Epilepsy is most common in older people and yet optimizing the management of seizures in this demographic has often been somewhat overlooked. With populations aging across the world and those with complex early-onset epilepsies thankfully living into later life, the prevalence of epilepsy in older people is escalating rapidly. Assessment and management in this age group can be challenging. Seizures may present in unusual ways and the complex comorbidities and polypharmacy that often characterize older age, might make establishing a diagnosis of epilepsy in older persons difficult. Drug choices and treatment options are often more limited and need to be specifically tailored to the older individual with careful consideration of relevant comorbidities. The complex inter-relationship between epilepsy, dementia, and vascular disease in older people would seem a research priority, as there might be interventions to help reduce adverse outcomes in a growing and potentially vulnerable group.