Injury in the elderly is increasing, and we now see a bimodal distribution of injury deaths. The first peak in death rates is in the 16 to 24 age group, and the second is after the age of 60. This increase in the number of elderly patients is due in no small part to the fact that they are more active, continue to drive, and remain involved in some risk-taking sports, such as skiing and driving motorcycles. One can ask, “When does ‘old age’ begin?” If one reviews the National Trauma Data Bank maintained by the American College of Surgeons, there appears to be an increase in deaths after the age of 45. I wish to emphasize the variability in the physiologic changes that occur in the aged. The most common comorbidities that I see are cirrhosis, smoking, heart disease, and chronic obstructive pulmonary disease.