The proportion of the population of the U.S. 65 years of age and over is increasing. Biliary tract disease is estimated to involve 15% of the adult population. A review of 12,200 patients treated surgically at one medical center reveals that 2401 (20%) had acute cholecystitis. There were 93 deaths, for a mortality rate of 3.8%. Sixty-five of the 93 deaths, for a mortality rate of 3.8%. Sixty-five of the 93 deaths occurred in 665 patients 65 years of age and older, for a mortality rate of 9.8%. These elderly patients accounted for 69.9% of the deaths from acute cholecystitis. It is suggested that acute cholecystitis in patients 65 years of age and older may be prevented by a more aggressive surgical approach to cholelithiasis when those patients are younger. Indeed, the present improved methods of diagnosis and an awareness of gallstones by the public is resulting in many more patients seeking medical advice in the early years of the disease. On the basis of a review of an experience in the surgical treatment of acute cholecystitis two proposals are made concerning the management of patients 65 years of age and over. First, the operation should be performed with minimal delay following diagnosis, and such specific correction of physiologic impairment should be performed as is feasible. Second, the procedure to be performed on the elderly patient should be one that alleviates the present problem, and accomplished by imposing the minimal burden upon the patient.