With the acceleration of global population aging, the disease burden of colorectal cancer in the elderly is escalating. However, postoperative adjuvant therapy for this population suffers from a long-standing lack of robust evidence-based medical evidence. Due to their unique physiological decline, high comorbidity burden, higher proportion of deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) tumors, and social psychological factors, treatment decisions have become more complicated. Comprehensive Geriatric Assessment (CGA) serves as the core tool for achieving individualized treatment. For patients with poor physical condition, metronomic chemotherapy holds promise as a low-toxicity maintenance strategy. Furthermore, strengthening supportive treatment (encompassing management of bone marrow suppression, nutritional support, anti-cachexia drugs, structured exercise programs, and fecal microbiota transplantation) is crucial for ensuring treatment safety and quality of life.In summary, managing adjuvant therapy for elderly colorectal cancer must abandon the age-dependent model and shift towards individualized, precision strategies guided by CGA, balancing efficacy, toxicity, and quality of life. Emerging directions such as immunotherapy, short-course chemotherapy, and organ preservation warrant attention. Future research should prioritize prospective studies specifically focused on the elderly population.