Aging is a universal and progressive physiologic phenomenon characterized by degenerative changes in both the structure and the functional reserve of organs and tissues. It produces many physical manifestations due to reduced connective tissue flexibility and elasticity or the degeneration of highly structured molecular arrangements within specialized tissues. At the tissue level, cross-linking, glycosylation, or similar dysfunctional interactions occur. The difference between maximum capacity and basal levels of function is organ system functional reserve.Increased life expectancy and reduced mortality from chronic age-related disease continue to enlarge that fraction of the surgical patient population considered elderly. Surgical procedures in the elderly will continue to require a disproportionately large share of social and institutional health care resources. Routine postoperative hospitalization and intensive care, especially after major trauma, are frequently protracted and may be further complicated by infection, poor wound healing and by multiple organ system failure for critically ill elderly patients.Surgery in the geriatric population is not without risk, but the mortality rate has markedly decreased. Chronological age is much less important as an independent risk factor. A more important predictor is the presence of coexisting disease. Although prospective trials involving risk modification are lacking, medical optimization, adequate planning preoperatively, including scheduling surgery electively as opposed to emergency, and improving nutritional status may be helpful. The anesthetic technique is probably not as important as meticulous control of hemodynamics perioperatively. Opportunity to improve perioperative outcomes in the elderly will be possible when risk factors for these adverse events can be modified and outcomes evaluated.For anesthesia departments employing increased usage of conscious and deep sedation outside their operating rooms, we may see the advent of formal anesthesia sedation services available throughout a hospital community. Advantages of such a service include providing a hospital with timely, reliable, high quality service with an optimization of recovery and turnaround time.