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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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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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Abstract
Anorexia nervosa (AN) rarely develops after the age of 30 years, and rarely occurs in men. We report a case of chronic AN in a 72-year-old man, who reported a 20-year history of extreme low body weight, persistent fears of obesity, and feelings of being fat even at 93 lb. Also reported were episodes of self-induced vomiting, laxative abuse, and excessive exercising. Patient's scores on a battery of questionnaires were also consistent with a diagnosis of AN.
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Affiliation(s)
- B C Riemann
- Center for the Study and Treatment of Anxiety Disorders, Oconomowoc, WI 53066
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Miller DK, Morley JE, Rubenstein LZ, Pietruszka FM. Abnormal eating attitudes and body image in older undernourished individuals. J Am Geriatr Soc 1991; 39:462-6. [PMID: 2022797 DOI: 10.1111/j.1532-5415.1991.tb02490.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
An anorexia nervosa-like syndrome has been reported in older persons. To gain additional insight into this condition, a questionnaire designed to assess the severity of eating disorders (the EAT-26) was administered to 183 male outpatients. Thirty-four subjects were found to be undernourished by midarm circumference measurement and 21 by weight adjusted for age-sex-height. Approximately 60% of malnourished subjects acknowledged inappropriate self-control around food, up to 26% described other unsuitable eating attitudes, and 3% to 52% evidenced various forms of distorted body image. They scored high on EAT-26 Oral Control subscale but low to normal on Dieting and Bulimia and Food Preoccupation subscales. These results indicate that abnormal eating attitudes and body image occur in an important minority of undernourished elderly males, but the pattern of abnormalities differs from that seen in classical anorexia nervosa. This association deserves additional investigation, with special attention to the psychopathology producing high Oral Control responses and to females as well as males. In the meantime, clinicians need to consider anorexia-like attitudes when caring for malnourished seniors.
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Affiliation(s)
- D K Miller
- Division of Geriatric Medicine, St. Louis University Medical Center 63104
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Fenley J, Powers PS, Miller J, Rowland M. Untreated anorexia nervosa. A case study of the medical consequences. Gen Hosp Psychiatry 1990; 12:264-70. [PMID: 2376327 DOI: 10.1016/0163-8343(90)90065-k] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This case demonstrates the devastating physical sequelae of 30 years of untreated anorexia nervosa. A full array of these consequences occur in this one patient and include the following: malnutrition and hypoproteinemia, electrolyte disturbances, cortical atrophy with hydrocephalus ex vacuo, tricuspid and mitral valvular dysfunction, anemia, impaired lower gastrointestinal motility, delayed gastric emptying, disturbances in the hypothalamic pituitary target organ axes, severe osteoporosis, marked edema, and extreme muscle wasting. Other possible physical sequelae of her anorexia nervosa are discussed. Psychiatrists, as well as other physicians, should be vigilant in diagnosing this illness and treating it as early as possible. This particular patient was in the medical system for numerous admissions and workups over three decades before the correct diagnosis of anorexia nervosa was made.
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Affiliation(s)
- J Fenley
- University of South Florida College of Medicine, Tampa
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