The treatment of older patients with acute myeloid leukemia (AML) has become increasingly important as the population ages. Progress, measured by overall survival rates, has improved in younger patients, perhaps due to the use of intensive post-remission therapies, but it is unclear what will enable progress for older AML patients. The older AML patient population is very heterogeneous, and both patient-specific and leukemia-specific factors must be taken into consideration when choosing the therapy that will most benefit each patient. In addition to standard and intensive chemotherapy regimens, a number of alternative therapies for previously untreated older AML patients are currently being investigated. These include gemtuzumab ozogamicin, azacitidine, decitabine, and clofarabine.