Nearly 60% of the Dutch population undergoing surgery is aged 65 years and over.Older patients are at increased risk of developing perioperative complications (e.g. myocardial infarction, pneumonia or delirium), which may lead to a prolonged hospital stay or death. Preoperative risk stratification calculates a patient's risk by evaluating the presence and extent of frailty, pathophysiological risk factors, type of surgery and the results of (additional) testing. Type of anesthesia, fluid management and pain management affect outcome of surgery. Recent developments focus on multimodal perioperative care of the older patient, using minimal invasive surgery, postoperative anesthesiology rounds and early geriatric consultation.