The overactive bladder (OAB) and incontinence may occur at any age but are more common in the elderly. These lower urinary tract symptoms are associated with reduced quality of life and morbidity. Urinary incontinence is a significant symptom that affects social life and incurs economic costs. Most patients do not seek treatment because of embarrassment and misperception of the normal consequences of the aging process. Most elderly patients have several comorbidities, and polypharmacy is common. Modifying lifestyle and behavior may prevent urinary incontinence. Muscarinic receptor antagonists are the most commonly used drug, and are well-tolerated, safe, and effective in elderly patients with OAB. However, the selection of an optimal agent must be considered carefully in elderly patients. Surgical treatment may also be indicated in some patients. Anti-incontinence procedures like the mid-urethral sling operation or the Burch procedure are appropriate in stress urinary incontinence. Botulinum toxin A injection in the bladder may have a useful effect in refractory OAB patients. The management of OAB/incontinence in the elderly often poses significant management challenges. With a variety of drugs and procedures, however, physicians can optimize OAB/incontinence treatment for elderly patients.