As life expectancy increases, the number of geriatric patients coming for surgery and anaesthesia will make up an increasing portion of our practice. Advancing age, comorbidities, altered pharmacokinetics and dynamics increase the morbidity and mortality of these patients. The importance of doing a thorough preoperative evaluation and identifying risk factors cannot be over emphasized in this frail and vulnerable group. Not all elderly patients have medical problems, stressing that physiological age is more important than chronological age. Current medical history and physical activity is a good indicator of how the surgical procedure will be tolerated. Addressed in this article is Post Operative Cognitive Dysfunction (POCD) which is being recognized as a significant issue facing the elderly patient. It is one of the problems specifically related to the geriatric age group. No ideal anaesthetic technique has been described, but if a thorough understanding of changes that occur in physiology and pharmacology is there, an optimal anaesthetic technique can be individually designed.