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Acute myocardial infarction is a significant world-wide problem, especially among older adults. More than 50% of older adults who experience this die before arriving at the hospital because of delaying seeking treatment. The aim of this integrative review was to describe factors related to a delay in seeking treatment among older adults with acute myocardial infarction. Studies published up to 2019 were extracted from the literature that dealt with a delay in treatment for acute myocardial infarction. These needed to be published in peer reviewed English or Thai journals or thesis/dissertations; and involved studies where at least 75% of participants were over 55 years. However, studies without comparisons about factors related to delay treatment were excluded. A total of 23 papers were selected for final review following standard methods for an integrative review. Results revealed three phases related to delays in seeking treatment: patient/bystander recognition action, transportation, and hospital action phases. Most older adults spent the longest average of time delaying in the first phase. Factors associated with delay seeking treatment were in four categories: socio-demographic (advanced age, female, non-white, single/widowed/separated, low education, and low income) ; physiological and environmental (using private car, living alone, experiencing symptoms at home/weekday/night, and living in impoverished/rural area); psychological and behavioral (feelings and thoughts hesitancy/ambiguity/bother and self-management); and clinical (lack of cardiac history, positive history of diabetes mellitus, hypertension, stroke, heart failure, angina pectoris, smoking, and symptoms mismatch/low intensity/atypical symptoms). Findings suggest that nurses need to educate older populations about the early recognition of acute myocardial infarction symptoms and tailor interventions to improve understanding of symptoms and need for emergency treatment. [ABSTRACT FROM AUTHOR]