Elderly patients account for a growing proportion of those with head and neck cancer. Moreover, this proportion is expected to grow as the U.S. population ages. Surgical and radiation therapy have been demonstrated to maintain their oncologic efficacy in elderly patients. However, elderly patients are more likely to suffer from co-morbid disease that increase their chances of perioperative medical complications and can result in unplanned treatment breaks. In contrast to surgery and radiation therapy, evidence suggests that chemotherapy is not as effective in elderly patients as it is in younger patients. This is  thought to be related to the increased toxicity and morbidity elderly patient suffer from cytotoxic chemotherapeutic agents. The recent advent of immune mediated and targeted drugs may allow for more aggressive treatment of elderly patients. Given the complexity of treatment decision making for elderly patients, several assessment tools have been described that predict perioperative risk in this patient group.