Managing Late-Life Bipolar Disorder: An Update

Abstract

Changing national demographics in concert with growing sophistication in the treatment of bipolar illness have highlighted the need for a better understanding of how bipolar disorder (BD) presents and might be best managed in older adults. Suffering and burden related to illness can be expected to not only affect the older adult with BD, but also families and society at large given the multidimensional effects of the illness on functional status and interpersonal relationships. Clinicians struggling to meet the needs of geriatric patients with BD have few evidence-based studies on which to base treatment decisions, and often must balance treatment of bipolar illness with extensive medical comorbidities. This article will address geriatric BD, including a discussion of epidemiology, illness onset chronology, clinical presentation of BD among geriatric patients, the entity of secondary mania or mania related to identified medical/neurologic pathologies, and treatment and management issues including pharmacotherapies, other biologic treatments and psychosocial interventions. Finally, ongoing challenges and unmet needs with respect to geriatric BD will be discussed.