Analgesia care in geriatric patients requires consideration of several age specific aspects of pain assessment and treatment. Geriatric oligoanalgesia is well known to occur in the acute care setting, and the problem has serious ramifications. Aging changes the physiology of drug absorption, distribution, metabolism, and elimination. Age-associated physiologic changes vary from patient to patient, in both degree and directionality. Opioid therapy provides an illustrative example of how altered elderly pharmacology dictates a conservative approach to analgesia titration. The Beers criteria have been adopted by many healthcare authorities, including the Centers for Medicare and Medicaid Services, and are now the most often-used consensus criteria guiding medication use in older adults. NSAIDs are widely prescribed, and frequently efficacious, in the acute care setting. Opioid selections for moderate (e.g. hydrocodone) or severe (e.g. morphine) pain in the elderly are generally similar to those for younger adults.