Do current national and international guidelines have specific recommendations for older adults with bipolar disorder? A brief report

• Published in: International journal of geriatric psychiatry Vol. 31; no. 12; pp. 1295 - 1300
• Main Authors: Dols, Annemiek, Kessing, Lars Vedel, Strejilevich, Sergio A., Rej, Soham, Tsai, Shang-Ying, Gildengers, Ariel G., Almeida, Osvaldo P., Shulman, Kenneth I., Sajatovic, Martha
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.12.2016; Wiley Subscription Services, Inc
• Subjects: Anticonvulsants - therapeutic use; Antidepressive Agents - therapeutic use; Antipsychotic Agents - therapeutic use; Bipolar disorder; Bipolar Disorder - blood; Bipolar Disorder - psychology; Bipolar Disorder - therapy; Comorbidity; evidence-based medicine; geriatric; Geriatric psychiatry; Geriatric psychology; guideline; Guidelines; Health Services for the Aged; Humans; Lithium - blood; manic-depressive disorder; older; Practice Guidelines as Topic; Psychotherapy - methods; bipolar disorder; older; geriatric; manic-depressive disorder; evidence-based medicine; guideline
• ISSN: 0885-6230; 1099-1166; 1099-1166
• DOI: 10.1002/gps.4534

Objective Older adults with bipolar disorder (OABD) are a growing segment of patients with bipolar disorder (BD) for which specific guidelines are warranted. Although, OABD are frequently excluded from randomized controlled trials due to their age or somatic comorbidity, more treatment data from a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world. Methods The International Society of Bipolar Disorders OABD task force compiled and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards). Results There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD. General principles for treating OABD with medication are recommended to be similar to those for younger adults, with special caution for side effects due to somatic comorbidity and concomitant medications. Therapeutic lithium serum levels are suggested to be lower but recommendations are very general and mostly not informed by specific research evidence. Conclusions There is a lack of emphasis of OABD‐specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited mental health workforce with geriatric expertise, it is critical that additional effort and resources be devoted to studying treatment interventions specific to OABD and that treatment guidelines reflect research findings. Copyright © 2016 John Wiley & Sons, Ltd.