Eating Disorders and the Elderly

Anorexia nervosa, bulimia, and binge eating, these are all forms of eating disorders. Previously associated primarily with the younger set—preteens and teens—such eating disorders have unfortunately expanded to affect more individuals in midlife and beyond, as older age proves to be no barrier for disordered eating practices.

When we think of eating disorders you picture a young woman, as that is who most people equate an eating disorder to be. The ‘new’ face of eating disorders is younger, older, and more diverse. Doctors are seeing the emergence of eating disorders in preadolescents, women over 30, and in people regardless of race, gender, religion, sexual orientation, and socioeconomic status.

Even though eating disorders have pushed their way into the lives of older adults, they often surface early. It is believed that eating disorders are still primarily a disease of the youth, as most women later in life with eating disorders developed the problem prior to turning 18 years old. Many of those women are now reaching out for treatment, so while it may look like they are emerging later in life, most eating disordered women have been suffering since adolescence. The difference is that doctors are now seeing women who have had the disorder for 10, 20, and 30 years rather than the adolescents who may have a much shorter experience with these disorders. After someone has an eating disorder for 30 years, the disorder has become almost a personality characteristic for these women, as many of them define themselves by the eating disorder.

Why is it that more elderly people are being diagnosed with an eating disorder? Well, if you pay attention you will notice there are more commercials today devoted to anti-age spots, ant-wrinkle creams, physical fitness and low-fat food, you may be right.  While looking and feeling young may be a great thing, there are some experts telling us that our cultural fixation on agelessness is coming at a price.  More and more evidence is coming to light that folks in their fifth, sixth, seventh and even eighth decade of life are struggling with an eating disorder.

One study in the U.K. found that 90 percent of women feel anxious about how they look.  Feeling self-conscious about one’s appearance is not always a sign of an eating disorder, but it can be a tell-tale marker on the road to getting there.  What doctors and mental health professionals are learning is that far from being a young person’s illness, eating disorders can afflict a person at any age. In fact, when elderly people in Great Britain were asked about how important their appearance was to them, they ranked it right up alongside concerns about health and well-being. 

Today’s senior citizens are less accepting of wrinkles, sagging and the bent of aging.  Fewer and fewer are okay with looking as old as their actual years.  Societal preoccupation with youth and loveliness has managed to creep down to the very young (sometimes as young as 5 years) and upward to the very old (even into their 80s). 

Today more elderly people are showing signs of low self-worth and even more serious conditions like body dysmorphic disorder than ever before.  Older people are not only buying into the unrealistic ideal embraced by a youth-fixated culture, they are falling prey to eating disorders in their effort to achieve it.

While a significant portion of eating disorders among the elderly may be accounted for as the relapse/remitting pattern of a disorder formed in younger years, there are still a notable number of eating disorders that form for the first time in later years.  Many of them are not discovered until a person is hospitalized for some reason. About one-half of the time, a precipitating event triggered the eating disorder.  It may have been widowhood, illness or even family problems.  The majority of cases of eating disorders among the elderly probably go undiagnosed since few people are expecting that to be the explanation when grandma or grandpa starts losing weight or becomes obsessed with exercise and diet.

The ANAD, a nonprofit organization dedicated to alleviating eating disorders, acknowledges the difficulty of defining the level of prevalence of eating disorders in older adults

Types of Eating Disorders

People who have an eating disorder typically fall into one of three diagnoses, regardless of age: anorexia, bulimia, and eating disorder not otherwise specified.

Older adults suffering from eating disorders fall mainly into the following three categories:

• Those that have suffered from an eating disorder in the past and went untreated;

• Those whose eating disorder went into remission and resurfaced later in life; and

• Those whose disorder emerged later in life.

The majority of women who suffer from later-life eating disorders have actually been dealing with them from a much younger age. Usually women who had eating disorders when they were young, that went into remission and reemerged later in life because of some stressor.

Triggers for Disordered Eating

While some triggers of eating disorders may look similar for younger vs. older patients, there are some definite differences as the stressors in life change as one gets older. The triggers differ for younger vs. older women in that older women are dealing a lot more with issues of loss and grieving. Regardless of when you develop an eating disorder, the one common trigger is stress of some sort. The stressors just change with age. So while younger, the women may have been dealing with the transition from high school to college or from childhood to adulthood, older women’s stressors include such things as empty nest, divorce, loss of parents, widowhood, retirement, chronic illness/disability, death of an adult child, and growing old/facing mortality.

Additional triggers for older adults dealing with eating disorders can include lack of enthusiasm for life; attempts to get attention from family members; protest against living conditions, such as in a nursing home; economic hardship; and medical problems.

Certain medical circumstances can also bring on an eating disorder in older adults. After a major life event, such as a heart attack, a person can become scared that they will die if they do not eat the right things and if the person does not know what they are they can just stop eating all together causing an eating disorder or worse doing more damage to your body. Eating disorders are never about weight, food, numbers, etc., hey are a way of coping with something else that the person finds extremely difficult to express, feel, or control. In this way, the role of the eating disorder is much like alcohol for an alcoholic. Both serve the same purpose—to avoid, numb, and cope.

Signs, Symptoms, and Treatment

It can be difficult to identify or diagnose an eating disorder in older adults. But the following signs can be clues to later-life disordered eating:

• Significant change in weight (up or down) over a relatively short period of time;

• Changes in behavior such as disappearing after a meal or using the restroom after eating something;

• Boxes of laxatives, diet pills, or diuretics;

• Desire to eat in the bedroom alone rather than eating with family or spouse;

• Missing food;

• Sensitivity to cold

• Excessive hair loss, dental damage, or heart or gastrointestinal problems.

Eating disorders often occur in conjunction with depression or other types of anxiety disorders, so these can also serve as clues to possible problems. A lack of sufficient treatment options that provide programming for midlife and older women could be a deterrent to later-life women getting into treatment.  Many fear being put into groups with adolescents and young adults with whom they cannot relate because they are at such a different place in their lives. Additionally, these women tend to experience more shame and self-blame around their eating disorders and feel they should be the role models for the younger girls rather than sitting in a group as one of them.

Hope and Help

If older women seek treatment and join support groups through organizations like ANAD, they can recover and go on to lead healthy and productive lives. In the realm of helping older adults suffering from an eating disorder, there is treatment out there for them no matter the age.

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