Title: A pilot study to test the feasibility and acceptability of delivering recovery focused cognitive-behavioural therapy to older adults with bipolar disorder
Funder: Department of Health and Social Care

Abstract: Background Bipolar Disorder (BD) is a severe and chronic mental health problem that persists into older adulthood. Current estimates suggest around 0.5% of people over 65 years of age are living with BD (2). However this figure is set to rise as the UK experiences a rapid ageing of its population (3). BD in later life is associated with greater morbidity, including a higher prevalence of psychotic features (4) and a higher risk for suicide compared to older adults with other mental health conditions (5). Taking these factors together it is clear that addressing BD in older adults should be a high priority for healthcare researchers and clinicians (6). In practise however there has been very little research or service development for older adults with BD particularly with respect to psychological therapies (7). The National Institute of Clinical Heath guidelines for BD (NICE; 8) highlight the absence of evidence for older adults with regards to psychosocial interventions. Whilst research for BD in later life is lacking, there is evidence for the effectiveness of such interventions for BD in adults of working age (8, 9, 10). A recent RCT from our group has shown a recovery focused CBT intervention (RfCBT) for individuals with BD (below 65 years) is beneficial in terms of both functional and symptomatic outcomes (11, 12) Aim The aim of the research is to adapt the RfCBT manual for individuals with early BD so that it meets the needs of an older adult client group. Once adapted, the manual of recovery focused CBT for older adults (rfCBT-OA) will be tested out using a randomised controlled trial (RCT) design. Plan The first stage of the study is to conduct a transdiagnostic systematic review of psychological interventions for older adults. This will provide insight into effective psychological therapies and adaptations made to these for the treatment of mental health problems in later life. This information will be used during the intervention development at stage 2. During stage 2 a number of focus groups will take place with individuals with lived experience of BD and an expert' clinical and academic group. They groups will be asked to comment on the content of the draft manual and the acceptability and suitability of the intervention for the proposed client group. Finally, during stage 3 the intervention will be tested out using a RCT to determine the feasibility and acceptability of RfCBT-OA plus treatment as usual (TAU) compared with TAU. Potential benefits to patients and NHS The Department of Health (13) states that older adults with mental health problems should have access to the same range of therapies as those people under the age of 65, which is not the case for people with BD. There are no published studies evaluating psychological interventions for older adults with BD and there is a clear need to develop an evidence base for this population. There is evidence for the effectiveness psychological interventions for BD in adults of working age (8, 9, 10) and older adults should have access to the same provision of psychological treatments. The rapid aging of the population will make significant demands on healthcare services especially if the current lack of evidence based treatments continues. The development of a recovery focused psychological intervention has the potential to improve outcomes for service users, helping them to develop a range of coping strategies and putting them more in control of managing their mental health problems. This would save the NHS money through a reduction in use of mental health services.

Lay abstract: Psychological interventions are effective on a number of outcomes for individuals with bipolar disorder (BD); however the evidence base is limited for those over 65. The study will adapt an existing recovery focused cognitive behavioural therapy (CBT) intervention for individuals with early BD so that it meets the needs of a older adult (OA) population. The recovery focused CBT intervention for OA (RfCBT-OA) will be tested out by comparing two groups; one receiving RfCBT-OA plus treatment as usual (TAU) and one continuing with TAU. This will provide information on whether RfCBT-OA is a feasible and acceptable type of therapy. .

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH