12049 Background: Over the last few decades, improvements in healthcare have increased life expectancy by nearly 10 years resulting in a rise in America’s older population. As age is one of the most significant risk factors for the development of cancer, there is a projected increase in the incidence of cancer in the elderly population, with the largest absolute and relative increases in breast cancer (BC). Although treatment advances have improved outcomes for patients with metastatic breast cancer (MBC), patients in clinical trials are often younger and there is limited data for the older population. The goals of this study were to use the National Cancer Database (NCDB) to assess overall survival (OS) in older patients over 75 years of age with MBC and evaluate the impact of tumor features and demographic factors. Methods: Women with a diagnosis of BC at age ≥75 years and with metastases at time of initial diagnosis from 2010 to 2019 were identified from the NCDB. Patients were stratified into age subgroups of 75-79, 80-84, and ≥85 years. Chi-square tests were used to compare categorical variables. Kaplan Meier curves were used to determine OS distributions for patients by age, BC subtype and year of diagnosis. Log-rank tests and multivariable cox proportional hazards modeling was performed to assess the difference in OS by BC subtype. Results: Of 17,325 eligible women included in the final analysis, 39.4% were 75-79, 30.1% 80-84, and 30.4% ≥85 years of age. We observed an improvement in OS over time, with 5-year OS rates improving from 13.7% in 2010 to 15.2% in 2015, p = 0.017. Three-year OS rates were higher in patients aged 75-79 (34.2%) compared with patients aged 80-84 (28.7%) and ≥85 years (18.6%), p < 0.001. Outcomes varied by BC subtype with better prognosis in patients with hormone receptor (HR)+, HER2-negative BC (3-year OS 35.1%), followed by HR+, HER2+ (32.8%), HER2+, HR-negative (20.6%) and lastly, HR-negative, HER2-negative BC (9.7%), p < 0.001. Based on multivariable analyses, a higher comorbidity index was associated with worse outcomes (HR 1.654 [1.48-1.849], p < 0.0001). Higher income (≥$63,000) was associated with decreased mortality (HR 0.859 [0.784-0.941], p = 0.0011) compared with lower income ( < $38,000). While the type of cancer facility (academic, community, etc) did not impact mortality, older patients living in metropolitan areas ( > 1 million) had improved outcomes (HR 0.829 [0.689-0.996], p = 0.046), compared to those in rural areas. Conclusions: We observed a modest though significant improvement in survival outcomes over time in older patients with MBC. Prognosis was better in patients with HR+ BC compared with HR-negative, HER2+, and HR-negative, HER2-negative subtypes. However, outcomes in patients ≥85 years remain poor. Given the lack of clinical trial data in older patients with cancer, future studies should specifically focus on improving outcomes in this population.