The percentage of elderly people in our population is increasing, and anaesthesiologists and surgeons need to find ways of decreasing perioperative complications in these patients. The chronological age is of lesser importance than biological age as far as the risks of perioperative complications are concerned. Indicators for biological age are the number and type of previous diseases, nutritional status and the doctor's clinical impression of the patient. Preoperative evaluation of the perioperative risks in elderly patients is now mandatory. The physical status classification of the American Society of Anesthesiologists and the Goldmann Index are very useful for patient evaluation. Optimal preparation of the patient is helpful in decreasing risks, and the avoidance of emergency operations will also decrease risks. It is not yet clear whether regional anaesthesia, as opposed to general anaesthesia, decreases mortality in geriatric patients. It seems, however, that regional anaesthesia may have some advantages in terms of postoperative consciousness, blood loss, thrombotic complications and mean length of stay in hospital. The surgeon can help reduce the operative risk by a rapid and atraumatic operation technique. The most frequent perioperative complications are alterations to the cardiopulmonary system and postoperative bleeding. Even minor perioperative complications can have a predictive value for later fatal events. Thus, careful preoperative preparation, a suitable anaesthetic procedure and a fast and atraumatic mode of operation will help to decrease perioperative complications in elderly patients.