Acute respiratory distress syndrome (ARDS) is associated with increased morbidity andmortality in the elderly population (≥65 years of age). Additionally, age is widely reportedas a risk factor for the development of ARDS. However, the underlying pathophysiologicalmechanisms behind the increased risk of developing, and increased severity of, ARDSin the elderly population are not fully understood. This is compounded by the significantheterogeneity observed in patients with ARDS. With an aging population worldwide, abetter understanding of these mechanisms could facilitate the development of therapiesto improve outcomes in this population. In this review, the current clinical evidence ofage as a risk factor and prognostic indicator in ARDS and the potential underlyingmechanisms that may contribute to these factors are outlined. In addition, researchon age-dependent treatment options and biomarkers, as well as future prospects fortargeting these underlying mechanisms, are discussed.