Understanding OCD in the Elderly: Symptoms, Causes, and Treatment

Some people with obsessive-compulsive disorder (OCD) may only experience non-stop, unwanted, cyclic, and intrusive or upsetting thoughts, urges, fears, doubts, emotions, or visions (obsessions), while others may only experience repetitive and excessive rituals or routines (compulsions). Yet, most OCD sufferers experience both obsessions and compulsions. Compulsions are designed to ease the stress and anxiety triggering the OCD symptoms.

In cases of severe OCD, rituals, and routines (compulsions) can disrupt the sufferer’s daily activities, relationships, productivity, and quality of life, possibly leading to depression, panic attacks, or a general decline in their mental and physical health. Keep in mind, however, that OCD affects people differently. OCD may manifest in females differently than it does in males.

Likewise, OCD sufferers in their youth, teens, or 20s may experience it differently than people in their 30s, 40s, or 50s. And, OCD sufferers in their 60s, 70s, or 80s may experience it differently than younger people. As such, one area that remains murky is how OCD manifests in the elderly.

For instance, older people with early-stage dementia may obsess over relatively unimportant issues like dirty plates in the sink. This person may quip that when they were younger, they had to wash every dish after they ate. In cases like this, it can be hard to determine if the elder is experiencing dementia, OCD, or both.

As people age, they experience “changes” in their brain activity and thought processes, appearance, mobility, mental and physical health, perceptions and beliefs, and behavior. It is a normal part of living and aging. While most people adapt well to these “changes,” people with OCD, dementia, or both can become distressed – stressed, anxious, or depressed.

It can be hard to adapt to one’s new reality, so an “adjustment period” involving some confusion, sadness, stress, anxiety, and irritability is to be expected. However, if these challenging thoughts, emotions, and/or behaviors persist, or if the elder appears to be “fixating” on something, and unable to move past it, cognitive assessments, along with an OCD evaluation may be needed to get to the root cause of your loved one’s behavior.

You have come to the right place if you have noticed a “change” in your loved one’s cognitive function, mood, and/or behavior. This article will help you better understand how OCD affects the elderly (i.e., cause, symptoms, and treatment), so you can get your loved one the OCD help they need to improve their quality of life.

Causes of OCD In The Elderly Population

What Causes OCD in Older Adults? 

Although the exact cause of OCD in older adults is largely unknown and varies from person to person, the most common cause of obsessive-compulsive disorder (OCD) in older adults may be associated with one or more of the following factors:

• Brain chemistry and function changes 
• Genetics or a predisposition to OCD, an anxiety disorder, or another mental health condition (i.e., depression)
• Elder neglect or abuse
• Environmental factors or exposure to toxins or other chemicals
• Infections with a high risk of OCD like streptococcal infection
• Stressful or traumatic life events
• Aging
• Cognitive or neurological disorders like dementia or Alzheimer’s disease 
• Substance or alcohol abuse

OCD Symptoms In The Elderly Population

What Are Some OCD Obsessions Found In The Elderly?

Older adults with OCD tend to be angry, aggressive, irritable, confused, tired or lethargic, unmotivated, agitated, and unresponsive at times.

They also tend to “fixate” on aging, retiring from their jobs, becoming ill, being harmed, being contaminated by something, or dying. These obsessions are typically age-related. Although, pondering, worrying about, and/or becoming mildly anxious about the “changes” happening in one’s body and what the future holds, these thoughts, fears, and urges go into “hyperdrive” in elders with OCD. Growing old can be unnerving for people who do not have OCD, but for those with the condition, it can be extremely confusing and frightening. As a result, some older adults develop OCD.

What Are Some OCD Compulsions Found In The Elderly?

Moving to a new location, like assisted living (memory care) or a skilled nursing facility, or going from living alone or with a spouse to living alone or with other family members can be unnerving, stressful, and anxiety-provoking for older adults. In other words, “changes,” especially the ones that involve moving. Moving can cause a tremendous amount of angst for elders because doing so removes them from their “comfort zone” and “safe place.”

The stress from moving and other “changes” can spark some new or worsening behaviors, such as excessively cleaning, an extreme fear of contamination or becoming ill and dying, or a fear of harm or danger. For instance, your older parent’s need for tidiness blows into a full-fledged compulsion for extreme orderliness. In other words, what used to be your mother’s “tidiness quirk” could quickly morph into an unrelenting urge (obsession) to ensure that everything (i.e., plates, glasses, trinkets, blankets, furniture, personal items, clothes, etc.) is and stays “in order.”

In this case, the only thing that may ease your mother’s stress and angst is to constantly order and reorder things. Once things are organized “just right,” your mother will receive relief, however, this reprieve is only temporary. Once she spots something out of place, the stress and angst will return until she does something (compulsion) to get relief again. This behavior may look like “old age” or dementia, but there is a chance that it is OCD or OCD and anxiety or OCD and dementia. Researchers suggest that OCD comorbidities are common in the elderly population. In fact, OCD and anxiety, OCD and addiction, and OCD and depression are actually quite common in older adults.

Compulsive hoarding or collecting items, and/or animals is also common in the elderly population. Hoarding OCD tends to occur in older adults who experienced poverty or the need to collect things like food, milk, canned foods, toilet paper, and/or other essential items during childhood or adolescence to ensure that their basic needs were met. These elders believe that they must collect the things they need in bulk to ensure they always have what they need.

A tendency to collect or “hoard” things has probably been within your older loved one, however, the stress and “changes” that accompany aging can and often does spur these individuals into full-fledged OCD. When hoarding OCD is coupled with cognitive decline from dementia or Alzheimer’s disease or another cognitive disorder, the result is a confused, agitated, anxious, and/or depressed individual who has “fixated” on something, and who feels that the only way to ease these negative thoughts, urges, fears, doubts, and emotions is to perform rituals or routines.

Other compulsions that an elderly OCD sufferer may experience are:

• “My elderly mother is afraid something bad will happen to her if she leaves the house.”
• “My great aunt has to take exactly four baths each day because the number “4” is her lucky number. If she believes that if she takes fewer or more baths something bad will happen.”
• “My aging father compulsively hides large sums of money under his bed and couch cushions for fear that if he doesn’t someone will break in and still all of it.”

Understand that elders with OCD do not get pleasure or satisfaction from performing rituals and routines (compulsions). These behaviors or activities are designed to provide relief from the stress and anxiety causing and caused by intrusive or upsetting thoughts, urges, fears, etc. Also, keep in mind that although for most OCD sufferers, this condition is a chronic or lifelong condition, however, for elderly OCD sufferers, it typically presents later in life and is oftentimes linked to dementia, Alzheimer’s disease, or another cognitive disorder.

OCD Comorbidities in The Elderly

Is OCD Linked to Dementia?

Yes, as referenced above, OCD is sometimes linked to dementia. Keep in mind, however, that this association is still being studied. Still, preliminary studies suggest a comorbidity between OCD and dementia (or a similar condition). More specifically, seniors or elders with frontotemporal dementia or Alzheimer’s disease are at risk of experiencing obsessive thoughts and ritualistic behaviors that can sometimes mystify their caretakers.

Researchers have also found that early-stage dementia-related behaviors can mimic an OCD cycle of obsessions and compulsions. It is common for older adults with OCD and dementia also to experience generalized anxiety (GAD), which can be confusing to these individuals. And, while people with these OCD comorbidities have an especially hard time understanding the world around them, most, at least at the earlier stages, can live a fairly “normal” life. However, as dementia advances, short-term memory lapses, along with OCD rituals or routines, will cause these individuals to engage in repeat and redo behaviors.

For instance, a senior with OCD, anxiety, and dementia may become consumed with a fear that someone is going to break into her home and harm her. The origin of this fear from a home burglary when she was a child. Perhaps, she has not thought about this childhood experience for decades, but now it has re-arisen. This fear has gone from 1-100 in a matter of days, weeks, or months. She can’t get these upsetting thoughts and unrelenting fears and urges out of her mind. She remembers this scary incident like it happened yesterday – although it happened long ago.

The elder slips in and out of time, going from the past to the present and back to the past again. Many times, she still thinks and feels like she is still a little child who is experiencing a robbery in her home. She is confused, but also anxious because she truly believes it will happen again – if she does not take the proper steps. The only thing that can take away the elder’s stress and angst is to perform behaviors – getting extra locks, putting on all of her doors, bolting and boarding up all of the windows in the house, and refusing to leave her home.

These behaviors are part dementia and part OCD. Sometimes, the elder is putting locks on the doors and bolting and boarding up the windows because she believes and feels like she is a scared child in her childhood home after the robbery, and sometimes, she engages in these activities because it is the only things that will ease her powerful and unwanted thoughts, urges, and fears (obsession). In this case, the behaviors are actually compulsions.

For instance, a grandmother may collect and compulsively wash dishes the second someone finishes their last bite. Part of her excessive dishwashing practices may stem from normal “age-related cognitive decline,” a desire to keep pesky bugs out of her home, or memories of a different time, however, part of it could also stem from OCD. Elders who are “aware” of their thoughts, fears, urges, and repetitive and compulsive behaviors are at risk of stress and anxiety. Stress and anxiety can be precursors for OCD in people who are at risk of it.

And, because OCD can involve performing internal compulsions (i.e., silently counting or repeating phrases in one’s mind, etc.), OCD in the elderly population can get overlooked, or misdiagnosed as “age-related” cognitive decline or dementia with no mention of OCD.

OCD Treatment in The Elderly Population

How To Help Elders With OCD?

According to studies, the US Food and Drug Administration has not approved any medications specifically for OCD in older adults, as such OCD treatment in this population typically mimics the treatment in other OCD populations. 

Thus, the first line of treatment for the elderly population involves psychotherapy, specifically, cognitive-behavioral therapy (CBT) or exposure-response and prevention (ERP) therapy, along with patient- or client-specific therapies like acceptance and commitment therapy (ACT), family therapy, art therapy, or addiction therapy.

If psychotherapy alone is ineffective, medications may be added to the treatment plan. The most common medication used to treat OCD in the elderly population is SSRI antidepressants like Prozac or Luvox. 

If this combo does not provide the desired results – reduced or eliminated obsessions and/or compulsions, other medications may be tried. Note: pharmacotherapy is only considered if psychotherapy is unsuccessful. Researchers suggest that OCD is associated with a serotonin deficiency and/or dopamine imbalance, which is why the first-line treatment for OCD is typically a combined medication of clomipramine and SSRI antidepressants. 

Also, because OCD is considered an anxiety disorder, older adults are often taught stress-management techniques to help them cope with the stress and anxiety causing their OCD symptoms. Some of these stress-management techniques and coping strategies may include aromatherapy, mindfulness, journaling, exercising, relaxing to music, and/or adopting a healthy diet (i.e., reducing or eliminating caffeine, soda, junk, and processed foods, and salty or sugary foods). An OCD therapist can help the elderly stay calm when intrusive thoughts, fears, and urges arise, so they can retain a sense of self-control over their lives.

Reviews

• “My mother is 90 – she has had OCD tendencies all her life, she only wears cream blouses, she will not use public transport ( even taxis). She eats at certain times and everything has to have its place. In the last year, it has gotten considerably worse. She first stopped eating and drinking as she was obsessed with the notion that she would be sick. (She admitted to having a vomiting phobia and despite having 3 children, has never been sick since she was 14 – 76 years!) Eventually, she was hospitalized for dehydration. Once hydrated she was sent home and her medication was changed.

  She regained the ability to eat and drink – within narrow parameters – but she is now obsessed with me. She needs to know where I am at every moment of the day, when I do her shopping I call before I leave, when I arrive at the supermarket, when I have finished, and when I am leaving to bring her the shopping. She times the space between the calls and obsesses about the time. During the day if she cannot contact me by phone ( I work full time and am in meetings, traveling, etc.) she panics and calls my husband – who also works full time – to try and find out where I am.

  Strangely, the only time I do not have to call her is when I get home after I have visited her – it is all front-loaded onto me arriving from the first waking thought on the days that I visit watching every car driving past her house until I arrive. She has always been clinically depressed and has been on long-term antidepressants, in addition, she is taking diazepam 4 x day and pregabalin twice daily on top of the mirtazapine at night. She has now been offered CBT – again ( not worked in the past as she is resistant to change) but refuses to see the problem.

  She says that she has put in place her coping strategies – getting me to collude – and with them she is fine. If ever I give any indication that I find it a strain she goes into meltdown and tells me I do not love her. She insists on living alone. I am at my wit’s end as a daughter, she is a frail old lady but controls my life with a rod of iron. There seems to be very little comment, advice, or research on OCD in the elderly available – and even less on how to deal with it for carers/relatives.”

• “My mother-in-law was just diagnosed with OCD at 65 after ending up in the hospital. Her behaviors have worsened over the past 15 years to the point where she limited her diet severely until she grew dehydrated and anemic. Unknowingly we have made her worse and worse by reinforcing her fears and reassuring her behaviors as they controlled her more and more.

  Family members have bought her new clothes, special washing machines, and new vacuum cleaners after old ones became contaminated and were thrown away. Even her cars became fearful objects to send away for scrap metal. In her case, the OCD came on later in life and has slowly worsened until this point.”

• “My father is 93 years old and prior to an auto accident in October 2016, his mind and memory were excellent. After surgery and three months in a rehabilitation facility and a number of infections that resulted in another hospitalization, he is finally home. His mind and memory during most of his stay at the rehabilitation center were excellent. However after he developed the infection, he was hospitalized and was on heavy antibiotics. I saw a tremendous decline in his physical and mental condition.

  He has been home for three weeks and he has had a few good days where his mind and memory are good. However, then he suddenly goes into a state where he’s overcome by OCD tendencies. He obsessively draws lines. If he has a piece of paper he’ll draw lines on the paper. If he doesn’t have any he draws lines on his body. I also notice he uses his feet to draw lines following the lines on the ceramic tile floor. If I ask him to look into my eyes, I can get him to focus for 30 seconds. At that time he was lucid. My father’s OCD has gotten very bad in the last 2 days. I tried researching the problem but have come up with very little.”

Final Thoughts

Older adults are overlooked treasures. These individuals have had a lifetime of experiences, yet, once they reach a certain age, they tend to be ignored and dismissed. Because few are paying attention to the elderly, they often struggle with various ailments and mental health conditions in silence. While most people expect to experience some degree of cognitive decline as they age, relatively few imagine a life that involves OCD. OCD is often a hyper-reaction to the stress and anxiety of aging.

However, some people are predisposed to OCD – but do not know it. Growing old under any circumstance can be anxiety-provoking, however, for people with this disorder, growing old can be extremely frightening especially when dementia is also involved. The good news is there are effective treatments that can ease your loved one’s mind and provide them with an improved quality of life. Online OCD treatment programs, like Impulse Therapy, along with other natural remedies can provide elders with the life they deserve – a peaceful and productive life that is free of OCD.

References

• Sharma, E., Sharma, L., Balachander, S., Lin, B., Manohar, H., Khanna, P., Lu, C., Garg, K., Thomas, T., Au, A., Selles, R., Højgaard, D., Skarphedinsson, G., & Stewart, S. (2021). Comorbidities in obsessive-compulsive disorder across the lifespan: A systematic review and meta-analysis. Frontiers in Psychiatry,12. Retrieved from https://www.researchgate.net/publication/356144597_Comorbidities_in_Obsessive-Compulsive_Disorder_Across_the_Lifespan_A_Systematic_Review_and_Meta-Analysis#:~:text=Comorbidities%20are%20seen%20with%20obsessive-compulsive%20disorder%20%28OCD%29%20across,and%20neurological%20and%20degenerative%20disorders%20in%20the%20elderly.
• Chen, M. H., Cheng, C. M., Tsai, S. J., Tsai, C. F., Su, T. P., Li, C. T., Lin, W. C., Chen, T. J., & Bai, Y. M. (2021). Obsessive-compulsive disorder and dementia risk: A nationwide longitudinal study. The Journal of Clinical Psychiatry, 82(3), 20m13644. Retrieved from https://doi.org/10.4088/JCP.20m13644
• Moheb, N., Charuworn, K., Ashla, M. M., Desarzant, R., Chavez, D., & Mendez, M. F. (2019). Repetitive behaviors in frontotemporal dementia: Compulsions or impulsions? The Journal of Neuropsychiatry and Clinical Neurosciences, 31(2), 132–136. Retrieved from https://doi.org/10.1176/appi.neuropsych.18060148
• Jackson C. W. (1995). Obsessive-compulsive disorder in elderly patients. Drugs & Aging, 7(6), 438–448. Retrieved from https://doi.org/10.2165/00002512-199507060-00004
• Jazi, A. N., & Asghar-Ali, A. A. (2020). Obsessive-compulsive disorder in older adults: A comprehensive literature review. Journal of Psychiatric Practice, 26(3), 175–184. Retrieved from https://doi.org/10.1097/PRA.0000000000000463