Seniors Issues

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

Epilepsy is the fourth most common neurological disorder affecting older adults after migraine, dementia and stroke.

The symptoms may be different however, so 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

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 are more likely to have focal seizures. These seizures are more subtle. This can make diagnosis more challenging, because the seizures are often not recognised as seizures or misinterpreted as something else. The period of confusion after a seizure in this age group can also last much longer compared to younger people.

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, diabetes, fainting, migraine, mild strokes, blocked arteries, vertigo (dizziness with sensation of movement) or medication side effects.
• Older people often have more than one doctor, and sometimes there is little 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 can go unrecognised as seizures or 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 the events are important to help with diagnosis.

Medical management

Antiseizure medications are usually effective in controlling seizures in this age group. People may have a greater sensitivity to medications as they age, so may be more likely to experience unwanted side effects. Generally a low dose is usually all that is needed to control seizures.

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

Side effects

Some more common antiseizure medication side effects can include tiredness, dizziness, unsteadiness, tremor, visual disturbances, changes in mood or behaviour, depression or stomach upsets. It may be possible to lessen these by adjusting or changing medications.

Should these, or other side effects occur and you find them unsettling or intolerable, speak to your doctor or specialist. See our factsheet Medical Management of Epilepsy

Taking medication

Some people have difficulty taking medications regularly. Forgetfulness, confusion, especially when taking a number of medications, or simple problems such as difficulty opening pill bottles may all be issues. 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 your dose of antiseizure medications without consulting the doctor. This is dangerous and can trigger seizures, sometimes 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, falls 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 and take an active role in managing the disease. Self-management includes making healthy lifestyle choices and informed decisions about treatment, and actively monitoring your symptoms. It can give you more insight. Adequate sleep, good diet, stress management, limiting alcohol, exercise and stimulating activities often have a positive impact on seizure control.

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 works. 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 such as confusion and tiredness are occasionally long lasting. 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 factsheet 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
  • Many seniors live alone in the community. This can pose a number of risks. We can provide information about fall detectors, emergency response services and respite agencies.

Social

Developing epilepsy can be difficult. 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 falls and injury during seizures can lead to staying at home instead of taking part in usual activities.

Having good supports and keeping in touch with family, friends and community groups is vital.

For more information:

Factsheet – Seniors

Factsheet – Driving

EAA Smartclip – Associate Professor Cecilie Lander – Epilepsy and Seniors

How can we meet the needs of older adults with epilepsy?