Other than children under the age of 5 years, the highest incidence of new onset epilepsy occurs in the population over 65 years of age. Risk factors in this age group include stroke, head trauma, dementia, infection, alcoholism and aging. Clinically, seizure behavior may be confused with other neurological impairments, thus delaying accurate diagnosis. Concomitant drug therapy affects the choice of antiepileptic drugs. Neuroscience nurses need to identify high-risk patients, recognize and document seizure activity and adverse drug reactions and interactions, and modify traditional seizure first aid for the frail elderly. An understanding of the psychosocial impact of epilepsy is necessary when offering education and support to the patient and family.