ADHD in Older Adults

ADHD is not just for kids. And it does not necessarily stop in adulthood either.

Adults with ADHD can grow up to be seniors with ADHD. Have you ever considered that? Yes, ADHD can persist into old age, affecting about 3-4% of older adults.

The symptoms are more or less the same as in adults, but they would be less obvious in seniors for one, because they do not need to show up to work every day.

They would have difficulties with the following:

Cognitive Deficits

·       Concentration

·       Sustained focus

·       Losing or misplacing things

·       Listening

·       Memory

·       Following instructions

Executive Deficits:

·       Starting tasks

·       Staying on task

·       Organizing

·       Planning-Prioritizing

·       Finishing Projects

The truth is it might be very hard to find the ADHD in seniors because they are much better at hiding their deficits. They just don’t do what they are not good at. Do you blame them.

I can remember a few patients who were over 80, and came to me, wondering if they had ADHD, and could get some help for it.

One was a retired judge, tall, strong and serious. He wanted to write his memoirs, and he found he could not. When he was researching something from the past, he found he had to read the words over and over again and still could not retain the information. He couldn’t sit still, and months turned into years, and he still was getting nowhere. I treated his ADHD and within 3 months I got a copy in the mail.

One was a woman from the Island; energetic, whimsical and colorful. She had worked her whole life as an artist but felt that she had not met her full potential. She had sold a dozen or so paintings, but she counted 54 unfinished canvases in her garage. She asked me is she would lose her artistic capacity if we treated her ADHD. About a month later, she came back for her first follow up visit. With a bit of trepidation, I asked her whether she had lost her artist’s eye. “No, she said, it’s the same, but now I’m on time for the ferry!" Then she presented me with a fantastic watercolor of my first clinic, HealthSmith Community Clinic, which has hung on every one of my subsequent office walls.

The other octogenarian with ADHD who comes to mind was a renowned dentist. He’d taken care of some of the most known teeth in town. He was retired now and puttering about the house but driving his wife crazy! "What’s not working?” I asked. He thought a moment, then answered how all his life he could focus on what he was really good at, dentistry, and could delegate every other task. Now that he was at home, he'd get into one hobby after another, buy all the best equipment and instruction books, get somewhat proficient and then literally drop it in the corner and never look at it again: photography, calligraphy, stamp and coin collecting, violin, flute, Russian and Mandarin. Also, he said, "I can’t turn off my brain at night". A couple months later, his wife called me and asked, “What have you done to my husband?” Ahh, I'd treated his ADHD... "Well, I’ve never seen anything like it.... he reads books, listens when I talk, asks me about my day, no longer interrupts or changes the topic of conversation in mid-sentence and for once in 50 years he remembered our anniversary!"

To be safe, elderly patients with ADHD should review their cardiac health with their doctor, before they take stimulant medication, especially if they have ever had high blood pressure or heart-related issues. An in-depth mental health assessment, and a baseline ECG are a good idea, if applicable. Of course, the patient and their clinician should discuss the risks, benefits, how to take the medication and any possible side effects before considering stimulant medication.

Close monitoring during the first weeks of treatment is crucial. The absolute risks remain relatively small: 5 out of 100 stimulant users had any cardiovascular event over one year, compared to 3-4 out of 100 non-users. That’s not nothing, but in my 25 years of prescribing stimulants I think maybe 15 or 20 ever had any cardiac events and every one of those already had a personal or family history of high blood pressure or heart disease.

You know what strikes me the most about treating ADHD in any age group? It’s how treatment indirectly improves self-esteem. As one patient said, “When you’re more competent, you’re more confident, and you like yourself more.”

Antonio Ocana MD

Only 3 years before I become a senior citizen.