We all know that as you get older things change. People will start noticing changes in your moods, your energy levels or even your likes and dislikes. But watching someone you love suffer from a mental health disorder is disheartening. Especially when it is undiagnosed and untreated. Bipolar in the elderly is become more and more common. We are going to look at an elderly Mother who has undiagnosed Bipolar and doesn’t know how to accept she might be suffering from a mental health problem. It’s starting to consume the kind, soft person you used to know, and you want her ‘old self’ back.
Bipolar disorder in the elderly is one of those undiagnosed mental health disorders. As people age their memory starts to fade, their moods changes and one just assumes its part of growing old. Cognitive decline is a notable feature in older adults with bipolar disorder and can often be mistaken for normal aging, making it important to consider underlying causes.
What happens if it is more than part of growing old? What happens if it is an untreated mental health disorder? Bipolar in the elderly can be managed and treated to enhance their quality of living. But how, you may be wondering? Well, the same way as any other mental health disorder and any person of any age. The answer to this question is by meeting with a professional who specializes in Bipolar. And family members can educate themselves about the disorder.
You are here to help understand Bipolar and more importantly what is Bipolar in the elderly. You want to know how you can help your kind, soft-hearted Mother find a way to manage her symptoms and lead a life without the drastic ups and downs.
Whether it’s your Mother or Mother-in-law battling with Bipolar, it can be extremely scary for them. They can’t understand why they get these bursts of energy and then want to sleep for 4 days straight after it. It can be difficult for them to accept that they might be suffering from a mental health disorder. They might be in denial or refuse to accept that there might be something medically wrong.
From my personal experience, my Mother-in-law has great days. She’s dolled up and ready to take on the world. She is extremely friendly and welcoming. She wants to take on her backyard or redesign her kitchen. Then the next day, she is angry and wants to fight about simple things. She climbs into her bed and we don’t hear or see her for days. Leaving us wondering if she is okay. Then she is back to planning her future retirement years and even going on a date or two.
People who suffer from Bipolar can go days, weeks, and months without an episode. Take my Mother-in-law, for example, it has been 14 days since her last episode. She is currently renovating her entire home. Redoing her kitchen, redoing her bathrooms. Breaking out walls, putting in new sliding doors. She is even moving to another home for a few months so that her building team can really start ripping things apart. And there she is smiling and excited. Ready for her new home to be finished. I even got asked to help her choose new tiles and counters for her kitchen and bathrooms. Let me just say, the home is going to look amazing. I can’t wait to see the finished product. With her moving to another home for a few months, who will keep an eye on her? How will we know she is mentally doing okay?
It can be hard to keep track of whether it’s an up or down day. We walk around on eggshells, waiting for an outburst or wondering if she’s in our kitchen rearranging our cupboards. It’s taxing on even the most well-balanced family members. You can see the drastic change in her moods daily, and you want to reach out to her and ask her if she needs to see a Doctor. But the fear of her reaction if you mention the Doctor’s name means you avoid the topic.
Another thing we noticed with my Mother-in-law is that her memory is terrible. After she has an outburst in which she shouts and screams at everyone, she will simply forget. We will all be hurt and upset around her and she just walks around like nothing happened. Smiling or sleeping, depending if it’s an up or down day. She won’t understand why no one wants to come for tea or to talk. When we mention what she did, she denies it and states she never did such a thing.
Bipolar can cause you to suffer from brain fog and this will cause you to forget the simplest tasks, things you might have been doing for years. All of a sudden you forget the pot on the stove or forget to take the laundry out of the dryer. Simple things that would have been second nature in the past are now proving more complicated.
Cognitive functioning can be significantly affected from Bipolar in the elderly, making it harder to distinguish between symptoms of bipolar disorder and other causes of memory loss.
You want to help her, you see her struggling. If only you understood how to help, and how to approach the topic of her going for a mental health evaluation, without causing an outburst or putting her in a depressive state for days on end. People are often afraid to be labeled as someone with a mental health disorder, but by getting diagnosed, you can finally lead a normal life, understanding the disorder better and getting the appropriate treatment and support.
Explaining to your Mother that you aren’t here to judge her. You only want to help her. Help her find her strength, help her get treatment if she needs it. You love her and you want to support her.
Bipolar as You Get Older
There has been an increase of elderly patients presenting symptoms of bipolar disorder. Especially from the age of 50 years and over. These symptoms often get misdiagnosed and without the correct testing can be hard to correctly diagnose. Hence making OABD a more complex form of bipolar to diagnose and treat. If left untreated OABD can result in the patient suffering from increased risk of cognitive disorders, impaired psychosocial function or even premature death.
Research shows that Bipolar in the elderly or OABD sufferers are more likely to suffer from depressive episodes rather than manic episodes. Signs like your Mother not wanting to socialize anymore or becoming more of a recluse is prevalent. Staying in bed for days and not going on her usual walks is also a sign. Below are some more signs to be aware of.
Symptoms and Signs of Bipolar
- Engaging in risky or impulsive behavior, such as reckless driving or overspending
- Changes in appetite, eating more or less
- Suicidal thoughts or suicidal ideation
- Changes in energy level: sleeping much more or much less than usual
- Making major plans or commitments but not following through with them
- Feelings of hopelessness or despair alternating with feelings of extreme happiness and excitement
- Frequent changes in self-image or self-esteem
- Neglecting self-care and activities of daily living
Bipolar in the elderly doesn’t always present manic or depressive episodes. They may go weeks or months without any symptoms at all before a manic or depressive episode kicks in. This is one reason why bipolar disorder is such a complicated and misunderstood condition. The symptoms come and go and can vary so much, you or your aging loved one may feel like you’ve been “cured” of the illness when the symptoms have simply subsided for a time.
The importance of a thorough differential diagnosis cannot be overstated, as it helps distinguish bipolar disorder from other causes of mood and cognitive changes in late life, such as dementia, depression, delirium, or neurological disorders. Mood disorders, including bipolar disorder, are common in older adults and require careful evaluation and management.
Bipolar Disorder Care Plan
Mental healthcare professionals should treat all Bipolar in the elderly or OABD patients with integrative psychiatry. This takes into account cognitive and physical conditions, and requires careful assessment and management of both medical comorbidities and psychiatric comorbidities in older patients. This not only limits pharmacotherapeutic options but also impacts the quality of life and psychosocial functions.
Although medication tends to be effective in managing the symptoms of OABD, doctors may use special precautions when prescribing psychotropic medication to seniors. Pharmacological treatment in older patients requires consideration of age-related changes in drug metabolism, risk factors for adverse effects, and the presence of medical comorbidities. You might metabolize medicine at a different speed when you get older, so the dosage of the medication may change as you age.
Additionally, seniors are more likely to take other prescription medications, so your doctor will have to make sure that there are no drug interactions. This is why medication management is so important while getting treatment. This is to ensure that the correct medication is given and that you don’t experience any negative side effects. Doctors want to help you get better, they want to help you manage your symptoms better. Improve your state of life.
Elderly Bipolar Treatment
- Social support: A robust support system can include family members and close friends. Individuals with OABD can also join support groups alongside others who also live with the condition. This shared experience fosters a sense of belonging, reduces feelings of isolation, and provides insights into coping strategies.
- Lifestyle adjustments: Making lifestyle changes is integral to OABD management. A person can establish and maintain consistent daily routines, prioritize sleep, and learn stress management techniques.
- Medication: Doctors consider medications the cornerstone of OABD management. The options include mood stabilizers such as lithium and anticonvulsants. Maintenance lithium treatment plays a key role in the long-term management of bipolar disorder in older adults, with careful monitoring for side effects and dose adjustments. Antipsychotics, including atypical antipsychotics such as quetiapine, olanzapine, risperidone, lurasidone, and asenapine, can help manage severe symptoms, and in some cases, antidepressants can alleviate symptoms of depression. The choice of psychotropic medication should be individualized, considering the safety profile and comorbidities of older patients.
- Psychotherapy: Key therapeutic approaches include cognitive behavioral therapy and interpersonal and social rhythm therapy. Interpersonal and social rhythm therapy helps people learn to regulate their moods using their own social and biological rhythms.
Clinical symptoms and risk factors may differ in older patients compared to younger individuals, with variations in symptom presentation, comorbidities, and treatment response that require age-specific management approaches.
How to talk to loved ones with bipolar disorder:
Firstly, approach the topic with care and support. It’s a very fragile line to make assumptions and to offer help. Chances are, your Mother is already concerned about the way she is feeling and wondering what might be wrong. Sometimes the best way to talk to someone suffering from Bipolar is to listen more than you would speak.
Here are some tips on how to approach the subject
- Offer support: Try to be there for them.
- Listen more: Just listen, don’t offer advice.
- Help on Call: Offer your help when needed.
- Code Word: A code word when it’s a bad day.
- Doctor Checkup: Suggest a physician checkup.
- Don’t minimize: Be understanding when they talk.
- Open-ended Questions: Ask how they are feeling.
- Manic/Depressive Triggers: Help find their triggers.
- Noticeable Behavior: Mention noticeable behavioural changes.
Mental Health Checks in older age bipolar disorder
This might be the scariest step for your Mother to take. By doing the mental health evaluation, it means that she will get diagnosed. And we all know the saying ‘ignorance is bliss’. As you get older, you feel the less you know about illnesses, the better your life will be. Your Mother will need your support and care now more than ever to embark on this journey. You can’t force her to go for the evaluation, she needs to want to do the testing herself. It may feel frustrating to you, but remember this is a huge step she is taking. One of the biggest in her life.
Be patient with your Mother. Her life might be changing, and she is petrified. Encourage her and support her. Be the pillar she always was for you. Explain to her that nothing will change; she will just find suitable ways to manage her symptoms and she can still lead her normal life.
Finding a psychiatrist who specializes in geriatric patients and has experience with Bipolar would be a great start. It is especially important to consult a specialist in geriatric bipolar disorder to ensure best practices and tailored treatment for older adults. They will do the consultation, medication management, and all the necessary testing to correctly diagnose your Mother. Then her journey will start. This is not to say there won’t be bad days, because just like any other diagnosis, there will be good and bad days.
When it comes to diagnosis, it is crucial to distinguish between bipolar disorder and major depressive disorder in older adults, as these conditions can present with overlapping symptoms but require different treatment approaches.
The most important thing to remember is that your Mother and you have started this journey for a better future. Growing older shouldn’t be scary and Bipolar in the elderly is not a death sentence.
Light at the end of the tunnel
As with everything in life, there is always a light at the end of the tunnel. Your Mother has been diagnosed, she is seeing a psychiatrist to manage her symptoms, and she is on the right path. Unfortunately, Bipolar is not something that can be cured, but it is something that can be managed, and with family support, your Mother can lead a wonderful life.
Every day, she will start feeling more empowered and more in control of her ups and downs. She will feel more confident asking for help on her bad days. You will start seeing her smiling and laughing more. Things might not be exactly as they were before, but her moods will be more balanced. And to think this all started with you having the courage to speak to her about how she was feeling. Good job!!
Remember that being diagnosed with a mental health disorder is not the end of the world. Rather than suffering from symptoms that may make you worry even more. Go get it checked out. It will give you peace of mind knowing that is the cause of your ups and downs. Treatment is readily available and speaking about it will help you understand the disorder better. There is no shame in mental health. It takes a strong person to seek help. With the correct diagnoses you will know exactly what to expect in your future and your family will know exactly how to support you. You are not alone. You can do it.
Reach out today to a professional and start living your life the way you imagined it without the worry and turmoil. Everyone needs professional help in life. You will feel stronger and empowered knowing how to manage the symptoms. Knowledge is power. Start your journey today.
References:
- Anderson IM, Haddad PM, Scott J. Bipolar disorder. BMJ. 2012 Dec 27;345:e8508. doi: 10.1136/bmj.e8508. PMID: 23271744.
- Smith DJ, Whitham EA, Ghaemi SN. Bipolar disorder. Handb Clin Neurol. 2012;106:251-63. doi: 10.1016/B978-0-444-52002-9.00015-2. PMID: 22608626.
- Shobassy A. Elderly Bipolar Disorder. Curr Psychiatry Rep. 2021 Jan 6;23(2):5. doi: 10.1007/s11920-020-01216-6. PMID: 33404961.





