Purpose <p>Achalasia is an uncommon primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and esophageal body peristalsis, with a rising prevalence among the elderly due to global population aging. This review summarizes the current evidence on the clinical presentation, diagnostic algorithm, and management of achalasia in geriatric patients.</p> Methods <p>A literature search was conducted focusing on age-related differences in symptoms, endoscopic and functional testing, and outcomes of available therapeutic modalities.</p> Results <p>Clinical presentation of achalasia differs among younger and geriatric patients, with the latter presenting less pronounced symptoms. Geriatric patients experience a higher risk of malnutrition and aspiration and exhibit more often advanced disease stages, including sigmoid esophagus. High-resolution manometry represents the gold standard for diagnosis, and upper gastrointestinal endoscopy should precede it in order to exclude causes of mechanical obstruction. The treatment remains non-causative and encompasses botulinum toxin injection, pneumatic dilation, peroral endoscopic myotomy, and laparoscopic Heller’s myotomy with fundoplication.</p> Conclusion <p>Considering the evolving potential of minimally invasive techniques, advanced age should not be regarded as a contraindication for the definitive treatment of achalasia, and evidence-based, age-specific recommendations should be developed for optimizing clinical outcomes.</p>