Acute myeloid leukemia is a disease predominantly affecting older adults, with a median age at diagnosis of 65 years. Compared with younger adults or children with AML, older adults have a poor prognosis and represent a discrete population in terms of disease features, treatment-related complications, and overall outcome. Management of AML in this population often includes intensive, anthracycline-based chemotherapy, which can effect a 1.5- to 4-month survival advantage compared with nonintensive therapy but at a cost of early deaths, long length of hospital stay, and substantial transfusional support. Nonintensive therapy or palliative care remains an important option for many patients. Aggressive postremission therapy or the use of hematopoietic growth factor support does not appear to improve survival. Future directions include therapies targeted at immunomodulation, at angiogenesis, and in particular against intracellular signals that promote proliferation at the expense of differentiation.