The population of the world is ageing. This has led to an increase in interventions and surgical procedures that would have been unheard of about fifty years ago. In this chapter we discuss the perioperative management of older patients, and the emphasis is on hip fracture patients. Factors such as limited physiological reserve, comorbidities, and the trauma of surgery itself are discussed, together with their perioperative management. The impact of pre-existing dementia and of post-operative delirium and depression is also covered here. The pre-operative management of fluid and electrolyte imbalance, the reversal of anticoagulation before surgery, and the treatment of infections are included. The evidence base around cut-offs for haemoglobin levels acceptable for surgery is also discussed. Finally, the post-operative management of acute kidney injury, infections, myocardial infarction, congestive cardiac failure, post-operative delirium, post-operative cognitive dysfunction, and depression is explored in conjunction with their evidence base.