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

08/08/2026

AI Summary

Older-age bipolar disorder had higher all-cause mortality than age and sex matched controls over 8 years (HR 1.72, p=0.006).
Restricted mean survival time was 106.4 days shorter in OABD versus controls, equating to 3.5 months, p=0.018.
Excess mortality in OABD persists into later life; targeted interventions for modifiable physical health and lifestyle risk factors are needed.

AI Summary

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.

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).

Basic summary

Am J Geriatr Psychiatry. 2026 Jul 21:S1064-7481(26)00459-8. doi: 10.1016/j.jagp.2026.07.006. Online ahead of print.

ABSTRACT

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.

PMID:42567731 | DOI:10.1016/j.jagp.2026.07.006

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