Older Persons

Ageing is a gradual process which for some people creates new challenges and for others can pose some restrictions and adjustments. As with all stages in life, good health and general well–being are very important in this process.

Understandably, growing old with a diagnosis of epilepsy can pose additional challenges. Some of these challenges may be associated with the medical aspects of controlling epilepsy, others may be associated with the fear and anxiety of having to cope with both old age and a chronic condition.

This may result in loss of independence, confusion and social isolation. However, with increased understanding of this condition, with new medications, new tests and treatment methods, combined with recognition of the importance of a healthy lifestyle, the outlook for older people with epilepsy is more encouraging today.

The facts about epilepsy and older people

• People over 65 experience the highest incidence of first seizures apart from children under 5.
• A common cause is stroke.
• Other possible causes are head injuries, infection, alcoholism, tumours and dementia. As happens with other age groups, some older people develop it without a known cause.
• The most common seizures are partial seizures, particularly after a stroke. (Partial seizures are those where the seizure activity involves one part of the brain, where there is a focus, whereas generalised seizures occur in all of the brain).
• Many epilepsies in the elderly are still unclassified.
• Some types of seizures can become less frequent in the older population. Some of the issues facing older people with epilepsy.
• The process of diagnosis can be difficult and lengthy.
• Older people can have ‘“blackouts”’ which have many causes, most of which are not epilepsy.
• Clear descriptions of the event are not always available, particularly if the person is living alone, or if relatives and friends are uncertain about recognising and managing seizures.
• Developing epilepsy later in life can be difficult to adjust to.
• Forgetfulness, poor concentration, memory lapses and mental confusion are recognised as additional problems for many older people on medication. Poor memory can mean that medication is missed and appointments forgotten. This is where simple solutions such as dosette boxes, lists, notepads, alarm clocks and even reminder calls can provide peace of mind for everyone.
• The fear of injury, falling in public, the problems of taking a longer time to recover from a seizure, and the overriding issue of dependence, are some of the concerns facing older people living with a chronic condition like epilepsy. This is why there is a need for care and understanding from everyone, and for sharing of information as well as strategies between the individual, doctors, family members, friends and concerned others.

Medical Management

The mainstay of management is medication in conjunction with a healthy lifestyle. Medical management means controlling the seizures with the prescribed anti–epileptic medication. The aim of medical management is to stop the seizures with minimum adverse side effects from the drugs prescribed by the doctor.

Research and clinical experience indicate that some older people can experience more undesirable side effects from medication than other age groups. Side effects can include falls, drowsiness and memory impairment. Older people are known to metabolise their drugs more slowly and may be sensitive to drugs. There is also the possibility of interactions between the anti–epileptic drugs and other medications. Unchecked epileptic seizures in older people can cause problems particularly if there are known heart and circulatory difficulties. All of these problems, however, can usually be avoided because of the large number of medications now available.

Lifestyle Issues

A healthy lifestyle helps with the medical management. Lifestyle patterns that are important include adequate sleep, good diet, stress control, limitation of alcohol, plenty of exercise and stimulating activities. Strategies which encourage healthy living and which recognise the importance of self–management with understanding from others, can be of benefit in achieving seizure control and well-being.

Some further issues for you and your doctor to consider

• Whether the anti–epileptic medication is needed in the first place
• Whether monotherapy (one drug) is possible
• Simple dose routines
• Writing down the instructions from the doctor

Original courtesy of Epilepsy Foundation of Victoria: Reviewed June 2021