Epilepsy and ageing

Epilepsy is a common condition of the brain in which a person experiences recurrent unprovoked seizures.

Epilepsy most commonly begins in childhood or in older adulthood, although it can begin at any age. People over 65 years of age have the highest incidence of epilepsy of any age, accounting for almost a quarter of cases of new onset epilepsy.

Due to our ageing population, there is an increasing number of older adults with epilepsy, and therefore an increasing need to understand the effects of epilepsy on this group.

The incidence of new-onset seizures and epilepsy increases substantially after the age of 60. This is most commonly due to acquired neurological conditions such as stroke and neurodegenerative diseases, including dementia.

Causes of epilepsy in older people

There are many causes of epilepsy and seizures. The cause of your seizures should be investigated. This will help determine which types of management and support are suitable for you. Common causes of epilepsy in older people include:

• Stroke
• Brain injury
• Brain tumour
• Degenerative conditions such as dementia
• Medical conditions affecting brain function
• Other lifestyle risk factors such as alcohol, smoking, sleep deprivation and stress and depression.

A substantial amount of seizures in older adults have no clearly identified cause, despite investigation.

Diagnosis of epilepsy in older people

It can be hard to diagnose epilepsy in people in their later years. Epileptic seizures in older people are often mistakenly assumed to be related to another condition (such as dementia), or the ageing process.

Older adults are more likely to experience focal seizures. Focal seizures can be more difficult to identify often resulting in misdiagnosis or unrecognised seizures. Misdiagnoses can include dementia, Alzheimer's, stroke, vertigo, or cardiac conditions.

Everyone’s experience of a seizure will be different. Some people experience seizures every day, while others only have seizures very rarely or when they forget to take their anti-seizure medication (ASM). People are sometimes not aware that they are having a seizure. For this reason, it is important that friends, family or carers of older people take notice of any behavioural changes.

If you observe behavioural changes in someone you care for, such as seizures or cognitive impairment and confusion, make a note of:

• what symptoms occur
• when symptoms occur – is there a pattern to symptoms, such as time of day, fatigue levels or stress
• how long do symptoms last – this could be seconds or minutes
• what happens before and after these symptoms – this could be confusion, disorientation, fatigue or maybe nothing
• if periods of confusion last.

Diagnosis of epilepsy can only be made by a specialist, but accurate, thorough observations are important when making this diagnosis.

Ageing with an existing epilepsy diagnosis

As you get older, there may be a change in frequency of seizures, or sometimes seizures resume after years without them (with or without ASM). Sometimes return of seizures involves changes in presentation.

It is important that there is ongoing review of your medication – in particular if other medical conditions present that may require contradicting medication (for example, blood pressure, diabetes or arthritis).

See more on how the epilepsy experience may change as you age.

Treatment

Deciding on the correct treatment for your epilepsy is important and requires specialist expertise. It is common for people in their later years to have other health conditions that require medications.

Your specialist will consider these factors in developing your epilepsy treatment plan:

• Anti-seizure medication (ASM)
• Emergency medication
• Diet
• Surgery

It is common for older adults to have more than one doctor. It is important for all medical professionals to communicate clearly and regularly to ensure well-rounded care.

Risk management

Regular discussions with the person with epilepsy, their family, carers, doctors and allied health professionals are important to support safety and wellbeing.

As people get older, the risk of falls can increase. For people with epilepsy, managing this risk is an important part of staying safe and maintaining independence. This may include removing trip hazards, improving lighting, and using safety supports such as handrails.

Understanding and managing seizure triggers can also help reduce the chance of seizures that may lead to falls.

An Epilepsy Management Plan can be helpful to know how to manage seizures and what to do in an emergency.

Emotional and mental health impact

Epilepsy later in life can affect a person’s emotional wellbeing and mental health. People with epilepsy have higher rates of depression and anxiety, and changes such as losing a driver licence, relying more on carers, or needing to move into aged care can affect independence and self-esteem. Some people may also experience changes in memory, concentration or fatigue.

For those where epilepsy begins in later adulthood, it can be unexpected and difficult to accept, particularly because many people think epilepsy only starts in childhood.

Mental health support, clear information and ongoing discussions with health professionals, family and carers can help people manage these challenges.

Epilepsy and aged care

People in their later years living in aged care facilities are reported to have a higher occurrence of epilepsy than the wider community.

In older people, seizure activity and any associated behavioural changes can be subtle. It is important that aged care workers and carers know what to look for, can recognise the signs of seizure activity and can document it.

Epilepsy Smart Australia have produced a suite of Epilepsy in the Later Years resources, which have been developed for older individuals and their families and carers, and for aged care professionals.

Where to get help

• Your GP (doctor)
• You geriatrician (you may need a GP referral)
• The National Epilepsy Support Service (NESS) Tel. 1300 761 487 or email support@epilepsysmart.org.au
• My Aged Care