Inpatient medical stabilization for adolescents with eating disorders: patient and parent perspectives

Abstract

Inpatient medical stabilization for adolescent eating disorders may play an important role not only in addressing acute medical complications, but also in activating the patient and family regarding the need for ongoing treatment. Parents particularly appreciate staff supervision of meals and having a respite from meal planning.

Current eating disorder healthcare services – the perspectives and experiences of individuals with eating disorders, their families and health professionals: systematic review and thematic synthesis

“… 1 , 2 , 5 , 7 , 11 , 13 , 15 , 17 , 18 , 19 , 22 , 25 , 33 , 41 This ‘good professional’ needed to be available and consistent 7 , 13 , 15 , 22 and have a sufficient understanding, 5 , 11 , 12 , 13 , 18 , 19 , 21 , 23 , 33 knowledge and experience of eating disorders. 1 , 8 , 9 , 12 , 13 , 22 , 25 , 26 The ideal setting for this treatment to take place was in a safe and supportive environment – somewhere that feels ‘like home’, 7 , 11 , 13 , 15 , 21 , 22 , 23 , 27 , 28 , 29 considers the individual with eating disorders as a ‘whole person’, 7 , 18 , 19 , 29 and offers a ‘collaborative’ approach to treatment 7 , 18 , 19 , 21 , 24 , 26 , 27 , 29 , 33 , 41 that is ‘individualised and client-focused’…”

“… 19 , 25 , 35 , 43 Eating disorder services created limited access, 21 , 30 , 33 geographical barriers, 21 long waiting lists and delays, 1 , 19 , 21 , 30 rigid admission rules based on single treatment modalities and eating disorder physical traits. 21 , 25 , 30 , 33 Lower body mass indexes took priority, 26 , 30 and referrals were only accepted for very serious cases. 1 , 6 , 21 , 25 , 30 Furthermore, specialist eating disorder care provided no guarantee of treatment even after gaining access, 30 with the risk of losing a place if another patient took priority 25 , 30 and immediate discharge occurring after weight restoration, with little if any aftercare.…”

Community‐based mealtime management for adolescents with anorexia nervosa: A qualitative study of clinicians’ perspectives and experiences

“…The intervention was delivered in the context of participants’ work in or with an intensive community service. While studies have been undertaken about mealtime management in the hospital setting (Bravender et al, ; Hage et al, ; Long et al, ; Offord et al, ), this study demonstrates that those delivering the intervention in the community may experience additional complexity due to the relative isolation and intensity of their work, and the lack of access to immediate support. Weight gain and prevention of hospital admission were reported as the main drivers of the intensive intervention and were key indicators of perceived effectiveness.…”

“…The mealtime intervention is delivered within the family home meals are prepared by the family according to a food plan devised by a dietitian and comprise regular food or, in part or whole, high‐energy liquid nutritional replacements. The young person will preferably sit at the family dining table alongside the ICT clinician, who provides support but does not herself eat, and is given 20 min to consume their main meal and 10 min for their dessert in line with published recommendations (Bravender et al, ). Subsequently, 30‐min direct observation occurs to limit purging behaviors and inappropriate exercise.…”

“…It has the highest mortality rate of any mental health condition; in adolescents, 1.8% die and 17% remain unwell for the long term as a result (Beukers, Berends, de Man‐van Ginkel, van Elburg, & van Meijel, ). A recent population‐based study estimated the lifetime prevalence of the condition to be 0.9% for women and 0.3% for men (Bravender, Elkus, & Lange, ). Anorexia nervosa becomes treatment resistant over time and successful intervention during childhood onset can prevent chronicity (Bezance & Holliday, ; Lock et al, ).…”