Preoperative evaluation of elderly patients is an important component of surgical practice in the 21st century. It can offer a comprehensive geriatric evaluation and be a key element in decreasing postoperative morbidity and mortality in this unique population group. Advanced surgical and anesthetic techniques have contributed to an increasing number of elderly and sicker geriatric patients undergoing surgery. Elderly patients have limited physiologic reserve and pose many challenges in the perioperative setting, and a careful preoperative risk assessment aimed toward minimizing operative risks is essential. Advanced age increases the risk of developing complications post-surgery, but comorbidities are more important than age alone. General recommendations include avoiding drugs that increase the risk of delirium, ensuring appropriate hydration and calorie intake, minimizing bed rest, promoting ambulation, and early planning for discharge. Collaboration between surgeons and medical consultants aids in the identification of functional, cognitive, and nutritional deficits, provides structure for development and implementation of management plans, and promotes optimal patient outcome after surgical intervention in the elderly.