Developing a recovery focused therapy for older people with bipolar disorder

Tyler, Elizabeth and Jones, Steven and Lobban, Fiona (2022) Developing a recovery focused therapy for older people with bipolar disorder. PhD thesis, Lancaster University.

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Abstract

Background There has been little research into the psychosocial needs of older people living with bipolar disorder (BD). There is evidence to suggest that psychological treatments developed for working aged adults are effective. These treatments may not be acceptable or effective for an older population due to differences in presentation in later life. Aims The overarching aim of the thesis was to develop a recovery focused therapy (RfT) for older people with BD. The main aims were to: improve our understanding of how BD presents in older adults, identify whether any potential adaptations were needed to an existing therapy (RfT) to meet the needs of an older adult population and to evaluate the feasibility and acceptability of RfT for older adults (RfT-OA) with BD. Methods Study one was a systematic review of psychosocial functioning and quality of life in older people with BD. Study two was a qualitative study, using focus group methodology, to increase our understanding of BD in later life and inform the development of RfT-OA. Study three was a mixed methods study to evaluate the feasibility and acceptability of RfT-OA. Results The results from study one indicate that older adults demonstrate a wide range of functioning. Study two found that older adults with BD reported changes in their symptomatology, physical health and cognition. They proposed a number of specific adaptions for delivering RfT-OA including techniques to enhance memory and learning and recommendations for the therapist including: nurturing pre-existing strengths and work focused on building assertiveness and confidence. The findings from study three largely support the feasibility and acceptability of RfT-OA. Clinical assessment measures provided evidence of a signal for effectiveness on a range of outcomes including: mood symptoms, time-to-relapse and functioning. Conclusions The findings suggest that RfT-OA is feasible, acceptable and has the potential to improve a range of outcomes for older adults with BD.