Research has shown that 1.8% to 3.8% of eating disorders occur after the age of 40.4
Eating disorders occur among all ages, genders, ethnicities, and demographics. However, elderly patients with eating disorders often get disregarded because many people believe the condition only affects younger people.
Research suggests that the prevalence of eating disorders has been rising over the past decade, a trend that is concerning in older populations.1 This article provides a comprehensive overview of eating disorder treatment programs for the elderly.
Older adults above the age of 60 experience eating disorders, but their triggers and challenges may differ from how they present in younger adults. Regardless of age, disordered eating is often adopted as a coping mechanism to deal with stress.
Stress triggers that increase the risk of eating disorders in the elderly may include the following:
It is important to note that many newly diagnosed patients are not necessarily new to eating disorders. Many patients confirm they have struggled with disordered eating throughout their lives, some having never sought out treatment.
Elderly individuals with eating disorders fall into three primary categories:
Most patients with eating disorders receive a diagnosis before the age of 25, but there are exceptions. One study found that as many as 4% of women over the age of 60 met the diagnostic criteria for an eating disorder.3 Similarly, another study found that late-life eating disorders—those occurring after the age of 40—have a prevalence of 1.8% to 3.8%.4
The most common type of eating disorder presenting in the elderly population is anorexia nervosa, with depression being the most common related condition.5 The use of laxatives as a purging behavior is also higher in late-life patients.4
The development of eating disorders in elderly patients has been associated with age-related body changes and shifts in family relationships.14
Due to eating disorders being less common in the elderly, they are frequently overlooked by health care providers as a cause of weight loss. For this reason, it’s important to know how to recognize the signs and symptoms associated with disordered eating behaviors.
Some unique risk factors that place elderly people at an increased risk for eating disorders include the following:7
The following are common signs and symptoms of eating disorders in the elderly:
Identifying eating disorders in the elderly can be particularly challenging because there are many causes for weight loss in older people.
Some of the most common causes of weight loss in the elderly include the following:
Many older patients with eating disorders also have other medical conditions that interfere with appetite and digestion. These can become barriers to maintaining a healthy weight.
Regardless of the cause, weight loss in older individuals increases risks for serious medical complications if allowed to continue. Losing even modest amounts of weight, such as 3% in one week or 5% in one month, is a significant concern for older people.6
Weight loss and dehydration have been linked to falls, urinary tract infections (UTIs), deconditioning, and confusion. It can also result in poor-fitting dentures, which further impedes food intake and often leads to more weight loss.
While there are many different treatment formats for eating disorders, not all are appropriate for the elderly.
Eating disorder treatments for the elderly must consider related factors, such as living conditions, caregiver status, financial constraints, and any other health conditions being concurrently managed, to achieve the best outcomes.
Elderly patients are often isolated, making them more susceptible to mental health issues. Comprehensive treatment programs should be equipped to offer referrals to other health disciplines when related health conditions surface during treatment.
Comorbid mental health illnesses occur in approximately 60% of elderly patients with eating disorders.5 Depression and anxiety are also more common in elderly patients with disordered eating behaviors.4 In addition, compulsive personality disorder is also associated with late-life eating disorders.4
There are many causes for weight loss in the elderly, with eating disorders being just one of them. Dysphagia, a swallowing disorder, can lead to malnutrition and weight loss. Dementia, which often leads to changes in eating habits, is also a common cause of weight loss in aging populations.15
Mortality risks are higher for elderly patients with eating disorders.4 For this reason, eating disorders should be explored as a differential diagnosis in elderly patients who experience weight loss.5
The two most commonly prescribed medications for treating eating disorders include Fluoxetine hydrochloride (Prozac, Sarafem, Rapiflux, Selfemra) and Lisdexamfetamine dimesylate (Vyvanse).12
Many elderly patients are already taking multiple medications, providers should carefully consider potential drug interactions before prescribing new medications.
For elderly patients with supportive families, it may be beneficial to include family members in treatment sessions. Grieving associated with the loss of a spouse or partner can also play a role in the development of late-life eating disorders.16
Strong evidence suggests that cognitive behavioral therapy (CBT) is the most effective treatment for eating disorders, particularly for patients with Bulimia nervosa, Night Eating syndrome, and Binge Eating disorder.8 For late-life eating disorder patients with significant cognitive impairment, however, treatment may be less effective.
In married or partnered patients with eating disorders, cognitive-behavioral couples therapy (CBCT) has been shown to improve communication, emotional regulation, and problem-solving skills.9
Couple-based therapies can also strengthen support systems, which is essential for patients throughout the treatment process, especially for older individuals struggling with age-related challenges.
Some patients need considerable medical care and monitoring, and it may be necessary to place them in a residential care facility, where ongoing medical care is available.
Within the residential care landscape, there are three primary options, each offering increasing levels of care.
When patients are medically compromised, hospitalization may be necessary. Inpatient stays are common in cases of severe dehydration, malnutrition, or unstable medical conditions.
Disordered eating behaviors are coping strategies. Those who struggle with eating disorders use compensatory behaviors as a way to cope with stress because it gives them a sense of control when life feels chaotic. One of the primary goals of treatment is to help patients establish healthier coping strategies.
Replacing unhealthy coping strategies with healthier ones requires a holistic, individualized approach to treatment.
Without proper treatment, eating disorders can lead to serious health decline – and even death. This is why getting proper medical care is critical.
Unfortunately, studies have shown that less than 30% of women with eating disorders ever seek treatment.10
There are many reasons for this.
The biggest reason older patients are hesitant to enter treatment is they don’t believe programs will address their needs properly. Eating disorder programs traditionally target younger people, with topics often focusing on challenges that arise in early and mid-life. Unless treatment program facilitators reassure older patients that the program will address a wide variety of life challenges and stressors, they may not see the value.
Another reason elderly people may be reluctant to enter treatment is that many are caregivers. A survey conducted by the U.S. Bureau of Labor Statistics found that more than 60% of the 40.4 million eldercare providers in the U.S are over the age of 55.11 That number doesn’t account for those who are caregivers for neighbors, children, or grandchildren.
Caregivers often feel selfish for tending to their own needs, and instead worry about how the disruption will affect others.13
If you suspect someone you love is struggling with an eating disorder, do not stay silent. Early intervention saves lives.
Here are a few more ways you can help when you suspect someone you care about has an eating disorder:
[OurCompanyInStealth] offers a holistic alternative to traditional eating disorder programs for patients of all ages. Contact [OurCompanyInStealth] to learn more today.
Research has shown that 1.8% to 3.8% of eating disorders occur after the age of 40.4
Hallmark signs of eating disorders include unexplained weight loss, a fixation on weight or body image, and visiting the restroom after meals.
[OurCompanyInStealth] offers eating disorder treatment programs for the elderly. Contact us [insert contact information] to learn more about resources available in your area.
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2. AARP. (June 14, 2017). The Age at Which You Are Officially Old.
3. Mangweth-Matzek, B., Rupp, C. I., Hausmann, A., Assmayr, K., Mariacher, E., Kemmler, G., Whitworth, A. B., & Biebl, W. (2006). Never too old for eating disorders or body dissatisfaction: a community study of elderly women. The International journal of eating disorders, 39(7), 583–586.
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6. Stajkovic, S., Aitken, E. M., & Holroyd-Leduc, J. (2011). Unintentional weight loss in older adults. CMAJ: Canadian Medical Association journal, 183(4), 443–449.
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9. Bulik, C. M., Baucom, D. H., Kirby, J. S., & Pisetsky, E. (2011). Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN). The International journal of eating disorders, 44(1), 19–28.
10. Micali, N., Martini, M. G., Thomas, J. J., Eddy, K. T., Kothari, R., Russell, E., Bulik, C. M., & Treasure, J. (2017). Lifetime and 12-month prevalence of eating disorders amongst women in mid-life: a population-based study of diagnoses and risk factors. BMC medicine, 15(1), 12.
11. U.S. Bureau of Labor Statistics Survey. (2017-2018).
12. Bello, N. T., & Yeomans, B. L. (2018). Safety of pharmacotherapy options for bulimia nervosa and binge eating disorder. Expert opinion on drug safety, 17(1), 17–23.
13. Cleveland Clinic. (January 2019.) Caregiver Burnout.
14. Gupta, M. A. (1990). Fear of aging: a precipitating factor in late onset anorexia nervosa. International Journal of Eating Disorders, 9, 221–224
15. Cipriani, G., Carlesi, C., Lucetti, C., Danti, S., & Nuti, A. (2016). Eating Behaviors and Dietary Changes in Patients With Dementia. American journal of Alzheimer's disease and other dementias, 31(8), 706–716.
16. Aziz, V., Rafferty, D., & Jurewicz, I. (2017). Disordered eating in older people: Some causes and treatments. BJPsych Advances, 23(5), 331-337.