Obsessive-Compulsive Disorder (OCD) can occur at any age, manifesting as obsessions and compulsions. Obsessions are persistent thoughts that are often invasive and unwanted, while compulsions are behaviors designed to control those thoughts. OCD in elderly people can be something that is pre-existing or something that arises as a result of other neurodegenerative disorders like dementia, Alzheimer’s, or mild cognitive impairment. OCD in the elderly comes with a unique set of challenges.
Understanding OCD in the Elderly
Studies indicate that while OCD typically manifests long before someone reaches an elderly age, those who were already diagnosed tend to experience increased symptoms, particularly checking behaviors.
Age-Specific Factors Influencing OCD
Checking behaviors where an individual regularly checks something increases in people over 65 as a compensatory method for age-related cognitive decline. Individuals who are elderly may not realize that the issues they are having are unrelated to OCD but rather related to cognitive decline like Dementia or Alzheimer’s.
Cognitive Decline and OCD
With cognitive decline, the brain’s function and structures change, particularly in the areas that control decision-making and emotional responses. Neurodegenerative issues can:
- Make pre-existing OCD symptoms much worse
- Cause late-stage OCD in elderly people
Studies indicate that OCD appearing after the age of 50 is rare, but if it does manifest as a new condition for an elderly individual, it is likely related to neurodegenerative issues or brain lesions.
Comorbidities
In elderly patients, comorbidities with OCD include mood disorders, anxiety disorders, and OCS.
Treatment Approaches for OCD in Elderly
OCD in elderly treatment should involve psychotherapy, medication, and other integrative or supportive therapies based on the client’s current awareness and cognitive function.
Medication Management
Medication management can help control obsessions and compulsions, although there is no specific FDA-approved medication for OCD in adults. Antidepressants are usually tried first because they have the fewest side effects, and it’s important to monitor the impact these antidepressants have as well as their potential side effects.
Depending on the circumstances, antipsychotics might also be prescribed, but in any case, it’s important to recognize any age-related changes to renal function or hepatic function and consider previous responses to similar medications.
Psychotherapy Adaptations
Medication for OCD in elderly patients is most successful if combined with therapy. Exposure and response prevention is a subset of cognitive behavioral therapy that helps to expose individuals on a gradual basis to the things that they obsess about or fear and teach them how to avoid the compulsions they use when they are triggered. This can help improve overall quality of life and is something that can be supported by a caregiver and family members.
Integrative and Supportive Therapies
Integrative and supportive therapies can help provide tools for controlling obsessions and compulsions like:
- Senior Yoga
- Art Therapy
- Music Therapy
- Animal Therapy
- Garden Therapy
Participating in integrative and supportive holistic care like senior yoga can help maintain focus on the present moment instead of obsessions about the future or compulsions about the future while also supporting better physical fitness, cognitive function, memory, and sleep quality.
Another key integrative and supportive therapy is transcranial magnetic stimulation. Transcranial magnetic stimulation has been successfully used across several age groups to treat symptoms of OCD. It does not add another medication to a long list that elderly patients might have to take, nor does it come with contraindications or side effects. As such, it is a safe and popular integrative therapy to manage OCD symptoms, reducing or alleviating symptoms entirely for the majority of patients over the span of 6 months to one year, after which patients can repeat the therapy to repeat the results.
Challenges in Managing OCD in the Elderly
There are challenges in managing OCD in elderly clients or patients, particularly the need for caregiver support and family participation to overcome resistance to treatment.
Resistance to Treatment
Many people who present with OCD in the elderly stages have already been diagnosed with OCD at a younger age and, as such, may have been on medication for several decades. At this point, they are more likely to struggle with resistance to certain treatment medications or, depending on their cognitive faculty, resist treatment altogether.
It can be challenging to add yet another medication to a long list of medications for elderly clients. It can also be difficult to get patients to participate in therapy at this age, but one way that this can be improved is by integrating support from family members and caregivers.
Caregiver Support
Managing OCD symptoms in elderly people involves caregiver support. Caregivers can help those with OCD manage symptoms by avoiding situations that would lead to compulsions or obsessions.
For example:
Margaret is a caregiver and her client leaves balled up tissue throughout the house, under seat cushions and in corners. Instead of cleaning up the tissue, Margaret asks her client why those tissues are there and learns that her client is embarrassed about potential drooling so she likes to keep tissues in every part of the house.
Practical Tips for Caregivers and Families
Caregivers and families should focus on daily management tips to help individuals with OCD symptoms in elderly situations manage those symptoms, reduce triggers, and distinguish between symptoms of cognitive decline that are age-related versus symptoms of OCD.
For example:
- Provide kind and gentle support on a regular basis, perhaps creating code words to share with other family members to indicate a problem rather than embarrassing your elderly family member.
- Focus on having normal household routines.
- Try to incorporate stress reduction techniques throughout the day like playing relaxing music in the background, going through guided meditation, even avoiding crowds, exercising adequately, and getting enough sleep.
- Support an individual taking their medication and if they refuse, provide education through things like books or lectures or even podcasts that might encourage them to better understand how medication is important.
Creating a supportive environment will go a long way toward not only encouraging someone to form a better relationship with their symptoms but also to participate in therapy or holistic treatment, take their medication if prescribed, and find ways to live successfully.
Conclusion
Managing OCD in elderly individuals needs personalized, compassionate care strategies that address mental and physical health needs. This includes providing support on a regular basis, incorporating stress reduction as well as physical health through diet and exercise, and utilizing integrative and supportive therapies in addition to medication for OCD and elderly patients.