What does it mean to age well with bipolar disorder?
Creators: name: Warner, Aaron
Publisher: name: Lancaster University
Year: 2023

description: Background: Bipolar disorder is characterised by episodes of mania and
 depression that cause significant impairment and disruptions to people’s
 lives. This diagnosis has been linked to increased rates of suicide,
 reduced lifespan, and increased mortality, although there is limited
 research exploring the challenges faced by people with bipolar disorder as
 they age. It is possible that there is an important interaction effect
 between ageing and bipolar disorder that exacerbates the difficulties
 faced by this group, meaning further attention and support is required.
 This thesis investigated the challenges faced by older adults with bipolar
 disorder and explored their preferences, priorities, and needs in later
 life. Knowledge gathered from four studies helped to identify potential
 adaptations to care that can be used to improve quality of life in this
 population and enable them to age well with bipolar disorder.
 
 
 Methods: A range of methods were used to complete this thesis. First, a
 systematic review and narrative synthesis of 23 papers reporting on 19
 studies was completed to investigate the prevalence and predictors of
 physical health comorbidities in older adults with bipolar disorder.
 Second, a qualitative study consisting of photo elicitation interviews
 with 17 participants used reflexive thematic analysis to analyse data and
 explore what it means to age well for older adults with bipolar disorder.
 Third, 16 biographical narrative interviews were analysed using narrative
 analysis to understand the changing care and care needs of older adults
 with bipolar disorder. Finally, a multilevel analysis of seven waves from
 The English Longitudinal Study of Ageing data was completed to examine
 quality of life in older adults with bipolar mood states and assess the
 predictors of quality of life in this group.
 
 
 Results: Ageing with bipolar disorder was associated with an increased
 prevalence of certain physical health comorbidities such as cardiovascular
 disease and some forms of cancer. To age well, participants highlighted
 the importance of lifelong learning to improve their understanding and
 management of bipolar disorder and find balance in later life. This
 learning also helped participants to feel confident in taking an active
 role in treatment decisions which enabled them to regain agency. Finding a
 sense of belonging, feeling accepted and building upon strengths all
 supported older adults with bipolar disorder to age well. Furthermore,
 giving back to others, such as helping younger age groups with bipolar
 disorder, allowed participants to develop confidence and self-worth.
 Participants indicated that there was a disconnect between the care they
 desired and the care that they currently received from services. Older
 adults with bipolar
 
 disorder appeared to have unique and changing care needs that were often
 neglected. To improve support, services should attempt to offer care that
 is consistent and facilitates the development of trusting relationships
 with professionals. The range of issues faced by this population was found
 to result in poorer quality of life that appeared to be partly driven by
 loneliness.
 
 
 Conclusions: Older adults with bipolar disorder face unique challenges and
 changing care needs that mean treatments require adaptation to improve
 outcomes in this group. At present, treatments appear to focus on symptom
 reduction, although participants indicated that treatments prioritising
 connection and consistency of care are desired. Further attention is
 required to understand the difficulties associated with ageing whilst
 experiencing bipolar disorder, to improve care and reduce the inequalities
 currently experienced by this population.