The safety of elders in acute care settings has been a long-standing nursing concern; it is well known that elders are at a higher risk for injury and adverse events during hospitalization. Common sensory changes, comorbidities, and frailty of elders may contribute to injury and poorer outcomes. Confusion, delirium, falls, or adverse drug events experienced by hospitalized elderly also may contribute to injury and adverse hospital outcomes. Nurses may use strategies to protect hospitalized elderly from injury and optimize their outcomes by establishing a culture of safety. Approaches to foster safe hospital stays for elderly patients are outlined, and recommendations for institutional management and administration, policy and nursing practice, education, and research are identified.