To understand the current literature on age-related neural and detrusor changes associated with overactive bladder symptoms. Recent functional magnetic resonance imaging (fMRI) studies have unveiled an age-related decrease in the neural control of continence, represented in the insula, anterior cingulate cortex (ACC), and prefrontal cortex (PFC). Older individuals with overactive bladder symptoms also demonstrate heightened activation of the ACC with low volumes, representing increased bladder sensitivity or sense of urgency. At the level of the bladder, age-related changes in the urothelium, neurotransmitters/receptors (both muscarinic and purinergic), and inflammation (including nerve growth factor (NGF), monocyte chemoattractant protein-1 (MCP-1), and oxidative stress) are also associated with overactive bladder. Overactive bladder among older adults is a complex condition incorporating physiologic age-related changes from the brain to the bladder and beyond.