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We have collected data on 39 persons with late-life onset of paranoid symptoms, all but two of whom are women. We identified a subset of nine patients that met the criteria for delusional disorder. This group differed significantly from both demented and long-term schizophrenic patients on a number of variables. There was only one live birth among these nine women; more than half were refugees or holocaust survivors; there was an absence of a predicted sensory loss; and the manifestation of the paranoia was qualitatively different. Several issues are discussed: there is a late-life delusional state that is neither schizophrenia nor dementia; the paranoia in these delusionally disordered patients cannot be accounted for exclusively by the social isolation hypothesis; there is an interaction among early trauma, the absence of children, and the appearance of paranoid ideation late in life.

Records of eight elderly patients identified as BPD by a geriatric team were analyzed for compliance with DIB-R and DSM-III-R criteria. A nonborderline control group was randomly selected and matched for age, gender and residence. Clinicians experienced in geriatric mental health performed retrospective chart reviews and found that not one clinically diagnosed BPD patient was identified by either instrument. Although there appear to be a number of constant features of BPD throughout life, this study delineated two major areas of change in BPD in late life.