Background <p>Acute poisoning among elderly populations is a serious health concern with particularly hazardous consequences. This review synthesizes findings from multiple studies investigating acute poisoning among the elderly in Iran and compares them with similar studies in other countries.</p> Method <p>This study reviews data from several studies conducted in various regions of Iran that investigated acute poisoning among elderly individuals (older than 60 years old). Studies were included that provided information on demographic characteristics and clinical findings in English or Persian up to date.</p> Results <p>Six studies from five provinces in Iran were analyzed, revealing a consistent male predominance in poisoning cases, particularly among those aged 60–69. Most incidents occurred at home, primarily through oral ingestion. While pharmaceutical agents were initially the primary cause, illicit drug use, particularly opioids, has become increasingly prevalent. Accidental poisoning and drug overdoses were more common among men, whereas suicide attempts were more frequent in women. Clinical presentations often included altered mental status, with average hospital stays of up to 3.5 days. Mortality rates ranged from 3.5 to 11.7%, predominantly due to opioid poisoning.</p> Conclusion <p>Reviewing international studies highlighted that patterns of poisoning vary between countries, underscoring the need for a context-specific approach. The rise in opioid-related poisonings and distinct patterns observed highlight a critical and evolving public health challenge for elderly Iranians. These findings underscore the urgent need for targeted interventions, including opioid monitoring programs, enhanced access to mental health services through primary healthcare, and community-based support systems. Training caregivers and implementing public health campaigns are also crucial to address this growing concern and improve the safety and well-being of this vulnerable population.</p>