Purpose of Review <p>Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death worldwide. While screening colonoscopy reduces CRC incidence and mortality in adults aged 45–75, its role beyond age 75 remains uncertain. This review examines how to determine which older adults may still benefit from screening.</p> Recent Findings <p>Guidelines from the USPSTF and ACG recommend individualized screening for adults aged 76–85, considering overall health, prior screening, and preferences. The benefits of colonoscopy decline with age, as polypectomy effects may take 7–10 years to appear, and procedural risks increase. Tools such as the Clinical Frailty Scale and ePrognosis help assess life expectancy and guide decisions. Evidence suggests benefit primarily for those with fewer than three comorbidities, good functional status, and ≥ 10 years of expected survival.</p> Summary <p>Screening decisions for adults over 75 should focus on health status rather than age alone. Colonoscopy is reasonable for healthy, unscreened individuals with adequate life expectancy, but the risks outweigh the benefits for frail adults or those with limited survival. Shared decision-making using prognostic and frailty tools ensures screening aligns with patient goals.</p>