Purpose of Review <p> This review article highlights the challenges of diagnosing and managing spontaneous and traumatic pneumothorax in the elderly population, with a focus on age-related physiological changes, frailty and treatment considerations.</p> Recent Findings <p>Recent data indicate that secondary spontaneous pneumothorax is more common than primary, with a significant peak during the COVID pandemic. Management strategies need to be individualised with MDT input. Resurgence of older practices (autologous blood patch) and novel devices (endobronchial valves) support a move towards less invasive approaches when feasible. Surgical options are effective but require careful risk assessment due to reduced physiological reserve.</p> Summary <p> Pneumothorax in the elderly requires heightened clinical awareness and acknowledgement of the distinct challenges including recurrence and higher morbidity. A tailored approach to both diagnosis and intervention is essential, taking comorbidities and frailty into consideration and balancing minimally invasive interventions with the patient's overall health status to improve outcomes.</p>