Borderline personality disorder in older adults: Emphasis on care in institutional settings

With the book Borderline Personality Disorder in Older Adults: Emphasis on Care in Institutional Settings, Drs. Hategan, Bourgeois, and Xiong address an often underappreciated clinical problem that is likely increasing with the aging of the population. Geriatric patients with borderline personality disorder, like their younger counterparts, experience social and relationship challenges, comorbid psychiatric illness (including but not limited to substance use disorders), comorbid systemic illness, and are high utilizers of medical and social services. With the aging of the population worldwide, more older patients with chronic/progressive illnesses are to be found in various institutional settings such as skilled nursing facilities, rehabilitation units, and residential care, as well as in the general hospital. However, these patients' habitual patterns of behavior (including affective dyscontrol, externalizing of blame, "splitting" the external world into groups who are "all good" and "all bad") make the compromises and need for collectivity in institutional settings more challenging than for any other easily defined and demarcated patient group.