With the increase in the average age of the population, more and more older persons undergo surgery. Major surgery, cardiovascular, orthopaedic and abdominal interventions expose the elderly patient to a significant risk for postoperative morbidity and mortality. This is not only related to the advanced age of these subjects, which is a recognized independent risk factor, but also to the aging process itself and to the greater prevalence of heart and lung diseases affecting this population segment. An important role is also played by the so-called physiologic modification found in subjects without recognized illnesses. Reduced organ function reserve requires accurate preoperative assessment that takes into account cardiovascular reserve and physiologic and pathologic alterations in the respiratory system that may predispose the patient to hypoxemia and favour the development of postoperative infection. Moreover, alterations in pharmacokinetics and pharmacodynamics require individualized drug dosing. Particular attention should also be directed at the prevention of postoperative cognitive disorders that favour the development of complications and negatively affect postoperative recovery of body function.