Bipolar disorder in the latter half of life: symptom presentation, global functioning and age of onset.

BACKGROUND: Little is known about bipolar disorder in late life. Recent research has been in acute, in-patient, settings, and has focused on late-onset mania, or has produced samples with surprisingly late mean ages of onset. No recent study has used a larger out-patient sample to address late-life outcomes of bipolar disorder.
METHODS: 86 community-residing, middle-aged and older adults who met RDC for bipolar I or II were interviewed using the Schedule for Affective Disorders and Schizophrenia, three times over 8 months.
RESULTS: Participants were primarily unmarried and impoverished. Most were living alone or with immediate family members. The majority were in depressive episodes. Depressive symptoms were more common and more predictive of functioning than manic symptoms. Age of onset was related to global functioning. The effect of age of onset was mediated by number of depressive episodes.
CONCLUSION: Most adults in this sample had supports to maintain them in the community in spite of chronic or intermittently cycling manifestations of affective disorder and limited medication. Consistent with prior research, early age of onset was related to poorer functioning, apparently by increasing the number and severity of depressive episodes. LIMITATIONS: Limitations stem from possible exclusion of those people with the worst and best outcomes. It also is a relatively young sample for a gerontological study. CLINICAL RELEVANCE: The study suggests that more attention needs to be paid to diagnosing and treating depressive episodes in later life.