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This disorder affects all age groups — and the number of seniors with bipolar disorder is expected to increase as the population ages. Here’s what you need to know.
Bipolar disorder can affect people of all ages, including older adults. According to one study, 10 percent of new cases occur after the age of 50. In the past, it was believed that bipolar symptoms “burn out” and slowly disappear with age. However, newer research has shown that this is not so, and other research suggests that untreated bipolar disorder actually worsens over time. Individuals who are first diagnosed with bipolar disorder late in life may well have had undiagnosed bipolar disorder for decades, with symptoms that simply became more noticeable and problematic with age. And as the American population grows older, the number of bipolar cases in seniors is expected to increase. Caring for seniors with the illness often falls on the shoulders of family members, such as spouses and adult children. Here’s what family members need to know about bipolar disorder in older adults.
Bipolar Disorder in Seniors: Symptoms
Just as depression is not a normal or natural part of aging, neither are the manic episodes associated with bipolar disorder. However, seniors may not exhibit the classic signs of mania, such as elation and feeling on top of the world. “Another version often seen in older folks is agitation and irritability,” says Michael First, M.D., a professor of clinical psychiatry at Columbia University and editor of the American Psychiatric Association’s latest diagnostic guidelines. Other common symptoms in 60-plus adults include distractibility, confusion, hyperactivity, and psychosis. “When bipolar shows up for the first time after age 60, it can be quite severe,” says Carrie Bearden, Ph.D., associate professor of psychology and behavioral sciences at UCLA and an expert in the disorder. Often, it’s the rapid-cycling form of the disorder, characterized by frequent episodes of depression and mania or having symptoms of both at the same time. As a result, bipolar seniors may appear to be in a state of irritable depression. Additionally, seniors with bipolar disorder show significant changes in cognitive functioning, including difficulties with memory, perception, judgment, perception, and problem-solving.
Bipolar Disorder in Seniors: Diagnosis
The first step in getting help for an older family member is to schedule a complete medical examination to rule out other medical problems. Alzheimer’s disease, dementia, and even a brain tumor can mimic some aspects of bipolar disorder. Some medications can produce bipolar symptoms too. Antidepressants and corticosteroids, for instance, can cause mania. “Anyone over age 60 with suspected bipolar disorder needs a full medical workup, including a discussion of past health complaints, family history, and an evaluation of all over-the-counter and prescription medications,” advises Dr. First. If warranted, a referral to a mental health professional is the next step. For help in locating a psychiatrist with special training in bipolar disorder in older adults, log onto the Web site of the American Association of Geriatric Psychiatry.
Bipolar Disorder in Seniors: Treatment
There are special considerations when treating seniors for bipolar disorder. Older patients may tolerate or metabolize medications at different speeds than younger adults, so they may need different dosages. And older people are likely to have other medical conditions and to be taking other medications. “Treatment is much more complicated for this age group because doctors need to take into account drug interactions, as well as the fact that medications may be tolerated differently,” says First. However, older adults with bipolar disorder should be treated for their mania and depression; a number of medications can be helpful. Ongoing research is comparing lithium to antiseizure medications in older bipolar patients in order to determine which type of drug has the greatest benefit with the least risk of side effects. Talk therapy can also be a valuable addition to bipolar treatment for older adults. Some therapy programs are specifically geared to older bipolar patients.
Help for Caregivers
Support groups can be an important resource for family members caring for an older adult with bipolar disorder. Many psychiatrists specializing in bipolar disorder can put caregivers in touch with family support groups. Additionally, the Depression and Bipolar Alliance and the National Alliance for Mental Illness have links to caregiver education programs and support groups for families dealing with bipolar disorder. Family caregivers can also find a wealth of information, as well as message boards and online support groups, through the National Family Caregivers Association.