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Diffuse Large B-cell Lymphoma (DLBCL) is classically a disease of older individuals. However, varying definitions of “older” age, underrepresentation in clinical trials, and significant patient heterogeneity requires a highly personalized treatment approach. Older patients often have comorbidities leading to decreased tolerance with standard of care therapies; however, predictive tools such as the simplified Comprehensive Geriatric Assessment may help tailor treatments accordingly. Several approaches have been introduced to augment therapeutic tolerance in the front-line setting, including prephase therapies, attenuation of current standard of care chemoimmunotherapy dosing, or alternative chemotherapeutic agents when prohibitive comorbidities such as cardiovascular disease are present. In the relapsed and refractory disease setting antibody-based therapies have improved outcomes and demonstrated therapeutic tolerance in older patients. Cellular therapies and bone marrow transplantation remain options for fit patients who are eligible and should be considered. The aim of this review is to focus on patient assessment and treatment recommendations in older patients with DLBCL.