Comparing 8-Year Survival Rates in Older-Age Bipolar Disorder (OABD) and Its Clinical Predictors to the General Population.

OBJECTIVE: w?>Bipolar disorder (BD) is associated with reduced life expectancy, but it is unknown if this extends into later life or if older-age bipolar disorder (OABD) represents a survival cohort. METHODS: In this prospective cohort study, 227 adults aged ≥50 years with BD from the Dutch Older Bipolars (DOBi) study were compared with 681 matched (on age and sex) controls (CG) from the Longitudinal Aging Study Amsterdam (LASA). All-cause mortality was assessed over 8 years. Kaplan-Meier survival, restricted mean survival time, and Cox proportional hazards models were applied. RESULTS: In total, 37 (16.3%) OABD and 138 (20.3%) CG participants died during the 8-year follow-up. Kaplan-Meier curves indicated earlier mortality in OABD. Restricted mean survival time over 7.5 years was 2500.7 days (95% confidence interval [CI] 2419.9-2581.5) in OABD and 2607.2 days (95% CI 2572.3-2642.0) in CG, corresponding to an average survival difference of 106.4 days (3.5 months; 95% CI 18.4-194.5; p = 0.018). In Cox models, OABD was associated with higher mortality risk compared with CG (hazard ratio (HR) = 1.72; 95% CI 1.17-2.54; p = 0.006). CONCLUSION: In this longitudinal cohort study, OABD had significantly higher all-cause mortality than age- and sex-matched population controls, with a shorter restricted mean survival time and an increased hazard of death over 8 years. Thus, excess mortality persists into later life, and OABD is not solely a survivor cohort. Targeted strategies addressing modifiable physical health and lifestyle risk factors are warranted to reduce premature mortality in this vulnerable population.