Purpose of review <p>Advanced age and frailty pose unique challenges to treatment of many disease states, including pelvic organ prolapse (POP). In this narrative review, we review evaluation and management strategies of pelvic organ prolapse (POP) in older, frail women.</p> Recent findings <p>POP symptoms can significantly impact on quality of life. Prevalence of symptomatic prolapse is estimated to reach 50% by 2050 due to the aging population. Conservative management with vaginal pessaries and pelvic floor physical therapy (PFPT) for mild-moderate symptoms have shown 70–90% symptomatic improvement. When utilizing surgery for this population, colpocleisis/vaginectomy offers low complications paired with high success rates of &gt; 90%.</p> Summary <p>Expectant management, vaginal pessaries and PFPT remain preferred options for POP management in elderly and frail populations. If considering surgery, colpocleisis/vaginectomy is an ideal option for women with advanced prolapse. Reconstructive approaches such as colporrhaphy can be considered if the patient desires maintenance of vaginal function. Sacrocolpopexy should generally be avoided in this population given higher risk of morbidity particularly in frail patients.</p>