Dr. Tarra Bates-Duford
Late Onset Bipolar Disorder: Seniors
Bipolar disorder is a characterized as a severe, chronic psychiatric disorder that includes chronic cycling between both high and low mood states. Persons suffering from bipolar disorder often experience significant mood fluctuations that are not necessarily influenced by external stimuli. Those with bipolar disorder (untreated) often experience challenges related to maintaining relationships, functional challenges/limitations, financial problems, increased ideations of suicide and an overall decreased in quality of life. Until recently, the extent of late onset bipolar disorder was called into question. Late onset symptoms were called into question because most people assume it was basically impossible for persons to experience symptoms for the first time late in life. It was initially thought most people had begun experiencing bipolar symptoms much earlier in life, however, it was more than likely they never sought treatment or they were over reporting the seriousness of the manic symptoms. Fortunately, late onset bipolar symptoms are now recognized by mental health professionals and other treatment providers. We now know that there is a specific form of bipolar disorder that can develop in older adults.
In contrast to younger individuals with bipolar disorder, studies have determined that older adults are more likely to be hospitalized for manic symptoms and experience a significant degree of disability related to the depressive symptoms. Additionally, older adults are more likely than their younger counterparts to experience “rapid cycling” meaning they experience more than 4 episodes of depression or mania over the course of a single year, making treatment a must.
Co-occurring disorders in senior populations is often difficult to identify as decline in physical and mental health can mimic other illnesses or exacerbate pre-existing issues. While it can be difficult to determine true co-occurring conditions in older populations due to normal fluctuations in health and realistic worries and concerns, research suggests that certain disorders do co-occur with late onset bipolar disorder.
6 Disorders That Are More Likely to Co-Occur with Seniors Include:
Post-traumatic Stress Disorder
Social Phobia / Social Anxiety
Substance / medication induced anxiety disorder
Generalized Anxiety Disorder
The specific causes of late onset of bipolar disorder are unknown, however there is support indicating certain factors are positively correlated to the development of this group of disorders. Factors include but are not limited to; neurological issues, genetic, previous history of strokes, brain shrinkage, etc.
Signs and Symptoms of Depression Include:
Symptoms of bipolar disorder are present, yet they often appear more pronounced than they are in younger suffers of bipolar disorder.
Chronic often lengthy sadness
Frequent episodes of crying with or without cause
Disproportionate concerns about the state of one’s health
Lack of interest in enjoyable activities
Changes in “normal” eating and sleeping patterns
A sense of helplessness over the perceived inability to control anything within their environment
Changes in weight
Confusion and disorientation
Symptoms of Mania include:
Moving faster than usual, leading to falls and injuries
Complex paranoid delusions
Decreased need or desire for sleep
Hyperverbal speech or being overly talkative, talking in a rambling manner or speaking in an incoherent manner
Effects of Late Onset Bipolar Disorder:
Increasing inability to tolerate physical pain
Impaired cognitive functioning
Increased use of medical health services/Decreased use of behavioral health services
Increased risk of morbidity and mortality due to complications of other illnesses and risk of suicide
Debilitating effects on general ability to function normally in daily activities
Hyper-vigilance related to bodily functions and interpreting normal aches and pains as an indication of a catastrophic illness
Manic episodes in older adults often present with confusion, disorientation, distractibility, and irritability rather than elevated, positive mood. The presence of psychosis, sleep interruptions/ disturbances, and aggression may lead to the mistaken diagnosis of dementia or depressive disorder rather than mania. Late-onset mania is more often secondary to or closely associated with other medical disorders, most commonly stroke, dementia, or hyperthyroidism; it is also associated with medications including antidepressants, steroids, estrogens, and other agents with known central nervous system properties.