The paper analyzes the elderly survival strategies in an increasingly urbanizing city of Maseru in the period 2009-2012 using the household survey conducted on poor elderly in the three urban communities of Thibella, Sekamaneng and Motimposo. It seeks to understand the impact of rapid urban growth of Maseru on the elderly and the possible range of responses to this change and poverty The analysis shows that the elderly people living in poverty have devised means of survival while a few increasingly depend on social welfare grant provided by the government to cope with poverty. Despite this good effort, more than 50 percent of the population still lives in poverty. The burden of caring for orphans particularly in female elderly headed households exposes them to more poverty. Lifting the elderly group out of poverty will require a continued growth based policy and further expansion of social services. This paper serves as a basis for policy review so that the needs of the elderly are fully addressed. Furthermore, the paper seeks to fill the existing gap in the literature on the elderly survival in Lesotho as no studies have yet been done. The paper is composed of four sections. First, it introduces urban growth and features of poverty in the context of the developing world including Lesotho. Second, it deals with the general perspectives on urbanization and its impact on the elderly in Africa. Third, it discusses the observed repercussions of urbanization on the elderly living in Maseru and their coping strategies. The fourth section presents the conclusion and suggested ways of improving the lives of the elderly living in Maseru. The paper considers the elderly as people who are aged 60 and above.