Eating disorders are often thought of as a problem that affects only teenagers and young adults. However, recent research has shown that eating disorders can also affect individuals well into their golden years. In fact, a growing number of older adults are experiencing disordered eating behaviors, with serious consequences for their physical and mental health.
Despite this, eating disorders in older adults remain vastly underdiagnosed and undertreated, in part due to the common misconception that they only affect younger individuals.
In this blog post, we will explore the prevalence of eating disorders in older adults, the unique challenges and risk factors that contribute to their development, and the importance of awareness and prevention efforts.
By shedding light on this often-overlooked issue, we hope to increase understanding and improve the quality of care for older adults who struggle with eating disorders.
Eating Disorders in Older Adults: Overview
According to the NHS, an unhealthy relationship with food can dominate an older adult’s life and lead to illness, which is known as an eating disorder. This disorder can manifest as persistent overeating or undereating, often accompanied by fixation on body size and appearance.
Older adults with eating disorders can be classified into three groups: those who have had an untreated eating disorder for a long time, those who have had therapy for an eating disorder but relapsed, and those who developed an eating disorder later in life. The first two groups are more common, while the third group is less common but still possible, and it is often triggered by stress or trauma.
It is worth noting that some older adults with eating disorders had difficulties controlling their food intake in their younger years, due to a combination of environmental, psychological, and genetic factors. These factors can contribute to eating problems and are significant regardless of a person’s age.
Eating disorders are serious conditions that can negatively impact relationships, productivity, and both physical and emotional well-being. Anyone experiencing an eating disorder should seek professional assistance because these disorders can be fatal. For instance, the National Institute of Mental Health (NIMH) reports that people with anorexia nervosa have an 18-fold increased risk of dying young compared to their peers in the general population.
Most cases (84.6%) of this mental health condition were diagnosed with anorexia nervosa, and 56.4% of all cases were recorded as having a late onset per study (i.e., after age 40 years).
The majority (94.8%) received care, with hospital-based care being the most common form of treatment, constituting 51.5% of cases. In most case descriptions where improvement was noted, a multifaceted strategy combining hospital admission, treatment, and pharmacology was utilized.
In general, 79.5% of patients with eating disorders who received therapy experienced improvements, while 20.5% either relapsed or passed away due to eating disorder-related complications.
However, the instances were documented with significant discrepancies and omissions, which impacted the interpretation of the data and the conclusions that can be drawn.
Types Of Eating Disorder
Many symptoms, side effects, and physical challenges are specific to older individuals when they experience an eating disorder. Therefore, it is crucial to understand the following eating disorders that older adults may encounter and how these illnesses can specifically affect them.
1. Anorexia nervosa
Anorexia nervosa is a serious eating disorder characterized by an intense fear of gaining weight, a distorted body image, and a severe restriction of food intake. People with anorexia nervosa often perceive themselves as overweight or obese even when they are underweight or of normal weight. They may engage in behaviors such as calorie counting, excessive exercising, and purging through means such as vomiting or laxative abuse. Anorexia nervosa can lead to numerous physical and mental health problems and can be life-threatening if left untreated.
Causes and Risk Factors
The exact causes of anorexia nervosa are unknown, but it is likely to be caused by a combination of genetic, environmental, and social factors. Some potential risk factors for developing anorexia nervosa include:
- Psychological factors
- Cultural and social pressure
- Life transitions
- Neurobiological factors
Here are some common symptoms of anorexia nervosa:
- Significant weight loss, often to the point of being underweight
- Intense fear of gaining weight or becoming overweight
- Distorted body image, including a persistent belief that one is overweight even when underweight
- Preoccupation with food, calories, and/or cooking
- Refusal to eat certain foods, food groups, or entire categories of food (such as carbohydrates or fats)
- Skipping meals or eating very small amounts of food
- Engaging in restrictive eating behaviors, such as counting calories or grams of fat
- Excessive exercise or compulsive exercising
- Changes in mood, such as increased anxiety, irritability, or depression
- Physical symptoms, such as fatigue, dizziness, fainting, or feeling cold all the time
- Changes in menstrual cycle or loss of menstrual cycle (in females)
- Secretive behavior around food or eating
- Withdrawing from social activities or avoiding situations involving food
2. Bulimia Nervosa
Bulimia nervosa is a type of eating disorder characterized by recurrent episodes of binge eating, followed by behaviors to compensate for the binge, such as purging (vomiting or using laxatives), fasting, or excessive exercise.
People with bulimia nervosa often feel a loss of control during their binge episodes and experience feelings of guilt, shame, or embarrassment afterward. This cycle of binging and compensating behaviors can lead to physical and psychological health problems. Like other eating disorders, bulimia nervosa can have serious consequences if left untreated.
Causes and Risk Factors
Some potential causes and risk factors of bulimia nervosa include:
- Environmental factors
- Psychological factors
- Dieting and restrictive eating
- Substance abuse
Here are some common symptoms of bulimia nervosa:
- Recurrent episodes of binge eating, which involve eating an abnormally large amount of food in a short period of time and feeling a lack of control during the episode.
- Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, laxative or diuretic abuse, fasting, or excessive exercise.
- A distorted self-image, with an intense fear of gaining weight or becoming fat, despite being underweight or having a normal weight.
- Low self-esteem that is heavily influenced by body shape and weight.
- Chronic sore throat, mouth sores, and/or swollen glands.
- Irregular menstrual periods.
- Dehydration and electrolyte imbalances that can cause weakness, dizziness, and fainting.
- Gastrointestinal problems, such as bloating, constipation, or diarrhea.
- Dental problems, such as enamel erosion, cavities, and gum disease, due to frequent vomiting.
- General physical weakness and fatigue.
3. Binge Eating Disorder
Binge Eating Disorder (BED) is an eating disorder characterized by recurrent episodes of eating large amounts of food (often referred to as binging) in a short period of time and feeling a loss of control during these episodes.
Unlike bulimia nervosa, people with BED do not engage in purging behaviors such as vomiting or excessive exercise after binging. BED can lead to serious physical and psychological health problems if left untreated.
Causes and Risk Factors
Women are more likely than males to suffer from a binge-eating disorder.
Your chance of getting binge-eating disorder may be affected by the following factors:
- Dieting or restrictive eating
- Psychological factors
- Environmental factors
- Neurotransmitter imbalances
The primary symptom of binge eating disorder is recurrent episodes of binge eating, which involves consuming an excessive amount of food within a short period and experiencing a lack of control over eating during these episodes. Other symptoms may include:
- Eating until feeling uncomfortably full
- Eating large amounts of food when not physically hungry
- Eating alone due to embarrassment about the quantity of food being consumed
- Feelings of guilt, shame, or disgust after binge eating
- Hiding or hoarding food
- Rapid eating or eating until feeling overly full when not physically hungry
- Depression or anxiety
- Avoiding social situations involving food
- Frustration with oneself or one’s eating habits
4. Avoidant/Restrictive Food Intake Disorder (ARFID)
ARFID, formerly known as “Selective Eating Disorder,” is a new diagnosis in the DSM-5. It is similar to anorexia in that both disorders involve limitations in the amount and types of food consumed, but unlike anorexia, ARFID does not involve any distress about body shape or size or fears of fatness.
Causes and Risk Factors
The risk factors for ARFID include a variety of biological, psychological, and societal concerns, as with all eating disorders. Two persons with the same eating problem may have quite different viewpoints, experiences, and symptoms due to the possibility that these elements interact differently in various individuals.
Much less is known about what predisposes someone to acquire ARFID. However, this is what is known:
- Sensory sensitivity
- Anxiety or fear
- Gastrointestinal issues
- Developmental disorders
- Traumatic experiences
- Family or cultural factors
- Psychological and behavioral
- a dramatic decrease in weight
- wears layers of clothing to be warm or cover up weight loss.
- reports of extra energy, tiredness, cold intolerance, and constipation
- reports routine, nebulous digestive difficulties around mealtimes that have no clear cause
- drastic changes in the types or amounts of food consumed
- will only consume food with a certain texture
- panic about choking
Anorexia and ARFID share physical symptoms and medical outcomes because both conditions are characterized by an inability to fulfill dietary demands.
- Constipation and other general gastrointestinal symptoms
- Missing periods or only having periods when using hormonal birth control (this is not regarded as a “real” period) are examples of menstrual irregularities.
- issues with concentration
- anomalous laboratory results (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)
- Dry and brittle nails
- Fine hair on the body
- Women who have reached puberty stop having periods
- Feeling cold all the time
- Sleep problems
- Dry skin
- Thinning of hair on the head, dry and brittle hair
- Muscle weakness
What Causes Eating Disorders in Older Adults?
The causes of eating disorders in older adults are not entirely clear, and there is no one single cause. However, some factors that may contribute to the development of eating disorders in older adults include:
- Age-related changes: Older adults may experience physical changes, such as a decrease in appetite, changes in hormones, or a decrease in taste and smell, which can affect their eating habits.
- Chronic illness: Chronic illnesses, such as diabetes, cancer, or heart disease, can lead to changes in appetite, weight loss, or weight gain, which may trigger disordered eating behaviors.
- Medications: Some medications can affect appetite, taste, or digestion, which can lead to disordered eating behaviors.
- Psychosocial factors: Psychosocial factors, such as stress, depression, anxiety, or a history of trauma, may contribute to the development of disordered eating behaviors.
- Body image: Negative body image can affect individuals of any age and may lead to disordered eating behaviors.
[QUICK FACT: It is important to note that eating disorders in older adults are often underdiagnosed and undertreated, as healthcare providers may assume that disordered eating behaviors are a normal part of aging.]
Signs of Eating Disorders in Older Adults
When an individual has an eating disorder, their actions, thoughts, and emotions are disrupted, leading to negative effects on academic performance, professional development, and physical well-being. As a result, it’s important to be aware of the signs of eating disorders in older adults, such as:
- Significant weight loss or gain
- Changes in eating habits, such as skipping meals or avoiding certain foods
- Obsessive calorie counting or weighing of food
- Frequent trips to the bathroom after meals
- Fatigue or weakness
- Dizziness or fainting
- Changes in mood, such as depression or anxiety
- Physical symptoms such as dry skin, brittle nails, and thinning hair
- Insomnia or disturbed sleep patterns
- Social withdrawal or isolation
Despite the negative personal and physical effects, individuals with eating disorders continue to engage in these behaviors. While the cause and purpose of the eating problem may vary, the actions are harmful and can result in serious functional impairment and, in extreme cases, death.
Impact of Eating Disorders in Older Adults
Individuals with eating disorders face significant challenges when their symptoms become severe enough to interfere with their daily lives. For example, spending excessive amounts of time exercising or monitoring their diet may make it difficult for them to fulfill their everyday responsibilities, leading to potential issues in the future.
As a result of these disruptions and a subsequent decline in their quality of life, seeking admission to an eating disorder rehabilitation facility may become necessary.
Certain types of eating disorders can arise in older adults due to physical health problems. For example, diabetes, some cancers, dementia, heart disease, liver or kidney disorders, gastrointestinal infections, or thyroid issues can cause a loss of appetite. Treatments for these conditions may also decrease hunger or appetite sensations. Chemotherapy, antibiotics, digoxin, and opioid painkillers can all cause chronic appetite loss.
If left untreated, eating disorders can cause permanent damage to internal organs such as the heart, kidneys, and liver. Physical symptoms can also impact daily activities and mobility. Extreme dizziness, for instance, can impair driving or other activities until treated with the help of a professional.
Mental health issues can also impede daily living for individuals with untreated eating disorders. The worsening of physical symptoms can further exacerbate disordered thoughts and behaviors, leading to lower self-confidence.
Older adults with eating disorders frequently have obsessions about food, hunger, exercise, body image, and other topics. It is probable that they “utilize up” part of their cognitive resources with these ideas most of the time, leaving them with less capacity to make other judgments and complete other activities. It is also probable that inadequate nutrition also reduces their mental capacity.
Depression and other mental health issues can make it difficult to care for oneself, which includes eating and maintaining regular hygiene. If depression is the main cause of malnutrition, therapy options, including medication and other mental health counseling, can reduce symptoms and restore appetite in the patient.
Treatment Options for Older Adults
Treating eating problems in older individuals often requires a different approach than treating younger adults or adolescents. This is because older adults may have underlying medical conditions that need to be addressed alongside their eating issues. As a result, treating eating disorders in older individuals may involve multiple types of therapy or treatment methods simultaneously.
Treating eating disorders requires a range of therapy options, including cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and family-based therapy. For older adults, nutritional guidance may also be critical. The best care for older adults should be personalized to meet their specific needs.
In some cases, older adults may require multiple medications and therapies simultaneously to achieve optimal care. Additionally, participation in support groups is often an essential part of treatment for this population.
Residential or Outpatient Treatment
When it comes to treating eating disorders, the decision between residential and outpatient treatment depends on an individual’s specific needs and circumstances. Residential treatment, which involves living in a facility with round-the-clock supervision, may be necessary for older adults with multiple co-occurring disorders.
On the other hand, outpatient treatment, which involves attending several weekly therapy sessions and medical appointments while remaining at home, may be sufficient for those who do not require as much intensive care. Ultimately, the decision should be made in consultation with a healthcare professional who can help determine the most appropriate level of care.
Individual Variables to Take into Account
According to Harvard Medical School, obtaining a thorough physical examination is an important step in determining the treatment that would be most effective for an older adult.
In order for therapy to be effective, dietary and medicinal requirements must also be taken into account. While residential therapy suits people who need treatment for underlying medical concerns, many older people may find it challenging to commit to residential treatment.
Prevention Strategies For Eating Disorders In Older Adults
By implementing prevention strategies, healthcare professionals and caregivers can help older adults maintain a healthy relationship with food and their bodies, reducing the risk of developing eating disorders.
You may start with these suggestions or pieces of advice to help older adults right away:
- Learn more about eating disorders and how to avoid them by taking appropriate action.
- Begin to pay attention to and critically analyze the messages about “beauty” and “ideal body types” that the media and those around us constantly provide to us. Refuse to accept what is deemed “beautiful” by the media.
- Discuss eating problems and harmful behaviors or attitudes with everyone.
- Encourage people to create self-esteem that is not just focused on beauty.
- Remove your scale! Numbers are merely one type of information and can be misleading.
- Food is just food; do not label it as good or bad.
- Educate people that their worth is unrelated to their appearance or diet.
- Put an end to your diet!
- Call out society for fostering a negative body image. Never be critical of oneself.
- Share your thoughts on the “thin ideal” and the harm it may do.
- Set a good example by choosing to lead a balanced, healthy lifestyle.
- Understand that there are many different types and sizes of health and well-being.
- Learn about the elements that may lead to the development of eating disorders.
Importance Of Healthy Eating for Older Adults
Healthy eating is essential for older adults as it provides the necessary nutrients to maintain a healthy body and mind, prevent chronic illnesses, and improve overall quality of life. As people age, their nutritional needs change, and a balanced diet can help meet these changing needs.
Firstly, a balanced diet can prevent chronic illnesses such as heart disease, type 2 diabetes, and certain cancers. It can also help maintain a healthy weight, which is important for reducing joint pain, sleep apnea, and mobility issues.
Secondly, a balanced diet can improve mental health and cognitive function by consuming essential nutrients such as omega-3 fatty acids, vitamins B12 and D, and folate.
Adequate hydration is also important for preventing dehydration-related health issues.
Healthy eating can help older adults maintain their physical and mental well-being as they age.
In order to enhance early detection and treatment results for this demographic, we must endeavor to increase knowledge of both the prevalence and special therapeutic concerns of eating disorders in older adults. Regardless of age, anyone battling an eating disorder needs access to effective therapy. You can fully recover at any time; it is never too late.