New-onset bipolar disorder in later life.
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.
Sajatovic
Martha
M
Dept. of Psychiatry, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA. Martha.sajatovic@uhhs.com
Blow
Frederic C
FC
Ignacio
Rosalinda V
RV
Kales
Helen C
HC
D017668:Age of Onset; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001714:Bipolar Disorder / Q000453:epidemiology*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D014728:Veterans / Q000706:statistics & numerical data