The global population is ageing, but inequalities remain in older people's access to treatment, especially people 75 years of age and older. These people receive less frequent interventions and lower quality medical treatment than their younger counterparts. Explanations for these inequalities include ageism, a lack of testing of medicines in older people, unclear diagnoses resulting in hesitancy to institute treatment, polypharmacy, and a general lack of concordance and compliance. In Europe, responsibility for improving this situation lies with the pharmaceutical industry, the European Medicines Agency, national regulatory agencies, prescribers, dispensing pharmacists, and the patients or consumers themselves. Clinical trial and health economic data are needed to assure the effective and safe treatment of older people.