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Magnesium is an essential bivalent cation. Its fine balance in human organism is extremely important and is involved in a wide range of functions. We need to maintain its amount in human organism within range considered as physiological. This is particularly true for elderly people, and especially for “frail” elderly people, whose systems and apparatuses are in a state of serious homeostatic precariousness. In fact, hypomagnesemia is involved in a very large range of pathological conditions (requiring multiple therapies) that could compromise elderly's autonomy. The aim of this review has been to go through the most important trials, in order to understand the direction taken by research during the last years and to detect the room for improvement in this field. We have tried to understand when magnesium content is truly physiological or pathological, and how we could prevent an inappropriately low magnesium intake in elderly people. First of all, we have remarked the absolute need of an adequate evaluation method for magnesium content in human organism. Current literature appropriately encourages the use of a synoptic assessment of magnesium serum concentration, urinary excretion, and dietary intake. We have also discussed the most important trials relating hypomagnesaemia with human pathology. Specific studies conducted on elderly patients have extensively demonstrated its decisive role in maintaining bone health, adequate glyco-metabolic compensation, a correct cardiac and vascular functional profile, and probably also a physiological psycho-cognitive profile. From the implications discussed above, therefore, it is essential to ensure physiological levels of magnesium in body, particularly in geriatric patient, itself more prone to a reduction in the level of cation. We have concluded, according to the literature, that the best way to prevent hypomagnesemia and its clinical implications in elderly subjects is represented by a proper diet (more fiber and complex carbohydrates, more vegetable proteins, less sugars and fats), which ensures an adequate supply of cation. If with diet alone (due to comorbidity or other concomitant factors) it has not been possible to guarantee suitable serum levels of cation, or in the case of a patient defined as “frail elderly”, a reintegration therapy (per os) will be undertaken, after a careful analysis of renal function.