Outcomes of hospitalization of elderly patients can be improved through a systematic and comprehensive approach that physicians can incorporate into their practices. The first step is to recognize the patients who are at risk for functional decline in hospital, despite appropriate treatment of their acute illness. Many of these patients will present with one or more of the common geriatric syndromes, functional dependency, cognitive dysfunction (delirium), mood disorders (depression), and malnutrition. The next step is to avoid iatrogenic illness from diagnostic tests or medications and deconditioning due to immobility. Finally, discharge planning can help to ensure that patients receive needed services when they leave the hospital.