OBJECTIVE: We aimed to analyze management and survival outcomes of older patients (≥75 years) with stage ≥II epithelial ovarian cancer across gynecological cancer centers in the United Kingdom. METHODS: Retrospective cohort study performed using the IMPRESS project data set. Clinical information for patients diagnosed with epithelial ovarian cancer from 6 sites of varying size and population demographics was collated between January 2018 and December 2019. We compared treatment of patients aged ≥75 years with those <75, within and between centers, using multivariate analysis to understand effects on outcomes. RESULTS: After exclusions, we assessed 721 patients for overall survival and 702 for progression-free survival. Patients aged ≥75 years had poorer performance status and more comorbidities. Older patients were less likely to receive combination treatment with surgery and chemotherapy (in either order) (overall = 392/721 (54.4%); <75 cohort = 320/495 (64.6%); ≥75 cohort = 72/226 (31.9%), p < .0001). Treatment varied between sites, with some having no active treatment rates of 49% for patients aged ≥75 years. Older patients had twice the relative risk of death (relative risk 1.98, 95% CI 1.63 to 2.39, p < .001). Adjustment for confounders individually caused only a relatively modest reduction in magnitude and strength of association. Adjustment for treatment led to this association essentially disappearing (relative risk 1.10, 95% CI 0.88 to 1.38, 99% reduction in χ2), though with significant variation in association between age and overall survival between treatment groups (p-heterogeneity = .0004). CONCLUSIONS: Older women may do as well as younger women in terms of survival if treated similarly, although this varies depending on treatment groups. Treatments varied between and within sites, with some sites treating older women differently than others.