Seniors Issues

This age is the most common time in life to develop epilepsy

In people over 65, epilepsy is the fourth most common neurological disorder after migraine, dementia and stroke. It is the most likely time you will be diagnosed with epilepsy.

However in this age group it sometimes takes longer to diagnose and therefore not recognised or treated.

Causes of epilepsy

The most common causes of epilepsy in older people are:

  • Disease of the blood vessels in the brain such as stroke
  • Dementia or Alzheimer’s Disease
  • Trauma causing head injuries or a brain haemorrhage
  • Brain tumours
  • Alcoholism
  • Seizures can also occur in relation to some medications, illnesses and infections but these are not considered epilepsy

Up to one third of people in this age group have no known cause for their epilepsy

Difficulties diagnosing in this age group

Older people most often have focal seizures, with less prominent features and longer periods of confusion after seizures compared to younger people.

This can make diagnosis more challenging, particularly if the seizures are subtle, such as focal seizures, because they are often not recognised as seizures or misinterpreted as something else.

Some other diagnostic challenges that may come up include:

  • Other medical conditions and medications
    • Seizures or seizure like activity may be due to or confused with other causes such as; cardiac conditions, kidney or liver failure, diabetes, fainting, migraine, mild strokes, blocked arteries leading to the brain, or vertigo (dizziness with sensation of movement) or medication side effects.
  • Older people often have than one doctor, and sometimes there is poor communication between specialists meaning important health information can be overlooked.
    • It is best to have a GP who can be the central point and coordinator to keep all the health information together.
  • Confused states may be due to seizure or post-seizure activity but may also be due to dementia, psychiatric illness, medication, high fever (infections), urinary tract infections or dehydration.
  • Clear descriptions of the episodes or seizures are not always possible, especially if the person is living alone, or there are no witnesses.

Types of seizures

Because focal seizures are commonly seen in older people, and are far less obvious than tonic-clonic seizures, they often go unrecognised as seizures and can be attributed to or confused with ageing or dementia.

Episodic blackouts, ‘faints’, ‘funny turns’ and falls are all good reasons to see the doctor as they may be epilepsy.

Undetected epileptic seizures in older people are a safety concern. Good observation, diarising and description of events are important to help with diagnosis.

Medical management

Antiepileptic drugs are usually quite effective in controlling seizures in people over the age of 65. People may have a greater sensitivity to medications as they age, so a low dose is usually all that is needed.

Other health conditions and medications influence what antiepileptic drug will be chosen. If you are taking medications for other health problems, there is a risk that the antiepileptic medication may interact with them. So, it is important to tell the doctor and pharmacists about existing health conditions and medications.

Side effects

Older people may be more sensitive to medication side effects which can include tiredness, dizziness, unsteadiness, tremor, visual disturbances, changes in mood or behaviour, depression or stomach upsets. It may be possible to eliminate these by adjusting or changing medications.

Should these side effects occur and you find them unsettling or intolerable, speak to your doctor or specialist.

Taking medication

Some people have difficulty taking medications regularly. Forgetfulness, confusion over taking a number of medications, or simple problems such as difficulty opening pill bottles may all be involved. It is important for spouses, families and caretakers to be alert for these problems and provide help when necessary.

A weekly pill box may be helpful and easy. These can be obtained from most chemists. You can also get medications pre-packed into similar monthly (disposable) packs, but will need to speak to the pharmacist about costs. See Living with Multiple Medicines.

Never stop taking or change doses of antiepileptic medications without consulting the doctor. This is dangerous and can trigger more severe seizures that could be life threatening.

Lifestyle management

Epilepsy can affect lifestyle and quality of life at any age, but older people are often more vulnerable to medication side effects, risk of injury and isolation.

Having epilepsy at this age undoubtedly can contribute to social isolation, withdrawal, anxiety and depression and living alone may make the unpredictable nature of epilepsy more problematic. It is not surprising that a new diagnosis of epilepsy in older people is potentially life changing and may result in many life changes.

Older people are often more vulnerable to medication side effects, risk of injury and isolation

Self-management is just as important in this age group as any other. If the person is able, it is important to learn about epilepsy to enable taking an active role in managing the disease. Self-management includes making healthy lifestyle choices and informed decisions about treatment, and actively monitoring and managing symptoms. It can give the person more control over their disease and life. Adequate sleep, good diet, stress control limitation of alcohol, plenty of exercise and stimulating activities often help in seizure management.

Issues

Some issues that may arise for someone diagnosed with epilepsy in their senior years:

Medical

Medications for epilepsy can affect other medications taken for other conditions or change how either medication acts. Your doctor should be aware of this, but always check with the doctor and pharmacist about possible side effects and medication combinations.

  • Seizures
    • The after effects of seizures are occasionally lengthy, and rarely can last a few days, with confusion and tiredness. If this happens, it is important to have a plan, rest and seek support from family, friends or neighbours during this time.
    • Seizures are more likely to lead to falls, fractures or injury at this age. To reduce the likelihood of injury during seizures, see our Safety fact sheet for more information.
  • Memory
    • Poor memory can mean forgetting to take medication. Use a calendar, pillbox, set an alarm or take medications with meals, as reminders.
  • Safety

Social

Developing epilepsy later in life can be difficult to understand, accept and adjust to. However many older people cope relatively well with epilepsy. This acceptance may simply reflect a population who has already begun coping and adapting to other illnesses.

Loss of driving license and fears about injury during seizures can lead to staying at home instead of participating in usual activities.

The fear of injury, falling in public, the problems of taking a longer time to recover from a seizure may contribute to social isolation difficulties and anxiety. Having good supports and keeping in touch with family, friends and community groups is vital.

For more information:

EAA factsheet – Seizure Smart Seniors

EAA Smartclip – Associate Professor Cecilie Lander – Epilepsy and Seniors