Nail changes in the elderly are often overlooked and neglected by the patient and sometimes the consulting physician also. Onychodystrophies due to chronic faulty biomechanics, recurrent trauma, and infections are common in the elderly. Nail abnormalities that were present at an earlier age might get modified further with advancing age. Routine nail care can be hampered in the elderly due to difficulty in reaching feet, nails that become too thick to cut, or poor vision. Nail changes can either cause severe symptoms hampering the daily activities or they may be asymptomatic causing cosmetic concern. This chapter discusses the physiological changes that occur with aging like the change in growth rate and thickness of nail, nail surface changes, alterations due to faulty biomechanics, and infections.