Purpose of Review <p>This review article aims to summarize the safety and efficacy of medical therapies in elderly inflammatory bowel disease (IBD) patients contextualizing the therapies within the framework of polypharmacy, comorbidities and frailty.</p> Recent Findings <p>Anti-TNF therapies are the most extensively studied advanced therapy in elderly IBD patients. Based on most published studies, elderly IBD patients on anti-TNF therapy versus no advanced therapy demonstrate decreased treatment persistence that could be attributed to both diminished clinical response and increased adverse events. Caution should be used when considering Janus Kinase inhibitors in the elderly given the risk of infection and the possible increased risk of thrombosis.</p> Summary <p>The majority of literature on the medical management of elderly IBD patients revolves around retrospective and observational studies. Further prospective research is required in the areas of disease pathophysiology, comparative effectiveness of therapies and frailty to better inform clinical practice. Multidisciplinary care models can best position elderly IBD patients to obtain optimal outcomes.</p>