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The S-Elixhauser score was internally validated and calibrated. Weights were derived for 38 comorbidities to predict 30-day, in-hospital, and 1-year mortality. Persons hospitalized in 2018 ( n = 899 844) and 3 disease-specific hospitalized cohorts. Medicare beneficiaries from 2017 to 2019. To develop a summary Elixhauser (S-Elixhauser) comorbidity score to predict 30-day, in-hospital, and 1-year mortality in older adults using the 38 comorbidities operationalized by the Agency for Healthcare Research and Quality (AHRQ). These indices are effective methods to incorporate the influence of comorbid conditions in models designed to assess the risk of in-hospital mortality and readmission using administrative data with limited clinical information, especially when small samples sizes are an issue.Older adults have many comorbidities contributing to mortality. The addition of other commonly used covariates (age, sex, expected payer) improved discrimination modestly. The indices were stable across multiple subsamples defined by demographic characteristics or clinical condition. The c-statistic for our index scores without inclusion of other covariates was 0.777 (95% confidence interval, 0.776-0.778) for the mortality index and 0.634 (95% confidence interval, 0.633-0.634) for the readmissions index. Our index scores performed as well as using all 29 Elixhauser comorbidity variables separately. Model validation was conducted with c-statistics. Odds ratios and index weights were generated for each Elixhauser comorbidity to create a single index score per record for mortality and readmissions. The final models were derived with bootstrapped replications of backward stepwise logistic regressions on each outcome. We used a large analysis file built from all-payer hospital administrative data in the Healthcare Cost and Utilization Project State Inpatient Databases from 18 states in 20. The Elixhauser measures are commonly used in research as an adjustment factor to control for severity of illness. We extend the literature on comorbidity measurement by developing 2 indices, based on the Elixhauser Comorbidity measures, designed to predict 2 frequently reported health outcomes: in-hospital mortality and 30-day readmission in administrative data.