Outcomes in older, unfit, and frail patients with diffuse large B-cell lymphoma (DLBCL) are inferior compared to younger and fit patients. Despite tremendous progress in the treatment landscape of DLBCL, few clinical trials have focused specifically on this high-risk patient population. This review focuses on the pathophysiology unique to the older patient with DLBCL, as well as the evidence behind current treatment approaches. This article also aims to highlight emerging prognostic tools and novel treatment strategies that may improve the outcomes in this patient cohort in the future.