Finally, physicians reported that both psychotherapy alone, and in combination with pharmacotherapy, were less effective for older patients than for younger patients. In addition to other possible reasons for older adults' low rates of mental health service use, this study suggests that family physicians' beliefs and treatment intentions could be contributing factors. Changes in medical education aimed at replacing inaccurate beliefs with accurate information regarding older patients might be one way to increase rates of use in this underserved age group, because family physicians play a key role in the mental health care of older adults. This article has been peer reviewed. To review the classification, clinical characteristics, and epidemiology of bipolar disorders in old age with a special focus on neurologic comorbidity, high mortality, and management.
Most available data is gleaned from retrospective chart reviews and cohort studies.
Treatment recommendations are based on evidence from younger populations and a few anecdotal case reports and series involving elderly people. While relatively rare in the community setting, mania in old age frequently leads to hospitalization. Management of bipolarity includes cautious use of mood stabilizers, especially lithium and divalproex. Close clinical follow up is essential. This article has been peer reviewed.