Optimal medical care and welfare is an urgent issue among the elderly population in a rapidly aging society. Epilepsy is a common chronic neurological disorder that affects all ages with peaks observed in children and in elderly individuals. Considering rapid population aging, the prevalence of epilepsy in the elderly population is expected to increase in the future. Clinicians should be aware of the clinical features of epilepsy in elderly patients because these differ from those observed in young patients from several perspectives. In this article, we review the clinical practice and recent updates in epilepsy in the elderly population. Epilepsy in elderly patients requires careful attention to subtle seizure symptoms and electroencephalography findings, and this disorder is associated with a wide range of differential diagnosis. Treatment is primarily pharmacological, and seizures may often be well controlled. Etiologies include dementia and cerebrovascular disease; however, a few patients may present with epilepsy secondary to an unknown cause. Psychosocial issues such as driver's license and stigma are also important.