Elderly individuals are living longer, healthier, and more active lives, and, in the process, they are continually exposed to the risk of injury. Trauma is now the fifth most common cause of death in people over the age of 65 years, and the elderly suffer disproportionately high injury-related mortality rates compared with younger adults. They consume a vast portion of health care resources and their care precipitates some of the most difficult ethical and sociologic questions in modern medicine. Physiologically, the elderly present a unique and complex picture that requires an understanding of the process of aging and the concomitant effects of acquired diseases. As surgeons involved in the care of the injured, we find ourselves becoming more frequently involved with this national dilemma. This review provides some insights and guidelines for the care of the injured elderly, with the hope of improving our understanding and their outcome.