As a consequence of improving medical care, anesthetic care and surgical skill, anesthetists will be faced more and more with elderly patients. Aging is an all-encompassing, multifactorial process which results in decreased capacity for adaptation and produces a gradual decrease in functional reserve of many of the body's organ systems. The pre-operative assessment of the elderly should respond to a logic of safety, ethic, adequate resource management and network between all medical specialties in charge of the patient. Every patient should be assessed individually in regard of the inter subjects variability, and the organ at risk should be particularly evaluated.