Untreated bipolar, age 57, what to expect with aging?

OP here.

Thank you for the replies. I've been taking care of Mom for close to 6 years and cannot take on POA or care of anyone else.

I suspect my sister has her step daughter on her POA's and that is fine with me. I figure I can supply support to the step daughter if need be.

Mostly I grieve the loss of a relationship. We had a good sisterly relationship for decades. She is an extreme athlete and I think the extreme fitness coupled with a very healthy diet helped to minimize symptoms over the decades. She was married to a really good guy for 20 years until he passed from cancer. I think her husband helped to stabilize her. I suspect with aging her symptoms are getting worse.

My uncle had unmedicated schizophrenia for the last 15 years. He road his exercise bike for an hour a day to manage symptoms and ate the specific carbohydrate diet to manage symptoms.
There is only so much diet and exercise can do. The last 15 years he was in rough shape.

Mostly I'm grieving the loss of the relationship with my sister. I feel battered from our interactions the last year and I don't feel safe being physically in the same room with her.
I've been raged at too many times.

Sadly, if her main symptoms are mania with rage and psychosis, it's likely that she will eventually do something that either harms herself or others. At this point, she will enter the justice system and perhaps the social services system in an abrupt and unplanned manner.

Then it will be up to the courts and the judge how to proceed, depending on what exactly happened. She will be assigned a social services caseworker, a public legal defender, or both.

She may find herself in a locked down psychiatric facility or in jail. If so, she will be heavily medicated so that her behaviors are manageable for the facility. This may turn her into a virtual "zombie", because what's convenient for a facility may not align with what's best for her personally.

If she's not locked up somewhere, she may find herself court-ordered to regularly see a psychiatrist and take her prescribed medications, or else be locked up again.

With aging? More of the same, I would expect.
Are you meaning IF she gets dementia, because that will be difficult to assess for any neuro-psyc if she isn't currently getting followed.

I think the only answer is the same as it would be for any well person.
Expect the unexpected.
That may hold true for all of life. We none of us have a roadmap for any of this, and it is all very unpredictable.

I wish you the best.

There is no cure for bipolar disorder. It’s managed through meds and therapy.

Since your sister isn’t on meds she won’t be managing her disorder and you can expect her to behave irrationally.

Bipolar disorder affects everyone differently. It’s impossible for a forum to answer your question.

I am very sorry that you are in this situation.

My mother has had untreated bipolar for most of her life. Now she has mental decline in her 70s, and her bipolar is much more pronounced.

She has nearly all the symptoms you’ve clearly described: extreme anger and rages, irritability, feelings of grandiosity, rapid non-stop speech, and paranoia that makes her think her neighbors are doing things against her. Whenever she loses or misplaces something she says that someone broke into our house to take her sheet of paper or something worthless or insignificant. She accuses everyone of racism or discrimination if things don’t go her way. She miscontrues what others say to her in order to support her arguments that everyone is racist towards her.

Her doctor prescribed her Risperidone earlier this year. It was the first time in her life she took medication for bipolar. We didn’t use the term bipolar, only stating it was to address her stress and anxiety. I thought the Risperidone worked wonders. She took 1mg but stopped taking it once her doctor increased the dosage to 2mg and she started experiencing side effects. She refused to go back to 1mg. I very much regret increasing the dosage because the 1mg worked so well for her rage issues. Being that my mom is incapable of self reflection, she doesn’t realize she has a mental illness. She started accusing me and her doctor of trying to control her.

This has been a very delicate subject but her doctor and I have successfully gotten her on .5mg of Rexulti just last week. I’m hoping for good results. So far she hasn’t experienced any side effects. Personally, I think Risperidone was much more effective for her issues, but I’m happy to get her on any medication that can help alleviate her rage and paranoia.

It’s an absolute nightmare for me to deal with and it’s so selfish of people with bipolar who refuse to recognize that anything is wrong with them, and refuse to take medication or go to therapy. You need to help your sister now by going with her to a PCP and convincing her to get on medication. It’s not going to get better. If she refuses medication you’re going to need to step back and let her loose to do whatever insane things she will do until she’s committed to an institution.

Speak with PCP. Do you have POA for her? Who does? Do you have the needed permission to speak with her PCP ? Does she live with you ?
Lots of questions.....

Best to get direct communication with her PCP or you can always call 911 to have her transported to ER if you are observing unsafe or harmful or potentially harmful behaviors. If she lives alone or with someone else, you can also call APS, Adult Protective Services and make an anonymous report ; let APS take it from there. ( Anyone can call APS ).

Lot's of fun for many years. Not. My sister has BPD. Lots of downs with mental illness. It's just sad and heartbreaking.

While our family members with schizophrenia have a decent chance of their symptoms lessening somewhat as they age, our family members with bipolar often experience their symptoms worsening and becoming more frequent.

I am sorry, yes that sounds like a lot of mania. I'm sure you know that everything you listed is mania. Have her extreme episodes become more frequent?

If she doesn't now assign you as her DPoA, then you can expect to not have any control or much ability to help her as she ages. Even for elders who don't have a history of mental illness, once they cross over into dementia without a legally assigned representative/authority, family members burn themselves out trying to help someone who won't/can't help themselves. You can't force people to do anything in their own best interests without a legal vehicle to do so. At that point, the most you'll be able to do is keep her on APS's radar as a vulnerable adult or attempt to get guardianship for her. There are plenty of first-hand accounts on this forum if you search for "bipolar".

Right now, you can attempt to have a discussion with her about what happens to *any* person who becomes cognitively/mentally incapacitated: social services has a judge assign a 3rd-party guardian (because a private citizen pursuing guardianship through the courts can cost thousands of dollars depending where they live). You attempt to make the case to her that having a trusted LO such as yourself as her "voice" may be better than leaving it up to chance. All you can do is keep having a calm, non-threatening discussion with her.

BUT... you need to think long and hard if this is something you really want. Right now you are somewhat "romanticizing" things because you simply cannot imagine how bad attempting to help her in the future can get. Please find and read the other stories on this forum by well-meaning and desperate family members trying to help someone they love and care about with BPD... it is exhausting on many levels and can be that way for years and decades. I wish you much clarity, wisdom and peace in your heart while you ponder this.

More of the same behavior but add dementia symptoms: forgetfulness, more paranoia, difficulty paying bills, poor decision-making.