BPD and the Elderly

QUESTION:

Dear Dr. Heller,

Where can I obtain information on BPD and the elderly? There is a lot of information online about BPD but nothing seems to address the specific needs of an older person who has this disorder. How does one properly place their parent in an adult family home or nursing care facility when it is necessary to do so?  Many caretakers know how to handle them.  Some are unwilling to do so.

ANSWER:

There isn't a lot of information. I remember one study showing how elderly borderlines act self- destructively by acting passive aggressively in ways like refusing to eat, refusing to take pills, refusing to go on outings, etc. I've taken care of many elderly borderlines and I agree with that assessment. Many BPD symptoms remain, particularly the moodiness and misinterpretation of motives.

Elderly borderlines are often referred to as "cantankerous" or "problem" patients. I treat them identically as younger patients. All the diagnoses need to be made and comprehensively treated, and I use my screening test for them as well.

The only significant difference is that physicians usually have to start with lower doses and go somewhat slower. The advantage - in addition to them being happier and their loved ones less stressed - is that the individual is usually less sick from other causes and often needs lower doses of medication for high blood pressure, arthritis, and diabetes.

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