Lifestyle and psychotherapy interventions for older adults with bipolar disorder

PURPOSE OF REVIEW: Bipolar disorder (BD) in older adults presents unique clinical challenges, and nonpharmacological interventions are an important component of comprehensive care, with more favorable side-effect profiles. This review synthesizes recent evidence on lifestyle and psychotherapy interventions for older adults with BD. RECENT FINDINGS: Evidence derives predominantly from observational studies, with few interventional trials. Lifestyle analysis - largely from large-scale biobank cohorts - identifies smoking, sleep dysregulation, sedentary behavior, suboptimal diet, and weight extremes as modifiable risk factors associated with BD onset and course. Despite guideline recommendations, cognitive behavioral therapy for insomnia remains underutilized in BD. In psychotherapy, recovery-oriented and strengths-based models, including Recovery-focused Therapy and Functional Remediation for older adults, show feasibility and acceptability, with a randomized trial underway. Physical activity research is severely limited by absence of interventional studies in older adults with BD, with available evidence indicating that cognitive function and sedentary behavior may be bidirectionally associated. SUMMARY: Lifestyle and psychotherapy interventions for older adults with BD remain limited by paucity of interventional evidence, particularly for this age group. Integrated, age-sensitive, and recovery-oriented approaches hold promise. Future research must prioritize trials that include older adults and address lifestyle factors and their impact on course, cognition and psychosocial functioning.