The symptoms of bipolar disorder can change with age. For some, the balance of mania and depression may evolve over time.
Co-occurring conditions, whether medical or mental health related, can impact outlooks for older adults with bipolar disorder.
Geriatric bipolar disorder can be managed with the right support. This usually means working with doctors, therapists, psychiatrists, and other specialists.
Everyone experiences changes to their minds and bodies as they age. Some of us might develop conditions like heart disease or arthritis. Others might begin to struggle with mobility or balance. These are often natural parts of the aging process, and they can change how we move through the world.
But for people with bipolar disorder, aging can create other concerns. Some bipolar symptoms might improve with time. Others might get worse, depending on the person. For example, mania may become less frequent or severe [1] as a person ages. But for many older adults, the depressive side of bipolar disorder will become more prominent [2] in later life.
If you're navigating mental health as you age, please know that you're not alone, and help is available. Knowing how bipolar disorder can change with age can help ensure you or a loved one gets the right support during this important life stage.
1. Some symptoms might get better, while others might get worse
Most people with bipolar disorder begin experiencing symptoms long before becoming an older adult. A late onset of bipolar disorder is possible, but it’s not typical.
The average age of onset [3] for bipolar disorder is between 12 and 24 years old. Adolescents and young adults will usually experience a combination of manic and depressive episodes. Their length and intensity will vary based on the type of bipolar disorder. But research shows that, as time goes on, the way they experience their condition may shift.
For younger people, mania may bring about a sense of euphoria. It may be characterized by boundless energy, overconfidence, and an increase in risky behavior. But for older adults, mania may subside [4] or take a different form.
Mania in older people can result in irritability, confusion, or psychosis [1]. Meanwhile, depressive episodes may become more dominant. One recent study of older adults with bipolar disorder found that around 38% of patients [2] had at least one recurrent episode. Of those episodes, most were depressive.
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2. It increases the risk of cognitive decline
People of all ages with bipolar disorder are at increased risk of cognitive decline. The condition is known to impact executive functioning [5]. This includes functions like memory, focus, and processing speed. These executive-functioning challenges may become more obvious as a person gets older. And, unfortunately, they can affect life outside of a mood episode.
Bipolar disorder can also increase the risk of Alzheimer’s disease and related dementias [6] (ADRDs) in older adults. However, we need more research to understand the connection between bipolar disorder and ADRDs. Experts have questioned whether memory issues in older adults are a sign of a new illness [6], like Alzheimer’s, or an aspect of pre-existing bipolar disorder.
3. Co-occurring conditions and the aging process may impact outlook
Having co-occurring conditions can affect health outcomes for older adults with bipolar disorder. People with bipolar disorder have higher rates [2] of diabetes, cardiovascular disease, stroke, and other physical diseases than people without bipolar disorder. They’re also more likely to live with co-occurring mental health conditions [7]. These include post-traumatic stress disorder (PTSD), anxiety, and substance use disorders (SUDs).
Living with multiple conditions can impact the daily functioning and quality of life for older adults. And sometimes, this situation can become complicated by the aging process itself.
As a person gets older, they may experience [2]:
A decrease in their social network size
Less support from friends and family members
Unwanted lifestyle changes
A loss of independence and autonomy
Reduced mobility
Poorer overall physical health
Other aging-related issues
These factors can all play a role in worsening mental health for an older adult with bipolar disorder — and are why getting support is essential.
Why treatment is so important in older age
Left untreated, bipolar disorder [8] can increase mortality and decrease quality of life for older adults.
While there’s no cure for the condition, it can be managed with the right support. This typically involves medical oversight, therapy, and psychiatric medication. However, older adults with bipolar disorder have unique treatment needs. So it’s important to work with providers who understand how the condition can evolve [9] over the lifespan and interact with other concerns.
Research shows that care that addresses both medical and mental health concerns simultaneously can reduce the severity of your symptoms [10]. It can also increase life expectancy [11] for people with bipolar disorder.
The members of your care team will vary based on your unique needs. Some medical and mental health professionals focus specifically on aging. This includes doctors, psychiatrists, therapists, and other specialists. With their combined support, older adults can live a full, vibrant life with bipolar disorder.
Bipolar disorder in older adults is often mistaken for depression, anxiety, or normal aging. Past manic or hypomanic episodes may be forgotten or minimized. This can delay the right diagnosis and lead to treatment that does not fully address the condition.
Brandy Chalmers, LPC
Clinical reviewer
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The way a person experiences bipolar disorder can evolve with age. For some, symptoms will become less severe. For others, the balance of mania and depression might shift. Co-occurring conditions and the aging process can play a role in the mental health of older adults. It’s essential to get the right support for older adults with bipolar disorder.
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References
- Bipolar disorder in late life: clinical characteristics in a sample of older adults admitted for manic episode https://pmc.ncbi.nlm.nih.gov/articles/PMC2518147/
- Older age bipolar disorder https://www.researchgate.net/publication/372417591_Older_age_bipolar_disorder
- Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients https://pmc.ncbi.nlm.nih.gov/articles/PMC3266753/#:~:text=Age%20at%20onset%20of%20type,%2C5%2C6%2C7.
- Bipolar Disorder Among Older Adults: Newer Evidence to Guide Clinical Practice https://gage-bd.org/wp-content/uploads/2024/07/dols-et-al-2023-bipolar-disorder-among-older-adults-newer-evidence-to-guide-clinical-practice.pdf
- Age as a Predictor of Cognitive Decline in Bipolar Disorder https://pmc.ncbi.nlm.nih.gov/articles/PMC3977013/
- Bipolar Disorder and Aging https://pennmemorycenter.org/bipolar-disorder-and-aging/
- Psychiatric comorbidity in older adults with bipolar disorder https://pubmed.ncbi.nlm.nih.gov/16783798/
- Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370%2823%2900471-6/fulltext?utm_
- Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD): Building a Global Consortium Benefiting People with Bipolar Disorder in Later Life https://pmc.ncbi.nlm.nih.gov/articles/PMC12003440/
- Bipolar Disorder Among Older Adults: Newer Evidence to Guide Clinical Practice https://psychiatryonline.org/doi/full/10.1176/appi.focus.20230010?utm_source
- Lithium is associated with decrease in all-cause and suicide mortality in high-risk bipolar patients: A nationwide registry-based prospective cohort study https://www.sciencedirect.com/science/article/abs/pii/S0165032715002888?utm_
Liz Talago
Liz Talago, M.ed. is a mental health professional turned content writer and strategist based in the Detroit metro area. As an independent consultant for mental health organizations, Liz creates meaningful connections between brands and their audiences through strategic storytelling. Liz is known for championing diverse perspectives within the mental health industry and translating bold ideas into inspiring, affirming digital experiences.
In her free time, you can find her hiking with her two German Shepherds, puttering around her dahlia garden, or spending time with her family.
Brandy Chalmers, LPC
Having faced challenges like childhood abuse, neglect, and the loss of her father to suicide, Brandy Chalmers is deeply passionate about providing compassionate care. She is a Licensed Professional Counselor, Nationally Certified Counselor, and Registered Play Therapist with a Master’s Degree in Clinical Counseling and Marriage and Family Therapy.
Brandy also teaches at a university, sharing her expertise with future mental health professionals. With over a decade of experience in settings like inpatient care and private practice, she specializes in helping clients with perfectionism, trauma, personality disorders, eating disorders, and life changes.
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