Objective: To evaluate the prevalence and effect of overactive bladder (OAB) on healthcare-seeking behavior, mental health, and generic and condition-specific health-related quality of life (HRQL) in older adults. Design: Secondary analysis of the U.S. sample of the Epidemiology of Lower Urinary Tract Symptoms (EpiLUTS) study-a population-based, cross-sectional, Internet-based survey. Setting: Community. Participants: Two thousand four hundred eighty-five men and 2,877 women aged 65 and older. Measurements: Prevalence and effect on HRQL of urinary symptoms, including OAB. OAB was defined as the presence of urinary urgency and/or urinary urgency incontinence. Descriptive analyses and subgroup comparisons were conducted to evaluate the prevalence of OAB in men and women aged 65 and older and the effect of OAB on various aspects of HRQL. Results: The survey response rate was 46.9% of men and 61.0% of women. Prevalence rates of OAB at least "sometimes" were 40.4% in men and 46.9% in women. OAB was associated with significant impairments across all domains of patient-reported outcomes, including general HRQL (Medical Outcomes Study 12-item Short-Form Survey), ratings of anxiety and depression (Hospital Anxiety and Depression Scale), and urinary condition-specific outcomes (Overactive Bladder Questionnaire Short Form and Patient Perception of Bladder Condition) (P<.001). Conclusion: OAB is common in older adults in the United States and is associated with substantial impairment in mental health and HRQL, but rates of treatment seeking behavior are low. Older patients should be assessed for OAB. © 2011, The American Geriatrics Society.