New Research Addresses Symptoms of Older-Age Bipolar Disorder

Martha Sajatovic, MD

With the population aging, clinicians might soon begin to see more and more older patients suffering from psychiatry disorders, including bipolar disorder (BD).

By 2030, the number of people over 60 years old is expected to increase 3.5 times more rapidly than the general population. Currently, about 25% of those with bipolar disorder are at least 60 years old.

However, researcher into the impact of bipolar disorder among older individuals are limited.

A team, led by Martha Sajatovic, MD, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, analyzed data from the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) to assessed older-age bipolar disorder associations among age, bipolar disorder symptoms, comorbidities, and functioning.

“With the global population of older adults increasing more rapidly than any time in history, there is an urgent need for data that are specific to late-life among individuals with BD,” the authors wrote.

The Analysis

In the analysis, the researchers identified harmonized, baseline, cross-sectional data from 19 international studies involving 1377 participants with a mean age of 60.8 years old. In addition, 72% of the patient population was diagnoses with bipolar disorder I.

The researchers used various standardized measures, including the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS). And Global Assessment of functioning (GAF).

The mean total YMRS score was 4.3 and 22% of patients suffered from moderate to severe depression.

Associations

After controlling for sample effects, both manic and depressive symptom severity appeared lower in older participants (P <0.0001). The negative relationship between older age and symptom severity was similar across sexes.

However, this relationship was stronger among participants with lower education levels.

GAF was mildly impaired (mean = 62.0; SD = 13.3), while somatic burden was high (mean = 2.42; SD = 1.97).

Finally, comorbidity burden was not linked to GAF, but higher depressive (P <0.0001) and manic (P <0.0001) symptoms were associated with lower GAF, most strongly among the older participants.

“Findings suggest an attenuation of BD symptoms in OABD, despite extensive somatic burden,” the authors wrote. “Depressive symptom severity was strongly associated with worse functioning in older individuals, underscoring the need for effective treatments of BD depression in older people. This international collaboration lays a path toward a better understanding of aging in BD.”

The results are generally in-line with other studies examining these trends, including an inverse association between duration of diagnosis and depressive symptoms in older patients with bipolar disorder. This suggests that older adults have acclimated to their bipolar disorder diagnosis and symptoms and have devices effective coping strategies.

However, the results were somewhat surprising.

“Our original hypothesis that greater somatic burden would be associated with reduced functioning was not confirmed in the full sample of studies,” the authors wrote. “This may be because our measure of functioning, the GAF, is not intended to reflect impairment due to physical or environmental limitations. It is also possible that the same acquired competence in mood symptom management that some people with OABD achieve might be helpful in optimizing functioning.”