Future development of services for older people needs to be tailored to suit the health systems context. Low-income countries lack the economic and human capital to contemplate widespread introduction of specialist services. The most cost-effective way to manage people with dementia will be through supporting, educating and advising family caregivers. The next level of care to be prioritized would be respite care, both in day centres and in residential or nursing homes. An important prerequisite to improving care for older persons is to create a climate that fosters such advances. Better awareness is a necessary precondition for appropriate help-seeking, and lack of awareness is a public health problem for which population level interventions are needed.