Special Considerations for Older People With Bipolar Disorder

Experts are paying more attention to bipolar disorder in older people. People with bipolar disorder who are over 40 or 50 years of age have not always been the focus of new research, but that may be changing.¹

Over the past 40 years, the number of people over the age of 60 has doubled. And by 2050, the number of people 80 years and older will quadruple. A growing elderly population means that the number of older adults with bipolar is also likely to increase.¹

How common is bipolar in older adults?

Up to 1 percent of older adults have bipolar disorder. This is slightly less than the 1.4 percent of people with bipolar who are 18 to 44 years old.²

Some older adults with bipolar disorder may be diagnosed with bipolar earlier in life. Others are diagnosed in their later years after previous episodes of depression.²

Who is an "older adult" with bipolar disorder?

Different researchers use different ages to define who is considered an older adult with bipolar. But many experts agree that 60 years or older is a good threshold. Meanwhile, the International Society for Bipolar Disorder (ISBPD) proposed an age cutoff of 50 years or older.¹

But the ISBPD also proposed a cutoff of 40 years to distinguish early- and late-onset bipolar disorder. Early-onset bipolar is linked to a family history of bipolar disorder. Late-onset bipolar disorder is often linked to:¹

• Disease of the brain, nerves, or spinal cord (neurological disease)
• Decline in brain processes
• Other physical disorders

Both early- and late-onset bipolar disorder may be present in older people.¹

Bipolar in older adults can be described in 4 groups:³

• Early-onset bipolar disorder: Bipolar patients who are now old but had their bipolar start early in life
• "Real" late-onset bipolar: Bipolar disorder starts after 50 years of age
• Late-onset bipolar with earlier signs: Episodes of depression start before 50 years of age, but episodes of mania in bipolar disorder start after 50 years of age
• Secondary manias: Mania happens as a result of physical disease, drugs, or drug side effects

What are the treatment options for older adults with bipolar?

Evidence-based treatment for older adults with bipolar disoder is an area of great need in healthcare. In fact, many older adults with bipolar are excluded from research studies. This is because they are at higher risk of side effects from drugs used to treat bipolar disorder. As a result, treatments for older adults with bipolar disorder are often based on studies of younger people.³

Because of this, treatment recommendations for older adults with bipolar mirror those offered to younger people. This can fail to address the more complex treatment plans older adults with bipolar diosrder may need.³

Bipolar disorder drugs include:³

• Lithium
• Valproic acid or drugs derived from it
• Carbamazepine
• Lamotrigine
• Drugs used to treat psychosis (antipsychotics)
• Drugs used to treat depression (antidepressants)

A few non-drug treatments for older adults with bipolar disorder also exist, such as:³

• Psychotherapy (talk therapy)
• Electroconvulsive therapy

Older adults may also make lifestyle and age-related changes to manage their bipolar.^3,4

What are the unique challenges in treating bipolar in older adults?

Older people with bipolar disorder tend to have more complex treatment needs. This is because they:³

• Often have other health conditions
• Are more likely to face side effects from treatment
• May have more complex psychosocial challenges

For example, older adults with bipolar may need support dealing with:^3,4

• Loss of relationships
• Loss of jobs
• Other disorders

A study of older adults with bipolar found that many also had:^3,4

• Arthritis
• Hearing challenges
• Back issues

Many felt a sense of loss for activities they could no longer do. At the same time, they reported having more free time, which led to feelings of:^3,4

• Loneliness
• Guilt
• Shame

Older adults with bipolar often report having memory and concentration problems. It is not clear if these problems are because of:⁴

• Natural aging
• Drugs
• Bipolar disorder, or
• A combination of these factors

But older adults with bipolar disorder report that using repetition and association helped with these problems, especially in therapy sessions.⁴

If you are an older adult with bipolar, you may want to talk to your doctor. Let your doctor know about any other health conditions you may have. Talk to your doctor about how social changes or challenges are affecting you. If it helps, make a list of your concerns and bring it to your doctor's visit.