Background: the aim of this study was to assess the predictive ability of self-rated health (SRH) on ischaemic heart disease (IHD) and all-cause mortality in elderly women and men. Methods: a total of 5,808 participants aged ≥70 years with no diagnosed atherosclerotic diseases at baseline in the Nord-Trøndelag Health Study (HUNT 2, 1995–97) were followed for 10 years. Participants provided data on psychosocial, behavioural and biomedical factors. The association between SRH and mortality was assessed using Cox proportional hazard model. Results: the SRH below good was reported by 50% of the women and 35% of the men. For SRH below good, the mortality from IHD was 1.62 (1.14–2.29) in women and 1.23 (0.91–6.67) in men. The corresponding adjusted hazard risk ratio for all-cause mortality was 1.59 (1.38–1.83) in women and 1.43 (1.26–1.63) in men. Conclusions: poor SRH predicted mortality in elderly people. For older women, the predictive value of poor SRH was higher than that of men, and this was true independent of age, marital status, diabetes, any limiting long-standing illness and selected biomedical, behavioural and psychosocial factors. These results are in contrast to most studies on the SRH–mortality association in elderly people. Further theoretical and empirical studies are needed to identify the particular factors that should be taken into account when elderly women and men rate their own health.