Pruritus is one of the most common skin conditions in older people. People may develop pruritus for many reasons but often it is not possible to diagnose the cause. Pruritus can cause physical and psychological suffering, affecting quality of life. The persistent itch leads to scratching which is a threat to skin integrity. It can also disrupt sleep and affect relationships. Pruritus should be treated actively. It is essential that people with pruritus receive a holistic assessment and that treatment plans are negotiated to maximise concordance and thus effective outcomes.