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Mulchandani M, Shetty N, Conrad A, Muir P, Mah B. Treatment of eating disorders in older people: a systematic review. Syst Rev 2021; 10:275. [PMID: 34696804 PMCID: PMC8543781 DOI: 10.1186/s13643-021-01823-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 09/28/2021] [Indexed: 11/11/2022] Open
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.
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Affiliation(s)
- Megha Mulchandani
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW, 2300, Australia.,Older People's Mental Health Service, Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW, 2300, Australia
| | - Namrata Shetty
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW, 2300, Australia.,Older People's Mental Health Service, Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW, 2300, Australia
| | - Agatha Conrad
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW, 2300, Australia. .,Centre for Brain and Mental Health Research (CBMHR), The University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Petra Muir
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW, 2300, Australia.,Older People's Mental Health Service, Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW, 2300, Australia
| | - Beth Mah
- Centre for Brain and Mental Health Research (CBMHR), The University of Newcastle, Callaghan, NSW, 2308, Australia.,Karitane Residential Service, 138 The Horsely Drive, Carramar, NSW, 2163, Australia
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2
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Prevalence and correlates of self-reported disordered eating: A cross-sectional study among 90 592 middle-aged Norwegian women. PLoS One 2019; 14:e0211056. [PMID: 30673772 PMCID: PMC6343912 DOI: 10.1371/journal.pone.0211056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/07/2019] [Indexed: 11/19/2022] Open
Abstract
Disordered eating (DE) is extensively studied among adolescents and young women. However, there is growing evidence that DE as well as the clinical eating disorders may occur at any age from childhood to advanced years. This study aimed to determine the prevalence and correlates of DE in a representative sample of middle-aged women from Norway. The study included 90 592 women (median age: 55 years) from the Norwegian Women and Cancer study who responded to a questionnaire between the years 2002–2005. Correlates of self-reported DE were assessed by logistic regression analyses. The overall period prevalence of DE between 2002–2005 was 0.28 (95% confidence interval 0.25–0.31) %, and was highest among women ≥ 66 years: 0.65 (0.60–0.70) %. DE was strongly associated with depression (Odds ratio [OR] 3.34 [95% confidence interval 2.53–4.41]), being unemployed (OR 1.78 [1.32–2.40]) and single (OR 1.66 [1.25–2.20]). Women with DE were more likely to report low energy intake (OR 1.41 [1.08–1.86]) and were less likely to be moderately physically active (OR 0.67 [0.47–0.95]). Using the largest study sample in the literature, the present findings confirm smaller studies showing that DE do occur in women in mid-life and older age as well. Our results contribute to address a somewhat under-communicated community health problem that needs attention in terms of age-specific treatment and prevention.
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Jenkins PE, Price T. Eating pathology in midlife women: Similar or different to younger counterparts? Int J Eat Disord 2018; 51:3-9. [PMID: 29205410 DOI: 10.1002/eat.22810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/12/2017] [Accepted: 11/20/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study examined potential similarities and differences between women with eating disorders (EDs) in midlife and their younger counterparts. METHOD Seven hundred and three women assessed by a specialist eating disorder service were divided into three groups based on age (18-25, 25-40, and 40+) and compared on a number of clinical and demographic measures. Distribution of ED diagnoses was also examined between groups. RESULTS Midlife women were less likely to receive a diagnosis of anorexia nervosa and more likely to receive a diagnosis of binge-eating disorder than their younger counterparts. Duration of illness was longer and age of ED onset later in the midlife group but no differences were seen on measures of global ED pathology, psychosocial impairment, or psychological distress. DISCUSSION This study adds to the developing literature concerning EDs in midlife women, although further work is needed to support the findings presented here and to examine profiles of males presenting to treatment centers.
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Affiliation(s)
- Paul E Jenkins
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, United Kingdom.,School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Tom Price
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Oxford, United Kingdom.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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4
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Conceição EM, Gomes FVS, Vaz AR, Pinto-Bastos A, Machado PPP. Prevalence of eating disorders and picking/nibbling in elderly women. Int J Eat Disord 2017; 50:793-800. [PMID: 28301060 DOI: 10.1002/eat.22700] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The aim of this study was to examine the point prevalence of eating disorders and picking/nibbling in elderly women. METHODS This was a two-stage epidemiological study that assessed 342 women aged 65-94 years old. In Stage 1, the following screening measures were used to identify possible cases: the Mini-Mental State Examination, to screen and exclude patients with cognitive impairment; Weight Concerns Scale; SCOFF (Sick, Control, One, Fat, Food) Questionnaire; Eating Disorder Examination Questionnaire-dietary restraint subscale; and three questions to screen for picking/nibbling and night eating syndrome. Women selected for Stage 2 (n = 118) were interviewed using the diagnostic items of the Eating Disorder Examination. RESULTS According to the DSM-5, the prevalence of all eating disorders was 3.25% (1.83-5.7, 95% C.I.). Prevalence of binge-eating disorder was 1.68% (0.82-3.82, 95% C.I.), of other specified feeding or eating disorders was 1.48% (0.63-3.42, 95% C.I.), and of bulimia nervosa 0.3% (.05-1.7, 95% C.I.)]. Binge-eating episodes were reported by 5.62% of women. No cases of anorexia nervosa or night eating syndrome were identified. The prevalence of picking/nibbling was 18.9%. Picking/nibbling was associated with increased body mass index (t(322) = -3.28, p < .001) and binge-eating episodes (χ2 (1) = 5.65, p < .017). DISCUSSION Prevalence rates of eating disorders on elderly Portuguese women were comparable to those found on young women. Our data support the literature that suggests that binge-eating disorder is particularly prevalent in older adults. Picking/nibbling was the most prevalent eating behavior and we provide further evidence for its association with weight and disordered eating.
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Affiliation(s)
- Eva M Conceição
- School of Psychology, University of Minho, 4710-057, Braga, Portugal
| | - Fabiana V S Gomes
- School of Psychology, University of Minho, 4710-057, Braga, Portugal
| | - Ana R Vaz
- School of Psychology, University of Minho, 4710-057, Braga, Portugal
| | - Ana Pinto-Bastos
- School of Psychology, University of Minho, 4710-057, Braga, Portugal
| | - Paulo P P Machado
- School of Psychology, University of Minho, 4710-057, Braga, Portugal
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5
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Midlarsky E, Marotta AK, Pirutinsky S, Morin RT, McGowan JC. Psychological predictors of eating pathology in older adult women. J Women Aging 2017; 30:145-157. [PMID: 28368780 DOI: 10.1080/08952841.2017.1295665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Eating pathology is generally considered to affect females during adolescence and early adulthood. However, in recent years, there has been an increased recognition that disordered eating occurs in middle-aged and elderly women and that the presentation is similar to that of eating disorders in younger women. In the research presented here, results of an Internet survey of older adult women (N = 245; aged 60-90 years) indicate that the factors significantly associated with eating pathology-perfectionism, depression, and sociocultural pressures to be thin-closely parallel those reported for both younger and middle-aged women.
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Affiliation(s)
- Elizabeth Midlarsky
- a Department of Counseling and Clinical Psychology , Teachers College, Columbia University , New York , New York , USA
| | - Ashley Kronen Marotta
- a Department of Counseling and Clinical Psychology , Teachers College, Columbia University , New York , New York , USA
| | - Steven Pirutinsky
- a Department of Counseling and Clinical Psychology , Teachers College, Columbia University , New York , New York , USA
| | - Ruth T Morin
- a Department of Counseling and Clinical Psychology , Teachers College, Columbia University , New York , New York , USA
| | - Joseph C McGowan
- a Department of Counseling and Clinical Psychology , Teachers College, Columbia University , New York , New York , USA
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6
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Johnston O, Reilly J, Kremer J. Women’s Experiences of Appearance Concern and Body Control across the Lifespan: Challenging accepted wisdom. J Health Psychol 2016; 9:397-410. [PMID: 15117539 DOI: 10.1177/1359105304042349] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study adopted a lifespan approach to women’s experiences of appearance concern and body control. Thirty-two women (aged 16 to 77) were interviewed about their exercise and food regulation. Results of the grounded theory analysis challenge social constructions of appearance concern as associated principally with the reproductive years, and of the body as malleable, and highlight the complexity of the relationship between appearance concern and body control. Despite frequent persistence of (or increase in) appearance concern beyond young adulthood, ‘healthier’ responses to appearance concern occurred due to changing priorities and increasing awareness. Findings highlight the utility of an inclusive and qualitative approach, and the absence of simple and sovereign factors determining an individual’s levels of appearance concern or body control.
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Luca A, Luca M, Calandra2 C. Eating Disorders in Late-life. Aging Dis 2015; 6:48-55. [PMID: 25657852 PMCID: PMC4306473 DOI: 10.14336/ad.2014.0124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 12/16/2022] Open
Abstract
Eating disorders are a heterogeneous group of complex psychiatric disorders characterized by abnormal eating behaviours that lead to a high rate of morbidity, or even death, if underestimated and untreated. The main disorders enlisted in the chapter of the Diagnostic and Statistic Manual of Mental Disorders-5 dedicated to "Feeding and Eating Disorders" are: anorexia nervosa, bulimia nervosa and binge eating disorder. Even though these abnormal behaviours are mostly diagnosed during childhood, interesting cases of late-life eating disorders have been reported in literature. In this review, these eating disorders are discussed, with particular attention to the diagnosis and management of those cases occurring in late-life.
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Affiliation(s)
- Antonina Luca
- Department “G.F. Ingrassia” Section of Neuroscience, University of Catania (Sicily), Italy
| | - Maria Luca
- Department of Medical and Surgery Specialties, Psychiatry Unit of the University Hospital “Policlinico-Vittorio Emanuele” of Catania (Sicily), Italy. Via S. Sofia 78, 95100 Catania
| | - Carmela Calandra2
- Department of Medical and Surgery Specialties, Psychiatry Unit of the University Hospital “Policlinico-Vittorio Emanuele” of Catania (Sicily), Italy. Via S. Sofia 78, 95100 Catania
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8
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Mitchison D, Hay P, Slewa-Younan S, Mond J. The changing demographic profile of eating disorder behaviors in the community. BMC Public Health 2014; 14:943. [PMID: 25213544 PMCID: PMC4246495 DOI: 10.1186/1471-2458-14-943] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The perception that eating disorders occur predominantly in young white upper-class women has been challenged. This study examined temporal differences to the demographic correlates of eating disorder behaviors over a 10-year period. METHODS Data from cross-sectional general population surveys in 1998 (n = 3010) and 2008 (n = 3034) were collected on demographics (sex, age, income, residency), current eating disorder behaviors (binge eating, extreme dieting, purging), and health-related quality of life (SF-36). RESULTS Below-median annual household income was associated with increased prevalence rates from 1998 to 2008 in binge eating, extreme dieting, and purging. Male sex was associated with increased prevalence rates in extreme dieting and purging. Age over 45 years was associated with increased prevalence rates in purging. In 2008 versus 1998, binge eating was associated with greater mental health-related quality of life impairment in males but not females; and greater physical health-related quality of life impairment in regional but not metropolitan areas. Extreme dieting was also associated with greater physical health-related quality of life impairment in 2008 versus 1998 in the lower but not the higher socioeconomic sector. CONCLUSIONS Findings suggest the 'democratization' of disordered eating, with greatest levels of associated impairment being within marginalized demographic sectors. Implications include the need for broader intervention programs and recruitment of demographically representative samples in eating disorder research.
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Affiliation(s)
- Deborah Mitchison
- School of Medicine, University of Western Sydney, Locked Bag 1797, Penrith, NSW 2751, Australia.
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Fazeli PK, Wang IS, Miller KK, Herzog DB, Misra M, Lee H, Finkelstein JS, Bouxsein ML, Klibanski A. Teriparatide increases bone formation and bone mineral density in adult women with anorexia nervosa. J Clin Endocrinol Metab 2014; 99:1322-9. [PMID: 24456286 PMCID: PMC3973785 DOI: 10.1210/jc.2013-4105] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Anorexia nervosa (AN), a prevalent psychiatric disorder predominantly affecting women, is characterized by self-induced starvation and low body weight. Increased clinical fractures are common, and most women have low bone mineral density (BMD). Previously investigated treatments have led to no or modest increases in BMD in AN. OBJECTIVE Our objective was to investigate the effect of teriparatide (TPT; human PTH[1-34]), an anabolic agent, on low bone mass in women with AN. DESIGN, SETTING, AND PATIENTS This randomized, placebo-controlled trial at a clinical research center included 21 women with AN: 10 (mean age ± SEM, 47 ± 2.7 years) treated with TPT and 11 (47.1 ± 2.3 years) treated with placebo. INTERVENTIONS TPT (20 μg s.c.) or placebo was administered for 6 months. MAIN OUTCOME MEASURES Our primary outcome measure was change in BMD of the spine and hip by dual-energy x-ray absorptiometry. Secondary outcome measures included changes in serum N-terminal propeptide of type 1 procollagen (P1NP), C-terminal collagen cross-links, sclerostin, and IGF-1 levels. RESULTS At 6 months, spine BMD increased significantly more with TPT (posteroanterior spine, 6.0% ± 1.4%; lateral spine, 10.5% ± 2.5%) compared with placebo (posteroanterior spine, 0.2% ± 0.7%, P < .01; lateral spine, -0.6% ± 1.0%; P < .01). The results remained significant after controlling for baseline body mass index, P1NP, and IGF-1. Changes in femoral neck (P = .4) and total hip (P = 0.8) BMD were comparable in both groups, as were changes in weight. Serum P1NP levels increased after 3 months of TPT treatment and remained at this higher level at 6 months, whereas P1NP levels were unchanged in the placebo group (P = .02). TPT was well-tolerated by all subjects. CONCLUSIONS This study demonstrates that TPT administration increases spine BMD substantially after only 6 months of therapy in women with AN.
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Affiliation(s)
- Pouneh K Fazeli
- Neuroendocrine Unit (P.K.F., I.S.W., K.K.M., M.M., A.K.), Biostatistics Center (H.L.), and Endocrine Unit (J.S.F.), Massachusetts General Hospital, Boston, Massachusetts 02114; Center for Advanced Orthopaedic Studies (M.L.B.), Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215; and Harvard Medical School (P.K.F., K.K.M., D.B.H., M.M., H.L., J.S.F., M.L.B., A.K.), Boston, Massachusetts 02115
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Abstract
The onset of an eating disorder in middle-age men is poorly researched as are eating disorders in men generally. Therefore, life events that influence eating disorders in men, including delayed onset of an eating disorder remains unknown. Given the limited understanding of males with eating disorders and limited access to large samples of men with eating disorders, an in-depth analysis of a single case of a male in middle age with an eating disorder was chosen to gain insight and understanding into this phenomenon. A Life History approach explored the case of Joseph (pseudonym), who was diagnosed at age 44 years with an Eating Disorder Not Otherwise Specified. Data were collected through (a) life course open-ended questioning through interviews, (b) written statements, and (c) comments on transcripts. Three themes emerged, loss and unworthiness, becoming bigger, and wanting to change reflecting eating behaviors associated with attachment disruption, loss and trauma, body dissatisfaction, and negative affect. Later in life, an emotional “tipping point” precipitated an eating disorder. Results indicate traumatic loss leading to early attachment disruption as influential in Joseph’s delayed onset of an eating disorder. The value of thorough narrative life histories during therapy when eating disorders occur late in life is discussed as well as the significance for men.
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Affiliation(s)
- Lynne McCormack
- University of Newcastle, Callaghan, New South Wales, Australia
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Bueno B, Krug I, Bulik CM, Jiménez-Murcia S, Granero R, Thornton L, Penelo E, Menchón JM, Sánchez I, Tinahones FJ, Fernández-Aranda F. Late onset eating disorders in Spain: clinical characteristics and therapeutic implications. J Clin Psychol 2013; 70:1-17. [PMID: 23801539 DOI: 10.1002/jclp.22006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The literature on later age of onset (LAO) in women with eating disorders is scarce. We compared the severity of eating disorders, eating disorder subtype, and personality profiles in a clinical sample of consecutively assessed women with eating disorders with later age of onset (LAO, > = 25 years) to women with typical age of onset (TAO, <25 years). METHOD All eating disorder patients met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria and were admitted to the Eating Disorder Unit of the University Hospital of Bellvitge in Barcelona, Spain. Ninety-six patients were classified as LAO and 759 as TAO. ASSESSMENT Measures included the Eating Attitude Test-40 (EAT-40), Eating Disorders Inventory-2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist Revised (SCL-90-R), and the Temperament and Character Inventory-Revised (TCI-R), as well as other clinical and psychopathological indices. RESULTS LAO individuals reported significantly fewer weekly vomiting episodes, fewer self-harming behaviours, less drug abuse, and lower scores on the BITE symptoms, the EDI-2 drive for thinness, and the TCI-R harm avoidance scales than TAO individuals. Conversely, the LAO group reported more current and premorbid obesity than the TAO group. CONCLUSION LAO eating disorder patients in this sample presented with milder symptomatology and less extreme personality traits. Premorbid obesity may be more relevant to LAO than TAO eating disorders and should be routinely assessed and considered when planning treatment.
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Affiliation(s)
- B Bueno
- Department of Psychiatry, University Hospital of Bellvitge; CIBER Salud Mental (CIBERSAM), ISCIII
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Gagne DA, Von Holle A, Brownley KA, Runfola CD, Hofmeier S, Branch KE, Bulik CM. Eating disorder symptoms and weight and shape concerns in a large web-based convenience sample of women ages 50 and above: results of the Gender and Body Image (GABI) study. Int J Eat Disord 2012; 45:832-44. [PMID: 22729743 PMCID: PMC3459309 DOI: 10.1002/eat.22030] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Limited research exists on eating disorder symptoms and attitudes and weight and shape concerns in women in midlife to older adulthood. We conducted an online survey to characterize these behaviors and concerns in women ages 50 and above. METHOD Participants (n = 1,849) were recruited via the Internet and convenience sampling. RESULTS Eating disorder symptoms, dieting and body checking behaviors, and weight and shape concerns were widely endorsed. Younger age and higher body mass index (BMI) were associated with greater endorsement of eating disorder symptoms, behaviors, and concerns. DISCUSSION Weight and shape concerns and disordered eating behaviors occur in women over 50 and vary by age and BMI. Focused research on disordered eating patterns in this age group is necessary to develop age-appropriate interventions and to meet the developmental needs of an important, growing, and underserved population.
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Affiliation(s)
- Danielle A. Gagne
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Ann Von Holle
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | | | | | - Sara Hofmeier
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | | | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, Department of Nutrition, University of North Carolina, Chapel Hill, NC
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Guerdjikova AI, O'Melia AM, Mori N, McCoy J, McElroy SL. Binge eating disorder in elderly individuals. Int J Eat Disord 2012; 45:905-8. [PMID: 22576715 DOI: 10.1002/eat.22028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To preliminarily describe the clinical features of elderly individuals with binge eating disorder (BED). METHOD The psychological and general medical characteristics of 20 elderly individuals (65 years of age and older) who met DSM-IV-TR for BED were systematically evaluated. RESULTS Elderly individuals with BED reported an average (SD) of 4.5 (2.9) binge eating episodes per week. Weight and shape concerns were of significant importance for participants' schema for self-evaluation. Mood disorders were the most frequent co-occurring psychiatric disorders. Despite having a mean (SD) body mass index of 36.4 (10.6), most participants presented in good general medical health. DISCUSSION Regarding eating pathology, psychiatric comorbidity, and associated obesity, BED in this group of elderly individuals was similar to BED in younger adults. However, other than presenting with obesity, the participants reported good general medical health. BED might be a problem for a subset of physically healthy elderly individuals. Studies further examining psychiatric and medical presentation, including metabolic profile, of elderly individuals with BED may be warranted.
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Scholtz S, Hill LS, Lacey H. Eating disorders in older women: does late onset anorexia nervosa exist? Int J Eat Disord 2010; 43:393-7. [PMID: 19536881 DOI: 10.1002/eat.20704] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The objective of this study is to determine whether eating disorders can present for the first time in older people. METHOD This is a descriptive study of patients above the age of 50 years who have presented to a national eating disorder center within the last 10 years. RESULTS Thirty-two patients were identified; data were available for 26 of these patients and 11 agreed for further interview and questionnaire completion. There were no cases where the eating disorder had its onset late in life. Of the 11 interviewed, six participants retained a diagnosis of anorexia nervosa, four had Eating Disorder Not Otherwise Specified and only one was recovered. Comorbid depression was universal in those still suffering with an eating disorder diagnosis, and their level of social functioning was impaired. DISCUSSION Anorexia nervosa is a chronic and enduring mental illness that, although rare, can be found in older people. In our sample, we found no evidence of late-onset disorders; all described cases were lifelong.
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Affiliation(s)
- Samantha Scholtz
- Division of Mental Health, St George's University of London, London, United Kingdom.
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Abstract
BACKGROUND Eating disorders in the elderly are often overlooked. When they occur, significant morbidity and mortality result. In this study we review all existing literature on eating disorders in the elderly and provide practical guidelines for clinicians in recognizing and managing eating disorders in the elderly. METHODS A literature search using Medline, PubMed, Web of Knowledge, and PsychINFO revealed 48 published cases of eating disorders in people over the age of 50 years. RESULTS The mean age was 68.6 years (range 50-94), and the majority (88%) of cases were females. The majority (81%) of cases had anorexia nervosa, and 10% had bulimia nervosa. Late onset eating disorders were more common (69%) than early onset. Comorbid psychiatric conditions existed in 60%, most commonly major depression. Management with a combination of behavioral and pharmacologic interventions was most successful, although only 42% were treated successfully. Mortality was high (21%) secondary to the eating disorder and its complications. CONCLUSION Eating disorders do occur in the elderly and should be included in the differential diagnosis of unexplained weight loss in the elderly.
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Altschuler J, Katz AD. Keeping your eye on the process: body image, older women, and countertransference. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2010; 53:200-214. [PMID: 20336569 DOI: 10.1080/01634370903507589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Research on body image and older women has grown in the past decade. However, there is a gap in the literature regarding body image, older women, and countertransference. This article provides 7 case examples of racially and ethnically diverse women over 60, drawn from MSW student and agency staff supervision, and participant feedback from a national conference on aging workshop. Themes related to loss and grief, adult daughter and aging mother issues, incest, anger, disability, personality disorders, phobic reactions, and shame are discussed. Recommendations and implications for social work practice, education and research are provided.
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Affiliation(s)
- Joanne Altschuler
- School of Social Work, California State University, Los Angeles, California 90032, USA.
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Kimura H, Tonoike T, Muroya T, Yoshida K, Ozaki N. Age of onset has limited association with body mass index at time of presentation for anorexia nervosa: comparison of peak-onset and late-onset anorexia nervosa groups. Psychiatry Clin Neurosci 2007; 61:646-50. [PMID: 18081626 DOI: 10.1111/j.1440-1819.2007.01719.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The clinical characteristics differentiating late-onset anorexia nervosa (AN) from typical pubertal onset AN remain unclear. The purpose of the present study was to examine these differences in a retrospective analysis. A total of 149 female AN patients was divided into two groups: a peak-onset AN group (n = 125) in which onset occurred between the ages of 15 and 24 years, and a late-onset AN group (n = 24) in which onset occurred at the age of > or =25 years. A logistic regression analysis was conducted with this classification as the target variable and five clinical factors as explanatory variables for the clinical characteristics at the time of initial examination. Body mass index (BMI) at the time of presentation was identified as a possible factor affecting classification as peak-onset or late-onset AN. In addition, a negative linear correlation was detected between age of onset and BMI at the time of initial examination. The results suggest that BMI at the time of the initial examination is an important clinical characteristic to differentiate peak-onset AN and late-onset AN.
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Affiliation(s)
- Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Mangweth-Matzek B, Rupp CI, Hausmann A, Assmayr K, Mariacher E, Kemmler G, Whitworth AB, Biebl W. Never too old for eating disorders or body dissatisfaction: a community study of elderly women. Int J Eat Disord 2006; 39:583-6. [PMID: 17078123 DOI: 10.1002/eat.20327] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of the study is to examine eating behavior and body attitude in elderly women. METHOD A randomly selected nonclinical sample of 1,000 women, aged 60-70 years, was contacted for our questionnaire survey covering current eating behavior, weight history, weight control, body attitude, and disordered eating (DSM-IV). RESULTS The 475 (48%) women included in our analyses had a mean BMI of 25.1 but desired a mean BMI of 23.3. More than 80% controlled their weight and over 60% stated body dissatisfaction. Eighteen women (3.8%; 95% confidence interval: 2.3-5.9%) met criteria for eating disorders (ED; N = 1 anorexia nervosa, N = 2 bulimia nervosa, and N = 15 EDNOS) and 21 (4.4%) reported single symptoms of an ED. CONCLUSION Although EDs and body dissatisfaction are typical for young women, they do occur in female elderly and therefore should be included in the differential diagnosis of elderly presenting with weight loss, weight phobia, and/or vomiting.
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Affiliation(s)
- Barbara Mangweth-Matzek
- Department of Psychiatry, Innsbruck Medical University, Anichstr. 35, A-6020 Innsbruck, Austria.
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Abstract
Anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified have a significant impact on the health care and childbearing outcomes of the female population. Primary care contact for gynecologic care, childbearing, or infertility can serve as a critical entry point for the initial recognition of potentially devastating disorders that may result in permanent impairment and/or chronic debilitation. This review addresses the nature and prevalence of eating disorders and the management of pregnancy complicated by an active eating disorder or a history of an eating disorder. Genetic influences and intergenerational transmission of eating disorders are discussed. Finally, the increased risk for postpartum depression among women with a current or past eating disorder is examined. Factors critical to improving pregnancy outcome and reducing the risk for exacerbation or relapse in the postpartum period are identified.
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Bulik CM, Reba L, Siega-Riz AM, Reichborn-Kjennerud T. Anorexia nervosa: definition, epidemiology, and cycle of risk. Int J Eat Disord 2005; 37 Suppl:S2-9; discussion S20-1. [PMID: 15852310 DOI: 10.1002/eat.20107] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Anorexia nervosa is a debilitating psychiatric disorder with profound biological, psychological, and social consequences. After an initial evaluation of the most widely used diagnostic criteria for anorexia nervosa, this paper reviews genetic and environmental risk factors for the development of anorexia with special emphasis on gene environment interplay and the impact of adverse perinatal events.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, 27599-7160, USA.
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Reas DL, Kjelsås E, Heggestad T, Eriksen L, Nielsen S, Gjertsen F, Götestam KG. Characteristics of anorexia nervosa-related deaths in Norway (1992-2000): data from the National Patient Register and the Causes of Death Register. Int J Eat Disord 2005; 37:181-7. [PMID: 15822079 DOI: 10.1002/eat.20104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study investigated demographic and diagnostic characteristics of individuals whose medical record or death certificate indicated the presence of anorexia nervosa at the time of death. METHOD Two national registers, the National Patient Register (NPR) and the Causes of Death Register (CODR), were examined in Norway for anorexia nervosa-related deaths occurring across a 9-year period (1992-2000). RESULTS The medical record or death certificate listed anorexia nervosa as a diagnosis or cause of death for 66 individuals. Rates of death were 6.46 and 9.93 per 100,000 deaths for the NPR and the CODR, respectively. A substantial percentage of deaths (43.9%) in both registers occurred at or above the age of 65 years. For the NPR, the mean age at the time of death was 61 years and 31% of deaths occurred among men. For the CODR, the mean age at the time of death was 49 years and 18% of deaths occurred among men. DISCUSSION Potential merits and shortcomings of assessing mortality rates using register-based data without linkage to a previously identified clinical sample are discussed.
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Mermelstein HT, Basu R. Can you ever be too old to be too thin? Anorexia nervosa in a 92-year-old woman. Int J Eat Disord 2001; 30:123-6. [PMID: 11439419 DOI: 10.1002/eat.1064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED Anorexia nervosa is a common psychiatric condition that most often affects young adults. If left untreated, it can have significant morbidity and mortality. METHODS AND DISCUSSION In this report, we describe a woman first diagnosed with anorexia nervosa at age 92 and we discuss the relevant diagnostic and treatment-related issues. CONCLUSION This case underscores the need to heighten diagnostic sensitivity for this and other eating disorders at any age.
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Affiliation(s)
- H T Mermelstein
- Department of Psychiatry, North Shore University Hospital, Manhasset, New York
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23
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Abstract
OBJECTIVE To demonstrate a case of anorexia nervosa in the elderly and to highlight the need for broadening of current diagnostic criteria. CLINICAL PICTURE First onset of anorexia nervosa in a 72-year-old woman following bereavement of her husband. TREATMENT Nine treatments of electroconvulsive therapy. OUTCOME Treatment resulted in remission of the depressive symptoms and improvement of eating behaviour. CONCLUSIONS Anorexia nervosa does occur in the elderly and can be difficult to detect. Where comorbid depression exists it requires aggressive treatment.
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Affiliation(s)
- R Hill
- Auckland School of Medicine, Auckland, New Zealand
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24
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Abstract
Eating disorders are common among adolescent girls and young women and are associated with potentially serious medical complications, yet they often go undetected and untreated. All patients with eating disorders should be evaluated and treated for medical complications of the disease at the same time that psychotherapy and nutritional counseling are undertaken. Pharmacologic agents are often useful as adjuncts to psychotherapy for bulimia nervosa or binge-eating disorder; in the case of anorexia nervosa, psychotropic medication is generally reserved for patients with a concurrent psychiatric illness or those who have recovered some weight.
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Affiliation(s)
- A E Becker
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Harvard Eating Disorders Center, Boston 02116, USA
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25
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Abstract
Refusal to eat by the elderly, and subsequent malnutrition, occurs in both institutional and community settings. Causes include physiologic changes associated with aging, mental disorders such as dementia and depression, and medical, social, and environmental factors. Treatment approaches call for management of these causes while considering the roles that medicine, ethics, and culture play in the process.
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Affiliation(s)
- E L Marcus
- Acute Geriatric Department, Sarah Herzog Memorial Hospital, Jerusalem, Israel
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