Personality disorders in Older Adults Tier 1 What

Personality disorders in Older Adults Tier 1

What is personality? The word ‘personality’ refers to the collection of characteristics or traits that we have developed as we have grown up and which make each of us an individual. These include the ways that we: • think • feel • behave

Individuals with Personality disorders/ complex emotional needs • Personality disorder refers to pervasive disturbances within a person’s personality and behaviour, which can make it difficult for them to live with themselves and/or other people and negatively impacts on their social functioning and relationships. • Personality disorders can have a significant impact the ability to respond to life stresses. • People with a personality disorder can feel stigmatised because of this diagnosis and some prefer the use of the term having complex emotional needs instead

Prevalence of personality disorders • Older adults are less likely to attract a diagnosis of “personality disorder” so exact prevalence is unknown • Prevalence could be around 10% of an older community population

Types of Personality disorders • Personality disorders tend to fall into three groups, according to their emotional 'flavour': • Cluster A: 'Odd or Eccentric’ - seem to remain stable as one gets older • Cluster B: 'Dramatic, Emotional, or Erratic’- tend to decrease as one gets older • Cluster C: 'Anxious and Fearful’- seem to remain stable as one gets older

Personality changes causes Recent personality changes can be due to the following reasons so ensure the following reasons are investigated Medical or organic cause • Cerebrovascular event • Infection (i. e. , meningitis) • Head Trauma • Brain tumour • Dementia Prescribed Medications • Steroids Mental illness • Depression/Mania Illegal drugs and/or alcohol

Reasons for presentations Reasons for presentation in later life with personality disorder could be due to the following reasons: • The person may lose a significant other who has contained or compensated for the personality disorder • A move to long term care • Loss of a stabilising situation • Increased use of alcohol and prescription drugs • Retriggering of trauma • Bereavement and losses including loss of jobs/ roles • Difficulty in adapting to ageing

Challenges for the older adult Challenges faced by older adults with personality disorder includes • Worse physical functioning • Greater use of medications including opioids, benzodiazepines • More unstable/brief relationships and poor social network • More likely to have other mental health difficulties, like depression and anxiety • Increased chances of being discharged to a residential placement and ongoing challenges with forming relationships with carers • Less responsive to treatment for any of their other mental illnesses • Older adults with Personality Disorder make up 44% of completed suicides

Challenges for the caring teams Challenges faced by the teams caring for older adults with personality disorder include: • Staff receive a lot more calls from this cohort • They may repeatedly ask for prescription medication • They may have frequent attendances to A&E departments • The increased expression of psychological distress in the form of physical health symptoms (somatization) and demands for care from staff/family can lead to team frustration and longer hospital admissions • They create splitting among the team members (when staff disagree amongst themselves about the best way to support the person )

Core components of support for older adults with personality disorders • Establish and understand the importance of therapeutic relationship • Treat the older adults comorbidities (e. g. anxiety, depression) • Establish good links with other professionals – Have joined up care between community and inpatient services • Involve significant others where possible • Use supportive cognitive psychotherapy which may help the older adult to acknowledge some of these issues and work on them • Training and providing support to carers in helping them understand ways of managing and offering support

Core components of support Ensure the care team uses a systemic approach that fosters • Consistency • Containment • Empowerment • Compassion

References • Personality disorders in later life: epidemiology, presentation and management Ayesha Bangash BJPsych Advances (2020), vol. 26, 219 – 220 doi: 10. 1192/bja. 2020. 19 • Late-onset personality disorder: a condition still steeped in ignorance Peter Tyrer & Robert Howard BJPsych Advances (2020), vol. 26, 219– 220 doi: 10. 1192/bja. 2020. 19