Is It ADHD, or Is It Age?
It’s not always easy to determine whether it’s attention deficit or aging that’s causing an elderly loved one to be forgetful, distracted, and prone to procrastination.
It was the story about her pink woolen mittens that convinced me that my 85-year-old mother has undiagnosed attention deficit hyperactivity disorder (ADHD).
“When I was in high school, I wanted to knit a sweater,” Mom told me. “So Aunt Laura bought me some pretty pink yarn, on the condition that I finish it. When I left for college, I was still working on the sleeves. The sweater and the rest of the yarn stayed in the cedar chest for nine years, until I got pregnant with you. I probably should have made a pair of baby booties, but I unraveled the sweater and made a pair of mittens for myself. I didn’t need to finish the sweater after all!”
Help for the Elderly
A psychiatrist would instantly recognize the ADHD symptoms of procrastination, lack of follow-through, and mismanagement. But current diagnostic criteria require that full-blown symptoms be present before age seven. I’m not sure Mom can remember enough about her childhood to qualify. And I’m not sure her doctors are paying attention to the possibility of ADHD in the face of more urgent medical problems: diabetes, high cholesterol, arthritis, lifelong mood disorder. The longer she lives, the longer the list of ailments grows.
Even if we could put Mom’s medical disorders aside, it’s tough to sort out whether forgetfulness and inattention are ADHD or part of the “normal aging process.” (I hate that phrase. It sounds inevitable, as if our cognitive fates are sealed by longevity.)
Was her ADHD ignored all these years? And if she were diagnosed now, what treatment options are available?
The short answer is that there are no answers. There has been only one study in the medical literature about treating ADHD in the elderly. Published in 2008, it showed that methylphenidate (Ritalin and its ilk) was effective in treating a 67-year-old woman. One woman. That’s it.
My psychiatrist describes the research on older adults as “pathetic,” and I agree. She said research studies have excluded subjects older than 45 because, like my mom, they may not have childhood anecdotes to support an ADHD diagnosis.
Worse, treatment options narrow significantly in the elderly ADHD population. (Is there an elderly ADHD population? Probably — we don’t know yet.) Take exercise, for instance. Studies show that it significantly improves ADHD symptoms in children and adults. But my mom’s knees are so painful, and her balance so iffy, she can’t do the aerobic exercise that would deliver the benefits.
I’m sure stimulants would help my mom; her doctor prescribed diet pills (amphetamines) in the 1970s, and she was able to clean the house, from top to bottom! But stimulants can cause or exacerbate high blood pressure and cardiac problems. And Atomoxetine, a nonstimulant, increases the risk of glaucoma.
Working-memory training is effective for ADHD and learning disabilities, and it shows promise for mild dementia. But almost all memory training is computer-based; many adults over age 70 are not computer-literate, and many have no access to computers.
Embracing a New Cause
I am frustrated because I can’t help Mom, and I’m not alone. Recently, I received an e-mail from an ADHD woman who is desperate to find support for her 80-year-old mother, who is exhibiting severe executive-function impairment. “She avoids making decisions, and is content to sit in bed all day and be waited on,” said her daughter. “I don’t know what to do.”
The temporary solution, I suspect, is to set up structures for our aging parents, as they did for us when we were youngsters. I neatened and organized my mom’s closet, so she has fewer clothes to manage. I’ve set up automatic prescription refills that are delivered to her assisted-living facility. I bought her a loud timer to remind her to head to the bathroom every couple of hours. And I’ve intervened with her doctor to change her antidepressant to one that specifically targets dopamine.
On her behalf (and mine, since the genetic link for ADHD is fact), I’ve taken up a new cause: advocating for ADHD research on the elderly. Perhaps one day we’ll be able to answer the question: Is it ADHD, or is it age?