Background <p>Disorders of gut-brain interaction (DGBIs), including irritable bowel syndrome, functional dyspepsia, chronic constipation, functional fecal incontinence, are common and clinically impactful in older adults, often intersecting with multimorbidity, polypharmacy, sensory impairment, cognitive decline, and social constraints, a constellation known in geriatrics as multicomplexity. New-onset symptoms later in life also carry high pre-test probability of organic disease, requiring careful evaluation before diagnosing DGBIs. Despite these considerations, most evidence guiding DGBI management is extrapolated from trials conducted in younger adults. This review summarizes current non-pharmacologic and pharmacologic treatment strategies for common DGBIs in the older adult. We focus on safety, feasibility, and alignment with patient-centered goals of care.</p> Recent Findings <p>Emerging evidence supports non-pharmacologic therapies, including dietary optimization, pelvic floor rehabilitation, and brain-gut behavioral therapies. Technology delivery formats, including phone-, web-, and device-based interventions have emerged as scalable approaches to expand access to evidence-based care while reducing medication burden. Pharmacologic therapies remain important for select patients but require conservative dosing and proactive monitoring due to age-related vulnerability to adverse effects to medications.</p> Summary <p> Management of DGBIs in the older adult should be individualized, function oriented, and aligned with patient goals. Low-risk and feasible non-pharmacologic strategies should be prioritized, and medications should be used judiciously and monitored proactively for complications. Integrating principles of geriatric multicomplexity into DGBI care can improve function, preserve independence, and enhance quality of life in this growing and heterogeneous population. Future research should incorporate geriatric-relevant outcomes to better inform care in this growing and heterogeneous population. </p>