This chapter summarizes the recent knowledge on diagnosis, etiology, and treatment of restless legs syndrome (RLS) in the elderly. In the elderly, the ability to express experienced bodily sensations verbally may be limited by the impact of co-morbid conditions such as cognitive impairment, speech disorders, or aphasic syndromes. A potential central role of iron pathology for the pathophysiology of RLS is indicated primarily by secondary forms of the disorder, i.e. iron deficiency, end-stage renal disease, and pregnancy. The dopamine precursor levodopa in combination with a dopa-decarboxylase inhibitor is an effective therapeutic agent with high tolerability and without serious side effects, also in patients with concomitant medical disorders. The most clinically relevant problem with dopaminergic drugs in treating RLS is the development of augmentation, a medication use-related increase of symptoms, which usually occurs after an initial improvement. In severe cases, augmentation demands a switch of medication.