Age-Related Aspects and Clinical Implications of Diagnosis and Treatment of Personality Disorders in Older Adults

To investigate age-related diagnostic and therapeutic aspects of personality disorders in later life (≥ 60 years) and implications in clinical practice, such as the introduction of a specific mental health care program, diagnostic assessment procedure, and treatment criteria for personality disorders in older adults, a Delphi study was conducted among 35 Dutch and Belgian experts in the field of personality disorders in older adults. Consensus on a statement was defined as agreement by two thirds or more of the experts. This Delphi study ultimately yielded consensus concerning 20 of the 21 statements. It was generally agreed that late-onset personality disorder is a useful construct in geriatric psychiatry and that aging can lead to a distinct behavioral expression of personality disorders in older adults. The experts confirmed that a specific mental health program is useful to refine the diagnostic assessment and treatment in older patients with personality disorders as well as older adults with mild psychiatric problems often superimposed on personality disorders, such as adjustment disorders, dysthymic disorders, and diffuse anxiety disorders. The Longitudinal, Expert, and All Data (LEAD) standard combined with a stepwise, multidimensional diagnostic approach appears highly suitable for personality assessment. Finally, stratification of subjects among four treatment levels was regarded as a useful strategy and there was agreement concerning specific criteria for each level of treatment. In conclusion, it is recommended that age-specific aspects in the diagnosis and treatment of personality disorders be included in guidelines and protocols and addressed in future scientific research. Further research is indicated involving cross-validation studies of these Delphi statements in other countries and evaluation of the clinical implementation of the specific mental health care program, diagnostic assessment procedure, and treatment criteria on clinical utility.