The life expectancy has improved globally as well in India, and one of factors responsible for increased life expectancy is better outcomes from chronic as well as acute age-related diseases. The main concerns are the age related physiological changes and the comorbidities that often accompany the aged. But what is ageing anyways? Do we start ageing from the time we are born? In a sense: yes, yet it would be appropriate to differentiate between ageing and the process of maturation, comprising of growth and development. Growth and development is designed to attain anatomic as well as functional optimization for an individual. Thereafter there is a variable period of plateau, wherein the individual maintains the peak performance levels, followed by a gradual decline of physical and functional attributes, a phase identifiable as that of ageing. At what age does the plateau end and ‘old age’ sets in? Physiological ageing doesn’t necessarily match chronological age due to interplay of several factors like genetic ‘commands’, environment, individual lifestyle and socioeconomic conditions, yet 65 has been arbitrarily accepted as the age at which most individuals will start showing changes purely attributable to ageing. The changes may be physiological or due to associated comorbidities, the fact remains that perioperative management of elderly patients is certainly more complex. And the overlap between the two, not an uncommon occurrence, makes it even more so. It is not uncommon to see an elderly patient have symptoms that are blunted or are of diminished intensity and get overlooked being labeled as due to old age. The age-related changes in the elderly population, whether physiological or pathological, must be carefully evaluated by the anaesthesiologist while planning perioperative management.