The incidence and prevalence of inflammatory bowel disease (IBD) is increasing globally. IBD of the elderly is common with prevalence rates. Genetical background involve less in the pathophysiology older-onset of IBD. Response to drug therapies appears to be similar in elderly patients and younger patients. Corticosteroid treatment carries additional risk for elderly patients. In addition, poly-pharmacy and malignancies need to be taken into account. Pre-existing comorbidities and nutrition are important indicators of surgical outcomes. This article will review management of IBD in the elderly.