The prevalence of geriatric mania is uncertain. Although there are high rates of mania in clinical and residential facilities, community based epidemiologic studies are limited. Given the difficulty in making an accurate diagnosis, geriatric mania appears to be underreported. Although the commonly held opinion is that onset and prevalence of mania decreases with age, there is contradictory evidence that, particularly in men, the incidence of new onset mania increases with age. Clinically, the diagnosis and treatment of geriatric mania is challenging, because these patients present with comorbid medical, neurologic, and dementing illnesses. This paper reviews presentations of mania in the elderly and updates the pharmacologic treatment of mania in the elderly. Although few of the studies target the elderly, the published data in younger patients on the use of the atypical antipsychotics, as well as the advent of newer anticonvulsants, have demonstrated promise in the treatment of older patients.

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