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Aging with mental illness: Bipolar disorder in older adults

About the author:

Jill Hanika Stout

I was diagnosed with bipolar disorder at the age of 36, but I first showed symptoms at age 10. Now I am 72 years old, and thanks to a hard-won medication regimen, I have been in good balance for a long time . . . until now. I recently noticed distinct signs of hypomania. My doctor and I made some adjustments to my medications, and after a few weeks, I am beginning to balance out again. As we age, it’s important to keep tabs on what our bodies are telling us. As much as we hate the term “mental illness,” bipolar disorder needs to be addressed. Here are the symptoms and where to get help if you or a loved one is diagnosed:

Bipolar disorder is a serious mental illness that is a lifetime diagnosis. It can't be “cured,” but it can be controlled with the right medications and “balance” can be achieved. But as we age, we respond to physical and mental health medications differently, sometimes less effectively. Many seniors have difficulty maintaining good physical and mental health as they get older, and those with bipolar disorder are no exception. Bipolar disorder requires medication as an adjunct to therapy, and in older adults, it is difficult to adjust dosages of medications and manage side effects, especially with co-occurring chronic physical illnesses and their medications.

An estimated 4.4 percent of U.S. adults experience bipolar disorder at some time in their lives.

There are three phases to bipolar disorder: hypomania, mania and depression. Bipolar disorder used to be called manic depression disorder, but the word “bipolar” is thought to better describe the disease as a range of phases. Hypomania is a phase of heightened energy and clear thinking; then it becomes mania, with rapid speech and racing thoughts, decreased need for sleep, grandiose plans, distractibility, provocative or aggressive behavior, and extremely poor judgment. Then comes depression with apathy, a sad or empty mood, loss of energy, sleeping too much, difficulty concentrating, poor memory, and sometimes suicidal thoughts or attempts.

Having both a chronic physical illness or illnesses and a severe mental illness such as bipolar disorder is called comorbidity, and rates of comorbidity in adults over 64 are increasing with the aging population, according to a 2016 article in Geriatric Psychiatry by Dols et al. They found that additional efforts in treatment and research were necessary to optimize care for older adults with bipolar disorder, especially with a shortage of geriatric psychiatric specialists.

Financial considerations are often paramount for older people with bipolar disorder: Therapy and medications cost a lot of money and many older adults live on fixed incomes. But many pharmaceutical companies offer deep discounts on psychiatric meds; check with your doctor or pharmacist for which company to contact.

Older adults with bipolar disorder are at higher risk for suicidal thoughts or overt suicide. Adults 65 and older constitute just 12 percent of the American population, but in 2017 they accounted for an overall suicide rate of about 18 percent. And men commit suicide at a rate of nearly 41 in 100,000 at age 75 and older, the highest of any age group in 2020. Among suicide attempts, one in four seniors will succeed.

Signs of suicidal thoughts include: Loss of interest in activities they used to enjoy; giving possessions away or changing their wills; avoidance of social and family activities; neglect of grooming and/or self-care, or refusing medications; a preoccupation with death; or a lack of concern for their personal safety. If you note any of these signs in your older loved ones or friends, ask them outright if they are considering suicide. Ask them if they have a plan, and ask them to go with you to a doctor or therapist as soon as possible.

You can call the Suicide Hot Line at 800-273-TALK (8255). And as of July 16, 2022, the new 988 emergency number will be available nationwide; it will route callers directly to the National Suicide Prevention Lifeline, where people can call, text or chat to trained counselors who listen, provide support and connect them to resources if necessary. The number 800-273-TALK will remain available.

Bipolar disorder can be a disheartening diagnosis at any age, but people do have opportunities to control the disease and regain control of their lives.

For more information, contact the National Alliance for the Mentally Ill (NAMI) at 800-950-6264, Monday through Friday from 10 a.m. to 10 p.m.; or Mental Health America at (703) 684-7722 to find a local MHA affiliate; or locate local treatment facilities by using the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment locator at 800-622-HELP (4357).

Jill H. Stout works with people who have physical and developmental disabilities. She is an Indianapolis native who now lives in North Carolina. Contact her at


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