Multiple sclerosis living in older adults

Overview

Multiple sclerosis (MS) is a condition where the immune system mistakenly attacks the protective covering of your nerves, called myelin. This disrupts signals between your brain and body, leading to a range of symptoms. In older adults, MS often requires careful management alongside age-related changes.

MS is not very common – about 1 in 1,000 people worldwide have it. However, it is one of the more common neurological conditions in younger adults, and the number of older adults living with MS is increasing thanks to better treatments.

MS is more common in women than men. It most often starts between ages 20 and 40, but it can affect people of any age. Today, many people with MS are living into their older years, and the healthcare needs of this group are growing.

Symptoms

Common symptoms

• Fatigue (extreme tiredness that does not always improve with rest)
• Numbness or tingling in the face, arms, or legs
• Vision problems such as blurred vision or double vision
• Muscle weakness and stiffness
• Problems with balance and coordination
• Difficulty with memory, concentration, or planning

Symptoms in older adults

• Increased fall risk due to weakened legs and balance issues
• Bladder and bowel problems, like urgency or incontinence
• Greater sensitivity to heat, which can make symptoms worse
• Depression or mood changes that may be mistaken for normal aging
• Cognitive changes (trouble finding words, slower thinking) that can overlap with age-related forgetfulness
• Osteoporosis (thinning bones) may be more common in older adults with MS, especially if they use steroids or are less mobile

Causes

Main causes

• The exact cause of MS is not known. It appears to be a combination of genetic and environmental factors that trigger the immune system to attack the myelin sheath.
• In older adults, MS is not caused by aging, but the natural aging process can affect how symptoms are experienced and managed.

Risk factors

• Being female (women are about 2-3 times more likely to get MS)
• Having a family member with MS
• Previous infection with the Epstein-Barr virus (which causes glandular fever)
• Low vitamin D levels
• Smoking

When to see a doctor

See a doctor urgently if:

• Any sudden, severe symptoms like severe weakness, loss of vision, or trouble talking or walking
• Signs of infection (fever, painful urination, cough) – infections can trigger relapses

Book a routine appointment if:

• Regular follow-up appointments with your neurologist or MS specialist
• When symptoms slowly get worse over time and affect your daily activities
• If you have concerns about side effects from your MS medications

Diagnosis

There is no single test for MS. Doctors use a combination of your history, a neurological exam, and specific tests to rule out other conditions and look for signs of damage in the brain and spinal cord.

Tests that may be done

• Magnetic resonance imaging (MRI) to look for areas of damage (lesions) in the brain and spinal cord
• Lumbar puncture (spinal tap) to check fluid around the brain and spinal cord for signs of immune activity
• Evoked potentials – tests that measure how fast your nerves send signals
• Blood tests to rule out other conditions that can cause similar symptoms

What to expect at your appointment

The diagnosis process can take time. You will likely need to see a neurologist. They will ask about your symptoms, do a physical exam, and arrange tests. If you are diagnosed with MS, your healthcare team will work with you to create a plan that fits your age, overall health, and personal goals.

Treatment

Treatment for MS has two main goals: to slow the disease and to manage symptoms. There is no cure, but many treatments can help you live well for many years. Your plan will be tailored to your age, how active your MS is, and any other health conditions you have.

Self-care at home

• Stay as active as you can – gentle exercise like walking, swimming, or chair yoga can help maintain strength and balance
• Get enough rest and pace your activities to avoid overdoing it
• Drink plenty of water and eat a balanced diet to support overall health
• Keep cool – use air conditioning or cool cloths if heat makes your symptoms worse

Medical treatments

Medical treatments include medications that can reduce the number of relapses and slow disease progression (called disease-modifying therapies). Other medicines treat specific symptoms like muscle stiffness, depression, or bladder problems. Your doctor will discuss options that are safe for you based on your age and other conditions. Never stop or change your medication without talking to your doctor.

When is surgery considered?

Surgery is rarely needed for MS itself. In some cases, surgery may be considered for complications such as severe spasticity (muscle tightness) or for a device to help with bladder control. Always discuss any surgical options with your MS healthcare team.

Living with this condition

Living with MS as an older adult means adapting to both MS and the normal changes of aging. You may need to plan your days around your energy levels, use walking sticks or a wheelchair if needed, and ask for help with tasks like housework or shopping. Many people find that keeping a routine helps them feel more in control.

Lifestyle tips

• Stay connected with family and friends – loneliness can make symptoms feel worse
• Join a local or online MS support group to share experiences
• Learn relaxation techniques such as meditation or deep breathing to manage stress
• Avoid smoking and limit alcohol – both can worsen symptoms

Diet and exercise

A heart-healthy diet rich in fruits, vegetables, whole grains, and lean proteins can benefit your overall health. There is no special MS diet, but some people find that cutting down on processed foods helps. Gentle exercise – even just stretching or walking for 10-15 minutes a day – can improve strength, balance, and mood. Talk to a physiotherapist for exercises that are safe for you.

Mental health and emotional wellbeing

MS can be emotionally challenging. Depression and anxiety are common – not just because of the diagnosis, but also because the condition affects the brain. It is normal to feel frustrated, sad, or worried. Talk to your doctor about these feelings; treatments like counselling and medication can help. If you ever have thoughts of harming yourself, call your local emergency number or a crisis helpline immediately.

Prevention

MS cannot be prevented, as the exact cause is not known. However, maintaining a healthy lifestyle – including a balanced diet, regular exercise, not smoking, and keeping vitamin D levels normal – may help reduce the risk or delay progression. For those already diagnosed, these habits can support overall well-being and may help manage symptoms.

Vaccines

Vaccines are generally safe for people with MS, but always ask your doctor before getting any vaccination. Some live vaccines may be avoided if you are on certain MS medications. Vaccination against flu and pneumonia is often recommended for older adults with MS.

Screening programmes

There is no routine screening test for MS. If you have symptoms that could be MS, see your doctor for an evaluation.

Complications

If left untreated

• More frequent and severe relapses
• Gradual build-up of disability, such as problems walking or using your hands
• Greater risk of infections, especially bladder and lung infections
• Increased risk of depression and social isolation

Long-term outlook

Living with MS as an older adult can be challenging, but many people lead full, productive lives. With good medical care, lifestyle adjustments, and support from family and professionals, you can manage symptoms and maintain independence for many years. Research continues to improve treatments and quality of life. Stay hopeful and stay connected with your healthcare team.

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