How eating disorders affect the elderly

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It’s a common misconception perpetuated by pop culture 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 their eating disorder may go undiagnosed, particularly if they have other health problems.

Last updated on 
May 13, 2022
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How common are eating disorders among older adults?

Because eating disorders were previously thought to only affect teens and young adults, there is limited research related to eating disorders in elderly people. Researchers suggest that it has been difficult to establish a prevalence in this community, because eating disorders may be misdiagnosed as a medical condition or a consequence of another issue, since eating disorders often co-occur with other conditions. They also suggest older adults may be better at hiding their eating disorder than younger people. (1)

Current research has revealed that between 1.8% and 3.8% of independently-living women over the age of 60 have an eating disorder. Anorexia nervosa (AN) is the most common eating disorder among older adults. And about 60% of elderly people with an eating disorder have a co-occurring mental health disorder, with the most common being major depression. (1,2) The mortality rate for this population is an alarming 21%. (1) Given this high mortality rate, early detection and diagnosis of eating disorders in the elderly is vital.

A review of literature found the average age of older adults with an eating disorder was 68.6 years old, and 88% of the patients were women. About 10% of cases had bulimia nervosa (BN) while approximately 81% had anorexia nervosa. About 69% of older adults in the review experienced late onset eating disorders as opposed to early. (2)

And yet another study found the following statistics: (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 disordered eating 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.

Signs of an eating disorder in the elderly

Many of the signs of eating disorders in elderly individuals are similar to those in younger people and should be considered holistically. These signs may include: (3)

  • Weight phobia
  • Weight loss
  • Vomiting
  • Body image distortion
  • Depression and anxiety
  • Excessive hair loss
  • Gastrointestinal issues
  • Heart problems
  • Dental damage
  • Skipping meals
  • Eating alone or an intense desire to eat alone
  • Using diuretics, diet pills, or laxatives
  • Going to the bathroom right after a meal
  • A significant decrease or increase in weight in a relatively short period

Risks of weight loss for older adults

Though there are many people with eating disorders who are of “average” or higher weight, anorexia and weight loss are common among elderly individuals. And while weight loss could be explained by mental health issues, medical conditions, or ability-related complications, it is a problem, regardless of its cause. Weight loss in elderly individuals can lead to many harmful health risks, including: (3)

  • Frailty
  • Compromised immune system
  • Depression
  • Increased vulnerability to various conditions
  • Muscle wasting

These complications could negatively impact caloric intake, creating a cycle of weight loss that can be difficult to disrupt. (3)

Eating disorder triggers specific to the elderly

Though triggers for eating disorders tend to be stress-related in all ages, elderly patients may experience triggers that differ from their younger counterparts, whose triggers may be more related to large life transitions. For example, elderly individuals are more likely to experience: (3)

  • Death of a parent or sibling
  • Adult children leaving home
  • Death of a child
  • Widowhood
  • Divorce
  • Chronic medical conditions
  • Signs of aging and associated body dissatisfaction

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 control. (3) 

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)

  • Not wanting to participate in group counseling with younger people they can’t relate to
  • Stigmatized comorbidities, such as substance use, addiction, anxiety, and depression

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

It’s important for treatment providers to avoid overlooking eating disorders in older adults, because of bias, misinformation, or any other influences. It’s also essential to understand that a decreased appetite is not an inherent component of aging, it usually indicates an underlying condition. As such, it should not be dismissed when assessing older adults. In fact, provider vigilance can help to diagnose eating disorders earlier before they progress to more severe prognosis. (3)

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 had an ongoing eating disorder from a young age

The first group is the least common among elderly individuals with an eating disorder, and those belonging to this group may actually belong to the last one—that is, they likely had an untreated eating disorder for quite a long time before being diagnosed. (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)

There is little information published on the treatment of eating disorders in the elderly population, and most research is limited to case studies. The prognosis is also challenging to predict, because of the limited published research. 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 not established treatment protocols for addressing the unique needs of the elderly community. (1)

That said, research has indicated that a multidimensional treatment approach proved the best treatment outcomes in older adults with eating disorders. A multidimensional 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.

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.

Resources

  1. Mulchandani, M., Shetty, N., Conrad, A. et al. (2021). Treatment of eating disorders in older people: a systematic review. Syst Rev, 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.

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