title: Do current national and international guidelines have specific recommendations for older adults with bipolar disorder? A brief report.
abstract: Older adults with bipolar disorder (OABD) are a growing segment of patients with bipolar disorder (BD) for which specific guidelines are warranted. Although, OABD are frequently excluded from randomized controlled trials due to their age or somatic comorbidity, more treatment data from a variety of sources have become available in recent years. It is expected that at least some of this emerging information on OABD would be incorporated into treatment guidelines available to clinicians around the world.
  
  
  
  The International Society of Bipolar Disorders OABD task force compiled and compared recommendations from current national and international guidelines that specifically address geriatric or older individuals with BD (from year 2005 onwards).
  
  
  
  There were 34 guidelines, representing six continents and 19 countries. The majority of guidelines had no separate section on OABD. General principles for treating OABD with medication are recommended to be similar to those for younger adults, with special caution for side effects due to somatic comorbidity and concomitant medications. Therapeutic lithium serum levels are suggested to be lower but recommendations are very general and mostly not informed by specific research evidence.
  
  
  
  There is a lack of emphasis of OABD-specific issues in existing guidelines. Given the substantial clinical heterogeneity in BD across the life span, along with the rapidly expanding population of older individuals worldwide, and limited mental health workforce with geriatric expertise, it is critical that additional effort and resources be devoted to studying treatment interventions specific to OABD and that treatment guidelines reflect research findings. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Old Age Psychiatry, GGZinGeest, VU Medical Center, Amsterdam, The Netherlands. a.dols@ggzingeest.nl.
authors.forename: Annemiek
authors.initials: A
authors.lastname: Dols
authors.affiliation: Psychiatric Center Copenhagen, Faculty of Health and Medical Sciences, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lars Vedel
authors.initials: LV
authors.lastname: Kessing
authors.affiliation: Bipolar Disorder Program, Gerontopsychiatry Department, INECO, Neurosciences Institute, Favaloro University, Buenos Aires, Argentina.
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Strejilevich
authors.affiliation: Division of Geriatric Psychiatry, University of Toronto, Toronto, Canada.|Geri-PARTy Research Group, Jewish General Hospital, McGill University, Montreal, Canada.
authors.forename: Soham
authors.initials: S
authors.lastname: Rej
authors.affiliation: Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan.|Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Shang-Ying
authors.initials: SY
authors.lastname: Tsai
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Ariel G
authors.initials: AG
authors.lastname: Gildengers
authors.affiliation: School of Psychiatry and Clinical Neurosciences & Centre for Medical Research, The University of Western Australia, Perth, Australia.
authors.forename: Osvaldo P
authors.initials: OP
authors.lastname: Almeida
authors.affiliation: Geriatric Psychiatry, Faculty of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Shulman
authors.affiliation: Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000097:blood / Q000523:psychology / Q000628:therapy*; D015897:Comorbidity; D006299:Health Services for the Aged; D006801:Humans; D008094:Lithium / Q000097:blood; D017410:Practice Guidelines as Topic; D011613:Psychotherapy / Q000379:methods*
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D008094:Lithium
keywords: bipolar disorder; evidence-based medicine; geriatric; guideline; manic-depressive disorder; older