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Eating disorders in the elderly

Published online by Cambridge University Press:  22 February 2010

Maria I. Lapid ,
Maria C. Prom ,
M. Caroline Burton ,
Donald E. McAlpine ,
Bruce Sutor  and
Teresa A. Rummans
Maria I. Lapid*
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, U.S.A.
Maria C. Prom
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, U.S.A.
M. Caroline Burton
Affiliation:
Department of Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.
Donald E. McAlpine
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, U.S.A.
Bruce Sutor
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, U.S.A.
Teresa A. Rummans
Affiliation:
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, U.S.A.
*
Correspondence should be addressed to: Maria I. Lapid, MD, Mayo Clinic Department of Psychiatry and Psychology, 200 First Street SW, Rochester, MN 55905, U.S.A. Phone: +1 507-255-7184; Fax: +1 507-255-7365. Email: [email protected].
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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(R), PubMed(R), Web of Knowledge(R), and PsychINFO(R) 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.

Keywords

anorexiabulimianervosalate onsetagedappetite disorderthinnessobesity
Type
Review Article
Information
International Psychogeriatrics , Volume 22 , Issue 4 , June 2010 , pp. 523 - 536
Copyright
Copyright © International Psychogeriatric Association 2010

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References

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision). Washington, DC: American Psychiatric Press.Google Scholar
Beck, D., Casper, R. and Andersen, A. (1996). Truly late onset of eating disorders: a study of 11 cases averaging 60 years of age at presentation. International Journal of Eating Disorders, 20, 389–395.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Berkman, J. M. (1930). Anorexia nervosa, anorexia, inanition, and low basal metabolic rate. American Journal of Medical Sciences, 180, 411–424.CrossRefGoogle Scholar
Berkman, N. D., Lohr, K. N. and Bulik, C. M. (2007). Outcomes of eating disorders: a systematic review of the literature. International Journal of Eating Disorders, 40, 293–309.CrossRefGoogle ScholarPubMed
Bernstein, I. C. (1972). Anorexia nervosa, 94-year-old woman treated with electroshock. Minnesota Medicine, 55, 552–553.Google ScholarPubMed
Campbell, P. R. (1996). Population Projections for States by Age, Sex, Race, and Hispanic Origin: 1995 to 2025. Washington, DC: U.S. Census Bureau, Population Division.Google Scholar
Chevrier, A. (1991). Karen Blixen: un cas d'anorexie mentale du troisième âge. Actualités Psychiatriques, 7, 44–47.Google Scholar
Cosford, P. and Arnold, E. (1991). Anorexia nervosa in the elderly. British Journal of Psychiatry, 158, 286–287.CrossRefGoogle ScholarPubMed
Cosford, P. and Arnold, E. (1992). Eating disorders in later life: a review. International Journal of Eating Disorders, 7, 491–498.Google Scholar
Fairburn, C. G., Cooper, Z., Bohn, K., O'Connor, M. E., Doll, H. A. and Palmer, R. L. (2007). The severity and status of eating disorder NOS: implications for DSM-V. Behaviour Research and Therapy, 45, 1705–1715.CrossRefGoogle ScholarPubMed
Fenley, J., Powers, P. S., Miller, J. and Rowland, M. (1990). Untreated anorexia nervosa: A case study of the medical consequences. General Hospital Psychiatry, 12, 264–270.CrossRefGoogle ScholarPubMed
Forman, M. and Davis, W. (2005). Characteristics of middle-aged women in inpatient treatment for eating disorders. Eating Disorders, 13, 231–243.CrossRefGoogle ScholarPubMed
Gadalla, T. M. (2008). Eating disorders and associated psychiatric comorbidity in elderly Canadian women. Archives of Women's Mental Health, 11, 357–362.CrossRefGoogle ScholarPubMed
Gowers, S. G. and Crisp, A. H. (1990). Anorexia nervosa in an 80-year-old woman. British Journal of Psychiatry, 157.CrossRefGoogle Scholar
Gupta, M. A. (1990). Fear of aging: a precipitating factor in late onset anorexia nervosa. International Journal of Eating Disorders, 9, 221–224.3.0.CO;2-K>CrossRefGoogle Scholar
Gupta, M. A. (1995). Concerns about aging and a drive for thinness: a factor in the biospychosocial model of eating disorders? International Journal of Eating Disorders, 18, 351–357.3.0.CO;2-L>CrossRefGoogle Scholar
Hall, P. and Driscoll, R. (1993). Anorexia int he elderly: an annotation. International Journal of Eating Disorders, 14, 497–499.3.0.CO;2-1>CrossRefGoogle Scholar
Harris, M. and Cumella, E. J. (2006). Eating disorders across the life span. Journal of Psychosocial Nursing, 44, 21–26.Google ScholarPubMed
Hewitt, P. L., Coren, S. and Steel, G. D. (2001). Death from anorexia nervosa: age span and sex differences. Aging and Mental Health, 5, 41–46.CrossRefGoogle ScholarPubMed
Hill, R., Haslett, C. and Kumar, S. (2001). Anorexia nervosa in an elderly woman. Australian and New Zealand Journal of Psychiatry, 35, 246–248.CrossRefGoogle ScholarPubMed
Hoek, H. W. and van Hoeken, D. (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders, 34, 383–396.CrossRefGoogle ScholarPubMed
Hsu, L. K. G. and Zimmer, B. (1988). Eating disorders in old age. International Journal of Eating Disorders, 7, 133–138.3.0.CO;2-J>CrossRefGoogle Scholar
Jonas, J. M., Pope, H. G., Hudson, J. I. and Satlin, A. (1984). Undiagnosed vomiting in an older woman: Unsuspected bulimia. American Journal of Psychiatry, 141, 902–903.Google Scholar
Kellett, J., Trimble, M. and Thorley, A. (1976). Anorexia nervosa after the menopause. Britsih Jounal of Psychiatry, 128, 555–558.CrossRefGoogle ScholarPubMed
Launer, M. A. (1978). Anorexia nervosa in late life. British Journal of Psychology, 51, 375–377.CrossRefGoogle ScholarPubMed
Lucas, A. R., Beard, C. M., O'Fallon, W. M. and Kurland, L. T. (1991). 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study. American Journal of Psychiatry, 148, 917–922.Google ScholarPubMed
Lucas, A. R., Crowson, C. S., O'Fallon, W. M. and Melton, L. J. III (1999). The ups and downs of anorexia nervosa. International Journal of Eating Disorders, 26, 397–405.3.0.CO;2-0>CrossRefGoogle ScholarPubMed
Manejias Parke, S. G., Yager, J. and Apfeldorf, W. (2008). Severe eating disorder initially diagnosed in a 72-year-old man. International Journal of Eating Disorders, 41, 376–379.CrossRefGoogle ScholarPubMed
Mermelstein, H. T. and Basu, R. (2001). Can you ever be too old to be too thin? Anorexia nervosa in a 92-year-old woman. International Journal of Eating Disorders, 20, 123–126.CrossRefGoogle Scholar
Miller, D. K., Morley, J. E., Rubenstein, L. Z. and Pietruszka, F. M. (1991). Abnormal eating attitudes and body image in older undernourished individuals. Journal of the American Geriatrics Society, 39, 462–466.CrossRefGoogle ScholarPubMed
Morgan, C. D. and Marsh, C. (2006). Bulimia nervosa in an elderly male: A case report. International Journal of Eating Disorders, 39, 170–171.CrossRefGoogle Scholar
Morgan, J. F., Reid, F. and Lacey, J. H. (1999). The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ, 319, 1467–1468.CrossRefGoogle ScholarPubMed
Nagaratnam, N. and Ghougassian, D. F. (1988). Anorexia nervosa in a 70 year old man. British Medical Journal, 296, 1443–1444.CrossRefGoogle ScholarPubMed
Nicholson, S. D. and Ballance, E. (1998). Anorexia nervosa in later life: an overview. Hospital Medicine, 59, 269–272.Google ScholarPubMed
Pellerin, J., Mure-Petitjean, C. and Boiffin, A. (2000). Anorexie mentale au cours du vieillissement: à propos d'un cas. Annales de Médecine Interne, 151, A47–A51.Google Scholar
Pobee, K. A. and LaPalio, L. R. (1996). Anorexia nervosa in the elderly: a multidisciplinary diagnosis. Clinical Gerontologist, 16, 3–9.CrossRefGoogle Scholar
Price, W. A. (1985). Anorexia nervosa in the elderly. Journal of the American Geriatrics Society, 33, 213–215.CrossRefGoogle ScholarPubMed
Price, W. A., Babai, M. R. and Torem, M. S. (1986). Anorexia nervosa in later life. Hillside Journal of Clinical Psychiatry, 8, 144–151.Google ScholarPubMed
Ramell, M. D. and Brown, N. (1988). Anorexia nervosa in a 67 year old woman. Postgraduate Medical Journal, 64, 48–49.CrossRefGoogle ScholarPubMed
Riemann, B. C., McNally, R. J. and Meier, A. (1993). Anorexia nervosa in an elderly man. International Journal of Eating Disorders, 14, 501–504.3.0.CO;2-U>CrossRefGoogle Scholar
Rome, E. S. and Ammerman, S. (2003). Medical complications of eating disorders: an update. Journal of Adolescent Health, 33, 418–426.CrossRefGoogle ScholarPubMed
Ronch, J. L. (1985). Suspected anorexia nervosa in a 75-year-old institutionalized male: Issues in diagnosis and intervention. Clinical Gerontologist, 4, 31–38.CrossRefGoogle Scholar
Russell, J. D., Berg, J. and Lawrence, J. R. (1988). Anorexia tardive: a diagnosis of exclusion? Medical Journal of Australia, 148, 199–201.CrossRefGoogle ScholarPubMed
Ryle, J. A. (1936). Anorexia nervosa. The Lancet, 2, 893–899.CrossRefGoogle Scholar
Soundy, T. J., Lucas, A. R., Suman, V. J. and Melton, L. J. III (1995). Bulimia nervosa in Rochester, Minnesota from 1980 to 1990. Psychological Medicine, 25, 1065–1071.CrossRefGoogle ScholarPubMed
White, A., Harries, D. and Allen, S. C. (1990). Anorexia nervosa in the elderly: a case report and review of the literature. British Journal of Clinical Practice, 44, 630–631.Google ScholarPubMed
Wills, A. and Olivieri, S. (1998). Anoreixa nervosa in old age. Aging and Mental Health, 2, 239–245.CrossRefGoogle Scholar
Zerbe, K. J. (2002). Eating Disorders in midlife and beyond: transition and transformation at a crucial developmental stage. Psychoanalysis and Psychotherapy, 19, 9–19.Google Scholar
Zerbe, K. J. (2008a). Middle and later life. In Karbe, K. J., Integrated Treatment of Eating Disorders: Beyond the Body Betrayed (pp. 192–220). New York: WW Norton and Company.Google Scholar
Zerbe, K. J. (2008b). Eating disorders in middle and late life: a neglected problem. Primary Psychiatry, 10, 80–82.Google Scholar