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Birthday greetings can be sent in a variety of ways. Older folks probably appreciate a printed card with a handwritten note and some family photos more than anything. Remember that for folks over 80 you can get birthday greetings sent from the White House. Younger people are apt to have email and can be sent electronic birthday greetings. Include some personalized note with these as well to show you have thought about the person and not just made a few mouse clicks for them!
*If you want to make your own birthday greetings, a standard-sized card can be made by folding an 8.5 x 11 inch sheet of paper into quarters. You can buy invitation sized envelopes to fit your handmade cards.