“IT'S NOT ME, IT'S YOU” PERSONALITY DISORDERS IN GERIATRIC PATIENTS

Introduction Personality refers to the unique characteristics and qualities that define an individual's ability to form relationships, cope with life stressors, and approach the tasks of daily living. However, when these patterns become debilitating or interfere with interpersonal relationships or overall functioning, the result is referred to as a disorder. Personality disorders persist into late life and pose complex challenges in patients across various medical and psychiatric settings. Many older adults with personality disorders can easily become overwhelmed by age-associated losses and stresses, largely because they lack appropriate coping skills and the personal, social, or financial resources to buffer their losses. Personality disorders persist into late life and pose complex challenges in patients across various medical and psychiatric settings. Most studies estimate that 10% of older adults have personality symptoms that rise to the level of a clear disorder, the most common include Borderline, Narcissistic and Dependent traits. Methods 3 case studies from patient population at Mount Sinai Beth Israel Psychiatric Department, which is full service teaching hospital which has been serving New York City for the past century. Beth Israel has an academic affiliation which Ichan School of Medicine at Mount Sinai and is a major clinical campus. The psychiatric department serves a multicultural, varied socio-economic patient population. One case was chosen from outpatient geriatric clinic, comprehensive psychiatric emergency program (CPEP) and inpatient geriatric psychiatry unit from 2017 to 2019. The cases presented illustrates symptoms on of the three categories of personality disorders as listed in DSM 5, and the barrier it presented to treatment. A personalized treatment planning approach was utilized in each case. Results Case Studies: 1) Mr. RG an elderly male with overwhelming Dependent Personality Disorder has exhausted many clinicians before arriving to the outpatient clinic of an academic medical center. He utilized high levels of services, often visiting the Emergency Department and Clinic in the same day, several times per week. A safety net intervention was created for the patient, with frequent check ins and calls to help reduce excess service utilization and prevent unnecessary hospitalizations. 2) Ms. MZ an older woman with many Borderline and narcissistic traits was dissatisfied with every clinician who cared for her in the past. She wrote, called and came to the institution demanding different providers, medications and care plans without following up on any. A behavioral contract with utilized to maintain support but prevent overt acting out. 3) Ms. AS has been with the program for decades, with frequent periods of absences due to moving in with friends and relatives over suspiciousness towards landlords and neighbors. She has been highly functional in isolative jobs but has difficulty relating to others as her suspicious thoughts become overwhelming. She has difficulty trusting health care professionals and is reluctant to seek care for medical problems. While supportive therapy proved limited, low doses of a second generation antipsychotic agent allowed her to feel less anxious in some settings. Conclusions The limited literature on the prevalence and longitudinal course of older adults with personality disorders makes treatment strategies difficult and challenges the clinician to adapt therapies on a case by case basis. These clinical vignettes illustrate how therapeutic strategies may be adjusted to meet the needs of older adults who are dissatisfied with care, utilize services at high rates but reject care repeatedly and often show limited benefits. Plans include setting up a data base of personality disorder symptoms in late life and the interventions found to be most successful. Matched with up to date clinical practice information on late life personality disorders frequently encountered by practicing clinicians designed to offer practice guideline for psychotherapeutic and psychopharmacologic strategies. This research was funded by: n/a