Limited data exist on the characteristics of older adults (aged 65 years or older) with multiple sclerosis (OAwMS). This study aimed to investigate the clinical presentation, disease-modifying therapy (DMT) use and neurological disability in OAwMS. We sought to determine how disease activity and disability manifest in this age group and whether early DMT use is associated with reduced disability at an advanced age.

OAwMS treated at Tampere University Hospital (TUH) were identified from the Finnish MS registry as of 5th December 2023. Demographic and clinical data were extracted and analysed.

Of 13,037 individuals in the Finnish MS registry, 1395 were treated at TUH. Of these, 264 (18.9 %) were identified as OAwMS. Progressive disease was common (71.6 %), and only 62 subjects (23.5 %) had ever used DMT. A single subject was still receiving DMT. Relapses after age 65 were rare, occurring in 9.2 % of subjects with a history of relapsing-remitting multiple sclerosis. The median last available Expanded Disability Status Scale (EDSS) score after age 65 was 6.5 (Q1–Q3 5.5–7.0), indicating significant mobility impairment. Among subjects with repeated EDSS assessments available after age 65 (64 subjects), 71.9 % showed disability worsening.

Most OAwMS had a progressive disease course and marked disability. Since disease activity in the form of clinical relapses appears to be rare in this age group, treatment of OAwMS should adopt a multidisciplinary approach, focusing on rehabilitation and symptomatic care. The role of DMT in older adults warrants further investigation, especially in cases of active disease.