Persons over 65 years currently represent greater than 13 % of the population. In the 1990’s, a multicenter study demonstrated that 15% of nearly 100 million Emergency Department (ED) visits were made by elder patients, and that these patients were more likely to be brought in by ambulance, consume more ED resources, have serious illness or injury, and require surgery or admission. The percentage of older patients is projected to increase over the next decade with 25% of ED visits generated by this age group by 2020. This lecture will enhance emergency physicians to recognize and treat surgical illness that are not very obvious upon ED presentations.