[Prevalence, diagnosis and treatment of personality disorders in older adults]

Abstract

Aim: This article addresses manifestation, course, diagnosis and treatment of personality disorders in older adults (>60 yrs).

Method: A literature search, using "Cochrane Central Register of Controlled Trials (CENTRAL)", Cochrane Database of Systematic Reviews (CDSR)", "PsychINFO 2000-present" and "PUBMED", concerning relevant literature from 1980-2009. Keywords were "personality disorder", "elderly", "older adults", "prevalence", "diagnosis" and "treatment". The combinations of these keywords resulted in 32 relevant hits.

Results: Prevalence studies addressing specific personality disorders show that within different subpopulations personality pathology of clusters A and C (odd respectively anxious behaviour) are quite common in older adults whereas cluster B personality disorders (impulsive behaviour) is more prevalent in younger adults. Besides, it appears that the personality questionnaires and interviews used in adult care are not yet validated for older adults in mental health care and nursing homes. Furthermore, there is no convincing reason why psychotherapy variants proven to be effective for adults (<50 yrs) wouldn't be feasible for older adults. Particularly with respect to cognitive (behavioural) therapy and schema therapy, there is some evidence from case studies suggesting that these therapies are well applicable to the elderly.

Conclusion: Prevalence rates appear questionable since the assessment methods applied in the epidemiological studies correspond inadequately to the specific behavioural manifestations of elderly persons with personality pathology. In addition, the number of specific (test)diagnostic tools for older adults are scarce. Currently, there is a lack of empirical data concerning treatment of personality disorders in older adults. However, at this moment several studies are focussed to improve diagnostics and therapy of personality disorders in geriatric psychiatry in the Netherlands and Belgium.