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How eating disorders affect the elderly

It’s a common misconception that only thin, young, white girls and women experience eating disorders. However, eating disorders affect people of all genders, races, sizes, and ages, including the elderly.

Many older adults struggle with eating disorders, such as anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Though a number of unique challenges exist that may make it more difficult to detect—or treat—these issues in elderly patients.

6
 minutes read
Last updated on 
April 12, 2024
April 12, 2024
How eating disorders affect the elderly
In this article

How common are eating disorders among older adults?

Because eating disorders were previously thought only to affect teens and young adults, there is limited research related to eating disorders in older adults. Still, studies have been done show that:1,2

  • Between 1.8% and 3.8% of independently-living women over the age of 60 have an eating disorder
  • The average age of older adults with an eating disorder is 68.6 years old
  • 88% of older eating disorder patients are women

Among the patients in one study, anorexia nervosa (AN) was the most common eating disorder, followed by bulimia nervosa (BN). About 60% of elderly people with an eating disorder also had a co-occurring mental health disorder, with the most common being major depression.2

Additionally, elderly individuals with eating disorders typically belong to one of three categories, including:3

  • People who develop an eating disorder later in life
  • People who received treatment early in life but have experienced a recurrence
  • People who have lived with an undiagnosed eating disorder for many years

The first group represents the least common scenario, and these patients may be part of the third group.3 This is consistent with research that has shown the duration of the eating disorder is far longer in elderly patients than in young adults or teens.1

At Within, we treat elderly patients of all ages. If you're struggling with an eating disorder, give us a call today to learn more about remote treatment.

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Anorexia in elderly patients vs. eating disorders

While learning more about eating disorders in the elderly, it's important to understand some subtle technical distinctions that can help clarify specific statistics.

Anorexia is not the same thing as anorexia nervosa. Despite the two often being used interchangeably, anorexia refers simply to a loss of appetite common in older adults. Anorexia nervosa refers to a mental health disorder that involves many other symptoms and related issues.

Anorexia in older women typically leads to diminished food intake, which can be attributed to several things, including the effects of certain medications and loneliness.5 Anorexia nervosa in older patients will stem from a different set of causes, including body image issues and a fixation on body weight, and have different treatment approaches.

That said, both AN and anorexia in elderly women and other patients are dangerous and need to be addressed appropriately.

Signs of elderly anorexia and eating disorders

Many signs of eating disorders and anorexia in senior citizens are similar to those in younger people and should be considered holistically. These signs may include:3

Unfortunately, both eating disorders and anorexia in elderly patients contribute to startling mortality rates. Anorexia is associated with an 83% increased mortality risk.5 Eating disorders in older patients have a mortality rate of 21%, which makes early detection and proper treatment even more important.1

Eating disorders in older patients have a mortality rate of 21%.

Eating disorder triggers specific to the elderly

Many eating disorders develop as maladaptive coping mechanisms for stressful situations or trauma. While these events sadly impact people of all ages, there are some situations more particular to older age and the aging process that can bring on these types of disordered thoughts and behaviors, including:3

  • Death of family members
  • Adult children leaving home
  • Losing a spouse through death or divorce
  • Acute and chronic infections and other medical conditions
  • Loss of particular memories, skills, or perceived independence
  • Signs of aging and associated body dissatisfaction
  • Increased likelihood of living alone/experiencing loneliness
  • Less contact with friends or family members, which allows for conditions to be more easily hidden

These stressors and traumatic events can increase the risk of an elderly person either developing an eating disorder or returning to previous disordered eating behaviors as a means of coping and regaining a sense of control.3

Eating disorders in older females and body image

Sadly, it seems that one of the primary drivers of disordered eating in older patients—and particularly older women—are the same types of body image issues that many younger patients contend with. One study found:3

  • 62% of women over the age of 65 reported a desire to lose weight
  • 31% of women over 65 reported dieting
  • Over 20% of women over 70 reported dieting
  • Over a 5-year period, 70% of women over 50 reported weight loss, and 13% exhibited eating disorder symptoms

Knowing how common eating disorders are among elderly people can help professionals change the narrative around eating disorders and combat stigma and stereotypes. With more awareness about disordered eating in the older community, more individuals can receive the help they need to recover.

Treatment for elderly anorexia and eating disorders

Because eating disorders have primarily been thought of as teen or young adult disorders, there are well-established treatment guidelines for this population. However, there are no established treatment protocols for addressing the unique needs of the elderly community, as little research has been done on this issue outside of case studies.1

That said, research has indicated that a multidimensional treatment approach proved the best course of action for older adults with eating disorders. This type of approach may include:1,3

  • Medications for co-occurring psychiatric conditions
  • Nutritional support
  • Individual psychotherapy
  • Family therapy
  • Hospitalization
  • Care planning related to values 
  • Vision and hearing care
  • Medical care
  • Family training for dementia-related eating disorders, such as providing regular snacks or small meals at set times

As with all other individuals who have eating disorders, it’s particularly vital that elderly patients receive high-quality, specialized care from providers who understand their unique needs and can provide comprehensive, integrated care.

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Barriers to treatment for elderly individuals

Though there are barriers to care that affect people from all backgrounds and identities, some are distinct to the elderly population, such as:3

  • Feeling they won't relate to younger people in group counseling
  • Greater stigma around seeking care
  • Challenges around mobility or transportation
  • Living alone and not experiencing regular support or concern from others about their symptoms

Heartbreakingly, many senior patients also decline to seek out care for any type of condition when they feel they're toward the end of their life, citing concerns with quality of life, "not wanting to be a nuisance," "having nothing to live for," and "having lived long enough."4

These treatment barriers may prevent elderly individuals from receiving specialized eating disorder treatment designed to address their individual needs, health, and situation. And without timely eating disorder treatment, this community is at risk of experiencing many dangers to their health.

Unique challenges for assessment and treatment

While patients may face some barriers to treatment, healthcare professionals also play a role in how these conditions are assessed, diagnosed, and treated.

Eating disorders can go unnoticed in older patients due to the high number of co-occurring conditions this population usually experiences and their higher likelihood of taking medications, which can cause overlapping symptoms. For example, doctors may perceive anorexia in elderly patients as an effect of medication as opposed to part of an eating disorder.

Still, provider vigilance can help lead to earlier eating disorder diagnoses, which is overall better for a patient's health and long-term outlook.3 With the right kind of attention and thoughtful care, it's possible for any patient to overcome these conditions.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

Resources

  1. Mulchandani, M., Shetty, N., Conrad, A., et al. (2021). Treatment of eating disorders in older people: a systematic review. Systemic Reviews, 10, 275. 
  2. Lapid, M. I., Prom, M. C., Burton, M. C., McAlpine, D. E., Sutor, B., & Rummans, T. A. (2010). Eating disorders in the elderly. International Psychogeriatrics, 22, 523-536.
  3. Aziz, V., Rafferty, D., & Jurewicz, I. (2017). Disordered eating in older people: Some causes and treatments. BJPsych Advances, 23(5), 331-337.
  4. Fleming, J., Farquhar, M., Cambridge City over-75s Cohort (CC75C) study collaboration, Brayne, C., & Barclay, S. (2016). Death and the Oldest Old: Attitudes and Preferences for End-of-Life Care--Qualitative Research within a Population-Based Cohort Study. PloS one, 11(4), e0150686.
  5. de Souto Barreto, P., Cesari, M., Morley, J. E., Roberts, S., Landi, F., Cederholm, T., Rolland, Y., Vellas, B., Fielding, R. (2022). Appetite Loss and Anorexia of Aging in Clinical Care: An ICFSR Task Force Report. The Journal of Frailty & Aging, 11(2), 129-134.

FAQs

Further reading

Anorexia among the elderly

Anorexia nervosa (AN) is one of the most well-known and widely recognized eating disorders, but there are...

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Bulimia in the elderly

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How eating disorders affect the elderly

It’s a common misconception that only thin, young, white girls and women experience eating disorders...

Further reading

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