The aging population is rising worldwide, leading to an increased need to understand the unique health and insurance needs of older adults. This chapter explores the complexities of underwriting for individuals aged 65 and older, emphasizing the importance of distinguishing between normal aging and impaired risk. It highlights the challenges posed by issues including co-morbid conditions, frailty, polypharmacy, a fall history, and cognitive impairment, and discusses the impact of these factors on mortality and morbidity. By providing insights into the physiological changes associated with aging and the prevalence of chronic diseases, this chapter aims to highlight the holistic approach needed to underwrite older adults, including the role of functional assessments, healthy aging practices, and build and laboratory values.