The treatment of aplastic anaemia (AA) in the elderly patient population is not always straightforward, as other factors apart from age per se and disease severity need to be considered in clinical management decisions. The presence of comorbidities needs to be evaluated carefully. In general, elderly patients have an inferior outcome following immunosuppressive therapy and haematopoietic SCT; hence patients need to be evaluated on an individual patient basis and their specific wishes respected, as quality of life is an extremely important outcome measure to consider. In this review we aim to provide some guidance on how to approach the options for treatment in the elderly patient.