The role of the primary physician in the preoperative evaluation of the elderly patient is critical. Due to the many associated changes of aging, careful assessment is required to reduce morbidity and mortality, and to identify treatable medical conditions which increase operative risk. Although increasing age is a major risk factor for surgery, the increased incidence of major diseases may be more important than age alone. Emergency surgery also involves considerably greater risk. It is important that the patient be involved in the decision-making process to the extent possible, and also that adequate postoperative and discharge planning be part of the preoperative management of the elderly person.