Most packed red blood cell (PRBC) transfusion research focuses on younger patient populations (younger than 65) given the complexity of care and presence of comorbidities in older adults. The purpose of the current study was to critically examine the current evidence related to PRBC transfusion among older adults (age =65). PubMed, CINAHL, and Embase were searched for randomized controlled trials that evaluated blood transfusion in any manner (e.g., prevention, associated outcomes). Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the search resulted in 10 studies focused on cardiac, orthopedic, and gastrointestinal surgery patients. SQUIRE (Standards for QUality Improvement Reporting Excellence) guidelines were used to evaluate studies for bias; the average bias score was 13.0 (SD = 3.4), indicating a low level of bias. Greatest sources of bias were methods to assess completeness/accuracy of data, details about missing data, and costs associated with the study. Interventions to prevent PRBC transfusion in older adults vary widely, and outcomes associated with PRBC transfusion in older adults require further evaluation.