Understanding Bipolar Disorder in Later Life

Bipolar disorder is a mental health condition that causes extreme shifts in mood, energy, activity, and concentration levels. Many think that bipolar disorder is only diagnosed in young people, but older adults are affected, too. Knowing how bipolar disorder can present in seniors — whether it’s managing symptoms from a diagnosis at a young age or late-onset bipolar disorder — is key to finding the proper care.

Key takeaways

• Bipolar disorder can affect seniors in very distinct ways, often showing up as subtler mania, more frequent depression, cognitive changes, and reduced daily functioning than classic symptoms.
• Late-onset bipolar disorder in older adults is frequently underdiagnosed or misdiagnosed, especially since symptoms can overlap with dementia, medical conditions, and normal aging.
• Early recognition, proper treatment, and strong caregiver support can significantly improve quality of life and reduce serious risks in older adults with bipolar disorder.

How bipolar is different for seniors

Late-onset bipolar or older age bipolar disorder (OABD) affects between 0.5%-1% of older adults. This is much lower than the rate for patients aged 18 to 44, which is 1.4%. But the lower prevalence rate among older adults is likely due to underdiagnosis and premature death from co-occurring conditions. 

Symptoms of bipolar disorder in older adults fall under two main categories: manic and depressive episodes.

Manic episodes (mania) are periods of abnormally elevated mood, behavior, activity, and energy levels.

Some common symptoms of manic episodes include:

• Excessive hopefulness, happiness, and excitement
• Sudden and severe mood changes
• Restlessness
• Recklessness and risk-taking behaviors
• Increased impulsivity and poor judgment
• Psychosis (in more severe cases)

People with bipolar disorder may also experience depressive episodes, whose symptoms mimic those of major depressive disorder (MDD).

Symptoms of bipolar depressive episodes in older adults can include:

• Feelings of sadness and overwhelm
• Lack of motivation
• Low energy and fatigue
• Loss of interest in activities you once enjoyed
• Insomnia or poor sleeping patterns
• Suicidal thoughts

Bipolar disorder can affect anyone regardless of age, but for older adults, it can manifest in different ways. 

A research review finds that bipolar disorder in seniors often shows up as: 

• Manic episodes that are more subtle, presenting as agitation, poor judgment, or sleep disruption
• More frequent and prolonged depressive episodes than manic ones
• Decline in daily functioning, independence, and social connection
• Changes in cognitive functioning, such as difficulties with memory, attention, and executive functioning
• Bipolar disorder often co-occurs with physical illnesses (e.g., heart disease, metabolic conditions, and neurological changes), which can influence mood and response to treatment

When it comes to bipolar disorder diagnosed at a young age vs. late-onset bipolar disorder or OABD, the former can pose more severe symptoms. Research shows that older adults with early-onset bipolar disorder (EOBD) typically experience more severe symptoms and a poorer treatment response. They also have higher rates of rapid cycling, which is four or more manic or depressive episodes a year.

For older adults with OABD, there are often fewer and milder manic symptoms. But they do tend to have more frequent irritability and a higher risk of cognitive issues.

Possible risk factors that may worsen already-existing bipolar disorder or trigger OABD include:

• Loss of social connections
• Loss of support from family and friends
• Limited mobility
• Worsening physical health

Why diagnosing bipolar disorder in older adults can be difficult

Diagnosing bipolar disorder in the elderly can be challenging for several reasons. One primary reason is that symptoms can often overlap with dementia. Research shows that many symptoms of frontotemporal dementia may be present in late-onset bipolar disorder, including cognitive issues, mood changes, and behavioral symptoms (sleep and appetite).

A study reveals that older adults with OABD are more likely to have co-existing medical conditions, including respiratory, cardiovascular, endocrine, and metabolic disorders. Patients may be managing three to four of these conditions simultaneously, along with bipolar disorder. These medical conditions can also worsen outcomes for OABD, including a higher risk for suicide.

Research also shows that alcohol use disorder, panic disorder, generalized anxiety disorder, and dysthymia (persistent depression) commonly co-occur in older adults with late-onset bipolar disorder. 

In addition to overlapping symptoms and co-occurring conditions, patients may overlook or even dismiss their bipolar symptoms, leading to a missed diagnosis. 

Unfortunately, misdiagnosis of bipolar disorder in the elderly can have a detrimental impact on recovery, potentially leading to:

• Worsening symptoms
• Ineffective treatment 
• Rapid cycling 
• Increased risk of suicidal ideation or suicide
• More complex physical conditions
• Cognitive decline
• More frequent hospitalizations
• Significant emotional distress

Noticing the signs and seeking help from a mental health professional can help correctly diagnose bipolar disorder and start proper treatment.

Managing and treating bipolar in seniors

If you or a loved one is showing signs of bipolar disorder, seeking treatment is recommended. Prescription medications, psychotherapy, and electroconvulsive therapy (if medication fails) may be suggested by a mental health professional. 

Aside from medical treatment, lifestyle changes can also support someone with bipolar disorder.

These include:

• Creating and maintaining a sleep schedule
• Getting between seven and eight hours of sleep (unless a healthcare provider advises otherwise)
• Practicing mindfulness, such as meditation, deep breathing, or yoga
• Engaging in regular physical activity
• Eating regular, balanced meals
• Learning the warning signs of mania or depression

How loved ones can support

Here’s what you can do to support a senior with bipolar disorder:

• Encourage routine and stability: Help them create and maintain consistent sleep, meal, and activity routines, which are all essential for mood regulation.
• Look out for subtle mood changes: In older adults, bipolar symptoms can look like irritability, confusion, agitation, sleep problems, or withdrawal. This is much different than classic symptoms like mania or depression.
• Support medication adherence: Without policing them, assist with medication organization and be aware of potential side effects or interactions.
• Reduce stress or overstimulation: Keep their living space calm, well-lit, and clutter-free, and avoid significant schedule changes when possible.
• Build a support network: Encourage them to connect with family, friends, peer groups, or senior programs.
• Take care of yourself: Supporting someone with bipolar disorder can be emotionally taxing. Seek caregiver support groups, respite care, or counseling when needed.

Strategies for adult children and caregivers

If you’re the child or caregiver of a loved one with bipolar disorder, it’s crucial to understand how to communicate with them.  Be calm, respectful, and grounded in empathy, while also accounting for age-related changes, such as reduced cognitive functioning and medical complexities.

Here are some practical tips that can help with communication:

• Lead with respect and dignity
• Keep communication clear and calm
• Validate their feelings without reinforcing their symptoms
• Offer suggestions to support independence 
• Choose the timing of conversations carefully
• Know when to pause if their emotions escalate

Bipolar disorder and suicide risk in older adults: When to seek help

Research shows that older men with bipolar disorder have a higher risk of dying from suicide. In addition, older women with bipolar have a higher risk of suicide attempts. The rate of suicide among patients with bipolar disorder is about 10 to 30 times higher than in the general population — signaling an urgent need for mental healthcare and support.

If you’re the child or caregiver of a senior struggling with bipolar disorder, here are a few warning signs that require immediate attention:

• Frequent conversations about harming themselves, feeling hopeless, having no reason to live, or being a burden to others
• Increased use of alcohol or other substances
• Seeking ways to end their lives, such as searching online for methods
• Withdrawing from activities they once enjoyed
• Isolating themselves from family and friends
• Giving away prized possessions
• Mood changes, such as anxiety, depression, loss of interest, irritability, shame, or relief

The sooner you can get your loved one in care, the better. If you or someone you know is experiencing thoughts of suicide, know that help is available. You can call or text 988 for the Suicide and Crisis Lifeline to speak to someone. 

Therapy, the role of telehealth, and your Medicare roadmap

Therapy can often complement medication for treating bipolar in seniors. Cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy, psychoeducation, and family-focused therapy are different types of talk therapy that can help older adults manage their bipolar symptoms.

Therapy can help seniors with bipolar disorder:

• Identify triggers for episodes and learn coping mechanisms
• Stabilize their daily schedules
• Address age-related challenges like cognitive changes or social isolation
• Improve medication adherence
• Strengthen support networks

For seniors who face mobility challenges, can no longer drive, or don’t want to visit an office, telehealth might be an option. They can meet with their therapist from the comfort and privacy of their home, keeping them safe and giving them autonomy in their care.

Cost is often a barrier for people seeking mental healthcare. Fortunately, for seniors receiving Medicare, their Part B plan should cover mental health services for bipolar disorder. 

Medicare Part B covers the following outpatient mental health services:

• Talk therapy
• Family counseling
• Medication management
• Psychiatric evaluation
• Annual depression screenings

Seeing a mental health provider who accepts Medicare insurance can help reduce the costs of therapy for late-onset bipolar disorder.

At Sailor Health, we offer telehealth via computer, phone, or landline, and most of our Medicare patients have a $0 copay for mental health services. Our therapists specialize in helping older adults and have a deep understanding of their complex emotional and psychological needs. We give seniors and their families peace of mind that they are in experienced, reliable hands. Get started today. 

References

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