An epidemiological profile of bipolar disorder among older adults with complex needs: A national cross-sectional study

Philip J Schluter; Cameron Lacey; Richard J Porter; Hamish A Jamieson

doi:10.1111/bdi.12511

An epidemiological profile of bipolar disorder among older adults with complex needs: A national cross-sectional study

Bipolar Disord. 2017 Aug;19(5):375-385. doi: 10.1111/bdi.12511. Epub 2017 Jul 5.

Authors

Philip J Schluter^{1

2}, Cameron Lacey^{3

4}, Richard J Porter^{4

5}, Hamish A Jamieson^{5

6}

Affiliations

¹ School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand.
² School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia.
³ Māori/Indigenous Health Institute (MIHI), University of Otago, Christchurch, New Zealand.
⁴ Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
⁵ Canterbury District Health Board, Christchurch, New Zealand.
⁶ Department of Medicine, University of Otago, Christchurch, New Zealand.

PMID: 28677869
DOI: 10.1111/bdi.12511

Abstract

Objectives: Research on bipolar disorder (BD) among community-living older adults is scant and often suffers from important methodological limitations. Using a national database, this study presents an epidemiological profile of BD in older community residents within New Zealand.

Methods: Since 2012, all New Zealand community care recipients have undergone a standardized needs assessment using the Home Care International Residential Assessment Instrument (interRAI-HC). The interRAI-HC elicits information using 236 questions over 20 domains, including BD diagnosis. Those who were assessed between 1 September 2012 and 31 January 2016, who were aged ≥65 years, and who provided consent were included. Statistical investigations employed bivariable and multivariable logistic regression models.

Results: Overall, 71 859 people were eligible; their average age was 82.7 years (range 65-105 years), with 43 802 (61.0%) being female and 798 (1.1%) having a BD diagnosis. Participants' sex, age and ethnic identification were significantly related to BD (all P<.001). Participants with a higher number of comorbidities had greater odds of BD; for those with at least six comorbidities, the adjusted odds ratio (AOR) was 2.32 (95% confidence interval [CI] 1.37-3.92). Almost all considered social and environmental variables were significantly and detrimentally associated with BD, such as living in squalid conditions (2.7% for those with DB vs 1.1% for those without DB; AOR=1.60 [95% CI 1.06-2.42]).

Conclusions: BD among older adults is not uncommon, and numbers will increase as populations age. Increasingly, health services are moving to home-based integrated models of care. Clinicians and decision-makers need to be aware in their planning and service delivery that significant deficits in environment quality and exposure to stressful living circumstances remain for older adults with BD.

Keywords: bipolar disorder; community care assessment; epidemiology; national study; older adults; population health.

MeSH terms

Aged
Aged, 80 and over
Bipolar Disorder* / diagnosis
Bipolar Disorder* / epidemiology
Bipolar Disorder* / psychology
Comorbidity
Cross-Sectional Studies
Databases, Factual / statistics & numerical data
Ethnicity / psychology
Ethnicity / statistics & numerical data
Female
Geriatric Assessment* / methods
Geriatric Assessment* / statistics & numerical data
Humans
Male
Models, Statistical
Needs Assessment
New Zealand / epidemiology
Odds Ratio