PERSONALITY DISORDERS IN LATE LIFE: PERSPECTIVES FROM CLINIC, ER AND LONG TERM CARE SETTINGS: Session 417

Abstract

Clinicians are often challenged with identifying and managing difficult personality disorders in older adults. Provocative and hostile behaviors can estrange treatment providers and interfere with care; indeed, patient attitudes in relation to caregivers and providers are often revealing of diagnosis, despite complexities of medical illness, cognitive changes and psychiatric co-morbidities. In this session, we will use case examples from multiple clinical settings (outpatient clinic, psychiatric emergency room, and long term care consultation service) to highlight the challenges geriatric psychiatrists face in working with older adults with severe personality disorders. Presenters will review age-related psychosocial stressors, including personal losses and debility, and connect them to varied dysfunction across the lifespan, including patterns of attenuation of symptoms over time, re-emergence of personality disorder in late life and chronically persistent illness. In the outpatient clinic, Dr. Marouf will review common difficulties associated with narcissistic and borderline personalities, including diagnostic dilemmas in the setting of medical and psychiatric co-morbidities and the evidence for a range of treatment options. In the acute emergency room, Dr. Needell will focus on the challenges of safety assessments in these patients and decision making around disposition planning to minimize risks. In long term care consultation, Dr. Frankel will discuss the impact of sociopathic and dependent personalities on quality of care and care delivery, including management of staff responses, milieu disruption and other challenges to facility administration.