The (lack of) knowledge about ADHD in the elderly
Blog by Lotta Borg Skoglund
What’s it like to suddenly, as an adult, realize that you’ve lived your entire life without understanding why certain things always seem to go wrong? Why others consistently misunderstand you, and why you can’t seem to do all the things you know you should do? My latest book, “Years Pass – ADHD Lasts” (Natur and Kultur 2023), describe how it can be to get an ADHD-diangosis as an adult or even aging adult. As in my previous books, this recent book is based on narratives from my patients, current research, and my own clinical insights.
Over the past twenty years, research on ADHD in adults has increased. Sadly, this is not the case for the older adults. But even though the knowledge about those over 50 with ADHD is scares, these persons exist and they live their lives among us. Indeed, if you work in healthcare or social services, it’s highly likely that they are already your patients. This week’s blog from Letterlife is about what we know and don’t know about ADHD in the elderly today.
How common is ADHD in the elderly?
Between 2 – 3 percent of all individuals over 65 live with ADHD. However, only about 0.2- 0.5 percent have a formal diagnosis. This means that many older individuals never get the correct explanation or tools to handle the challenges that they have struggled with throughout their lives.
What is challenging for the aging ADHD brain?
Our brains are constantly processing sensory input from the outside world and the body. If you have ADHD, you might find yourself struggling more than others to plan, organize, structure, and prioritize in your daily life? Or to regulate your emotions, energy and activity levels, sleep, alertness, and appetite? Perhaps filtering, sorting and avoid distracting stimuli, or shifting focus, getting started or finishing tasks, or try something new when the current approach isn’t working can also be tough? Just like younger individuals, older adults with ADHD grapple with ADHD 24:7 (more on the 24:7 model for ADHD in a previous blog here).
How are older adults with ADHD doing?
Older adults with ADHD, like their younger counterparts, are at high risk for both physical and mental comorbidities and often describe themselves as lonely and vulnerable. This may be due to struggles to establish healthy routines in life around important lifestyle factors such as: diet, exercise, sleep, stress, emotions, addictions, and finances. Since ADHD manifests so differently in different people, not everyone with ADHD will face the same or all these problems.
How to diagnose ADHD in the elderly?
ADHD assessments for older adults can be somewhat tricky. For instance, it’s required that symptoms where present before the age of 12, and finding someone who still lives or remembers that can be hard. But honestly, is it ethically reasonable to deny someone support and care simply because evidence of problems from over 60 years ago cannot be found? Additionally, distinguishing ADHD symptoms from declining memory or dementia can be complicated. The key often lies in the timeline, whether the individual has always been this way or if the symptoms emerged in later life. It can also be difficult to discern what came first when it comes to physical and psychiatric comorbidity, which are more prevalent due to ADHD. For women, symptoms of declining estrogen levels during menopause, such as sleep problems, mood swings, “brainfog”, and fatigue, can resemble what they’ve experienced throughout their lives with ADHD.
Can older adults take ADHD medication?
There’s very little research on ADHD medication for older adults. Sandra Kooij, world leading expert on ADHD in elderly, recommends psychoeducation, medication, and practical daily support, just like for younger individuals. The limited research on ADHD medication suggests it’s probably effective for older adults as well, but there’s insufficient guidance on dosages and side effects. It’s possible that older adults should have lower doses than younger ones, or that physical comorbidities and other medications make ADHD medication unsuitable. Side effects like decreased appetite, weight loss, and sleep problems can also be more serious for older than younger individuals.
People typically don’t grow out of their ADHD, and children with ADHD grow into older adults with the same (and new) challenges of ADHD in all ages. Statistically 2 – 3 percent of all individuals over 65 live with ADHD, still only about 0.5 percent have a formal diagnosis. Given the personal suffering and societal costs associated with undiagnosed ADHD, more knowledge about older adults with ADHD is crucial. Society can’t afford to ignore this issue, especially since many older individuals with ADHD, due to lifestyle-related health problems, already are our patients.