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Approximately 25% of geriatric patients with mood disorders have late-onset bipolar disorder. The American Psychiatric Association reports that approximately 5-12% of psychiatry admissions to hospitals for people over 65 years of age are for bipolar disorder. These patients tend to have less of a family history of bipolar disorder than people with younger onset bipolar disorder.

Bipolar episodes in geriatric patients tend to be longer and/or more frequent. Manic syndromes may be associated with substance abuse, medication, or comorbid medical conditions. Mania is more common in older women than men, though in early life the incidence is relatively equal. Bipolar disorder is often the ultimate reason that geriatric patients are placed in a nursing home.

Late-life onset of mania is often associated with neurological disease. In the elderly bipolar population, estimates are that 17-43% of patients have a primary central nervous disorder. This highlights the importance of testing for underlying medical problems when a geriatric patient presents with a mood disorder.

Treatment principles are the same as for younger bipolar patients except that older people may not be able to tolerate the full doses of many medications, (e.g. lithium), because of organ sensitivity or altered metabolism. Side effects may be stronger for older people as well, (e.g., movement disorders or orthostatic hypotension) and this may increase their risk of falling or hip fractures. Geriatric patients are also more likely to develop cognitive impairment from certain medications given for bipolar disorder.