Treatment of eating disorders in older people: a systematic review

Abstract

Background Historically, eating disorders were not identified in older populations and it is only in more recent times that there is greater recognition of the existence of eating disorders among the elderly. This is despite the high level of morbidity and mortality associated with these disorders. Current guidelines focus on treatment of eating disorders within the adolescent and general adult age groups, without apparent concessions made for the older age group. The aim of this study was to review existing literature on the demographics and treatment of eating disorders in older people. Methods/design A systematic review of the literature was conducted using CINAHL, MEDLINE, EMBASE, PsycInfo, Scopus, and Web of Science to identify publications focusing on treatment of eating disorders in people over the age of 65 years, age of diagnosis, gender distribution, treatment setting, and treatment outcomes. Results A total of 35 articles (reporting on 39 cases) were relevant to our study, with 33 of the 35 articles being either case studies or case series. The mean age of participants was 73.2 years (range 66–94 years) with the majority (84.6%) being female. Most cases (84.6%) were diagnosed with anorexia nervosa, and 56.4% of all cases were reported as late onset (i.e., after age 40 years). The vast majority (94.8%) received treatment, of which 51.5% was hospital-based treatment. In case descriptions where improvement was reported, the majority described a multidimensional approach that included a combination of hospital admission, therapy and pharmacotherapy. Overall, 79.5% of cases who underwent treatment for an eating disorder improved, while 20.5% relapsed or died as a result of the complications from their eating disorder. There were significant inconsistencies and omissions in the way cases were described, thereby impacting on the interpretation of the results and potential conclusions. Conclusions The information available on the treatment of eating disorders in people over the age of 65 years is limited. The quality of case reports to date makes it difficult to suggest specific assessment or treatment guidelines for this population.

A Plea for Diversity in Eating Disorders Research

“…Moreover, restricting feeding patterns in transgender youth may serve to delay the development of secondary sex characteristics and may thus additionally function to cope with gender-related distress (15). Finally, preliminary findings suggest that older individuals could be more adept at masking ED symptoms (43), although their symptoms may not fundamentally differ from younger populations (44).…”

“…Updates in diagnostic criteria mirror an increased recognition of the role of diversity across the ED patient population (44). Specifically, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (2) was the first to include Binge Eating Disorder as a specific diagnosis, which is an ED more commonly found in men (3), older individuals (50), and more prevalent in ethnic minority individuals (51).…”

Strengths and weaknesses of the German translation of the Inflexible Eating Questionnaire and of eating disorder assessment in general

“…Thus, important diagnostic information may be overlooked, especially in males (Murray et al, 2017 ). More generally, not only the gender aspect is underrepresented but also peculiarities regarding age (Peat et al, 2008 ; Mulchandani et al, 2021 ), BMI, diet preferences (McLean et al, 2022a , c ), and further specific populations. We found evidence for that claim in the latent correlation coefficients of the validity analysis which were 1) considerably higher in the female compared to the male subgroup, 2) considerably higher for the age group up to 34 compared to 35+, and 3) considerably higher for individuals with an BMI below 18.5.…”

The Role of Body Shame and Age on Appearance-Based Exercise and Positive Body Image in Women from Poland: Preliminary Results of a Cluster Analysis

“…It may also be important for the reason that it will favour the acceptance of the aging process and related body changes in the older age group, and thus protect people against deterioration of quality of life [ 29 , 59 , 60 ]. Moreover, the prevalence of the above-mentioned disorders (i.e., eating disorders) has increased recently in older women, and knowledge of the factors contributing to this phenomenon in this group is still very limited, e.g., [ 61 ]. Therefore, knowing that shame related to the body can also be significant in older women, it is worth exploring the operation of these mechanisms.…”