Bipolar Disorder in the Senior Population

Posted by Donna Mae Scheib on February 15, 2022

Bipolar Disorder in the Senior Population

Bipolar disorder usually affects teens and young adults aged 15-24, however, it can affect people of all ages. Furthermore, the number of seniors with this disorder is expected to increase as the population ages. In fact, 10% of the newly diagnosed patients today are over the age of 50. And although studies have found that bipolar disorder occurs for men and women equally, when it appears in adults over age 50, women are twice as likely to have these symptoms as men.

Many of these older individuals may have had undiagnosed bipolar disorder for some time, but the symptoms most likely became more pronounced as they got older. In addition, there is new research that supports the position that there is a specific type of bipolar disorder that appears for the very first time for some seniors.

Let’s first look more closely at bipolar disorder with the senior population in mind, and then at the causes, symptoms, effects, diagnosis, and treatment of this disorder. In addition, we will also learn about what types of support are offered for caregivers and family members of seniors who manifest this disorder.

What is bipolar disorder?

Bipolar disorder is defined as a severe and chronic psychiatric disorder characterized by very high and very low mood swings. Those individuals with the disorder typically experience severe functional disability, financial problems, thoughts of suicide, and an over-diminished quality of life. In the older population, in contrast to those who are younger and diagnosed with the disorder at this time, seniors who experience bipolar disorder are more apt to be hospitalized and exhibit a heightened degree of disability because of the depressive symptoms. Seniors also seem to be “rapid cyclers.” That is, they have 4 or more episodes of mania or depression within a given year.

Causes

Although the specific causes for the late-onset of bipolar disorder are really unknown, there are some distinct factors that correlate to the development of this disorder in this specific population.

• Cerebrovascular Disease – In a small number of seniors, there have been short blockages of blood flow to the brain that has led to minor symptoms of stroke for a 24 hour or less time period; the blockages are noted to have preceded the onset of late-onset bipolar disorder.
• Genetic – There appears to be a genetic link to late-onset bipolar disorder, but it isn’t as strong a link as it is for those individuals who were diagnosed at younger ages.
• Neurological Illness – There also appears to be evidence linking late-onset bipolar disorder with dementia. When this is the case, dementia usually is manifested first.
• Posterior Cortical Atrophy (Benson’s syndrome) – The back portion of the brain has shrunk and this factor has been found to directly cause late-onset bipolar disorder. In other cases, bipolar disorder is indirectly caused by the development of dementia with Lewy bodies which has preceded the disorder.
• White Matter Hyper-intensities − Small lesions have been found in the brain through imaging studies of some of these seniors with late-onset bipolar disorder.

Symptoms

Seniors with bipolar disorder often show distractibility, hyperactivity, confusion, and psychosis and they may experience episodes of both mania and depression frequently and/or simultaneously. These individuals also exhibit changes in their cognitive functioning (e.g., have more difficulty with problem-solving, judgment, perception, and memory) and exhibit social skill deficits (e.g., excessive talking), lack of social inhibition (e.g., doing or talking about things to family members or with strangers that they wouldn’t normally do or say), and disorientation (e.g., being confused, getting lost, and losing things).

Effects

The effects of bipolar disorder vary from individual to individual, the illnesses/diseases the individuals are undergoing, and their current life situations, but there are some common effects.

• Inability or difficulty doing/partaking in normal daily activities and events
• Hyper-vigilance over bodily functions (e.g., believing “normal” aches and pains are a serious, life-threatening illness)
• Impaired cognitive functioning (e.g., especially with skills in problem-solving, decision making, executive planning, and memory)
• Increased inability to tolerate any degree of physical pain
• Increased risk of morbidity, mortality, and thoughts/actions of suicide because of complications with other illnesses
• Malnutrition or loss of appetite

Diagnosis

First off, it is important to have a complete medical examination to check for underlying medical problems as Alzheimer’s, dementia, and brain tumors can also have some of the same resulting behaviors as bipolar disease. During the exam, the licensed healthcare provider can review the senior’s over-the-counter and prescription medications as some medications are known to cause similar symptoms of this disorder as well. For example, corticosteroids and antidepressants can cause mania. Depending on the findings, the senior might be referred to a licensed mental health professional (i.e., a geriatric psychiatrist) who specializes in bipolar disorder in older adults. They can help diagnose the disorder and develop an individualized treatment plan to manage the symptoms.

Treatment

The treatment for older individuals who have bipolar disorder is different from other age groups who have this disorder. Medication is one common treatment. However, there are some considerations when prescribing medicine for those individuals treated for bipolar disorder when they are older, for two distinct reasons: 1) Older patients metabolize and tolerate medications at a different rate, and 2) Older people are most likely to be taking other medications which may interfere with the prescribed medicine to treat bipolar disorder. Besides, seniors may have pre-existing conditions that need to also be considered before specific medications are prescribed.  

Talk therapy, also known as psychotherapy, is often used with older adults in conjunction with medication. This therapy is based on the idea that talking about your thoughts, emotions, and challenges can help you bring clarity and eventually cause a positive change in your emotional state. The psychotherapist is trained to work with the patient to help find insights and solutions while maximizing the patient’s quality of life.

Other activities that will help your loved one deal with bipolar disorder (and accompanying symptoms of excessive stress, anxiety, and depression) include yoga, exercise, acupuncture, meditation, and any number of social/recreational/spiritual opportunities.

Support for caregivers

The doctor or mental health specialist can assist you in finding an appropriate support group that meets locally. Caregivers can find helpful information, message boards, and online support groups by contacting the National Family Caregivers Association. The Depression and Bipolar Alliance and the National Alliance for Mental Illness are additional resources that have links to caregiver education programs and support groups for individuals and families who have a loved one diagnosed with bipolar disorder.

In summary

Bipolar disorder is a treatable disorder when diagnosed and given proper medical attention. Various medications, therapies, and activities can help the individual cope with the disorder and to thus, live a higher quality of life. Through a better understanding of the causes, symptoms, effects, and treatment of this disorder, you and your loved one will be better equipped should such a diagnosis be made. Support for caregivers and families of loved ones who are diagnosed with bipolar disorder is helpful; there are several options available for you to attend in person or online.  

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