BACKGROUND: Elderly individuals have a higher burden of peripheral arterial disease (PAD), but currently, there are no global reports on the disease burden of PAD in patients aged 60 and above. METHODS: This study analyzed data on elderly patients with PAD from 1990 to 2021 using the Global Burden of Disease (GBD) database, focusing on prevalence, mortality, and Disability-Adjusted Life Years (DALYs). We summarized the trends in disease burden across 21 GBD regions and 204 countries and projected the global burden for the next 20 years. RESULTS: Between 1990 and 2021, the prevalence cases of elderly PAD individuals worldwide increased by 105%, from 42,618,313 to 87,523,486. However, the Age-standardized prevalence rate (ASPR) decreased to 8,220.2 cases per 100,000 population (95% UI: 6,717.3-9,995.7), with an Estimated Annual Percentage Change (EAPC) of -0.52 (95% CI: -0.56 to -0.48). Similar trends were observed in mortality and DALYs. In 2021, elderly individuals represented 77% of PAD prevalence cases and 94% of related mortality cases. The ASPR for women was 1.7 times higher than for men, yet women experienced a lower mortality rate and DALY rate, suggesting a heavier overall disease burden. The disease burden increased with the Socio-Demographic Index (SDI), with the fastest growth observed in Low and Low-middle SDI regions. Among the GBD regions, High-Income North America and Western Europe had the highest burden, with the United States bearing the heaviest burden of all 204 countries. High fasting blood glucose was the leading risk factor, contributing 36% of the PAD burden, with population growth being the primary driver of the rising burden. The disease burden is projected to intensify over the next two decades. CONCLUSIONS: From 1990 to 2021, the burden of PAD in the elderly has steadily increased, with projections for continued growth over the next two decades. Addressing diabetes and global population trends is essential for guiding effective public health strategies.