OCD and Older Adults

I blog for World Mental Health Day

Today is World Mental Health Day, and I’m pleased to be participating once again in the World Mental Health Day Blog Party.  I’ve been “partying” since the beginning, and you can read my 2011 and 2012 posts if you’re interested.

The theme of World Mental Health Day, 2013 is “Mental health and older adults”. Since I blog about obsessive-compulsive disorder, I naturally figured I’d write about OCD in older adults. I’ve been sitting here at the computer for a while, pondering the issue and doing a little research, and I realize I know little to nothing about OCD in the elderly. Furthermore, I haven’t been able to find any studies, articles, or facts to enlighten me. There’s plenty of  information available on OCD in children, teens, young adults, and even adults. But then it stops. What about OCD in older adults?

A few thoughts come to mind. Maybe OCD wanes as the senior years approach and the disorder is seldom an issue? Or better yet, it rarely exists? They’re nice thoughts, and I’d like to think they’re true. Or maybe OCD can become so tangled up in other illnesses such as dementia or Alzheimer’s Disease that it goes unnoticed and undiagnosed? Which brings up other questions. How common is it to develop OCD in old age? Or is it more likely that seniors with OCD have been suffering from the disorder for many years? Is ERP therapy and/or medication helpful for the elderly? I could go on and on with the questions. I just don’t have the answers.

Unless I’m missing a plethora of information out there, I don’t like what this says about us, as a society. The elderly aren’t as important as the rest of us. Why study a group of people who are nearing the end of their lives?

That question I have the answer to. Because we might be able to help them and improve the quality of their lives. Because any research on OCD just might benefit everyone who has the disorder. Because “the elderly” are our mothers, fathers, grandparents, friends, and neighbors. Because one day, if we live long enough, we will be them.

I’d love to hear from anyone who is able to share some insight on OCD in older adults.

My next post will appear the week of October 21, after I return from the OCD Texas Conference. Have a good week, everyone!

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30 Responses to OCD and Older Adults

  1. Great post, Janet. I think you’re absolutely right that we don’t know nearly enough about OCD among the elderly. I’m aware of some case studies and other small studies, but not of large trials that focused on OCD treatment among the elderly, and big OCD trials don’t usually include many individuals from this age group.

    I think you’re right about the societal issues you raised. As far as prevalence, OCD is less common among people over 60 (0.7%) than in younger people (based on Kessler et al., Arch Gen Psychiatry, 2005;62:593-602). There are also interesting data that address the question, Of the people who are going to get X condition, at what age will X percent of these people have developed the condition? For OCD the answer is 99% by age 54, and even by age 30 75% of people who will develop OCD already have. These ages are earlier than for some other conditions like depression (99% by age 73).

    You also raise the very important point about detection. Are we missing OCD among the elderly because it’s confused with other conditions like dementia? Clinically I think the perseverative nature of the obsessions can feel like dementia, especially for family members who don’t know a lot about OCD.

    I think I have as many questions as you, Janet! Thank you for raising them. And I’ll be joining the blog party later today!

    • Thanks for the comment and for the information, Seth. That’s really interesting that 99% of people with OCD develop it by age 54. So seniors who have OCD have likely had it a long time, and it does seem to wane, I’d think, given the fact that less than 1% of those over 60 have the disorder. i wonder WHY that’s true? Obviously, still lots of questions, but you’ve helped a lot. Thank you, and I’ll see you at the “party”! 🙂

      • It’s a great point that elderly people with OCD likely have had it for a long time, which certainly has been my clinical experience. The Why question is a great one. One thing I don’t think the Kessler article I cited can tell us is whether OCD actually wanes over time or if it’s just less common in older cohorts (like depression seems to be).

      • Thanks, Seth. In my unscientific mind I figured if about 2.5% of the general population has OCD, and only .7% of those over 60 have OCD, and 99% are diagnosed by age 54, than it might wane. Putting statistics aside, I’m happy to hear it doesn’t seem to be a huge problem in older folks.

      • Hi, Janet. I realized that my earlier response was confusing because I didn’t specify that 0.7% is the *lifetime* prevalence of OCD in people over age 60. By comparison the lifetime prevalence among 18-29-year-olds was already 2%. If this cohort effect is as large as it seems, it gives another good reason to better understand OCD in the elderly–namely, that in a few decades there will be many more elderly individuals with OCD in need of appropriately designed treatment!

  2. willitbeok says:

    I would imagine that those with undiagnosed OCD, as they get older, if they have learned to live with it will be less likely to seek diagnosis or admit that something is “wrong” with them. Also, I would think anxiety tends to decrease as people get older as well as over time we learn how to deal with anxiety better. But I do think you raise a very good point! More research should be done on this topic.

  3. I don’t know of any research, but I had a discussion about something similar with my psychiatrist recently. I asked him if OCD waned as one got older. He said there’s no evidence of that, but that OCD seemed to be especially active in preteen years and in the 20s. I know from experience that that fits me. But I have had some hard times in the 30s and 40s too. I will have to wait and see what the upper years does for my OCD. I think since I was diagnosed in my 20s and have had treatment of different types, I have benefited from that as I’ve gotten older. I think, too, that as we move through life, we have the opportunity to learn ways to cope better.

    I realize this doesn’t address whether or not people develop OCD in the 60s and beyond.

    • Thank you for your insights,Tina. It makes sense to me that we learn to cope better as we move through life and our varied experiences. Whether or not that’s actually true, I don’t know. In twenty years I’ll have a better idea :).

  4. parentsfriend says:

    Shared this on Pinterest http://www.pinterest.com/pin/147141112799028155/

    and as always TY for all you do.

  5. parentsfriend says:

    I think if one is not careful Perfectionism – often undx OCD – gets worse with age. Particularly, the need to have others believe as you do. On the other hand fading up close eye sight helps as to does my hearing loss.

  6. Krystal Lynn says:

    Hi Janet!! Considering it takes the average person many,many years to seek a diagnosis for OCD (around 15 years for me) and then, unfortunately, a few years more ,in my case, to properly be diagnosed with OCD, if I had first gotten OCD in my 60’s or 70’s I think I would have been a goner before treatment. I bet many people over 70 are not addressing it. Perhaps they themselves and family are dismissing it as dementia and unless they get in front of a medical doctor that can identify OCD symptoms, who knows if they getting diagnosed properly. I sure had years of problems and I hope doctors are educated more on the signs and symptoms of OCD but ??? I am 55 and I am less anxious and therefore have less OCD than when I was in my 20’s and 30’s , but cannot say whether that is due to aging or that I am still on medication plus the ERP tools I employ which I give more credit to for recovery than medication. Krystallynn

    • Great to hear from you Krystallynn and I appreciate your insight. You bring up a lot of good points, especially the fact that it’s hard to know why you are better off now at 55 than you were in your younger years. I agree that good doctors who can recognize OCD are so important for seniors who might be suffering. Thanks again for commenting!

  7. steve0reno says:

    We just had a provincial election here and it was interesting that all of the mental health talk seemed to focus on early intervention. Not a thing was said about support for the rest of the population which, of course, holds the majority of mental health concerns.

    • That’s interesting, SteveOreno. Thanks for sharing. Of course early intervention is extremely important, but, as you say, so are the mental health concerns of the rest of the population.

  8. Emily says:

    I know that my mom who is 74 now, has had anxiety for many-many years and possibly OCD but growing up, I never actually heard those words, she would just say “I am a worrier” so I am pretty sure many other elderly people are like that and that’s why the percentage of elderly OCD sufferers seems low. I personally can’t see my OCD disappearing anywhere no matter my age. I am handling it better I think and understand it much-much better but it’s still there and always will be.

    • Thanks for commenting, Emily. I think you bring up a good point. OCD is more talked about and out in the open now than when your mom was younger, I’m sure. How many elderly people have OCD and just don’t realize it? And while your OCD might not disappear, I’m glad you’re able to understand, as well as handle, it better as you age. Wishing you all the best!

  9. elizabeth howardson says:

    As a long time sufferer of OCD and student psychologist, I would agree that the many of the elder generation aren’t aware what OCD is and many still remember the stigma associated with mental illness. After all, they are from the generation that just ‘got on with it’! I believe OCD symptoms generally manifest around periods of anxiety and although it can’t be cured, it can sometimes be kept controlled if the person is in a content environment. During middle age, people often become more settled as they have learnt to control their environment but during old age the environment often changes and OCD can manifest again (bad health, losing loved ones or home). Unfortunately, elderly people who don’t want to throw things away or become insistent that things are kept in certain places etc aren’t always given the respect and understanding that they deserve or a diagnosis.Too often the words senile dementia are banded about when in reality, people might have come across hard times and an undiagnosed condition has become more prevalent.

    • Hi Elizabeth, Thanks for your comments and I think you bring up some excellent points, especially about changes that the elderly go through possibly causing their OCD to spike. I appreciate your insight. Thanks again for sharing!

  10. becky says:

    My mother-in-law was just diagnosed with OCD at 65 after ending up in the hospital. Her behaviors have worsened over the past 15 years to the point where she limited her diet severely until she grew dehydrated and anemic. Unknowingly we have made her worse and worse by reinforcing her fears and reassuring her behaviors as they controlled her more and more. Family members have bought her new clothes, special washing machines and new vacuum cleaners after old ones became contaminated and were thrown away. Even her cars became fearful objects to send away for scrap metal. In her case, the OCD came on later in life and has slowly worsened until this point.

    • Hi Becky, Thanks for sharing and I’m so sorry things have gotten so bad for your mother-in-law. Your family acted as any loving family would (who didn’t realize they were dealing with OCD), by trying to make her feel better. Hopefully now she can at least get some treatment and hopefully improve. Wishing you all the best.

  11. Deborah McSkimming says:

    My mother is 90 – she has had OCD tendencies all her life, she only wears cream blouses, she will not use public transport ( even taxis). She eats at certain times and everything has to have its place.
    In the last year it has got considerably worse. She first stopped eating and drinking as she was obsessed with the notion that she would be sick. ( She admitted to a vomiting phobia and despite having 3 children never been sick since she was 14 – 76 years!) Eventually she was hospitalised for dehydration. Once hydrated she was sent home and her medication changed. She regained the ability to eat and drink – within narrow parameters – but she is now obsessed with me. She needs to know where I am at every moment of the day, when I do her shopping I call before I leave, when I arrive at the supermarket, when I have finished and when I am leaving to bring her the shopping. She times the space between the calls and obsesses about the time. During the day if she cannot contact me by phone ( I work full time and am in meetings, travelling etc) she panics and calls my husband – who also works full time – to try and find out where I am. Strangely, the only time I do not have to call her is when I get home after I have visited her – it is all frontloaded onto me arriving from the first waking thought on the days that I visit to watching every car driving past her house until I arrive.
    She has always been clinically depressed and has been on long term antidepressants, in addition she is taking diazepam 4 x day and pregabalin twice daily on top of the mirtazapine at night. She has now been offerred CBT – again ( not worked in the past as she is resistant to change) but refuses to see the problem. She says that she has put in place her coping strategies – getting me to collude – and with them she is fine. If ever I give any indication that I find it a strain she goes into meltdown and tells me I do not love her. She insists on living alone.
    I am at my wits end as a daughter, she is a frail old lady but controls my life with a rod of iron.
    There seems to be very little comment, advice or research on OCD in the elderly available – and even less on how to deal with it for carers/relatives.

    • Hi Deborah, Thank you so much for sharing your story, and I’m sorry things are so tough for you and your mom. With a younger OCD sufferer, I believe the standard advice would be for you to stop enabling her (as in stop checking in with her, stop reassuring her, etc). But what is the best way to handle this situation with a ninety year old woman? I don’t know! I don’t know if you’ve talked with an OCD therapist yourself, but perhaps you might receive some guidance as to how to make your own life better, given the fact that your mom isn’t willing to try therapy. I wish you the best, and please keep me posted.

  12. Lisa says:

    I believe there is little information on OCD in the elderly because the medical community ignores our elderly. My father is 93 years old and and prior to an auto accident in October 2016 his mind and memory were excellent. After surgery and three months in a rehabilitation facility and a number of infections that resulted in another hospitalization he is finally home. His mind and memory during most of his stay at the rehabilitation center was excellent. However after he developed the infections, he was hospitalized and was on heavy antibiotics. I saw a tremendous decline in his physical and mental condition. He has been home for three weeks and he has had a few good days where his mind is and memory is good. However then he suddenly goes into a state where he’s overcome by OCD tendencies. He obsessively draws lines. If he has a piece of paper he’ll draw lines on the paper. If he doesn’t have any he drawers lines on his body. I also notice he uses his feet to draw lines following the lines on the ceramic tile floor. If I ask him to look in my eyes, I can get him to focus for 30 seconds. At that time he is lucid. My father’s OCD has gotten very bad in the last 2 days. I tried researching the problem but have come up with very little. If you have any suggestion I would truly appreciate your input. Thank you

    • Hi Lisa, I am so sorry to hear of your father’s ordeal. I’m not a doctor or therapist so maybe we might get some input from a professional who sees your comment. In the meantime, maybe contact someone at the International OCD Foundation to see if they could steer you in the right direction? Or perhaps connect with some teaching hospitals that have OCD Clinics and try to connect with someone knowledgeable. It sounds as if your dad’s infection has affected his brain and caused this OCD, but again, I’m not a professional. Sorry I can’t be of more help but please keep me posted. I hope you find some answers and are able to help him!

  13. My brother and I both have diagnosed OCD. I always wondered where we inherited the predisposition since no one in my family seems to have that specific anxiety disorder. Lo & behold, my mom has started to show SERIOUS signs of OCD & other worrying behaviors in the past 2-3 years.

    She is controlling to a fault. The A/C has to be a specific temperature right down to the degree. Excessively humid or windy that day? Too bad. It stays on 74 no matter how hot or cold the rest of us get.

    She washes her hair every other night and plans her outings around that schedule. Like “Oh, I can’t go to the store that day because I’m doing my hair on Thursday and it won’t be clean by Saturday morning.” Yeah.

    She won’t let me sit in the car with it idling while she shops because she says she feels “rushed,” even though I’m more likely to complain & rush her if I’m forced to go inside. (Don’t know whether she’s legitimately worried about leaving the A/C running for a few minutes in a parked car or if she just “feels” rushed if I’m sitting in the car, but I’ve never once rushed her except when she makes me go inside).

    She says “I like to leave the house at 8:30 a.m. so I can hurry back from shopping & take my nap.” But she doesn’t just “like” to do things that way; she refuses to do them any other way. If you ask her to deviate from it in any way, she gets an attitude & starts making up lame, insulting excuses.

    She has a ton of minutiae she does each day and INSISTS that the rest of us follow suit. Turn off the light when you leave a room. Rinse the tub out after bathing. Those things don’t SOUND bad on paper, but the intensity & persistence with which she engages in them is very worrying to me.

    My mother is 65 & has been on Xanax & statins (Lipitor) for10+ years if that matters. I know my OCD got infinitely worse on benzos, but everyone’s different.

    • Thank you so much for sharing. I don’t know if your mom is willing and/or able to get help, but of course that would be a good thing for everyone involved. I don’t know how old you are or if it’s possible for you to get advice on how to best deal with your mom and the demands she has placed on you, but that could be so helpful for your whole family. I wish you all the best!

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