ADHD in Older Adults

Does ADHD Get Worse with Age? Persistent Symptoms and Smart Treatment in Older Adults

Does ADHD get worse with age? Can you take ADHD medication if you’re over 65? What if you have a heart condition? Answers to these questions and more in this expert Q&A on treating ADHD in older adults.

David Goodman M.D., author image
By David W. Goodman, M.D., LFAPA Verified Updated on January 14, 2025
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ADHD after age 50 is not a rare phenomenon. With a prevalence of about 2% to 3% 1 2 — which may not seem like much — it is the second most common psychiatric disorder in adults, and clinicians encounter older patients with ADHD every day in practice. Still, very little attention is given to ADHD in middle age and beyond, especially for adults who were never diagnosed as children yet suffered and compensated for symptoms over their entire lives. The absence of training on older adult ADHD in medical programs explains why clinicians don’t consider this disorder when older adults present with cognitive complaints.

Whether you’re an older adult who thinks you have ADHD, were recently diagnosed, or have lived with a diagnosis since childhood, here are answers to common questions about ADHD in older adults.

Does ADHD Get Worse with Age?

ADHD does not necessarily get worse with age. The more likely story is that the experience of ADHD worsens with age in part because of the additive effects of aging and/or medical illnesses.

ADHD’s degree of impairment waxes and wanes depending on demands, circumstances, and environment. With aging comes natural cognitive decline, which impacts memory, time management, organization, task shifting, and other cognitive abilities that are already impacted by ADHD. Functioning challenges arising from cognitive decline can understandably give the impression that ADHD is worsening.

Even then, it’s not just cognitive decline that’s at play. Several conditions, factors, and processes can contribute to cognitive difficulty as you age; ADHD is only one of those. From perimenopause and increasing polypharmacy to mild cognitive impairment and other psychiatric conditions, many factors beyond ADHD can affect cognition.

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Can I Take ADHD Medication If I’m Over 65?

Whether you’re 50 or 80, it really is never too late to treat ADHD with medication. ADHD treatment improves cognition, mood, self-confidence, and daily functioning even in older adults. You should know, however, that there are no research control trials of ADHD medications for individuals over the age of 65. As drug trials enroll those who aren’t on other medications and who don’t have other medical conditions (to reduce adverse events and unclear trial results), it is difficult to find older adults who meet all criteria. This means that, technically, any stimulant prescription written for someone with ADHD over the age of 65 is considered off label.

You and your provider should weigh the benefits and risks of ADHD medication depending on your individual needs and circumstances.

Medical monitoring while on ADHD medication is crucial, and there are specific considerations for older adults. As stimulants may increase heart rate and blood pressure, it’s important that your doctor monitor conditions that could worsen under these drugs, like heart conditions, narrow angle glaucoma, and Raynaud’s syndrome. Urologic and sexual function should also be monitored. Your prescriber should know about other medications and over-the-counter supplements you may be taking so they can anticipate potential side effects that may emerge from drug interactions.

Can I Take ADHD Medications If I Have a Heart Condition?

The short answer is yes, though it depends on the nature of your cardiac condition.

  • History of heart attacks: It’s relatively safe to take stimulant medication six months after a heart attack. You should also be safe to take stimulants if you’ve had stent surgery, but always confer with your doctor or cardiologist on these decisions.
  • Atrial fibrillation: It’s critical to ensure that your medication doesn’t worsen this form of arrhythmia. Be sure to consult with your cardiologist.
  • Hypertension: It’s best if your hypertension is treated and controlled. If you add a stimulant, you should monitor your blood pressure and pulse at home, and you should talk to your prescriber, primary care doctor, or cardiologist if you notice elevations.

[Read: Heart Health and ADHD — On Cardiovascular Risks and Treatments]

If you have significant cardiac issues, your prescriber and cardiologist should discuss options. Your cardiologist will likely tell your prescriber about symptoms to watch for while you’re on ADHD medication.

A growing body of research indicates that stimulant medications are relatively safe for cardiac patients and older adults.4 5 There isn’t research to date on non-stimulants for adults over the age of 65. Your providers may be inclined to try a non-stimulant if a stimulant is exacerbating an existing heart condition, but non-stimulants can also increase blood pressure and pulse in some individuals.

The bottom line is that cardiac illness should not be the absolute contraindication to taking medication because untreated ADHD can significantly reduce quality of life. If you can benefit from medication and moderate any risks, then why not try ADHD medication?

Do I Need to Change My ADHD Medication or Dosage as I Age?

The primary reasons someone over age 50 may need to change medication dosages is if there’s a side effect or medical issue, especially one that becomes problematic in older age.

  • Dry mouth is a serious side effect for those who wear dentures, as it can affect the fit of dental appliances. Chronic dry mouth will accelerate gum recession. Consult with your dentist. Medications are available to increase saliva production.
  • In males who have benign prostatic hypertrophy, urinary hesitancy can be worsened by stimulant medication. If you have this condition, report it to your prescriber to consider options.
  • Appetite suppression, a common stimulant side effect, may be more problematic for older adults. For one, appetite already diminishes with age and can cause unhealthy weight loss. For older adults with diabetes, an adjustment in diabetic medication may be required if appetite suppression from stimulant medication occurs, especially if hypoglycemic symptoms are experienced more frequently, which increases the risk of falls.

Women with ADHD whose symptoms are compounded by perimenopause may benefit from increasing their ADHD medication dosage, though hormone replacement therapy may also help relieve mood and cognitive symptoms. Your GYN and provider should work together to address these symptoms.

Changing environmental demands could also warrant an adjustment in medication. Also, if you’ve developed a tolerance for your medication and it’s no longer effectively reducing impairments, even at higher doses, then you may benefit from changing to another medication to recapture the effect. There are currently more than 30 different preparations of stimulant medications, and non-stimulant medications are also available.

Does Taking ADHD Medication Increase Risk for Dementia?

ADHD’s link to dementia and neurodegeneration has become a research area of growing interest. A 2023 study that followed more than 109,000 participants for 17 years found that, compared to those without ADHD, patients with ADHD experienced a 2.77 times greater risk for dementia, even after adjusting for factors that increase risk for dementia, like obesity and diabetes.6 The study also compared stimulant use among participants, and found that those who were treated with medication had less risk for dementia than did those who were unexposed to medication. ADHD medication, it’s safe to say, does not increase risk for dementia. Much more research is needed to better understand the ADHD-dementia link.

What If My Doctor Refuses to Prescribe ADHD Medication Because of My Age?

ADHD in older adults is a very new area of clinical study, and most clinicians have no training or understanding of it. That said, I always say that it’s easier to educate the uninformed than it is to educate the misinformed. My suggestion is to see how your doctor responds to new information. Take research studies (like the ones cited in this article) to your next appointment. (You can also find the cited studies and more research via www.pubmed.gov.) If your doctor still won’t consider prescribing stimulants, whether due to your age or existing conditions and even in light of new information, then it’s not worth pushing them to see if they’ll change. Consider a second opinion from a clinician who is aware of and has experience treating adult ADHD. Verify that the new clinician is well-versed in adult ADHD prior to scheduling an appointment so your time and money are well spent.

Your access to knowledgeable clinicians need not be limited by geography. If you are seeking an ADHD evaluation, consider doing so via a specialist who offers telehealth. Interstate prescription regulation may restrict the evaluator from prescribing medication but, with the comprehensive evaluation report, perhaps someone in your area would follow up with recommended treatment.

Does ADHD Get Worse with Age? Next Steps

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “ADHD in Older Adults: Clinical Guidance and Implications” [Video Replay & Podcast #499] with David Goodman, M.D., LFAPA., which was broadcast on April 4, 2024.

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2 Michielsen, M., Semeijn, E., Comijs, H. C., van de Ven, P., Beekman, A. T., Deeg, D. J., & Kooij, J. J. (2012). Prevalence of attention-deficit hyperactivity disorder in older adults in The Netherlands. The British journal of psychiatry : the journal of mental science, 201(4), 298–305. https://doi.org/10.1192/bjp.bp.111.101196

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4 Zhang L, Yao H, Li L, et al. (2022). Risk of Cardiovascular Diseases Associated with Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. JAMA Netw Open. https://doi.org/10.1001/jamanetworkopen.2022.43597

5 Zhang, L., Li, L., Andell, P., et al. (2023) Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2023.4294

6 Levine, S. Z., Rotstein, A., Kodesh, A., Sandin, S., Lee, B. K., Weinstein, G., Schnaider Beeri, M., & Reichenberg, A. (2023). Adult Attention-Deficit/Hyperactivity Disorder and the Risk of Dementia. JAMA network open, 6(10), e2338088. https://doi.org/10.1001/jamanetworkopen.2023.38088