Geriatric companion animals often present with multimorbidity, requiring a shift from disease-centered to functional, quality-of-life–centered care. Effective management integrates thorough diagnostics, client-reported outcomes, and individualized treatment strategies that account for drug interactions, treatment burden, and caregiver capacity. Multimodal pain and symptom management, nutritional and environmental support, and regular medication review are central to sustaining comfort. Interdisciplinary collaboration, accurate record-keeping, and shared decision-making with owners help align medical goals with patient welfare. Ethical considerations, including transitions to hospice care, ensure compassionate, context-driven management that honors both the patient’s dignity and the caregiver’s values.