Two elderly women share their experiences with ADHD, highlighting resilience and coping strategies in their golden years.
As you enter the living room of Mae’s Farrer Park HDB flat, you’re immediately struck by the multitude of items on display. The space feels briefly settled from the ongoing decluttering and reorganizing process as we prepare to meet.
Eighty-three-year-old Mae and sixty-nine-year-old Terrie are surrounded by a vibrant collection of brown exercise books, stationery, trinkets, artworks, and decorative porcelain and crystal vases that adorn nearly every surface.
In this home, there is evident care for each item, despite the apparent disarray. Notebooks are neatly stacked, stationery is organized in holders, and decorative porcelain pieces are proudly showcased on shelves for all to see.
The visual richness of the environment makes it impossible to focus on just one item for long; your gaze flits from one captivating piece to the next, revealing hidden beauty within the delightful clutter. For Mae and Terrie, both of whom live with Attention Deficit Hyperactivity Disorder (ADHD), this sensation is all too familiar.
Aunty Mae’s Notebook
Mae and Terrie are fortunate in many ways. Mae is nearing her 90s, yet her eyes still sparkle with vitality. She lives independently in her flat.
During our interview, she frequently refers to a notebook filled with her thoughts, written in flowing letters with bold red ink. Color-coding her notes and calendars helps her keep track of the details in her life, which she sometimes struggles to recall.
As Singapore’s oldest property agent, Mae shares thrilling anecdotes about selling apartments, showcasing an impressive memory for dates, locations, and prices.
The conversation flows from ADHD to her experiences during the Japanese Occupation, her Catholic faith, and her education at a convent with the Infant Jesus Sisters.
Then we return to her school days, where she faced challenges concentrating in class—her religion and meticulous note-taking were vital in helping her excel.
“The headmistress instilled in us the importance of service. She didn’t want us mingling with the boys. We listened to [Felix] Mendelssohn while polishing silverware, igniting my love for classical music. I always knew I wanted to be Catholic and considered becoming a nun,” Mae reminisces.
The discussion shifts to the various opportunities she wished to pursue but often denied herself.
“I had a movie ticket ready, and just as I was about to leave for the theatre, I hesitated. I denied myself,” she recalls.
This free-flowing narrative style reflects Mae’s ADHD. Her faith, determination, and structured routines from her convent school helped her manage her symptoms effectively.
Despite the challenges, she has accomplished much—raising nine grandchildren, attending lectures on Zoom, frequently browsing the internet for political updates, and adamantly refusing to retire.
ADHD: Not Just a Childhood Issue
Recently, Mae underwent testing for ADHD and Mild Cognitive Impairment (MCI), and the results indicated a stronger inclination toward ADHD.
In children, ADHD symptoms—such as constant fidgeting, excessive talking, interruptions, inattention, forgetfulness, and carelessness—can lead to behavioral issues, low self-esteem, and academic struggles.
When these symptoms persist into adulthood, they may result in higher smoking rates, workplace challenges, and even depression or anxiety.
Mae’s condition is still being monitored to establish a baseline for observing symptoms and potential treatment. Moonlake Lee, the 53-year-old founder of Unlocking ADHD, emphasizes that awareness of Mae’s ADHD, even without a formal diagnosis, is crucial for family support.
“ADHD is not just a childhood issue; it carries into the Golden Years,” Moonlake notes.
Moonlake, Mae’s niece, received her ADHD diagnosis in her 50s, shortly after her teenage daughter was diagnosed. This genetic predisposition appears to span generations in their family.
Aunty Terrie’s Various Fancies
Terrie, more laid-back, shares her story from her carefully chosen spot beneath the cool air conditioner. Her voice is vibrant and full of life as she speaks.
Living with her husband and two tenants, Terrie’s children have long since moved out. She carved a successful career in sales and public relations before happily retiring to engage in volunteer work and spend time with her two sons and four grandchildren.
Like Mae, she has a lifelong habit of hopping between hobbies, diving into new interests with enthusiasm before moving on once her curiosity is satisfied.
With humor and warmth, Terrie recounts how ADHD affected her school life. Frequently reprimanded in class for her inattentiveness and for interrupting her teachers during discussions, her thoughts race ahead of her words.
“Can you let me finish?” she exclaims with a grin at my surprised expression. “People say that because I keep interrupting. I think it’s a shared trait, even with Mae.” Her hearty laughter fills the room.
‘I Don’t Have Dementia’
Terrie recognized her ADHD when her second son received his diagnosis.
“My son enjoys spending quality time with me. He shares his stories, and I find myself wanting to jump in with my own, often interrupting him. He’ll say, ‘Mummy, can you let me finish my story first?’ It’s happened more than once.”
Initially tested for dementia due to her forgetfulness, the results came back negative.
This confirmed her suspicions that her struggles stemmed from ADHD.
“I requested an ADHD report, but the tests showed similar results. They scanned my brain, and the doctor confirmed that I don’t have dementia.”
Terrie decided not to pursue a formal diagnosis, opting instead to focus on managing her symptoms with increased confidence. Understanding her condition allows seniors like Terrie to gain self-awareness, facilitating improved family relationships through a mutual understanding of their behaviors.
Marie Kondo for the Mind
These coping strategies for the elderly and their families serve as tools for managing ADHD symptoms without medication or a formal diagnosis.
Terrie, who volunteers with Unlocking ADHD, is fully aware of her condition and has learned to manage it independently. Like Mae, she employs coping techniques such as color-coding, note-taking, and arriving early for appointments.
These strategies help alleviate the daily disruptions caused by her symptoms.
Other cognitive methods include visualizing task completion, sorting through daily thoughts, and deciding which thoughts to prioritize or discard—essentially “Marie Kondo for the mind.”
Occasionally indulging in impulses can also provide relief. For Mae, prayer serves as a grounding force in managing her impulsivity.
Amidst the many distractions her wandering focus may introduce, her faith keeps her anchored.
“I credit my willpower to the nuns,” Mae reflects. “You desire something deeply but learn to deny yourself. When you’re passionate about something, you can pursue it wholeheartedly. But I’ve learned to let go too.”
When asked how she resists the many passions that capture her attention, she simply replies, “I procrastinated.”
The Tenuous Work of Diagnosing Elderly ADHD
As someone currently in the process of seeking an ADHD diagnosis, writing this article couldn’t have come at a better time.
My partner, who has been diagnosed, recognized similar symptoms in me.
I was able to focus on this article for a solid 10 hours, completely forgetting to eat.
When I sat down to write, my brain declared this article as my sole priority, disregarding all bodily needs.
Before considering ADHD, I perceived my symptoms as character flaws or signs of incompetence. Now, I understand that’s not the case.
“There’s a label for this condition,” Terrie reminds me.
Diagnosing ADHD in older adults is more complex than in children, as symptoms are often less obvious. Much of the Clinical Practice Guidelines in Singapore focuses on diagnosing and treating childhood ADHD.
Fidgeting, excessive movement, and talking are clear indicators, particularly in educational settings. Terrie finds herself in good company: “We have so much energy and so many interests.”
However, those with inattentive ADHD symptoms, such as “spacing out” or persistent forgetfulness, tend to receive their diagnoses later in life.
To diagnose adults, clinicians must identify at least five of nine traits outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Neuropsychological testing can accompany clinical interviews in the diagnostic process.
Yet, the DSM-5 does not adequately address how ADHD manifests in older adults.
“For many adults diagnosed later in life, there’s often a profound sense of loss for the years gone by,” Moonlake reflects. “What might their lives have been like if they had received an earlier diagnosis or better tools for managing life?”
For seniors far beyond middle age, these lost years can feel even heavier.
ADHD: A Mistaken Identity
In her book, Still Distracted After All These Years: Exploring ADHD after 60, Dr. Kathleen Nadeau identifies specific symptoms that frequently present in older adults.
These symptoms include forgetfulness, procrastination, increased irritability or mood disorders, time blindness, difficulty maintaining routines, restlessness, excessive talking, and challenges in recognizing social cues.
Clinicians often interpret these symptoms as more familiar conditions like Mild Cognitive Impairment (MCI) or dementia, as seen in Mae and Terrie’s cases, respectively.
Moreover, age-related cognitive decline complicates the diagnostic process for the elderly compared to children or adults. “ADHD is a complex condition intertwined with various comorbidities and mental health challenges,” Moonlake explains. “It’s not easy to differentiate.”
It doesn’t help that age-related cognitive decline, dementia, Alzheimer’s, and MCI often exhibit overlapping symptoms with ADHD. Frustratingly, these conditions can also co-occur with ADHD.
This complicates the task of distinguishing ADHD symptoms from these comorbid conditions. For starters, each condition requires different treatment approaches. Typically, ADHD symptoms are managed through medication.
This presents another hurdle for seniors. Managing physical ailments alongside neurological conditions makes introducing more medication both challenging and risky.
‘I Am More Worried About Losing My Mind.’
ADHD was less understood during Mae and Terrie’s youth, making their later discoveries about the condition surprising.
For Mae, neurological assessments continue as doctors try to discern whether her symptoms point to MCI or ADHD. While the doctors deliberate, Mae remains unfazed.
“I didn’t know I had ADHD,” Mae chuckles. “I had no clue what it was until I learned from Moon that certain children in the family had it, but I didn’t pay it much attention.”
Terrie approaches her situation with a similar light-heartedness. “I’m more concerned about dementia and losing my mind,” she admits.
Their ability to maintain a positive outlook likely stems from their effective coping strategies.
“I keep a diary,” Terrie shares. “My large A4 diary is essential. Losing it would feel like losing my mind. I transfer everything there, keeping very little in my head.”
This method aligns with Mae’s practice, as she meticulously color-codes her calendar to note everything from doctor appointments to knee pains and mass schedules.
Are Diagnoses Worth the Effort?
The lingering question remains: Is it even worth pursuing an ADHD diagnosis for older individuals?
In an interview with CNA, Dr. Bhanu Gupta, a senior consultant at the Institute of Mental Health’s mood and anxiety department, noted, “Clinicians possess extensive experience and can evaluate symptoms more objectively, ensuring that other potential co-existing conditions are ruled out or treated.”
Nevertheless, when approached for comments about ADHD in the elderly, doctors at IMH declined, citing its rarity in their clinic.
Moonlake suspects that many elderly individuals with ADHD navigate their symptoms without formal diagnoses or even recognizing the possibility of ADHD in their later years.
“If a child has ADHD, there’s a strong likelihood that one or both parents do too. If those parents are unaware of their condition and therefore unmanaged, how can they hope to support their child effectively?”
The same logic applies to adults caring for elderly family members who may exhibit ADHD symptoms. How can they adequately support their elders if they are unaware of their full condition?
A lack of education among the elderly and their families contributes to the oversight of this condition. Combined with the prevalent misconception that ADHD is solely a childhood problem, it’s easy to dismiss an elder’s ongoing forgetfulness as just a part of aging.
“Aiyah, Ah Kong is always like that”; “Nenek always forgets her hearing aid”; or “Tatta starts his shower only when we’re about to leave.” These instances may seem harmless, even endearing.
Yet they might signal a larger issue that, if left unchecked, could diminish the quality of life in their later years.
Living at Peace with Elderly ADHD
“It’s never too late to get diagnosed. If we take good care of our health, we can live into our 80s and 90s, which means there are still many decades to improve our lives,” Moonlake emphasizes.
Currently, Unlocking ADHD is working to reach the Silver Generation across communities. Earlier this year, they launched microsites and webinars offering information on ADHD in Malay, Mandarin, and Tamil to ensure vital resources are accessible in these languages.
For now, Moonlake believes education is the key to progress. Just because elderly individuals with ADHD have coped with their symptoms for a long time doesn’t mean it hasn’t impacted them.
“I was advanced for my age… but I knew we weren’t as far along in our learning, so I wanted to improve,” Mae reflects. “I sought to explore everything. I was determined to learn, but I often felt inadequate.”
“It was a revelation when I read about ADHD,” Terrie adds. “There’s a label for this condition? It clarified why I felt different from others.”
Understanding has equipped her with self-awareness, allowing her to appreciate how ADHD has shaped her life.
“In my golden years, I celebrate it.”
