UH Psychiatrist Honored for International Coalition to Better Understand Bipolar Disorder in Older Adults
September 18, 2023
UH Clinical Update | September 2023
Older adults with bipolar disorder are some of the least understood of all psychiatry patients. Because the condition can shorten a person’s lifespan by as much as two decades, many patients simply don’t survive into their 60s, 70s and beyond to help inform research and clinical decision-making about what the ideal care for them should be. As a result, doctors and researchers who study the condition consider an “older adult” with bipolar disorder to be age 50 or older.
“Folks lose one to two decades of life, so if you just focus on what we traditionally think of as seniors, age 65 or older, you're really not addressing the issue,” says UH psychiatrist Martha Sajatovic, MD, Director of the Neurological and Behavioral Outcomes Center and Willard W. Brown Chair in Neurological Outcomes.
Even with this expanded definition of “older adult,” data on bipolar disorder is relatively scarce, Dr. Sajatovic says.
“Predictors of clinical course in older-age bipolar disorder have not been clearly articulated so far,” she says. “Findings are primarily based upon data from a limited number of research samples with a relatively narrow geographic and age representation.”
“There’s not very much attention to what we need to do to support and treat people with bipolar disorder who are older,” she adds. “Many of them aren’t around, unfortunately. An additional and important burden to people living with bipolar disorder is stigma — negative societal attitudes and behaviors that are directed towards people with a mental health condition. Because they fear stigma or discrimination, people don't want to talk about it or seek help for their bipolar disorder. The other unfortunate thing that happens is when people get older, there can be a tendency to believe anything that happens in the brain is due to dementia or other kinds of conditions rather than bipolar disorder.”
Unique features: Some research to date has shown that bipolar disorder is indeed different in older adults, Dr. Sajatovic says. However, with more people now living longer, she says, much more study is needed.
“Some studies suggest a progressive worsening of symptoms over the course of bipolar disorder, with more depressive symptoms in older-age bipolar disorder and less psychotic symptoms,” she says. “Clinical course may differ depending on age at onset, gender and economic resources. Importantly, deficits of everyday functioning are common in older-age bipolar disorder, with mood symptoms, cognitive deficits and medical conditions all contributing to disability. Understanding symptom development and outcomes across adulthood will enable anticipation of the needs of people with bipolar disorder and fuel development of strategies to modify the condition’s course.”
International research effort: To that end, Dr. Sajatovic has helped lead an international coalition to invigorate the study of bipolar disorder in older adults. The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE‐BD) project is an integrated database, combining data from studies of older adults with bipolar disorder conducted by different sites from around the world. Funded by a grant from the International Society for Bipolar Disorders (ISBD), the project includes Dr. Sajatovic and contributors from University of California at San Diego, Lady Davis Institute of McGill University in Montreal, Canada, and University Medical Centre Utrecht in the Netherlands.
In fact, Dr. Sajatovic recently received the prestigious Mogens Schou Award for research from the ISBD in recognition of her leadership with GAGE-BD.
“Data analysis using GAGE-BD is expected to help address knowledge gaps in our understanding of older-age bipolar disorder, potentially informing future research and clinical care,” she says.
Urgent need: Dr. Sajatovic says now is the moment to invest more time and energy into research with this group.
“First, people are fortunately living longer,” she says. “That's true for everybody, but also for people with bipolar disorder around the world. Second, we do have more treatments available to us. Lithium is still foundational and a first-line treatment. But we have a bigger repertoire of medications and other treatments that are now available. We know that not everybody's going to respond to lithium and having more treatment options is critical. Third, we are making some progress on stigma. So there just is greater awareness now.”
Congratulations to Dr. Sajatovic on her Mogens Schou Award for research from the International Society for Bipolar Disorders.