Background: Approximately 15% of cases of early-stage triple-negative breast cancer (TNBC) are diagnosed in individuals over the age of 70. Despite studies indicating that older patients derive similar benefits from polychemotherapy as younger patients, breast cancer specific mortality among older patients remains disproportionately high. Use of the comprehensive geriatric assessment (CGA) and individualized risk tools can help tailor treatment and minimize negative side effects while preserving quality of life. We performed a retrospective analysis of patients ≥ 70 years of age diagnosed with stage I-III TNBC at Memorial Sloan Kettering Cancer Center between 2015 and 2019 to describe clinical practices for managing this population. Methods: Demographics, CGA, systemic therapy data were collected from electronic medical records. A multivariable logistic regression model was used to identify factors that were independently associated with the probability of receiving chemotherapy. Results: We included 159 women, with a median age of 74.5 years (range 70-96). 67 (42%) had stage I disease, 71 (45%) had stage II, and 21 (13%) had stage III. 29 (18%) reported difficulty in Activities of Daily Living (ADL), 34 (21%) reported difficulties in Instrumental Activities of Daily Living (iADL), and 40 (26%) were identified as having a high risk for falls. 25 (17%) patients underwent CGA per physician’s choice. The prevalence of cardiac risk factors was as follows: hypertension in 80 patients (50%), diabetes in 25 (16%), obesity in 7 (4.4%), heart failure in 1 (0.6%). 147 underwent breast surgery, with 106 (67%) receiving lumpectomy and 41 (26%) mastectomy. 97 (61%) patients received chemotherapy: 35 (22%) neoadjuvant and 62 (40%) adjuvant. Anthracycline, Cyclophosphamide, Paclitaxel (AC-T) and Cyclophosphamide, Methotrexate, Fluorouracil (CMF) were the most common regimens. In multivariable logistic regression analysis, use of chemotherapy was associated with younger age (odds ratio [OR] 0.84 for one year increase in age, 95% confidence interval [CI] 0.75-0.93, p = 0.001) and higher disease stage (stage II vs. I OR 4.97, 95% CI 1.66-16.4, p = 0.006; stage III vs. I OR 22.0, 95% CI 3.3-312, p = 0.006). No significant difference was found in geriatric referrals, cardiovascular risk factors, or difficulties with ADL or iADL between those receiving or not receiving chemotherapy. Conclusions: In our single center experience, 61% of older patients with early-stage TNBC received chemotherapy, with AC-T and CMF being the most common regimens. The referral rate for CGA was low. Age < 75 years and higher disease stage were significantly associated with receiving chemotherapy. Overcoming barriers to incorporating CGA and toxicity prediction into routine clinical practice is crucial for personalized treatment in this population.