Geriatric Anorexia Nervosa

Abstract

Eating disorders are not commonly diagnosed in individuals aged >50 years, yet they are associated with significant psychiatric comorbidities and overall morbidity. Anorexia nervosa is the most common eating disorder among this age group, and women are affected most often. We present the fatal case of a 66-year old woman with severe malnutrition and newly diagnosed anorexia nervosa. Inpatient refeeding was unsuccessful, and she succumbed to multisystem organ failure. The timely recognition of eating disorders among older people is important for family physicians who care for patients across the life spectrum. ( The onset of eating disorders has been most commonly described as occurring among adolescent and young adult women (16 to 25 years old). More controversy over the emergence of eating disorders in women aged Ͼ50 years has evolved regarding whether the eating disorder emerges at that time or is diagnosed from onset at an earlier age.1-3 The behaviors that coincide with eating disorders, such as restrictive eating patterns and body dysmorphia, have been documented among older women. Among a random community sample of 475 women aged 60 to 70 years, 3.8% met the criteria for an eating disorder. 4 Among older Canadian women, 2.6% of those aged 50 to 64 years, and 1.8% of those aged Ͼ65, reported symptoms of disordered eating. 5A strong association has been noted with comorbid psychiatric disorders in late-onset eating disorders. Major depression has been shown to be 2.4 to 4 times more likely in individuals with anorexia than in controls.6 Anxiety disorders, obsessive compulsive disorder, and social phobias have also been associated with eating orders. 7,8 In a study of women aged Ն50 years that investigated the relationship between eating disorder symptomatology (scores Ͼ20 on the EAT-26 eating disorders screening tool, where scores Ͼ20 indicate high risk of an eating disorder) and mood disorders, older women with eating disorder symptomatology had a significantly higher risk of a mood disorder than did those women who scored Յ20 on the EAT-26 module (odds ratio, 6.9 [95% confidence interval, 4.5-10.4] and 1.0, respectively). 2 A recent review of the literature regarding eating disorders in individuals aged Ͼ50 years revealed comorbid psychiatric conditions in 60% of this population; major depression was the most common mood disorder among patients in this age group.

Psychiatric comorbidity as a risk factor for mortality in people with anorexia nervosa

“…We decided not to set an age limit to achieve a comprehensive epidemiologic view on mortality of patients with AN. Moreover, there are case reports of patients newly diagnosed with AN at the age of 65 or older [32], and a recent study demonstrated that active eating disorders are common amongst women in mid-life, both due to new onset and chronic disorders [33].…”

“…One should keep in mind though, while interpreting the results of our study, that a diagnosis of AN did neither require that AN was the leading current diagnosis nor that it was the first episode of AN. Second, current research has highlighted the occurrence of AN in mid-life and older adults [32,33,49]. Third, studies in AN have used different upper age limits, for example, 40 years of age [20,31], even though other studies have shown that in a relevant proportion of people with AN is first diagnosed or first treated after the age of 40 [32,33].…”

Treatment of eating disorders in older people: a systematic review

“…In the older population, it would be possible to misdiagnose eating disorders as a medical issue or a consequence of an organic problem. Another complicating factor in identification could be that adults are more adept at masking their illness [ 11 ] than their younger counterparts [ 1 ].…”

“…This suggests that not only can eating disorders exist in the older age group, but that the risk of mortality and morbidity in this age group is significantly higher. Therefore, the timely recognition of eating disorders among older age groups appears to be of great importance [ 11 ].…”

Improving the Health of Patients and Communities: Evolving Practice-based Research (PBR) and Collaborations

“…National epidemiologic surveys show that anorexia nervosa manifests itself during young adulthood. 4 Zayed et al 5 report an exception: a malnourished 66-year-old woman with anorexia nervosa. This case report alerts clinicians in community-based practice to avoid age-related bias when diagnosing a condition with a potentially fatal trajectory.…”