Increasing proportions of patients admitted to intensive care units (ICUs) are >65 years of age. Geriatric critical care requires a nuanced approach that optimizes outcomes and is mindful of patient desires. This occurs by identifying at-risk patients and implementing protocols and multidisciplinary care which targets patients' clinical status, prevents neurologic and physical deterioration, and addresses comorbidities in the setting of altered physiology. In this article, we will review evidence-based practices to enhance the care of older adult patients in the ICU.