This chapter addresses the perioperative nursing strategies required to optimize care for older surgical adults. It explores preoperative assessment and care planning, intraoperative care specifics, and postoperative recovery. The chapter highlights the implications of nursing care for older adults, emphasizing personalized approaches tailored to their unique needs. It discusses mitigating measures for preventing anticipatory risks identified. It emphasizes the importance of early care planning with realistic, goal-oriented measures developed in collaboration with patients and their families. The chapter concludes with a patient-centered, holistic approach to perioperative care that acknowledges the vulnerabilities and specific needs of older adults.