A systematic review of measures of mania and depression in older people with bipolar disorder

Background: Previous research on bipolar disorder (BD) primarily focused on younger adults, with limited research on older adults. This systematic review is the first to investigate how mania and depression are measured in older adults with BD. Methods: The searches were completed in April 2024 using the databases PsycINFO, CINAHL Plus, MEDLINE, and Embase. Fifteen studies with a total of 1041 participants were included. These studies used quantitative measures to assess mania and depression in participants aged 50-98 with BD I or II. The studies' risk of bias was evaluated using the appropriate critical appraisal tools. Results: The Young Mania Rating Scale (YMRS) was the most commonly used measure of mania, while the Center for Epidemiologic Studies Depression Scale (CES-D) and the Hamilton Depression Rating Scale (HAM-D) were the most commonly used measures of depression. The pooled analysis revealed that older adult scores on the YMRS were relatively similar to younger cohorts in both euthymic and manic states. Variability in scores was seen across the depression scales. Limitations: The review followed rigorous systematic processes. However, in some studies, the participant's mood state was unknown, possibly impacting their pooled scores on the measures. Conclusions: The findings from the review add to our existing knowledge regarding the presentation of mania and depression in later life. There is still a great disparity in research developed for the older BD population. Largescale studies are warranted to inform the development of tailored measures and interventions to improve the outcomes for this population.