Lung disease in the elderly represents a significant and growing public health issue as the world’s population ages, driven by increased morbidity and mortality. In geriatrics, imaging interpretation can be particularly challenging due to age-related pulmonary changes that may mimic pathological findings, a phenomenon often referred to as the “presbyteric or senile lung.” Moreover, older individuals may present with a broad spectrum of diffuse interstitial lung diseases (ILDs), including idiopathic forms like IPF and secondary forms as those related to connective tissue diseases, as well as the fibrotic variants of hypersensitivity pneumonitis and sarcoidosis. ILDs associated with inhaled agents, particularly cigarette smoking, also become more prevalent with age. Lastly, the higher prevalence of comorbidities, cancer history and treatments in the elderly, contributes to an increased incidence of drug-induced pneumonitis and radiation-induced lung injury. This chapter explores the radiological features of these conditions, providing key insights for their accurate identification and differentiation in older patients.