Background: Bipolar disorder is characterised by episodes of mania and depression that cause significant impairment and disruptions to people’s lives. This diagnosis has been linked to increased rates of suicide, reduced lifespan, and increased mortality, although there is limited research exploring the challenges faced by people with bipolar disorder as they age. It is possible that there is an important interaction effect between ageing and bipolar disorder that exacerbates the difficulties faced by this group, meaning further attention and support is required. This thesis investigated the challenges faced by older adults with bipolar disorder and explored their preferences, priorities, and needs in later life. Knowledge gathered from four studies helped to identify potential adaptations to care that can be used to improve quality of life in this population and enable them to age well with bipolar disorder.

Methods: A range of methods were used to complete this thesis. First, a systematic review and narrative synthesis of 23 papers reporting on 19 studies was completed to investigate the prevalence and predictors of physical health comorbidities in older adults with bipolar disorder. Second, a qualitative study consisting of photo elicitation interviews with 17 participants used reflexive thematic analysis to analyse data and explore what it means to age well for older adults with bipolar disorder. Third, 16 biographical narrative interviews were analysed using narrative analysis to understand the changing care and care needs of older adults with bipolar disorder. Finally, a multilevel analysis of seven waves from The English Longitudinal Study of Ageing data was completed to examine quality of life in older adults with bipolar mood states and assess the predictors of quality of life in this group.

Results: Ageing with bipolar disorder was associated with an increased prevalence of certain physical health comorbidities such as cardiovascular disease and some forms of cancer. To age well, participants highlighted the importance of lifelong learning to improve their understanding and management of bipolar disorder and find balance in later life. This learning also helped participants to feel confident in taking an active role in treatment decisions which enabled them to regain agency. Finding a sense of belonging, feeling accepted and building upon strengths all supported older adults with bipolar disorder to age well. Furthermore, giving back to others, such as helping younger age groups with bipolar disorder, allowed participants to develop confidence and self-worth. Participants indicated that there was a disconnect between the care they desired and the care that they currently received from services. Older adults with bipolar
disorder appeared to have unique and changing care needs that were often neglected. To improve support, services should attempt to offer care that is consistent and facilitates the development of trusting relationships with professionals. The range of issues faced by this population was found to result in poorer quality of life that appeared to be partly driven by loneliness.

Conclusions: Older adults with bipolar disorder face unique challenges and changing care needs that mean treatments require adaptation to improve outcomes in this group. At present, treatments appear to focus on symptom reduction, although participants indicated that treatments prioritising connection and consistency of care are desired. Further attention is required to understand the difficulties associated with ageing whilst experiencing bipolar disorder, to improve care and reduce the inequalities currently experienced by this population.