Neurodivergent and Aging: Rethinking Eldercare in America
Monday June 23, 2025. This is for Hazel at UK, and Susan.
The first generations of Americans diagnosed with autism in childhood are now entering old age.
Yet eldercare systems—Medicare, senior housing, memory care—were never built with neurodivergent aging in mind.
Autism. ADHD. Sensory processing disorders. Dyspraxia.
These don’t disappear with age. They evolve.
And the support systems that served these individuals in youth and adulthood often vanish in old age. The result? A silent crisis of unmet needs—and a dawning recognition that eldercare must evolve, too.
Autism and Aging: The Forgotten Cohort
Increased Health Risks
Autistic older adults experience more anxiety, isolation, and chronic health conditions than their neurotypical peers (Mason et al., 2019; Walsh et al., 2022). They are also at higher risk for early-onset dementia and frailty (Bishop-Fitzpatrick & Kind, 2017).
Diagnostic Overshadowing
Conditions like memory loss, hearing problems, or even diabetes may go untreated in autistic adults because doctors wrongly attribute them to autism itself (Hand et al., 2020).
Lifelong Needs
Despite myths, autistic adults don't simply "grow out of it."
Many continue to experience sensory sensitivities, need support with routines, and struggle with executive functioning (Eaves & Ho, 2008).
ADHD in Older Adults: The Invisible Struggle
Still Misunderstood
ADHD doesn’t vanish with age. It just gets harder to recognize—especially when it was never diagnosed in childhood. Many older adults live with ADHD symptoms without knowing it (Brod et al., 2012).
Dementia Connection
Studies link ADHD in late life with increased risk for dementia—even when controlling for other conditions (Dobrosavljevic et al., 2022).
Executive Dysfunction Doesn’t Retire
Emotional regulation, working memory, and sustained attention remain major challenges for older adults with ADHD (Semeijn et al., 2015)—yet most eldercare staff receive no training on how to support them.
Gender, Menopause, and Masking: The Hidden Toll
Autistic women often mask symptoms for decades—then collapse under the weight of accumulated sensory overload and misunderstanding in later life.
Menopause may intensify sensory sensitivity and emotional distress, yet few eldercare settings are prepared for this reality (Lai & Baron-Cohen, 2015; Moseley et al., 2020).
Dyspraxia, Sensory Processing, and Fall Risk
Conditions like developmental coordination disorder (dyspraxia) and sensory processing disorder (SPD) increase vulnerability in later life—affecting mobility, falls, and daily self-care (Kirby et al., 2014). Yet few eldercare frameworks even acknowledge these diagnoses.
The Rise of Neuro-Inclusive Eldercare
Sensory-Friendly Design
Some care homes are now introducing flexible routines, visual schedules, and sensory-friendly environments tailored to neurodivergent aging adults (Gillespie-Lynch et al., 2017).
Staff Training Matters
Training eldercare professionals in neurodivergence is not optional—it’s essential.
Models based on the “double empathy problem” emphasize that communication failures go both ways (Milton, 2012). Respecting neurodivergent elders begins with understanding how they experience the world.
Interdisciplinary Innovation
Experts are calling for interdisciplinary care teams that integrate gerontology, neurology, occupational therapy, and neurodiversity-informed psychotherapy (Hwang et al., 2021).
What Needs to Change (Like Yesterday)
Better screening for ADHD and autism in geriatric settings
Longitudinal studies tracking aging trajectories in neurodivergent populations
Workforce education in sensory, emotional, and executive-function supports
Housing and memory care designed for neurodivergent aging
Policy reform that recognizes neurodivergence as a lifespan condition
Final thoughts
Neurodivergent elders are not edge cases. They are pioneers.
Their lives challenge outdated assumptions about what aging “should” look like.
They deserve more than compliance checklists—they deserve care systems designed with their brain and nervous system wiring in mind.
The next frontier in eldercare isn't just about Alzheimer’s units or senior yoga.
It’s about rethinking aging as a neurodiverse journey—and designing services and spaces that honor the full human spectrum. I’m looking forward to a number of fascinating discussion with the University of Kentucky toward that end.
Want to bring neurodiversity-informed training to your eldercare organization? Or download my Neuroinclusive Eldercare Planning Toolkit? Contact me here.
Be Well, Stay Kind, and Godspeed.
REFERENCES:
Bishop-Fitzpatrick, L., & Kind, A. J. H. (2017). A scoping review of health disparities in autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(11), 3380–3391. https://doi.org/10.1007/s10803-017-3251-9
Brod, M., Pohlman, B., Lasser, R., & Hodgkins, P. (2012). Comparison of the burden of illness for adults with ADHD across seven countries: A qualitative study. Health and Quality of Life Outcomes, 10, 47. https://doi.org/10.1186/1477-7525-10-47
Dobrosavljevic, M., Mihaljevic, M., Mandic-Maravic, V., & Mitkovic-Voncina, M. (2022). ADHD and dementia: Is there an association? A systematic review. Psychogeriatrics, 22(1), 11–22. https://doi.org/10.1111/psyg.12814
Eaves, L. C., & Ho, H. H. (2008). Young adult outcome of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 739–747. https://doi.org/10.1007/s10803-007-0441-x
Gillespie-Lynch, K., Kapp, S. K., Brooks, P. J., Pickens, J., & Schwartzman, B. (2017). Whose expertise is it? Evidence for autistic adults as critical autism experts. Frontiers in Psychology, 8, 438. https://doi.org/10.3389/fpsyg.2017.00438
Hand, B. N., Angell, A. M., Harris, L., & Carpenter, L. A. (2020). Prevalence of physical and mental health conditions in Medicare-enrolled, autistic older adults. Autism, 24(3), 755–764. https://doi.org/10.1177/1362361319878132
Hwang, Y. I., Foley, K. R., Trollor, J. N., & Lennox, N. G. (2021). Aging and autism: Health needs and service provision. Research in Autism Spectrum Disorders, 84, 101768. https://doi.org/10.1016/j.rasd.2021.101768
Kirby, A., Sugden, D., & Beveridge, S. (2014). Developmental co-ordination disorder (DCD) in adolescents and adults. British Journal of Occupational Therapy, 68(2), 61–66. https://doi.org/10.1177/030802260506800204
Lai, M. C., & Baron-Cohen, S. (2015). Identifying the lost generation of adults with autism spectrum conditions. The Lancet Psychiatry, 2(11), 1013–1027. https://doi.org/10.1016/S2215-0366(15)00277-1
Mason, D., McConachie, H., Garland, D., Petrou, A., Rodgers, J., & Parr, J. R. (2019). Predictors of quality of life for autistic adults. Autism Research, 11(8), 1138–1147. https