Recent developments in the epidemiology, co-morbidity and outcome of mania in old age

Factors related to hospitalization in elderly manic patients with early and late-onset bipolar disorder

OBJECTIVE

To identify factors contributing to relapse and hospitalization in elderly patients with bipolar disorder.

METHOD

Retrospective chart review surveyed consecutive patients over age 65 admitted to the Johns Hopkins Hospital for a manic episode over a five year period (n=73). Factors precipitating index admission were compared in patients with early-onset bipolar disorder (<or=age 45, n=38) and late-onset bipolar disorder (>age 45, n=35).

RESULTS

The distribution of ages of onset of bipolar disorder was most consistent with a bimodal pattern with a cut-point at age 45. Early-onset patients were more likely to have been aggressive and threatening prior to admission (p=0.014) compared to late-onset patients and were more likely to have been brought to the emergency room on emergency petition for evaluation (p=0.028). Early-onset patients were also more likely to have been non-adherent with prescribed psychiatric medication (p=0.032).

CONCLUSIONS

Relapse and rehospitalization were common among elderly manic patients with early-onset and late-onset bipolar disorder. Strategies which improve medication adherence are needed to help prevent recurring hospitalization.