Treatment of personality disorders in older adults is a highly underexposed subject. In this article it is illustrated by means of three case studies that a) treatment of personality disorders in the elderly is meaningful; b) it is useful in clinical practice to identify three levels of treatment, that is personality changing, adaptation enhancing and supportive-structuring treatment; c) at each level of treatment gerontologic aspects must be taken into account, such as increasing experiences of loss, how elderly people perceive somatic diseases and their disabling consequences, their changing life perspective, cohort-related and sociocultural beliefs, and the importance of intergenerational linkages. Further research is necessary whether the findings from these case studies can be generalised.