Recognizing Eating Disorders in the Elderly

Recognizing Eating Disorders in the Elderly

“Recognizing Eating Disorders in the Elderly” was written by Amy Puccini edited/reviewed by Aly Bouzek, MS, RDN. Amy is a dietetic intern at Oregon Health Sciences University.

Introduction

Eating disorders are a serious mental and physical illness that can affect anyone at any age. The National Eating Disorder Association (NEDA) estimates that about 10 million men and 20 million women in the US will struggle with an eating disorder. (1)

In this article, we’ll take a closer look at:

  • What is an eating disorder?
  • The differences between disordered eating and an eating disorder
  • Common misconceptions
  • Eating disorders in the elderly
  • What to do if a loved one may be suffering from an eating disorder

What is an Eating Disorder?

Eating disorders are very serious mental illnesses and are associated with eating behaviors as connected to thoughts and emotions. There is often a preoccupation with food and/or body weight/image so much so that activities of normal daily living are disrupted.

Most common types of eating disorders: (2)

  • Anorexia Nervosa – Self-starvation as seen through food and drink restriction that results in severe weight loss or lack of appropriate weight gain.
  • Binge Eating Disorder – Involves recurrent episodes of eating large amounts of food (within a short period of time) to the point of discomfort. There is also a sense of loss of control during eating followed by feelings of guilt and shame.
  • Bulimia Nervosa – A cycle of binge eating followed by behaviors such as self-induced vomiting, laxatives, diuretics, or other medications to prevent weight gain.
  • Other Specified Feeding or Eating Disorders (OSFED) – A term developed to diagnose those suffering from eating disorders who don’t meet the criteria for anorexia or bulimia.

Less common types of eating disorders: (2)

  • Orthorexia – An unhealthy fixation on eating only healthy foods. It’s often seen alongside a diagnosis of obsessive-compulsive disorder.
  • Avoidant Restrictive Food Intake Disorder (ARFID) – Similar to anorexia nervosa, ARFID is when you exclude or only eat certain amounts of certain foods. This results in weight loss or inappropriate growth patterns.
  • Pica – Eating non-food items such as hair, dirt, or paint chips.
  • Rumination Disorder – Regular (and unintentional) regurgitation of food which may be chewed, swallowed, or spit out.
  • Laxative Abuse – Frequently using laxatives to lose weight.   
  • Compulsive Exercise – Exercise that significantly interferes with activities of daily living. Using exercise to balance what’s been eaten and to “zero out” calories.
Eating Disorders in the Elderly

Eating Disorders vs Disordered Eating

As you can see, there are many different types of eating disorders. Some of the characteristics mentioned above may have reminded you of a loved one’s eating patterns.

It’s important to note that disordered eating does not always equal an eating disorder. However, developing disordered eating habits can still be dangerous and has the potential to turn into an eating disorder if left unchecked.

Disordered eating describes a range of behaviors related to abnormal eating habits.

An eating disorder is a diagnosis that’s made when you meet specific criteria defined by the American Psychiatric Association. (3)

Examples of disordered eating:

  • Frequent dieting and body checking
  • Anxiety associated with specific foods
  • Emotional eating
  • Chronic weight fluctuations
  • Strict routines with food and/or exercise
  • Social withdrawal
  • Binging and purging
  • Feelings of guilt and/or shame around food
  • Preoccupation with food, weight, and body image
  • Feeling of loss of control when eating
  • Extreme mood swings
  • Making up for “unhealthy foods” by using strenuous exercise, fasting, or restricting food
Recognizing Eating Disorders

Eating Disorder Myths

There are many myths associated with eating disorders including who can get them and how serious they are. Many people assume that eating disorders have a certain “look.”

Stereotypically, when we think of someone with an eating disorder, we might think of a young female.  However, eating orders don’t discriminate against age, sex, gender identity, body size, sexual orientation, race, ethnicity, or sexual orientation.

Check out this link to learn more.

Having an eating disorder is not a choice. It’s a serious and potentially life-threatening condition that can lead to heart attacks, kidney failure, osteoporosis, and electrolyte imbalances.

There are also numerous complications that can arise from binge eating, purging, starvation, and over-exercising all of which can impact an individual’s overall health and quality of life.

Some of these complications include: (4)

  • Stomach pain
  • Bloating
  • Not getting enough nutrients
  • Sore throat
  • Difficulty staying or falling asleep
  • Hormone imbalances (estrogen, testosterone, thyroid)
  • Dry skin
  • Kidney failure
  • Brittle hair
  • Fatigue/weakness
  • Shortness of breath
  • And many, many more
Eating Disorders in the Elderly Myths

Eating Disorders in the Elderly

Specific (and current) statistics on eating disorders in the elderly was difficult to find. Older adults are commonly undiagnosed. Continue reading to learn more about this topic including causes, symptoms, complications, and treatment.

The mortality rate for older adults with an eating disorder is 21%. (5) A 2017 study found that 3-4% of women over 40-years-old and 1-2% of men over 40-years-old had an eating disorder but were not getting treatment. (6)

Older women (and men) are just as susceptible to eating disorders as younger adults. The most common eating disorder for older women is OSFED. (7)

Another common eating disorder for older women is atypical anorexia. Atypical anorexia is when food is restricted for multiple days

Whether these individuals have a newly diagnosed eating disorder or have been struggling with it for years, it’s clear that eating disorders can affect more than just the younger population.

What Causes Eating Disorders in the Elderly?

The onset of eating disorders most likely occurs at a younger age and may continue into adulthood.

Newly diagnosed eating disorders in our elderly population may arise due to certain events such as divorce, death of a loved one, empty nest, retirement, or menopause.

Additionally, older adults might feel stress and pressure to “look the same” as their younger coworkers. This can be difficult to ignore when society is constantly depicting youthfulness and “healthy appearances” as ultimate goals.

Older adults with eating disorders commonly go undiagnosed or untreated as many of the symptoms related to eating disorders such as diarrhea, vomiting, or hair loss may be written off as general aging, side effects of medications, or other general illnesses.

Another stressor would be the stigma of seeking treatment at an older age. There might be embarrassment, lack of accepting age, or depression associated with asking for help.

Retirement

Symptoms of Eating Disorders in the Elderly

Note that these symptoms are like symptoms for younger adults with eating disorders, but we felt that it should be mentioned again.

  • Reflux
  • Gastroparesis (stomach is partially paralyzed and doesn’t empty properly)
  • Cognitive impairment (can begin much quicker for older adults)
  • Muscle loss
  • Bloating
  • Constipation

How to Spot an Eating Disorder in the Elderly (7)

As a reminder, eating disorders in the elderly may not be the first diagnosis due to several other health issues at play. This list is to help you be aware of common eating disorder signs, so that you can get help quickly.

  • Watch for dramatic changes in weight (this can look like weight lost quickly, or weight lost and gained repeatedly)
  • Anxiety or depression (isolated feelings that accompany these disorders can also contribute to eating disorder progression)
  • Issues with eating with others (refusal or makes excuses not to join)
  • Constant focus on weight
  • Constant dieting (may be seen as refusal to eat specific foods, food groups, or at particular restaurants)
Depression

Untreated Symptoms of Eating Disorders in the Elderly

If symptoms are left untreated, eating disorders in the elderly can progress very quickly and may lead to:

Treatment for Eating Disorders in the Elderly

Be thoughtful and gentle when suggesting treatment for an eating disorder. Recovery is always possible, and here are a few treatment options that might be helpful:

  • Nutrition education: facilities should have a Registered Dietitian on staff that can help with proper nutrition information
  • Treatment facility:  this can be in an inpatient setting, or an outpatient setting and may depend on the area you live or the severity of the eating disorder
  • Psychotherapy (talk therapy) and psychoeducation (education and information about mental illness)
  • Therapy: with spouse, significant other, family, friends, and/or loved ones
  • Medication

How to Talk to and/or Help the Elderly if They Don’t Want Help

This is a tough subject to approach, but it needs to be said. If you think an older adult in your life is struggling with an eating disorder, then you need to step in. Read on for some tips about getting them help while preserving trust and friendship.

The Talk

Take time to gather facts and other information that will help you meet them where they’re at in their eating disorder journey. Make sure you stay calm and use “I” statements.

There is no place for blame here (they are likely already feeling shame and don’t need additional stress).

Listen. Listen with empathy, compassion, and tenderness. This conversation is likely as hard for them as it is for you.

Suggest that they get help. If they are willing to seek help, then have some trusted websites and helplines available for them to visit. Offer to accompany them where acceptable.

If They Don’t Want Help

If you know ahead of time that they don’t want help, then don’t force the conversation of seeking treatment – and don’t ignore it! Try finding a middle ground and maybe ask if you can help make the initial appointment.

This might not be a one-and-done kind of scenario. It may take multiple times before they feel like they can trust and connect with the right doctor/facility.

It can be easy to lump all eating disorders together but remember that your loved one is unique – and so is their eating disorder.

Talking about an eating disorder helps to shrink the stigma and loneliness that come with it. Let them know that you are there to support, listen, and help them through this difficult journey.

Not Talking

Resources for Eating Disorders in the Elderly

It can be difficult to watch a loved one struggle with an eating disorder. Thankfully there are many amazing resources available to help those suffering get the help that they need.

Conclusion

Eating disorders in the elderly are a very serious medical concern. If left untreated, health can decline quickly, and quality of life can suffer. Please let someone you trust know about your situation and ask if they can help you seek help.

You are not alone and don’t have to go through the treatment process alone! Check out the recommended resources above and get help as quickly as you can.  

References:

  1. What Are Eating Disorders? NEDA: Feeding Hope. https://www.nationaleatingdisorders.org/what-are-eating-disorders.
  2. Information by Eating Disorder. NEDA: Feeding Hope. https://www.nationaleatingdisorders.org/information-eating-disorder.
  3. What Are Eating Disorders? American Psychiatric Association. https://psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders.
  4. Common Health Consequences of Eating Disorders. NEDA: Feeding Hope. https://www.nationaleatingdisorders.org/health-consequences.
  5. Aziz, V. Rafferty D, Jurewicz I. Disordered eating in older people: Some causes and treatments. BJPsych Advances. 2017;23(5):331-337.
  6. Mangweth-Matzek & Hoek H. Epidemiology and treatment of eating disorders in men and women of middle and older age. Current Opinion in Psychiatry. 2017:30(6):446-451.
  7. Eating Disorders & Older Women. Capital Women’s Care. https://www.cwcare.net/news/eating-disorders-older-women.

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