The prevalence of the overactive bladder (OAB) symptom complex increases with age. Older people also appear to experience more severe incontinence syndromes, including OAB, than their younger counterparts. Older patients are more likely than younger individuals to ask for medication for bladder problems and to require higher doses of medication. Conventional treatment for OAB with conservative and lifestyle measures in combination with antimuscarinic pharmacotherapy is effective in older people. Although there is a theoretical potential for cognitive impairment with antimuscarinic agents, the newer antimuscarinics are cognitively safe in cognitively intact older people.