Navigating Bipolar Disorder in the Elderly: Understanding Unique Symptoms and Challenges

Treating bipolar disorder in the elderly can bring new challenges than may be found in other populations. According to Amber Hoberg, PMHNP-BC, Morning Star Family Medicine PLLC, elderly patients with bipolar disorder and more depressive episodes than younger patients and have a more unique set of stressors that could be impeding treatment. Join Nurse Hoberg as she discusses how treatment differs between populations, how changes in the brain can affect treatment response, and how clinicians and other mental health professionals can approach this patient population. 

Nurse Hoberg discussed this and other topics at the 2023 Psych Congress NP-Institute in Boston, Massachusetts. Save the date for next year's NP Institute In-Person, March 20-23, 2024, in San Diego, California! For more information, visit the meeting website. Keep up with pre-conference meeting coverage in our newsroom. 

Read the Transcript:

Meagan Thistle, Psych Congress Network: How does bipolar disorder treatment in the elderly population differ from treating younger patients?

Amber Hoberg, PMHNP-BC: Bipolar disorder is still very similar in the types of symptoms that you would have with bipolar in the younger patient. The only big difference is that elderly patients actually have more depressive episodes in regards to their bipolar symptoms. As patients age, actually it becomes a little more protective, which means we need less medications and often the symptoms improve over time as patients age. We do see sometimes that they don't have the manic spells as often, but the depressive spells tend to still be such a problem in the elderly patient.

The reason why elderly patients tend to have a little more protectivity, this is both with bipolar and schizophrenia. What tends to happen is that as patients age, the brain changes. As the brain changes, what happens is the neurotransmitters change. With that comes sometimes the need for less medication and improvement in symptoms.

Thistle, PCN: What stressors are unique to older adults that may trigger manic depression?

Nurse Hoberg: The stressors that are unique to older patients in regards to depression and bipolar disorder are mainly a lot of the reasons why sometimes they may come into an assisted living or a nursing home. Just the change in environment tends to be a big stressor that can increase risk factors for this. Also, chronic medical conditions, especially if they become terminal or they're continuing to progress, that's another reason why we see depression and sometimes bipolar, both manic and depressive symptoms. Also, polypharmacy. As patients tend to age, they tend to get on more medical medications as well as psychiatric medications. So often we see worsening in their depression and their symptoms with bipolar as well. Some of the other factors tend to be loss, so they tend to experience more loss of loved ones, lost of family members, siblings, spouse. That tends to be also another factor that causes high risk for these things.

Amber Hoberg, MSN, APRN, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner from the University of Texas Health Science Center, San Antonio. She has been working for the past 12 years with the adult and geriatric populations treating all types of psychiatric conditions. Her background, as a psychiatric advanced practice nurse, includes outpatient, inpatient, group home, and nursing home/ALF settings. She currently works for Med Management Associates and Morning Star Family Medicine PLLC treating the chronically mentally ill in both inpatient and outpatient settings.