Introduction <p>IBS can significantly impact older adults; however, we do not currently understand how age-related changes affect the diagnosis and treatment of IBS in older adults compared to their younger counterparts.</p> Purpose of Review <p>This review aims to combine a systematic review of the literature focused on IBS in the older adult, defined as those aged ≥ 60, with practical recommendations for clinical practice.</p> Methods <p>PubMed and Embase were searched May 2025. The primary search terms were “irritable bowel” and “Rome” (to catch articles using the Rome Criteria), combined with an extensive list of synonyms for “older adult.”&#xa0;</p> Summary <p> Only eight studies were identified that directly addressed the pathophysiology, assessment, diagnosis, and treatment of IBS in the older adult. We discuss how older age can affect the multifactorial pathophysiology of IBS, including its effects on motility and brain-gut dysregulation. We also give practical advice on: (1) Differential diagnoses not to be missed especially in older adult including malignancy, inflammatory bowel diseases and other non-GI etiologies such as mesenteric ischemia, and (2) Therapeutic options for older adult patients with IBS using a step-up approach to therapy (e.g., diets, supplements, motility medications, and brain-gut behavior therapies, meditative movement practices, and neuromodulators).&#xa0;</p> Discussion <p> It is important to consider the unique characteristics of aging patients with IBS, which include lifestyle factors, comorbid conditions particularly affecting the older adult, and medication side effects in optimizing evidence-based treatment options for this population.&#xa0;</p> Recent Findings <p> Very few studies have focused on IBS in older adults. More studies are needed to understand the impact of aging on the brain-gut axis and to inform treatment recommendations for this group of patients.</p> Graphical Abstract <p></p>