Many older people with ADHD are untreated, study finds

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A group of experts has urgently called for improved international guidance on the treatment of attention deficit hyperactivity disorder (ADHD) in individuals over 50.

Their findings, published in the Expert Review of Neurotherapeutics, point out the crucial knowledge gap in understanding and managing ADHD in older adults, as the existing guidelines mainly target children and young adults.

Understanding ADHD in Older Adults

ADHD is not just a condition affecting children; it can continue into adulthood and later life, impacting around 2.5% of adults globally.

Symptoms such as impulsivity, hyperactivity, poor focus, and organizational skills can significantly affect one’s education, career, and social interactions. The disorder often requires medication, such as stimulants, to manage symptoms effectively.

Led by Dr. Maja Dobrosavljevic from the University of Orebro, Sweden, the research team, which included eminent experts like Professor Samuele Cortese and Professor Henrik Larsson, examined nearly 100 studies.

They focused on the prevalence, health outcomes, diagnosis, treatment efficacy and safety, and the existing clinical guidelines for ADHD in older adults.

Their findings reveal a striking lack of longitudinal studies on people transitioning into older age with ADHD, causing reliance on retrospective assessments of childhood symptoms, which can be unreliable due to age-related memory issues.

A Plea for Improved Guidelines

The team concludes that improved strategies are urgently needed to screen, diagnose, and treat people aged around 50 to 55 effectively.

A tailored approach is essential to address the unique challenges faced by older adults living with ADHD and to ensure their well-being.

Current diagnostic criteria and screening tools, according to the researchers, do not adequately recognize ADHD in older adults and are not specific enough, missing all but the most severe cases.

Moreover, they emphasized that medical conditions with similar presentations, such as mild cognitive impairment (MCI) and menopause-related memory decline, need to be distinguished carefully from ADHD in older adults.

The researchers suggest that attention to distinctive clues, like the report of childhood symptoms in ADHD, as opposed to the abrupt onset seen in conditions like MCI, can aid in more accurate diagnoses.

The Concerns

ADHD in older adults is associated with increased risks of mental health issues, elevated mortality rates, and other illnesses such as cardiovascular disease and dementia.

However, diagnosing ADHD in this demographic remains challenging due to the lack of specific consideration of how ADHD presents in older adults and the absence of adequate research into the safety and efficacy of ADHD medications for this age group.

The experts are calling for cooperation among the medical community, researchers, and policymakers to refine diagnostic criteria, treatment guidelines, and research initiatives to be more inclusive of all age groups affected by ADHD.

They recommend assessing the physical health of an older person with ADHD carefully before prescribing medication, considering the increased risk of other health conditions such as heart problems.

The research stresses the urgent need for more inclusive and specific ADHD guidelines for older adults. This age group faces unique challenges and risks, requiring a comprehensive and tailored approach to diagnosis and treatment.

Although future revisions of international classifications are expected to address the current gaps, immediate collaborative efforts are essential to ensure the well-being of older adults living with ADHD, by differentiating it accurately from other conditions with similar presentations and by providing effective, safe treatment options.

This proactive approach is vital to manage the rising global issue of ADHD in older adults, emphasizing the importance of inclusivity and precision in medical guidelines and practices.

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The research findings can be found in the Expert Review of Neurotherapeutics.

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