no significant difference of CT score was identified with respect to subgroup3 (p = 0.144). In subgroup1, CT score of 14.5 with a sensitivity of 83.3% and a specificity of 77.3% for the prediction of mortality was an optimal cutoff value, with an adjusted AUC of 0.881. In subgroup2, CT score of 27.5 with a sensitivity of 87.5% and a specificity of 70.6% for the prediction of mortality was an optimal cutoff value, with an adjusted AUC of 0.895. Conclusions "Initial CT" scores may be useful to speculate prognosis and stratify patients. Severe manifestation on CT at an early stage may indicate poor prognosis for older patients with COVID-19.