Understanding Bipolar Disorder in Older Adults
Bipolar disorder in older adults can have a later onset, often after the age of 50, with episodes of mania and depression. Recognizing symptoms like excessive energy, inability to sleep, and cognitive impairment is crucial. Late-onset bipolar disorder differs from early-onset in familial illness rates, medical morbidity associations, and relapse rates. The differential diagnosis includes early dementia stages, delirium, substance misuse, and physical causes like thyroid issues. Proper diagnosis and management are essential for elderly individuals with bipolar disorder.
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Bipolar disorder in older adults Tier 3
Bipolar disorder in older adults Bipolar disorder - episodes of mania along with episodes of depression. Some of these individuals would have been diagnosed with bipolar disorder when they were younger and some get diagnosed after the age of 50 years. Older adults account for only 0.1-0.5% of Bipolar disorder in the community but the risks of admission to hospital are high and account for 4-8% of admissions. The mean age of onset of Bipolar disorder in older adults is around 50 years of age. It is more common in females than in males. It can be missed as the person can present with more functional impairment and cognitive impairment.
Symptoms Symptoms of mania can include Excessive energy Inability to sleep Racing thoughts Pressured speech Excessive spending or reckless behaviour Inability to concentrate Grandiose ideas Delusional thoughts Hallucinations Symptoms of depression can include Sleep disturbance - early morning waking Fatigue Psychomotor retardation Loss of interest Poor memory Hopelessness Ideas of guilt Suicidal thoughts
Difference between later onset bipolar disorder and early onset bipolar disorder Late onset Bipolar disorder Early onset Bipolar disorder Develops around the age of 50 years or later Usually before the age of 40 years Lower rate of familial illness Higher rate of familial illness Higher rate of neurological and medical morbidity Not associated with higher rates of neurological or medical morbidity Higher rates of relapses Although there are relapses, the rates of relapses are not as high as in late onset
Differential diagnosis Early stages of dementia can present with symptoms suggestive of mania such as irritable mood, emotional lability, sleep disturbance, and impaired social judgment Delirium Alcohol and drug misuse/ withdrawals Medications such as steroids, Parkinson s medications, anti- hypertensive medications such as captopril, and antidepressants can precipitate mania Physical causes - thyroid issues including hyperthyroidism, infections, metabolic disturbances, neoplasm, stroke, encephalitis, epilepsy and toxins can precipitate mania
Impact of having Bipolar disorder on older adults Higher rates of cardiovascular disease Diabetes and Hypertension are more common Higher rates of cognitive issues Symptoms as a result of being on medications eg lithium - tremor of hands Death occurs an average of 10 years earlier than the general population.
Assessment Detailed history including details of the onset of the symptoms, progression, fluctuations of mood, impact on functioning, sleep changes, irritability, appetite changes, weight loss Past history of bipolar affective disorder or recurrent depressive episodes which have been refractory to treatment Medications and recent changes / compliance Use of alcohol and drugs Physical health history and current symptoms Risk taking behaviours including risk of suicide, driving etc Collateral history from carers and partners including impact on them
Risks to watch out for Wandering risk / going out late in the night or early hours Not eating / drinking - self-neglect Risky behaviour - excessive spending / excessive alcohol intake Driving Non-compliance with medications including physical health medications Loss of support network due to disorganised / odd behaviour Vulnerability to exploitation Risk of suicide
Investigations Investigations include detailed blood tests CT / MRI scan to rule out neoplasms, infections, lumbar puncture may be needed Alcohol and drug history / screening
Treatment Treatment would include referral to an Old Age Psychiatrist Medications such as mood stabilisers and anti-psychotic medications can help with regulation of the mood Anti-depressants can be used for depression along with mood stabilisers If they are on Lithium make sure that they have information leaflet about lithium and how physical ill health can impact on lithium levels Regular monitoring of serum lithium levels (12 hrs post-dose every 3 months) and yearly calcium levels Try to reduce any psychosocial stressors Encourage understanding of their illness and need for treatment Psychological therapies may be useful
Monitoring Check medication packs to check for compliance as they may not believe they are unwell .Monitor for side effects. If at all possible liaise with a family member to ensure that they are alerted and know who to call in a crisis Ask the older person about their Sleep - Advise re sleep hygiene Check on their Hydration - Are they drinking enough fluids? Check on their Nutrition - Are they eating enough? Monitor risks -Ensure that the patient is safe
Resources MPC_09_01 - Bipolar Disorder | Bipolar Disorder (mindedforfamilies.org.uk) This is an easy to access website for older adults and their families which has good advice about symptoms and treatment of Bipolar disorder in older adults
