Background: The association between diet and cancer, and diet and cardiovascular disease (CVD) is well established in younger adults, however limited evidence exists to demonstrate that these associations persist for older adults, particularly in the context of dietary patterns. Aims: To investigate whether the dominant dietary patterns identified in a cohort of older adults are predictive of cancer or CVD development. Methods: This study was a secondary analysis of data from the Australian Longitudinal Study of Ageing (ALSA). The ALSA is a multi-dimensional population based study of human ageing which commenced in 1992 with 2087 participants aged 65 years or more. Data from a 170-item food frequency questionnaire administered at baseline in 1992 to 1034 older adults free from cancer and CVD was explored using factor analysis to identify dominant dietary patterns, being those patterns which comprise foods commonly consumed by the sample. Pooled logistic regression from data available at baseline, 2 and 8 years of follow-up was used to determine whether any associations existed between dietary patterns and development of or death from cancer or CVD. Results: Five dominant dietary patterns were identified and labelled 'discretionary choices and breads and cereals', 'vegetable and fruit', 'white meat and milk products', 'breads and cereals, sweet bakery goods and milk products' and 'red meat and protein alternatives'. None of the dominant dietary patterns demonstrated a significant overall trend for the development of or death from cancer or CVD with the exception of the 'red meat and protein alternatives' pattern where an increased risk of cancer development or death was observed with adjustment for age, gender, smoking, overweight and obesity and total number of comorbidities (tertile 2: OR 1.46, 95% CI 1.03-2.07; tertile 3: OR 1.28, 95% CI 0.87-1.90). Conclusions: These results suggest that the development of or death from cancer and CVD may be independent of most dietary patterns in those who are free of either condition at age 70 years or older. Importantly, there was an association observed between the 'red meat and protein alternatives' pattern and cancer development and death. If these findings are confirmed then dietary guidelines for older adults may require further revision.