Lung cancer is the leading cause of cancer mortality, and in the ageing population, the elderly account for the majority of cases. Treatment options are continually expanding, and when patients of a good performance status are suspected of having lung cancer, a systematic assessment to confirm the diagnosis and establish a stage is necessary. Endobronchial ultrasound (EBUS) is a key tool, and we explore the utility of this in the elderly population. Over the past 20 years, EBUS has been shown to be an invaluable tool, comparable and exceeding in some cases the traditional mediastinoscopy. Studies show that EBUS can be performed with low complication rates and under moderate sedation, while in the elderly population, data demonstrates that it is safe and effective. The elderly population shares the highest burden of thoracic malignancy, and building evidence suggests that EBUS is an effective diagnostic and staging tool, which can be safely performed in this patient group.