<p>Major advances in drug development and supportive care have led to a paradigm shift in the management of many of the aspects of clinical care for older adults with acute myeloid leukemia. The development of validated geriatric assessments now enable clinicians to personalize treatment recommendations based on function, frailty, and fitness. The emergence of novel theory-driven methods to capture patient preferences has further enabled clinical teams to personalize therapy recommendations to what matters most to patients. Despite increasing excitement in the field created by the introduction of these new therapies and supportive care interventions, outcomes for older adults with acute myeloid leukemia remain very poor. Even with the best available therapies, median survival for most older adults is tragically short at around 15 months. Five-year survival for adults over the age of 75 years is profoundly low, below 10%. For many patients, current therapies fail to dramatically extend life or improve the quality of life. These stark realities must inform clinical decision making and fuel further research. This review critically examines current treatment options including recently approved targeted agents in the upfront and relapsed setting including FLT3 inhibitors, isocitrate dehydrogenase 1/2 inhibitors, and the newly approved menin inhibitors. We review the use of geriatric assessments and validated screening tools to characterize patient fitness and frailty beyond clinician-graded measures. We also introduce theory-driven preference assessments that are increasingly being used to capture patient treatment outcome priorities.</p>