Eating Disorders in Older People

Eating Disorders in Older People

‘Eating disorders are experienced by young females, in their late teens, and who come from middle class backgrounds’. 

This is the description of eating disorders declared by many of the books and articles written about eating disorders.  Of course, this description is inaccurate.  eating disorders do not discriminate.  They creep up upon anyone – of any gender – of any age or background.

As I mentioned, there has been much written about eating disorders in younger people, especially females.  However, there is growing evidence that older people, of all gender, also develop various forms of eating disorder. When I say 'older people', I mean anyone over the age of 40. Now, I am in my 40s myself, and while I don't classify myself as a 'older person', eating disorders are often perceived as being 'a young person's illness' i.e. those under 35 or 40. So, I want to emphasis that eating disorders can affect others outside this out-dated and inaccurate stereotype and can affect people of any age, including those over the age of 35/40.

I am an accredited psychotherapist working in a specialist eating disorder service, amongst other things. I see many clients who have developed an eating disorder at at earlier age (under 35/40) and who are in their 50s, 60s, and 70s and still struggling with that eating disorder/disordered eating. Yet, I also see clients who are in their 50s, 60s and 70s (I've also had someone in their 80s get in touch) who have developed an eating disorder in the last year or two, but with no history of eating disorder/disordered eating prior to that. What gets to me is that this group of people are often sent away from services, ignored, not taken seriously, told they 'should know better' or don't even come forward for support in the first place because of the inaccurate stereotype that eating disorders are 'a young person's thing'. How unfair is that?! They deserve understanding, empathy, support and a listening ear as much as anyone else.

Eating disorders in older adults are also witnessed in different settings: those in long-term care; those living independently; those with families; those living in supportive environments. 

The above highlights non-discriminatory nature of eating disorders. In other words, there is increasing research showing that eating disorders affect many older adults than previously thought & that all genders are vulnerable. 

Nevertheless, the idea of eating disorders in older people is not a new one.  Morley & Castele (1985) suggested a case of anorexia nervosa that was described by Guy’s Hospital, in 1890, when it was termed ‘senile marasmus’.  Such patients experienced anorexia nervosa and consequently, died with no apparent cause of death.

Is it really surprising to discover that eating disorders exist in older people? 

For me, it's not really that surprising, when we consider that many of the issues and  concerns that affect younger people are also similar in nature to those experienced by older adults. 

Like young people, older adults also develop eating disorders/disordered eating for variety of reasons.  There are many triggers that may initiate the development of eating disorders/disordered later on in life. These may be similar to those that may also trigger eating disorder thoughts and behaviours in younger people. We all eat after all, so I find it puzzling why anyone would deny the existence of eating disorders/disordered in 'older people' - some do though!

No matter what age we are, we all experience stressors and change at some time in our lives. 

Research and hearing first-hand experiences suggest that eating disorders are partly coping mechanisms: a way of exerting some control over one’s life.  This may be especially so when facing change or some form of stress - both may make us feel out of control. 

Eating disorders often develop as a way of regaining control: a way of coping with change, transitions & stress.  Change, transitions & stress are not exclusive to young people: older adults experience these too, albeit, in different ways.

Examples might include: career change; redundancy or retirement; family/children moving away; bereavement; illness or medical issues; death of parents or a spouse; moving house or city; financial difficulties; divorce or breakdown of relationships. 

The list is endless and significant events or situation that causes stress or loss of control could potentially act as a trigger for development of eating disorders/disordered eating in older adults.

Grishkat -  ‘EDs are never about weight, food, numbers etc, but they are a way of coping with something else that the person finds extremely difficult to express, feel or control....they serve a purpose to avoid, numb and cope....an unhealthy coping mechanism to deal with later life stressors, particularly if the person has never learned other, healthier ways of coping’.

Older adults experiencing eating disorder/disordered eating usually fall into one of following categories:

1.  Individuals whose ED developed later in life;

2.  Individuals who experienced an ED in the past but who were untreated;

3.  Individuals whose ED went into remission & resurfaced later in life.

Eating disorders in many older people can be serious and their health may already be compromised. 

Family, friends and work colleagues can help, especially as it can be difficult to differentiate the signs and symptoms of ED from other health issues.  Look out for following signs and symptoms in older people:

1.  Their kitchen looks unused.

2.  There is little or no food in fridge or cupboards.

3.  There are unopened packages of meals/unfinished meals.

4.  Unexplained weight loss or weight gain.

5.  Social anxiety or isolation.

6.  Depressive symptoms.

7.  Alienation.

8.  Loss of motivation to eat: e.g. making excuses not to eat, saying they feel sick, full or already eaten.

9. Reports of dizziness, weakness, disorientation or feeling faint.

This is not an exhaustive list, however, it may highlight some of signs and symptoms to look out for in older adults.  

I would suggest that there is a increasing need to develop and offer specialised support for older adults.  However, is also important to note that older adults may be less likely to seek help for emotional or psychological difficulties. This poses particular problem when we consider that eating disorders are  traditionally perceived as a ‘young female illness’. 

This is still a pervasive stereotype and it only serves to strengthen the reluctance of older people to seek support. However, I would assert that it is important for anyone – of any age, any gender– with an eating disorder/disordered eating, to seek help as soon as possible. 

ANAD suggests that delaying treatment can reduce its effectiveness and increase likelihood of medical complications, co-morbidity & problematic family, social & work relationships. 

Increasing awareness of eating disorders in older people and challenging stereotypes is one way of encouraging more older adults to acknowledge their problems, come forward and access the help & support available. 

The more people that do this, the more likely eating disorders/disordered eating in older people are recognised.  It's only then can we begin to develop specialised services specifically for this particular group of people. 

Undoubtedly, however, with increased awareness comes increased specialised training for eating disorders/disordered eating in older people, which, currently, seems very scarce in the UK, and Scotland, specifically. 

Alexandra O'Brien
Talking EDs (Glasgow and West Eating Disorders Support Service)

www.eatingdisorderscotland.co.uk
support@eatingdisorderscotland.co.uk