The incidence of C. difficile infections (CDI) in the elderly continues to rise and infection is associated with increased morbidity and mortality when compared to those affected in younger age-groups. Immunosenescence may be a contributory factor yet the exact immune responses that may protect against CDI are incompletely understood. Increased exposure to antibiotics, frequent and/or prolonged hospital admissions and residing in long-term care facilities provide multiple opportunities for host and pathogen to coincide. This review explores the epidemiology, diagnostic parameters and management of the spectrum of disease in the geriatric population. Deaths attributed to CDI are most common in the elderly population and are a major contributor to gastroenteritis-associated mortality in many countries. The elderly represent an at-risk population from this pathogen and efforts must be directed to preventing infection and optimising treatment in this group.