title: Optimal management of ADHD in older adults.
abstract: BACKGROUND
  The manifestation of attention-deficit/hyperactivity disorder (ADHD) among older adults has become an interesting topic of interest due to an increasing number of adults aged 50 years and older (≥50 years) seeking assessment for ADHD. Unfortunately, there is a lack of research on ADHD in older adults, and until recently only a few case reports existed.
  
  
  METHODS
  A systematic search was conducted in the databases Medline/PubMed and PsycINFO in order to identify studies regarding ADHD in adults ≥50 years.
  
  
  RESULTS
  ADHD persists into older ages in many patients, but the prevalence of patients fulfilling the criteria for the diagnosis at age ≥50 years is still unknown. It is reason to believe that the prevalence is falling gradually with age, and that the ADHD symptom level is significantly lower in the age group 70-80 years than the group 50-60 years. There is a lack of controlled studies of ADHD medication in adults ≥50 years, but this review suggests that many patients aged ≥50 years experience beneficial effects of pharmacological treatment. The problem with side effects and somatic complications may rise to a level that makes pharmacotherapy for ADHD difficult after the age of 65 years. Physical assessment prior to initiation of ADHD medication in adults ≥50 years should include a thorough clinical examination, and medication should be titrated with low doses initially and with a slow increase. In motivated patients, different psychological therapies alone or in addition to pharmacotherapy should be considered.
  
  
  CONCLUSIONS
  It is essential when treating older adult patients with ADHD to provide good support based on knowledge and understanding of how ADHD symptoms have affected health, quality of life, and function through the life span. Individualized therapy for each elderly patient should be recommended to balance risk-benefit ratio when pharmacotherapy is considered to be a possible treatment.
authors.affiliation: Department of Østmarka, St Olav's Hospital, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Terje
authors.initials: T
authors.lastname: Torgersen
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; Department of Psychiatry, Helse Nord-Trondelag Hospital Trust, Kirkegata, Levanger, Norway.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Gjervan
authors.affiliation: NevSom, Norwegian Center of Expertise for Neurodevelopmental Disorders and Hypersomnias, Women and Children's Division, Oslo University Hospital, Oslo, Norway.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Lensing
authors.affiliation: St Olav's Hospital, Broset Center for Research and Education in Forensic Psychiatry, Trondheim, Norway; Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Rasmussen
keywords: ADHD; adults; central stimulants; older adults; pharmacotherapy
references.citation: J Women Aging. 2011;23(3):246-62
references.pmid: 21767088
references.citation: J Atten Disord. 2015 May;19(5):368-79
references.pmid: 24378286
references.citation: Expert Rev Clin Pharmacol. 2013 Jan;6(1):35-9
references.pmid: 23272791
references.citation: J Affect Disord. 2015 Mar 15;174:574-9
references.pmid: 25562670
references.citation: Eur J Neurol. 2011 Jan;18(1):78-84
references.pmid: 20491888
references.citation: Am J Psychiatry. 2011 Feb;168(2):143-51
references.pmid: 21159727
references.citation: Neuropsychiatr Dis Treat. 2010 Sep 07;6:443-53
references.pmid: 20856608
references.citation: Neuropsychiatr Dis Treat. 2008 Feb;4(1):177-86
references.pmid: 18728815
references.citation: J Child Adolesc Psychopharmacol. 2014 Aug;24(6):302-10
references.pmid: 24956171
references.citation: BMC Med. 2012 Sep 04;10:99
references.pmid: 22947230
references.citation: Atten Defic Hyperact Disord. 2013 Jun;5(2):83-92
references.pmid: 23208078
references.citation: Am J Psychiatry. 1998 Apr;155(4):493-8
references.pmid: 9545994
references.citation: J Am Acad Child Adolesc Psychiatry. 2009 Nov;48(11):1085-1093
references.pmid: 19797980
references.citation: Am J Psychiatry. 2010 Apr;167(4):409-17
references.pmid: 20080984
references.citation: Eur Neuropsychopharmacol. 2013 Jun;23(6):508-27
references.pmid: 22917983
references.citation: Br J Psychiatry. 2012 Oct;201(4):298-305
references.pmid: 22878132
references.citation: J Clin Psychiatry. 2010 Jun;71(6):754-63
references.pmid: 20051220
references.citation: Am J Psychiatry. 1999 Jun;156(6):891-6
references.pmid: 10360128
references.citation: BMC Pediatr. 2012 Jun 19;12:78
references.pmid: 22712630
references.citation: Basic Clin Pharmacol Toxicol. 2014 Nov;115(5):417-22
references.pmid: 24690162
references.citation: JAMA. 1998 Sep 23-30;280(12):1086-92
references.pmid: 9757857
references.citation: Atten Defic Hyperact Disord. 2013 Mar;5(1):59-67
references.pmid: 23104523
references.citation: Curr Med Res Opin. 2011 Jun;27(6):1097-107
references.pmid: 21438796
references.citation: J Clin Psychiatry. 2010 Dec;71(12):1590-7
references.pmid: 20584517
references.citation: Biol Psychiatry. 2007 Jun 15;61(12):1361-9
references.pmid: 16950217
references.citation: BMC Psychiatry. 2012 Apr 05;12:30
references.pmid: 22480189
references.citation: Expert Rev Neurother. 2011 Oct;11(10):1443-65
references.pmid: 21955201
references.citation: Nat Genet. 2013 Sep;45(9):984-94
references.pmid: 23933821
references.citation: Expert Rev Neurother. 2012 Oct;12(10):1241-51
references.pmid: 23082740
references.citation: J Atten Disord. 2009 Jan;12(4):353-60
references.pmid: 18367759
references.citation: J Am Acad Child Adolesc Psychiatry. 2009 May;48(5):484-500
references.pmid: 19318991
references.citation: Psychol Med. 2005 Feb;35(2):245-56
references.pmid: 15841682
references.citation: Curr Psychiatry Rep. 2007 Oct;9(5):420-6
references.pmid: 17915083
references.citation: J Atten Disord. 2015 May;19(5):380-9
references.pmid: 24681898
references.citation: Biol Psychiatry. 2005 Jul 15;58(2):125-31
references.pmid: 16038683
references.citation: J Atten Disord. 2010 Jan;13(4):401-6
references.pmid: 19706876
references.citation: Psychol Med. 2006 Feb;36(2):159-65
references.pmid: 16420712
references.citation: Ann Med. 2001 Jul;33(5):337-43
references.pmid: 11491192
references.citation: J Nucl Med. 1996 Apr;37(4):554-9
references.pmid: 8691238
references.citation: J Atten Disord. 2015 May;19(5):405-13
references.pmid: 23514676
references.citation: JAMA. 2010 Aug 25;304(8):875-80
references.pmid: 20736471
references.citation: Am J Psychiatry. 1993 Jun;150(6):885-90
references.pmid: 8494063
references.citation: Qual Life Res. 2012 Jun;21(5):795-9
references.pmid: 21805205
references.citation: Pain Pract. 2015 Jan;15(1):4-11
references.pmid: 24134430
references.citation: J Atten Disord. 2019 Jan;23(2):173-180
references.pmid: 25795454
references.citation: Int J Geriatr Psychiatry. 2002 Sep;17(9):865-73
references.pmid: 12221662
references.citation: Eur Arch Psychiatry Clin Neurosci. 2014 Nov;264 Suppl 1:S35-43
references.pmid: 25231833
references.citation: Atten Defic Hyperact Disord. 2015 Jun;7(2):151-6
references.pmid: 25304687
references.citation: PLoS One. 2012;7(2):e31273
references.pmid: 22348063
references.citation: Psychogeriatrics. 2014 Dec;14(4):261-8
references.pmid: 25495088
references.citation: Lancet. 2015 May 30;385(9983):2190-6
references.pmid: 25726514
references.citation: Nord J Psychiatry. 2009;63(5):375-82
references.pmid: 19308795
references.citation: Eur Arch Psychiatry Clin Neurosci. 2006 Sep;256 Suppl 1:i26-31
references.pmid: 16977548
references.citation: Hum Genet. 2009 Jul;126(1):13-50
references.pmid: 19384554
references.citation: Atten Defic Hyperact Disord. 2014 Dec;6(4):281-90
references.pmid: 24700330
references.citation: Psychol Med. 2004 Aug;34(6):973-82
references.pmid: 15554568
references.citation: J Am Acad Child Adolesc Psychiatry. 2006 Feb;45(2):192-202
references.pmid: 16429090
references.citation: Expert Opin Drug Metab Toxicol. 2015 Apr;11(4):491-508
references.pmid: 25600059
references.citation: Allergol Immunopathol (Madr). 2016 Mar-Apr;44(2):120-4
references.pmid: 26251203
references.citation: Am J Psychiatry. 2015 Jul;172(7):674-83
references.pmid: 25615565
references.citation: J Clin Psychopharmacol. 2008 Jun;28(3):296-301
references.pmid: 18480686
references.citation: Curr Med Res Opin. 2014 Aug;30(8):1657-72
references.pmid: 24804976
references.citation: Eur J Clin Pharmacol. 2012 Oct;68(10):1443-50
references.pmid: 22434389
references.citation: Am J Psychiatry. 1995 Nov;152(11):1652-8
references.pmid: 7485630
references.citation: J Manag Care Pharm. 2007 Sep;13(7):570-7
references.pmid: 17874863
references.citation: Br J Psychiatry. 2009 Mar;194(3):204-11
references.pmid: 19252145
references.citation: Arch Gen Psychiatry. 2012 Dec;69(12):1295-303
references.pmid: 23070149
references.citation: Clin Neuropharmacol. 2011 Jul-Aug;34(4):148-54
references.pmid: 21738027
references.citation: BMC Cardiovasc Disord. 2012 Jun 09;12:41
references.pmid: 22682429
references.citation: Am J Psychiatry. 2016 Jan;173(1):34-43
references.pmid: 26315982
references.citation: J Child Psychol Psychiatry. 1993 Sep;34(6):1019-30
references.pmid: 8408366
references.citation: JAMA Psychiatry. 2015 May;72(5):490-9
references.pmid: 25785435
references.citation: BMC Psychiatry. 2011 Jul 25;11:116
references.pmid: 21787431
references.citation: J Am Acad Child Adolesc Psychiatry. 2013 Mar;52(3):250-63
references.pmid: 23452682
references.citation: Aust N Z J Psychiatry. 2002 Oct;36(5):610-6
references.pmid: 12225443
references.citation: J Intern Med. 2004 Sep;256(3):240-6
references.pmid: 15324367
references.citation: Int Psychogeriatr. 2015 Sep;27(9):1467-76
references.pmid: 25655491
references.citation: Eur Neuropsychopharmacol. 2014 Dec;24(12):1873-84
references.pmid: 25453480
references.citation: PLoS One. 2014 Jan 28;9(1):e86552
references.pmid: 24489743
references.citation: J Atten Disord. 2008 May;11(6):623
references.pmid: 18417727
references.citation: J Psychopharmacol. 2009 Sep;23(7):733-44
references.pmid: 18562416
references.citation: J Am Acad Child Adolesc Psychiatry. 1997 Sep;36(9):1222-7
references.pmid: 9291723
references.citation: Am J Psychiatry. 2010 Aug;167(8):958-68
references.pmid: 20231319
references.citation: Am J Psychiatry. 2000 May;157(5):816-8
references.pmid: 10784477
references.citation: Am J Geriatr Psychiatry. 2014 Dec;22(12):1623-32
references.pmid: 24656507
references.citation: Psychol Med. 2005 Jun;35(6):817-27
references.pmid: 15997602
references.citation: J Affect Disord. 2013 Jun;148(2-3):220-7
references.pmid: 23267726
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2011 Mar 30;35(2):554-60
references.pmid: 21185347
references.citation: Am J Psychiatry. 2002 Nov;159(11):1882-8
references.pmid: 12411223
references.citation: Am J Psychiatry. 2006 Apr;163(4):716-23
references.pmid: 16585449
references.citation: Am J Psychiatry. 1993 Dec;150(12):1792-8
references.pmid: 8238632
references.citation: J Clin Psychiatry. 2012 Feb;73(2):192-201
references.pmid: 22313720
references.citation: Curr Psychiatry Rep. 2012 Oct;14(5):552-60
references.pmid: 22886581