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New-Onset Bipolar Disorder in Later Life

Received July 21, 2004; revised December 9, 2004; accepted December 13, 2004. From the Dept. of Psychiatry, University Hospitals of Cleveland, Cleveland, OH (MS) and the Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor VA Healthcare System, Ann Arbor, MI (FCB, RVI, HCK). Address correspondence and reprint requests to Martha Sajatovic, MD, Dept. of Psychiatry, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106. e-mail: Martha.sajatovic{at}uhhs.com
© 2005 American Association for Geriatric Psychiatry

Objective: This analysis of a large VA database evaluated differences in clinical presentation, health service use, and psychotropic medication utilization among 16,330 patients with bipolar disorder age 60 and older. Selected differences were compared between new-onset and earlier-onset groups. Methods: Geriatric patients with new-onset bipolar illness (NOI) were compared with geriatric patients with earlier-onset bipolar illness (EOI) on selected clinical variables and on health resource utilization. Results: Among the 65,556 individuals with bipolar disorder treated in the VA in federal fiscal year 2001 (FY 01), 16,330 (24.9%) were age 60 or older. The large majority, 13,477 (82.5%), had earlier-onset bipolar illness, whereas 1,000 individuals (6.1%) had apparently new-onset bipolar disorder. A fairly consistent pattern in health resource use when comparing new- versus earlier-onset bipolar disorder was overall less resource utilization by individuals with new-onset illness. As compared with EOI individuals, NOI individuals have less outpatient care overall and fewer mental health care visits. Conclusions: Bipolar disorder among older adults is common in the VA and is an increasingly emphasized problem in older non-VA populations, as well. Health service use by older adults with bipolar disorder is high, and includes substantial utilization of inpatient non-psychiatric care. Distinctions between earlier- and new-onset bipolar disorder have important implications with respect to illness presentation and health resource utilization.

Key Words: Bipolar Disorder

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