Ulcerative colitis (UC) has a bimodal age distribution, with the majority of patients being diagnosed between the second and fourth decades of life. However, a second peak in diagnosis occurs in older patients and an estimated 15% of patients present after age 65. Caring for older UC patients who have either presented later in life or who have carried an inflammatory bowel disease (IBD) diagnosis for multiple decades may pose additional challenges in management. Recent studies using nationwide administrative databases from the USA have demonstrated that older IBD patients are challenged by worse hospital outcomes. This pattern, seen for both UC and Crohn’s disease, demonstrated increased rates of vascular complications (i.e. venous thrombosis), worse post-operative outcomes and increased rates of complicated and prolonged clinical courses compared to younger IBD patients. This article provides an overview of caring for elderly patients with UC, including diagnostic and therapeutic considerations.