Sarah, 68, was always known for her outgoing personality and passion for life. After she retired, Sarah began noticing changes in her ability to focus and remember things. Simple tasks, like paying bills on time or following through on plans, became increasingly challenging. “After retirement,” says Sarah, “life got harder, and I opened up to my family about some of the difficulties I had been experiencing.” Some family members were supportive and suggested seeking professional evaluation, recognizing Sarah may have undiagnosed Attention-deficit/Hyperactivity disorder (ADHD).
ADHD is complex and can occur any time. It is sometimes mistaken as a condition that occurs only in children and youth. This leads to misdiagnosis or dismissal of symptoms in older adults. The intensity and type of ADHD symptoms can vary over a person’s lifetime, but are broadly categorized into difficulties with sustained attention, impulsive behaviour, or sitting still. In Sarah’s case, the symptoms were present earlier but were not recognized and masked by the structured routine of her career.
There is now a growing body of research showing that at least 1 in 30 adults over the age of 50 have ADHD. It is often overlooked or mistaken for mild cognitive impairment (MCI). The cognitive deficits associated with ADHD, like memory loss, can closely resemble early signs of dementia. This can make it difficult to recognize ADHD, as Sarah describes. While some family members were supportive, others attributed Sarah’s difficulties to the natural effects of aging, dismissing the possibility of ADHD. Speaking at an APSARD conference (American Professional Society of ADHD and Related Disorder), Dr. Brandy Callahan, a geriatric neuropsychologist, addressed how memory or cognitive neurology clinics don’t have ADHD on the radar.
Neuropsychological tests are a specialized type of assessment that evaluate cognitive abilities, such as memory, attention, language, and problem-solving. There needs to be screening tools that tease apart ADHD from features of MCI or dementia. According to Dr. Callahan, “As a group, adults with ADHD have higher frequencies of social issues like social isolation that may put them at risk for depression and anxiety, relative to their neurotypical peers. The impulsive aspect of ADHD can lead to impulsive spending, missed career opportunities that result in significant financial issues right at the time where people are preparing to retire.”
If untreated, adults with ADHD have higher frequencies of medical conditions that can impact their cognition later in life. A large study reported a 2-3 fold higher risk of developing disorders of the central nervous system (epilepsy, sleep disorders), respiratory conditions (chronic obstructive pulmonary disease, COPD), musculoskeletal disorders that cause chronic pain, metabolic conditions (diabetes, obesity), and vascular conditions (hypertension, ischemic heart disease, atrial fibrillation, stroke).
Medication management, in combination with psychological therapies like cognitive behavioural therapy and coaching, can be a game-changer for adults with ADHD, as emphasized by Dr. Doron Almagor at a recent CADDAC conference. Personalized treatment enhances focus and the ability to manage daily tasks. However, there’s a pressing need for more clinical trials focusing on adults over 50. Studies often fail to include the 50+ community because of diagnostic uncertainty, drug interactions between medications, and difficulty in finding study participants.
Raising awareness and reducing stigma is critical.
Recognizing that ADHD often goes undiagnosed is the first step, as Sarah experienced. Better testing, and appropriate treatment is a significant next step. If you suspect that you or someone you know may have ADHD, seeking professional evaluation, can lead to effective healthcare management, greater support and improved well-being.
