Celiac disease is a common condition that is thought to affect 1 in 200 people throughout Europe and America, with prevalence rates reaching 1:100 in Ireland. Improvements in the sensitivity and specificity of serological testing for celiac disease over the past 15 years have resulted in a larger number of diagnoses being made. Up to 34% of patients with newly diagnosed celiac disease are older than 60 years of age. The symptomatic presentation of celiac disease in elderly patients can be subtle, leading to a considerable delay in diagnosis and potential accumulation of associated secondary complications. Given that celiac disease is associated with significant morbidity and reduced life expectancy, physicians need to be aware of this condition and its occurrence in the current increasingly elderly population. Compliance with a strict gluten-free diet is as easily achieved in elderly patients as in younger patients, and has been reported to reduce the risks of cancer and lymphoma associated with celiac disease. This Review highlights age-related differences in the clinical presentation and investigation of patients with suspected celiac disease.