Noticing extreme mood swings, decreased sleep, and increased anxiety and agitation in your elderly family member? They probably have bipolar disorder. 

Data shows that more than 145 million seniors around the world live with bipolar disorder. To put that in perspective, about 0.5% to 0.9% of people over 50 have this diagnosis. 

The numbers may seem small on paper, but for the families and caregivers involved, the daily reality can be heavy. 

Taking care of older adults with bipolar disorder might seem difficult because their bodies change as they get older. Plus, they often suffer from other serious health problems, like heart disease, at the same time.

There are several things you can do to help them maintain stability, independence, and a strong quality of life. We’ll share those here. 

1. Prioritize Accurate Diagnosis and Regular Monitoring

Getting the diagnosis right is the first priority in geriatric care. Bipolar disorder in the elderly is often misidentified because it mimics the cognitive decline seen in dementia. 

Executive and mnemonic impairments are central to both bipolar disorder and dementia. To make matters more complex, older patients often experience mixed states. These are far more common in late-life bipolar disorder than in younger patients. 

Only an experienced healthcare provider can evaluate symptoms, medical history, medications, and cognitive function and make the right call.

Once the diagnosis is made, the patient needs regular check-ups. The aging brain is very sensitive to small changes. Monitoring cognitive function and memory, besides medication blood levels, is important.    

Having a dedicated healthcare provider who understands these nuances is important. Many families are now finding that specialized care is more accessible than ever, thanks to the growth of highly trained psychiatric nurse practitioners (NPs). 

Many nursing professionals have upskilled through psych NP programs online. Online programs allow professionals to gain certifications without giving up on their jobs.  

Cleveland State University explains that these nurses develop the skills to treat and prevent a full spectrum of mental health disorders across all age groups using proven, evidence-based methods. 

2. Follow a Low-and-Slow Approach With Medications

Medication is a foundation of treatment for bipolar disorder. However, the bodies of older adults process drugs slowly. Adopt a start-low-and-go-slow approach.   

As people age, their organs change how they handle medicine. Renal clearance, or the ability of the kidneys to filter blood, decreases, so drugs stay in the body longer. This can lead to a build-up of toxic levels.  

Lithium is the most effective treatment for bipolar disorder. It helps with mania, depression, and preventing suicide. It may even protect the brain from dementia. A study published in ClinicalTrials.gov confirms that long-term lithium use is linked to a lower risk of dementia. 

But lithium has a narrow safety window in seniors. Therapeutic blood levels must be lower for older adults. For patients aged 60 to 79, the goal is 0.4 to 0.8 mmol/L. For those over 80, it should be 0.4 to 0.7 mmol/L. High levels can cause neurotoxicity.

Other drugs are often used alongside mood stabilizers. Second-generation antipsychotics like quetiapine are helpful for mania. It’s wise to start quetiapine at a very low dose, around 50 mg/day. It can be increased by 50 mg slowly based on how the patient feels.

3. Integrate Psychotherapy into the Treatment Plan

Medicine is rarely enough to manage bipolar disorder on its own. Psychotherapy, or talk therapy, provides tools for daily life. It helps patients understand their illness and stick to their plan. For seniors, therapy can also address the losses that come with aging.

According to PMC research, therapeutic intervention for bipolar disorder reduced medication skipping by 15% and cut down practical difficulties by 31%.

Interpersonal and social rhythm therapy (IPSRT) is built just for bipolar disorder. It focuses on the link between routines and mood. It is based on the idea that small changes in routine can cause big mood swings. This therapy helps people keep their internal clocks stable.

IPSRT typically follows a four-stage process:

• Identifying past mood patterns and life history.
• Selecting a specific focus area, such as grief, life transitions, or interpersonal conflict.
• Using the social rhythm metric (SRM) to track and stabilize daily habits.
• Reinforcing and sustaining these healthy routines for long-term stability.

Cognitive behavioral therapy, or CBT, is also helpful for bipolar disorder. It teaches patients to intercept negative thought patterns before they escalate. It also helps them develop better coping skills for stress.

Supporting Seniors to Lead Balanced, Fulfilling Lives

Managing bipolar disorder in elderly patients requires patience, coordination, and compassion. It’s rarely about one single solution. It’s about layers of support working together. 

When these elements come together, stability becomes much more achievable. Most importantly, approach care with kindness, and you can help seniors maintain their dignity and stay independent for as long as possible.