As the American population ages, older adults are likely to continue their active lifestyles including participation in high-level competitive sports. Physicians caring for the older athlete will need to guide activity and return-to-play to optimize the athlete's performance, as well as safely support their physical and mental health. Many medical concerns of the older athlete have the same etiology and treatment as those of their younger counterpart However, there are medical considerations of the mature athlete that are unique to this population. It is the purpose of this paper to review some of the medical considerations that may arise in the care of the older athlete. For the purpose of this review, the mature athlete is de!ned as an individual over the age of 40, who participates in sport at a competitive level.