Elderly surgical patients comprise a heterogeneous population, especially due to extreme variability in the aging process and the prevalence of chronic disease. Providing anaesthesia can be challenging as the sensitivity to anaesthetic agents is generally increased. Careful preoperative assessment is mandatory but can be difficult, and intraoperative care must be tailored to the extent of organ failure. The aim of this review is to highlight some specific concerns that must be addressed in the perioperative management of elderly patients.