The number of elderly individuals with interstitial lung disease (ILD) has never been higher as the human lifetime continues to increase. The most prevalent ILD among older individuals is idiopathic pulmonary fibrosis, while autoimmune illness and hypersensitivity pneumonitis are also major disorders in this age range. The histopathologic pattern of IPF is typical interstitial pneumonia; ageing processes implicated in alveolar epithelial cell injury and downstream aberrant fibroblast activity include mitochondrial dysfunction, oxidative stress from telomere damage, and endoplasmic reticulum stress from the unfolded protein response. These consequences are exacerbated by frailty and increased susceptibility to infection. Old age might complicate the management of ILD for these reasons, as well as polypharmacy issues. However, most elderly individuals tolerate therapy well, and advanced age is not a contraindication to immunosuppressive or antifibrotic treatments. Furthermore, lung transplantation might be advantageous in properly chosen elderly individuals.
Finally, it is unclear whether subclinical interstitial abnormalities seen on chest imaging in a significant proportion of elderly individuals constitute an early stage of ILD. While the evidence that is now available is comforting, further study is required to better understand the outcomes for these patients.