We examined 31 older couples’ wife demand/husband withdraw communication patterns and cortisol responses to marital conflict. Regression analyses indicated that wife demand/husband withdraw sequences during conflict related to cortisol responses only for wives. Based on a mixed model that accounted for the interdependence of spouses’ perceptions of communication patterns and outcomes, older spouses who reported greater wife demand/husband withdraw patterns in their marriage had greater cortisol responses during a conflict discussion; actual demand-withdraw did not relate to cortisol responses in this model. Findings suggest that perceived communication patterns contribute to neuroendocrine responses to marital conflict, and implications for marriage and health research with older couples are discussed.