Bipolar Disorder in Older Adults: Clinical Presentation, Challenges, and Management Strategy

Bipolar Disorder in Older Adults: A Comprehensive Overview of Pharmacotherapy Patterns and Clinical Considerations

Considerations for Opioid Use Disorder in Older Adults

To summarize current evidence regarding the epidemiology, risk factors, diagnosis, and treatment of opioid use disorder (OUD) in older adults, with emphasis on age-specific challenges related to screening, clinical presentation, pharmacologic management, and emerging treatment approaches. OUD among older adults is increasing despite declining opioid prescribing rates, with rising rates of opioid-related hospitalization and overdose mortality. Diagnosis remains challenging because age-related physiologic changes, polypharmacy, and cognitive impairment may obscure traditional manifestations of OUD. Existing screening instruments and diagnostic criteria have important limitations in elderly populations. Medications for opioid use disorder (MOUD) remain the cornerstone of treatment, with buprenorphine being favored for its safety profile and flexible formulations. Older adults represent a clinically distinct and understudied population with OUD. Current evidence supports individualized use of MOUD while accounting for comorbidities, polypharmacy, and age-related physiologic changes. Future research should prioritize geriatric-specific screening tools, diagnostic frameworks, treatment protocols, and clinical outcomes.

The recognition, diagnosis, and management of late-onset bipolar disorder.

INTRODUCTION Late-onset bipolar disorder (LOBD) represents a clinically relevant but understudied subtype of bipolar. Compared with early-onset bipolar disorder, LOBD may present with distinct clinical features, increased somatic comorbidity, and potential associations with neurodegenerative and vascular processes. Specific diagnostic and therapeutic recommendations for LOBD are currently limited. AREAS COVERED This narrative review examines the current evidence regarding epidemiology, pathophysiology, diagnostic workup, and management of LOBD. Literature was identified using PubMed to conduct a structured literature search of the MEDLINE database for articles between 2015 and 2025, and review of relevant articles. Particular attention is given to differential diagnosis with secondary mania and neurodegenerative disorders, the role of medical and neurological evaluation, and treatment considerations including pharmacological strategies, neuromodulation, psychosocial interventions, and longitudinal follow-up. EXPERT OPINION Current evidence suggests that LOBD likely represents a heterogeneous condition with multiple underlying mechanisms, including vascular burden, neurodegenerative processes, and age-related biological vulnerability. Comprehensive somatic and cognitive assessment is essential. While treatment generally follows established bipolar disorder guidelines, careful adaptation is required due to comorbidity, polypharmacy, and age-related pharmacodynamic changes. Lithium, with its potential neuroprotective properties, may be the first-choice medication. Future research should focus on clarifying pathophysiological mechanisms and developing tailored management strategies.

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Integrated approaches to geriatric mental disorders: pathophysiology, interventions, and precision medicine horizons

The global aging demographic has precipitated a surge in late-life mental disorders (LMDs)—including late-life depression (LLD), anxiety, and behavioral and psychological symptoms of dementia (BPSD)—posing critical public health challenges. This review synthesizes current evidence on the unique pathophysiology, clinical management, and emerging frontiers of geriatric mental health, emphasizing the interplay of neurobiological aging, multimorbidity, and psychosocial stressors. Key pathophysiological mechanisms include “inflammaging” (microglial overactivation), cerebral small vessel disease (CSVD), and senescence of monoaminergic systems, which collectively reduce neural resilience and complicate diagnosis. Clinical challenges—such as atypical symptom presentation (e.g., somatic masking of depression), polypharmacy risks, and diagnostic ambiguity between LLD and pseudodementia—necessitate tailored interventions. Notably, caregiver burden represents an independent predictor of patient institutionalization. Multiple systematic reviews and meta-analyses have consistently identified caregiver burden and distress as significant predictors of nursing home admission, with carer stress sometimes serving as the single determining factor for this transition. This underscores the critical need to integrate caregiver well-being into routine clinical assessment. Pharmacological strategies prioritize SSRIs/SNRIs but require cautious dosing due to age-related pharmacokinetic alterations (e.g., reduced renal clearance) and cardiovascular/metabolic risks. Emerging targets (e.g., ketamine for treatment-resistant LLD, anti-inflammatory agents guided by biomarker profiling) highlight a shift toward precision. Psychotherapeutic adaptations—including modified cognitive behavioral therapy (CBT), problem-solving therapy (PST), and life review therapy—address cognitive and psychosocial needs, while integrated care models (e.g., Collaborative Care Model [CoCM]) demonstrate superior outcomes over fragmented care. Lifestyle interventions (exercise) and neuromodulation (rTMS) further expand treatment options. Critical gaps remain, including underrepresentation of older adults in clinical trials and pervasive polypharmacy. Future directions emphasize pharmacogenomics, AI-driven early detection, and culturally equitable care to advance precision psychiatry for LMDs. This synthesis provides clinicians and researchers with a roadmap to navigate the complexities of geriatric mental health, advocating for multidisciplinary, patient-centered approaches to improve outcomes in aging populations.

Exploring and understanding delirium: a comprehensive narrative review with emphasis on neurological disorders

An updated overview of delirium is provided, emphasizing its complex pathophysiology, clinical characteristics, risk factors, diagnostic challenges, and management strategies, particularly in patients with neurological disorders.