Objectives The fifth revision of the Korean Medication Algorithm Project for Bipolar Disorder (KMAP-BP) was undertaken to provide more precise guidelines for clinicians. In this study, we evaluated treatment strategies recommended by the KMAP-BP 2022 for theelderly patients with bipolar disorder. Methods The review committee comprised eighty-seven psychiatrists with vast clinical experience in treating bipolar disorders, who completed a survey. An expert consensus was obtained on pharmacological treatment strategies for elderly patients with bipolar disorders. The executive committee analyzed the data and discussed the results to produce the final algorithm. Results In elderly patients with bipolar disorders, the first-line treatment option for manic episodes is monotherapy, with atypical antipsychotics or mood stabilizers, and a combination of a mood stabilizer and atypical antipsychotics. The first-line treatment option for depressive episodes was a combination of a mood stabilizer and atypical antipsychotics, monotherapy with atypical antipsychotics or a mood stabilizer or lamotrigine, and a combination of atypical antipsychotics or a mood stabilizer with lamotrigine. Conclusion In the KMAP-BP 2022, the recommendation for treatment options for elderly patients with bipolar disorder, has been newly introduced. We expect that this algorithm would provide valuable information for the treatment of elderly patients with bipolar disorder.