Osteoarthritis is a common diagnosis in older people aged 65 years and above, which causes significant pain leading to disability and decreased quality of life. Nonpharmacological measures such as exercise and footwear are essential in the management of osteoarthritis-related pain and disability in the older population if medication adverse effects and polypharmacy are to be avoided. Pharmacological approaches to pain management should complement nonpharmacological treatment. Most drug therapies give mild-to-moderate pain relief but their long-term efficacy and safety in older people remain undetermined. In older patients with severe osteoarthritis of the hips or knees responding poorly to analgesics, total joint arthroplasty offers the most effective intervention for those who are fit for surgery.