Older Age Resources
Resources for clinicians
Created by the OABD Task Force, this page is as a resource for clinicians who treat those with older age bipolar disorder (50+ year old). This information is being provided to help disseminate the decades of reseach that has now shown that there are unique treatment and outcome considerations for the OABD population.
Page Content
Information on Lithium Serum Levels in OABD
Global Aging and Geriatric Experiments in Aging Adults with Bipolar Disorder (GAGE-BD)
Assessment of Functioning
Despite the importance of psychosocial functioning impairment in bipolar disorder, its role among OABD is not well understood. Until recently, the field lacks a measure of functioning that was specifically adapted for older adults. Orhan et al developed and validated the Functioning Assessment Short Test for OABD – the FAST-O, for use with adults over 50 years. Adapted from the FAST, the main changes were to replace the occupational functioning domain with a societal functioning domain. This includes activities such as volunteer work or taking care of grandchildren in addition to paid work, since older adults may be retired. The FAST-O is an indicator of a patient’s current level of daily functioning, and therefore focuses on performance.
The ISBD OABD Task Force and its members have undertaken to translate and cross-culturally validate the FAST-O. Psychometrically-validated versions in English and Spanish are available below; translated (but not yet validated) versions are available in over 10 additional languages.
OABD Lithium Serum Levels
The ISBD OABD Task Force published Delphi consensus-based recommendations for lithium therapeutic ranges in OABD (Shulman et al. Bipolar Disord 2019; doi:10.1111/bdi.12714)
Ages 60 – 79 Lithium serum level 0.4 – 0.8 mmol/L
Ages 80 and above Lithium serum level 0.4 – 0.7 mmol/L
In older adults, the risk of lithium toxicity is increased due to decreased renal function, medical comorbidities, and polypharmacy associated drug-drug interactions with commonly used drugs such as diuretics, ACE Inhibitors and non-steroidal anti-inflammatory medications. Moreover, lithim toxicity is often unrecognized and misdiagnosed as other conditions and can result in inappropriate additional prescriptions (the “prescribing cascade”). The commonly reported lithium therapeutic ranges (0.6-1.2 mmol/L) are too high for older adults and poses risk in missing lithium toxicity becasue some potentially toxic levels can be misinterpreted as “within the therapeutic range”. Providing lower and narrower therapeutic ranges for older patients would help to prevent adverse side effects, particularly neurotoxicity.
Bibliography
Official Task Force Publications:
Learn more about Functioning in OABD
Learn more about Nutrition and Nutritional Supplements in OABD
Read the report “Do National and International Treatment Guidelines Include OABD?”
GAGE-BD
Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) is a collaborative effort of researchers dedicated to understanding how bipolar disorder evolves as people age. Although the elderly are the fastest growing group in the US, studies of OABD are extremely limited. GAGE-BD was initiated in 2016 by Martha Sajatovic, Lisa Eyler, Annemiek Dols and Soham Raj with seminal funding from the ISBD, through the generous support of Charles Bowden and Virginia Massey-Bowden and the Bowden Massey Strategic Research Initiative in Bipolar Disorder Grant.
The global team has collected data from studies of OABD previously conducted in over 13 countries and brought them together into the world’s largest set of information about aging with bipolar disorder. This has created a powerful framework for reusing old data to ask new questions and has generated novel, clinically relevant knowledge to help those working with OABD patients and pave the way for personalized and effective treatments.
Learn more about this effort at GAGE-BD.org. You can find PDFs of all GAGE-BD publications HERE.
Contact GAGE-BD if you would like to contribute data to this initiative – new collaborators are always welcome!
An OABD Task Force keynote on comorbidity in older adults Presenter: Annemiek Dols
An OABD Task Force Assessement of Fuctioning in Older Adults for Professionals
An OABD Task Force Assessement of Fuctioning in Older Adults for Professionals
An OABD Task Force Assessement of Fuctioning in Older Adults for Professionals
An OABD Task Force Assessement of Fuctioning in Older Adults for Professionals
An OABD Task Force Assessement of Fuctioning in Older Adults for Professionals