PURPOSE: Society is aging, and the proportion of older patients with lung cancer is increasing. However, the treatment choices and prognoses for older patients with cancer recurrence remain unclear. We retrospectively investigated the treatment choices and prognoses of older patients with recurrence. METHODS: We conducted a retrospective review of 1100 patients who underwent complete resection for non-small cell lung cancer at Kitasato University Hospital between 2004 and 2017. Patients of ≥75 years of age were defined as older patients, and the prognosis and prognostic factors of these patients upon recurrence were examined. RESULTS: Among the 290 patients who developed recurrence, 106 experienced recurrence at an older age. The factors associated with survival after recurrence included sex, time to recurrence, number of recurrences, performance status at recurrence, and active treatment. As the age at recurrence increased, the proportion of patients who did not receive active treatment increased, as did the proportion for whom the reason was the patient's and family's preferences. CONCLUSIONS: A considerable number of older patients who experience recurrence do not wish to receive active treatment. However, the prognosis can be improved by aggressive treatment for recurrence.