It’s Not A “Senior Moment”—It’s ADHD

 ADHD Weekly November 15, 2018

It’s not just the teenager who is receiving a diagnosis of ADHD. The newest member of the family with a diagnosis may be an adult at or past retirement. ADHD is experienced across the lifespan, and it affects a surprising number of senior citizens.

“ADHD in the older population is just as complex and sometimes confusing as ADHD in any age,” says Martin Wetzel, MD, associate clinical professor of psychiatry at the University of Nebraska Medical Center and author of The ADHD Handbook for Patients, Family & Friends. “The reason is that so many aspects of ADHD are dynamic—ADHD changes its characteristics in the same person as that person gets older.”

ADHD in older adults

Symptoms of ADHD are related to executive functioning, which includes working memory, the ability to either maintain or redirect attention as needed, and self-control. Executive functioning may decline a little as one gets older, so it can be tricky to distinguish whether it is actually ADHD.

If there wasn’t a diagnosis in childhood, chances are slim there will be one in adulthood. Dr. Wetzel says doctors who treat people 60 and older—whether they’re trained in internal medicine or psychiatry—aren’t taught to consider ADHD as a possible diagnosis.

“It’s not even on their radar,” he says of the majority of doctors treating older patients. It’s just a training issue, he adds, noting no one is at fault. “Even the general psychiatric screenings and studies done on people that at age to look at cognitive issues don’t ask the question, ‘Were you ever diagnosed with ADHD as a child? Do you have these signs and symptoms now?’ We just don’t do a great job teaching about ADHD across the lifespan.”

The science of ADHD in older adults

There haven’t been many studies on the subject, either. One survey of the few studies that have been done found it’s not really clear whether symptoms change as people age. When examining patients who are 60 or older, health professionals tend to be looking for signs of dementia or stroke, and the symptoms of those conditions can be confused with ADHD symptoms. The authors point out that trained neuropsychologists should be able to tell the difference “between attention and memory difficulties due to ADHD and those due to acquired cognitive dysfunction such as dementia,” in part because ADHD involves a “decreased rate of learning” and dementia involves a “rapid rate of forgetting.”

It’s also not known whether people with ADHD might be more likely to develop certain kinds of dementia, something that is being studied now.

In fact, a lot of older adults are recognizing they might have ADHD themselves.

“In my experience, it’s people who are reading about it” who get diagnosed, says Dr. Wetzel. “Very often, it’s people who have a son or a daughter or a grandchild who has been diagnosed. They come in and say, ‘I was reading about this—this is what I’ve been experiencing my whole life. Is this something I have?’”

Similar treatment regardless of age

In many ways, treatment for ADHD in seniors may not be different from that for their children or grandchildren.

“It starts with awareness and understanding that ADHD is something an individual needs to become aware of, and then to understand how it affects them,” says Dr. Wetzel, adding that family and friends should also learn about its effects. The next step in treatment is thinking practically about how to make life better, what he calls organizational therapy.

Medication can be very effective in treating ADHD in older adults, Dr. Wetzel says. Concerns about stimulants adding to cardiovascular risk for people over 65 have not been proven, he adds.

“The response to treatment in my opinion is no different in someone over 60 than someone who’s very young,” he says. Some studies agree, but there has not been much research into the long-term effects of medication for those older than 60. Dr. Wetzel’s own experience indicates that when older adults are treated for their ADHD, they tend to take better care of their other chronic medical conditions. He also noted there is a possibility that untreated ADHD may result in a shorter life expectancy, perhaps because people with ADHD may have more accidents.

What you can do

If you think you may have ADHD but have not been diagnosed, don’t hesitate to bring it up with your provider. This may mean you need to find someone who is familiar with ADHD in older people.

“It’s very important to find a specialist—a practitioner who has experience with the diagnosis and can do a comprehensive assessment,” says Dr. Wetzel. “That can be any healthcare provider—primary care or specialist—but you really need to make sure the person has a background and understanding in ADHD.”

Looking for more?

Join the discussion: If you or someone you know was diagnosed with ADHD after age 60, what treatments or lifestyle changes have been helpful?