Background The elderly population is increasing globally. In Pakistan, the elderly comprise 6% of the population that is predicted to triple by 2050. Non-communicable diseases are common health problems of the elderly in Pakistan, however, resulting geriatric impairments and disability are unknown. This study was conducted to determine geriatric impairments and identify associated socio-demographic factors and comorbidities among community dwelling elderly in Karachi, Pakistan. Methods A cross-sectional study was conducted during 2013–2014. Community clusters were selected from all sub-districts of Karachi, the largest city of Pakistan. Data was collected from systematically selected households within these clusters from individuals, aged 60 years, using standardized questionnaires. Geriatric impairment was assessed through validated questions and tools. We screened for depression, dementia, mobility and functional status. Descriptive statistics were computed for socio-demographic factors. We estimated the prevalence and 95% CI for geriatric impairments and comorbidities. Results A total of 1200 community-dwelling elderly participated in this study. More than half (n = 663, 55.3%) were females. The average age of the participants was 68.7 (SD = 7.8) years. Two-thirds suffered from chronic illness and the most common impairments were psychological and cognitive. Females were 2.45 times more at risk of developing three or more geriatric impairments. Participants with no formal education had the highest proportion (43.8%) of geriatric impairments. Participants living with more children were more likely to have three or more impairments. Conclusion A high burden of non-communicable diseases and associated impairments were identified among elderly in Karachi, Pakistan. High rates of psychological and cognitive impairments require urgent attention for resources and strategic planning in anticipation of a growing geriatric population.