Osteoarthritis is the most common cause of disability in older people, and diseased hip and knee joints cause most difficulty for older individuals because activities of daily living are significantly affected. Verbal and numerical rating scales best quantify pain intensity in older patients, including those with mild-to-moderate cognitive impairment. Non-drug therapies include educating patients, occupational therapy, weight reduction, and exercise. Pharmacological strategies include simple analgesia, non-steroidal anti-inflammatory drugs, and topical agents, progressing to weak then strong opioid painkillers for chronic severe pain. Surgery is an option for some patients to avoid the chronic pain cycle.