Background: Respiratory infections significantly impact older adults in Latin America, highlighting the need for regionally adapted consensus-based vaccination recommendations to guide preventive strategies. This study aimed to develop a consensus among Latin American experts on vaccination against respiratory diseases in older adults in the region, including influenza, Streptococcus pneumoniae pneumonia, coronavirus disease 2019 (COVID-19), respiratory syncytial virus (RSV), and pertussis. Methods: A two-round Delphi methodology was employed, involving 35 specialists from various medical fields. A rapid evidence review was conducted using scientific databases and clinical practice guideline repositories. Participants evaluated each recommendation on a 1-to-5 scale; recommendations with 80% acceptance (score of 4 or higher) were approved. Results: The consensus resulted in recommendations for administering Tdap (tetanus, diphtheria, and pertussis) boosters every 10 years for pertussis and annual influenza vaccination in adults aged 65 years or older, using high-dose or adjuvanted formulations. Additionally, primary and annual booster COVID-19 vaccinations were recommended, along with a single dose of RSV vaccine for individuals aged 75 years and older, providing protection for at least two winter seasons. Routine administration of pneumococcal conjugate vaccine 15 (PCV15) or PCV20 was also recommended for adults aged 65 years or older who had not previously received a PCV. Conclusions The consensus provides a vaccination guide tailored to the Latin American context, aiming to bridge gaps in vaccination coverage among older adults in the region. This effort seeks to reduce the burden of respiratory diseases on frail healthcare systems and promote healthy aging in Latin America.