Ageing is a normal process and much diversity exists in the physical, psychosocial and spiritual needs of older individuals. While many older people remain independent active and well, there is a rise in the prevalence of dementia. Developments in surgical techniques and improved patient outcomes have resulted in larger numbers of older people now undergoing surgery. However, age-related risks and complexities persist including the existence of cognitive impairment and dementia. Perioperative care of older patients with dementia provides additional challenges for nurses and other healthcare professionals. This paper discusses the unique care needs of older people with dementia and the role of perioperative nurses in meeting these needs.