Older end-stage renal disease (ESRD) patients presumably encounter multiple stressors: the need to undergo treatment for a chronic, life-threatening illness, age-related physical frailty and comorbidities, and exposure to psychosocial losses related to aging. However, most studies comparing older patients (typically patients aged 60 and older) with younger patients undergoing ESRD therapy indicate that the psychosocial well-being reported by older patients is at least as good as, and perhaps better than, the well-being reported by younger patients. These data reflect a health optimism generally characteristic of older persons, and ESRD patients' tendency to evaluate their functional status and their psychosocial well-being as largely independent domains. At the same time, availability of support from dialysis caregivers and from family members is acknowledged as a crucial variable affecting older patients' ability to successfully comply with treatment regimens and adjust to various ESRD therapies. Differential psychosocial outcomes related to older patients' sociodemographic characteristics are not well studied, but data from the United States show better perceived physical status and psychosocial well-being among older African-American patients than among older white patients on chronic dialysis. Suggestions are offered for methodological and conceptual refinements of research investigating the relation of age to psychosocial outcomes in ESRD.