Multiple sclerosis (MS) is a chronic, progressive neurological disease that causes demyelination of the central nervous system. Typically diagnosed in adulthood, it does not significantly reduce life expectancy. The goal of this exploratory study was to describe the health-related concerns and service needs of 27 older adults with MS, ages 55 to 81 years. Through in-depth interviews using a phenomenological approach, fear of the future was found to be a predominant concern among the participants. Within this fear, participants expressed particular concerns about experiencing further losses of mobility and independence, becoming a burden on caregivers, and having to move to a nursing home. The findings raise three major challenges for occupational therapists that include: (1) developing or modifying interventions that can enable older adults with MS to gain a sense of control over their future, (2) working with families affected by MS together with other disciplines such as psychology and social work, and (3) advocating for more and better community support options for persons with MS.