Large old hollow-bearing trees have a wide range of key ecological roles in forest and other ecosystems globally. Patterns and rates of mortality and decay of these trees had profound effects on the size and composition of their populations. Using an 18-year empirical study of large old trees in the Mountain Ash (Eucalyptus regnans) forests of the Central Highlands of Victoria, we sought to determine if there are particular patterns of decline that are shared by a proportion of the trees in a tree population. We also sought to identify drivers of decline of these trees by quantifying relationships between the condition state of trees (viz: tree form) and a range of covariates. We found that time, stand age and fire can individually and in combination, strongly affect the decay (and eventual collapse) of large old trees. In particular, we found compelling evidence that patterns of tree decline were markedly different in old growth forest (stands dating from ∼1850) relative to three other younger age classes examined. Trees in older forest decayed less rapidly than trees of equivalent tree form in younger forest. Old growth stands also were characterized by trees in an overall much lower (more intact) form category than the other age classes of forest. A key pattern in our study was the rapid deterioration of large old trees in the youngest aged stands (viz: those regenerating after fires in 1939 and following disturbance between 1960 and 1990). In these forests, a very high proportion of large old trees were either in the most advanced state of tree decay (form 8) or had collapsed (form 9). This is a major concern given that 98.8% of the Mountain Ash forest ecosystem supports forest belonging to these (or even younger) age cohorts. Our investigation highlights the need for forest management to: (1) increase levels of protection for all existing large old hollow-bearing trees, (2) expand the protection of existing regrowth forest so there is the potential to significantly expand the currently very limited areas of remaining old growth forest.