Lithium treatment in a very elderly nursing home population

We studied the result of long-term lithium therapy in 12 very elderly nursing home residents. Good treatment results occurred most often when the diagnosis was bipolar disorder-manic or manic episode. Many of the side effects encountered were well known (tremor, ataxia, lethargy, disorientation, and hypothyroidism) and were easily reversible. The development of significant sinus bradycardia in 25% of the group raised a question concerning lithium-induced cardiotoxicity. Nephrotoxicity was not apparent in spite of very advanced age and long duration of therapy. We conclude that the question of cardiotoxicity is important and requires further study. Other side effects were not sufficiently serious to contraindicate the use of lithium therapy in appropriately selected and well-monitored elderly patients.