The number of critically ill elderly continues to rise, causing health care workers to be faced with decisions regarding aggressiveness of care, rationing of resources, and optimizing outcome. Although survival rates in the critically ill elderly may be lower than those in the younger critically ill, health care workers must focus on customizing treatment to optimize physiologic recovery, quality of life, and functional status. We advocate better research designs incorporating long-term outcomes and genetic predisposition as a means of improving care in the elderly critically ill.