Police say the suspect knocked on the front door asking for directions. The elderly woman obliged.
He then went back to his vehicle shown on surveillance video at a nearby hospital.
He then reemerged with gloves, a ski mask, and a handgun.
"He then forced his way into the house and proceeded to scuffle with the individuals," Berlin Borough Police Chief Robert Cararra said.
The woman tried to escape. Her husband, who uses a walker, tried to help. He was pistol whipped and both were tied up.
The burglar ransacked the house and stole $180 cash.
"They thought they were going to die; they actually thought they were going to die," Cararra said.
The elderly man is dealing with a potentially deadly head injury. His wife has a couple of broken ribs and suffered a heart attack after the ordeal.
Police say it's the third time someone has broken into the home, however, investigators don't believe they're connected.
Neighbor Geoage Tiberino has also had his home broken into several times in recent years.
"They are all on drugs and they got to make a few bucks," Tiberino said.
Berlin police say the suspect was driving a 2008 to 2011 Mitsubishi Lancer.
It has New Jersey plates and the FBI is trying to enhance the plate number.
Anyone with information is urged to call police.
"They still fear for their lives. They are worried about retaliation by the suspect, so we're going to do everything we can to protect their identities while at the same time try to do the best we can to apprehend the suspect," Cararra said.