Few current standards exist for the identification and management of fever in older adults. Fever is one aspect of a controlled, complex febrile response that involves numerous physiological systems and must be distinguished from hyperthermia. Although most commonly identified with infection, numerous noninfectious etiologies exist. Fever is an adaptive response and is generally beneficial, especially in terms of the immunological response. Adverse consequences of fever are rare in older adults. Despite its metabolic costs, fever seldom requires treatment, except in certain patients who may not tolerate the stress. Controlling fever with antipyretic agents must be considered carefully, as the presence of fever may be helpful in guiding therapy, and antipyretic agents may have adverse effects. Recommendations are offered for identification and management of fever in older adults.