Heart valve disease (HVD) in the elderly presents unique challenges due to the interplay of age-related changes, comorbidities, and the physiological demands of aging. This review explores the complexities of diagnosing and managing heart valve disease in the elderly population. We discuss the challenges associated with traditional and innovative treatment approaches, including the management of comorbid conditions, the impact of frailty, and the role of advanced surgical and interventional techniques. Solutions and strategies to improve outcomes and quality of life for elderly patients with heart valve disease are also highlighted.