The influx of older patients into the office-based primary care setting is a demographic reality for most practices. A shift from the disease-driven model of care delivery to one that focuses on function and quality of life should occur if primary care clinicians are to provide appropriate services to their aging patients, especially as those patients reach a state of vulnerability as defined in the ACOVE studies. Incremental functional assessment may be a first step in making the shift and probably can be implemented in most office-based practices. The specter of dementia, however, is beginning to materialize and affect the approach to addressing the needs of older adults and the expected outcomes of care.