f t f m c l l a s N THE NEXT 50 YEARS, the United States will experience an unprecedented increase in the size of its older adult and lderly population. According to US Census Bureau projecions, the number of persons 65 years of age or older will ncrease from approximately 35 million in the year 2000 to pproximately 82 million in 2050, a net increase of 135%. uring the same time period, the number of persons 85 years of ge or older will increase by 350%, making this the most apidly growing segment of the US population.1 As a result, it s anticipated that the number of surgical procedures in the lderly will increase dramatically, especially among the very lderly. Currently, 25% to 30% of surgical patients are older han 65 years of age, and it is projected that at least 1 in 2 older ersons aged 65 years will undergo an operation in the emainder of his/her lifetime.2 Although age itself is an independent predictor for perioprative outcome,3 cardiovascular morbidity and mortality are ther contributors to overall adverse perioperative outcome.4 istory of congestive heart failure is an important predictor of ostoperative adverse cardiac outcome and in-hospital mortalty in the elderly,5,6 and the role played by diastolic dysfunction n the aging heart is increasingly recognized as a cause of heart ailure.7-9 Taken together with the fact that the majority of the urgical patients 65 years old will have normal ejection ractions and ventricular filling abnormalities on their preopertive echocardiograms,10 it behooves perioperative physicians o understand the aging heart and, in particular, aging’s impact n diastolic function, so that perioperative anesthetic manageent can be modified in a way that may improve outcome in his rapidly growing cohort of surgical patients.