Ageing of the liver mainly affects the sinusoids and the Kupffer cells. Pseudocapillarization, manifested by reduced sinusoidal fenestration and subendothelial collagen deposition, causes a reduction in oxygen-dependent hepatocyte functions such as oxidative drug metabolism. The liver mass in old people is somewhat reduced and the liver blood flow is diminished. This causes a reduction in the clearance of rapidly cleared drugs, but the clearance of slowly cleared drugs is not affected. The overall capacity of the liver to regenerate is maintained in old people. Therefore, hepatic resections for hepatocellular carcinoma can be carried out in non-cirrhotic elderly people. For liver transplantations, biological age is more important than calendar age. Transplantations in frail old people and in elderly people with very poor liver function are associated with increased morbidity and limited survival. In relatively healthy old people, the results are as good as those in younger age groups. An increased prevalence of hepatitis C associated cirrhosis and hepatocellular carcinoma in the elderly population is to be expected, at least in the next 20 years. There is a high prevalence of gallstones among old people, in particular among females. For symptomatic choledocholithiasis in elderly patients, endoscopic bile duct clearance does not necessarily need to be followed by cholecystectomy.