Aging is a multifactorial process often associated with many age-related disease states. It results in a decreased capacity for adaptation and produces a gradual decrease in functional reserve of the body’s organ systems. Organ system functional reserve is the difference between maximum capacity and basal levels of function. It is a “safety margin” to meet the additional demands of cardiac output, disease, trauma or convalescence. While the basal function in most elderly patients is sufficient to meet daily needs, under conditions of physiological stress, the impairment in functional reserve becomes evident. An elderly patient who maintains greater than average functional capacity is said to be “physiologically young”; while if the function declines at an earlier age he is considered as “physiologically old”. In the past, surgery for the elderly was usually avoided; however with advances in anaesthetic practice and surgical techniques, including minimal access surgical procedures, older patients are being accepted for surgery more readily. Beside selection of appropriate anaesthetic technique, we as perioperative physicians have a greater role to play in the optimization of the preoperative status and management of immediate postoperative period.