The elderly represent a unique cohort of the US population—and their numbers are on the rise. Among the medical community, being 65 years or older represents an age associated with multiple comorbid conditions and a point in life at which practitioners are typically less likely to advise aggressive diagnostic, medical, and surgical interventions for common medical conditions. It is increasingly recognized that a subset of older individuals live longer and healthier lives without major disease entities or limitations in functional status. Although aging is associated with declines in the cardiovascular, metabolic, renal, endocrine, musculoskeletal, immunologic, and neurologic systems, the gastrointestinal (GI) tract differs in its greater reserves and ability to maintain relatively normal digestive and absorptive function. Nonetheless, certain gastrointestinal disorders are more common and cause greater morbidity and mortality in the aged. Additionally, parallel diminished reserves in other systems may cause profound gastrointestinal effects and the contributing roles of depression, cognitive decline, lack of social support, and polypharmacy may further incite deleterious gastrointestinal consequences. Aging is also associated with the accumulation of genetic mutations and chromosomal instability, reflected in the higher incidence and mortality of GI cancers in the old.