Bipolar Disorder in Older Adult Inpatients

Abstract

The literature on bipolar disorder in older adults is very limited, in spite of the fact that the elderly are a growing population in the United States. This retrospective record review study evaluated clinical characteristics and hospital-based resource use patterns among 48 older adults with bipolar disorder, and compared groups with early-onset (EOS) versus late-onset (LOS) bipolar disorder. The mean age of the group was 67.3 years, with no difference in age between EOS and LOS categories. Late onset illness was identified in 29.2% of the group (N = 14). Compared with individuals with EOS, individuals with LOS were 2.8 times more likely to be female. Both groups had extensive medical comorbidity (mean of 3.7 comorbid medical conditions), substantial hospital usage (mean length of stay, 14.8 days) and polypharmacy usage. Bipolar disorder with onset after age 50 is not uncommon among older adults hospitalized on a geropsychiatric unit. Clinical characteristics may differ between individuals with early-onset and late-onset bipolar illness, and resource utilization may be extensive in both groups.

The prevalence of late‐life mania: a review

“…The 18 published reports provided information on 22,333 patients, of whom 1,766 were inpatients, with a total sample mean age of 69.8 years (standard deviation = 4.7 years, range: 50–103 years). Only one study included patients aged 50–60 years . In our review, the group of patients aged 90 years and over is under‐represented.…”

Two years' outcome of acute mania in bipolar disorder: different effects of age and age of onset

“…With regard to our second hypothesis about differences between EOB and LOB, there were no statistically significant differences in treatment. This suggests that differences in symptomatology and etiology between older EOB and LOB patients reported by others (Lehmann and Rabins, ; Sajatovic et al ., ; Sajatovic et al ., ; Schouws et al ., ; Besga et al ., ; Shou‐Hung et al ., ) may be better reasons to distinguish between EOB and LOB. However, the older EOB patients may be a too heterogeneous group consisting of a mixed age of onset group with a very early, intermediate, and late age at onset (but all before the age of 50 years), with two cutoff points between the three groups, at 21 and 34 years (Geoffroy et al ., ).…”

“…There is strong evidence of the existence of subgroups with early, intermediate, and late age at onset (Geoffroy et al, 2013). Differences have been reported between older EOB and LOB patients concerning behavior prior to hospitalization and adherence with medication (Lehmann and Rabins, 2000), sex ratio (Sajatovic et al, 2005a), length of hospitalization (Sajatovic et al, 2005b;Oostervink et al, 2009), use of mood stabilizers, severity of illness and utilization of health services (Sajatovic et al, 2005b), cognitive impairment (Schouws et al, 2009), findings at neuroimaging (Tamashiro et al, 2008;Shou-Hung et al, 2011), and etiology of white matter hyperintensities (Besga et al, 2011;Gunde et al, 2011). On the other hand, other studies reported only few to no differences between older EOB and LOB patients, suggesting that distinguishing between late onset and early onset is of limited clinical relevance (Almeida and Fenner, 2002;Sajatovic et al, 2005a;Chu et al, 2010).…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…Approximately 6% of geriatric psychiatry outpatients and 10% of inpatients have BD,620 and proportionally this population is one of the highest users of psychiatric and physical health services 621. Approximately 25% of the patients with BD in the USA in 2005 were over the age of 60 years,622 and by 2030 >50% of patients with BD are expected to be aged >60 years 623…”