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A Delphi study of late-onset personality disorders

Published online by Cambridge University Press:  21 February 2019

Erlene Rosowsky ,
Emily Lodish ,
James M. Ellison  and
S. P. J. van Alphen
Erlene Rosowsky*
Affiliation:
Department of Psychiatry, Harvard Medical School, Boston, MA, USA Alliance for Aging, William James College, Newton, MA, USA
Emily Lodish
Affiliation:
Clinical Psychology Department, William James College, Newton, MA, USA
James M. Ellison
Affiliation:
Psychiatry and Human Behavior, Sidney Kimmel Medical College of Jefferson University, Philadelphia, PA, USA The Swank Foundation Endowed Chair in Memory Care and Geriatrics, Christiana Care Health System, Wilmington, DE, USA
S. P. J. van Alphen
Affiliation:
Clinical Geropsychology, Department of Clinical & Lifespan Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, Heerlen-Maastricht, The Netherlands
*
Correspondence should be addressed to: Erlene Rosowsky, Alliance for Aging, William James College, 1 Wells Avenue, Newton, MA 02459, USA. Phone: Office: 617- 327-6777; Cell: 781-254-8381; Fax: 617-327-4447. Email: [email protected].
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Abstract

Objectives:

The DSM-5 describes personality disorders (PDs) as emerging in early life and remaining continuous throughout the life-span. Yet case studies and expert opinion support the existence of late-onset PDs. Little is known about PDs in late life, and our instruments for assessing them are not well validated. Thus, the focus of this exploratory Delphi study was the late-onset PD, with special attention to the accuracy of the core criteria for the diagnosis.

Design:

A Delphi study was designed to assess the presentation of PDs in late life. The Delphi consisted of three successive rounds of inquiry. Between rounds, the participants were provided with a summary of the panel’s responses.

Participants:

A panel of 21 experts included published authors, researchers, and teachers from the USA, the UK, Australia, France, Belgium, and the Netherlands.

Measurements:

Researchers designed a survey that included an introduction, a demographic questionnaire, and five questions that varied in presentation and response format.

Results:

Experts reached consensus that a variant of PD appears de novo in old age. The core features of inflexibility and pervasiveness may not pertain to late-onset PD. There was agreement that frequently occurring life events contribute selectively to the expression of late-onset PD, with the major ones being death of a spouse or partner and transition to a nursing or assisted-living facility.

Conclusions:

Nearly all participants took the position that PD can present for the first time in old age and be clinically identifiable without having been so identified earlier in life.

Keywords

late-onset personality disorderspersonality disorders in older adults
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 7: Issue Theme: Diverse Approaches to Stemming Cognitive Decline , July 2019 , pp. 1007 - 1013
Copyright
© International Psychogeriatric Association 2019 

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