[senior citizen]

Anorexia Nervosa in The Elderly

By Nikki Rosen R.S.W.
©2010 Gürze Books


I hadn’t seen my father for a couple of months. I was shocked by how much weight he had lost in that time.

“Dad.” I asked quite concerned. “Are you eating?”
“Yes, of course. Too much.”

“Can you tell me what you ate today?”
I watched as he tilted his head to the side trying to remember back to this morning. My mother turned to me. “He hasn’t eaten anything today. Nor yesterday. He keeps telling me he’s not hungry. It isn’t good what he’s doing.”

“Why aren’t you eating Dad?”

“Look.” He smiled as he unfastened his belt buckle and pulled his pants out in front to show how big they had become.

“But you’re losing too much weight.” I tried to reason with him.

“I like this. I like that I am finally thin.”

All his life my father had been a big man. Oversized. I often heard people crack jokes about his weight and tell him to stop eating so much. But now, I was worried. At 80 years old, he was depriving himself of food. He had fallen a number of times this past year and had sustained a fractured shoulder and a few broken ribs. Many times when I had phoned him, he told me he felt dizzy, weak and light-headed. Now I understood why. He was refusing food.

Much has been written on Anorexia Nervosa, a potentially lethal condition characterized by distorted body image, fear of weight gain, and food restriction.

It has been thought to affect mostly young females, but elderly people, both females and males, are also vulnerable.

Associate Professor Paul Hewitt and Professor Stanley Coran of the University of British Columbia, looked at 10.5 million death certificates in the United States from 1985-1990 to see how many listed Anorexia Nervosa as a contributing cause of death.

Their findings showed that Anorexia Nervosa strikes more elderly people than previously thought, and that both men and women are affected. In their findings, the average age of death from the disease was age 69 for women and age 80 for men.

In some ways, the issues of Anorexia Nervosa in the elderly are similar to those of the young. Both groups tend to refuse meals by saying they’re too full, not hungry, or feeling ill. Both have a distorted view of their bodies, see themselves as heavier than they are, have difficulty expressing their feelings, usually have family conflicts, and engage in secretive behaviors to hide their disease from others.

Both also may engage in purging behaviors, although the elderly are more likely to use laxatives rather than engage in vomiting, which is more common amongst younger people.

Yet older people face unique challenges, some of which might prevent them from being diagnosed. They may have medical problems which affect their ability to consume food, infections, bowel problems, loose or poorly fitted dentures that make it painful to eat, a loss of smell or taste, swallowing problems, medications that reduce their appetite, an addiction to alcohol, memory problems as a result of dementia so that they can’t remember if they had eaten a meal, and wasting diseases like cancer or other illnesses.

Social problems might be involved, such as an inability to grocery shop, cook meals or even feed themselves, poverty, social isolation, or elder abuse in which a caregiver withholds adequate food.

Similar to young people, the elderly develop eating disorders for a variety of reasons. A loss of independence or ability to care for themselves, coupled with the death of spouses, family and friends, could leave them feeling isolated and lacking control over their lives.

Refusing food can be a way of trying to regain that sense of control or, in some cases, a passive means of ending their lives.

Other reasons include: undiagnosed depression, unresolved issues from their past, and stress-related triggers from retirement, such as adjusting to a lower income level.

An eating disorder can also be a form of attention seeking, a way to protest restrictions placed on an older person by their family or care facility, or a challenge of limited family visits.

Anger is often an underlying issue for elderly men. Studies have also suggested that eating disorders can go into remission for years, even decades, and resurface in later life when the individual experiences unexpected stressors related to aging.

Living environments don't seem to make a difference. According to Anorexia, one woman living in supportive housing was found to have chronic issues with gagging, vomiting, and bouts of diarrhea. Staff discovered she had a collection of laxatives in her room.

Eating disorders in the elderly are particularly serious because their health is already compromised. Inadequate nutrition can result in falls, memory deficits, cognitive decline, slow healing from sores or infections, dizziness, and disorientation.

For this reason, it is important that caregivers be on the lookout for signs and symptoms such as depression, loss of motivation to eat, excuses for skipping meals such as frequent claims of not being hungry or feeling sick, a fixation on death, unexplained weight loss, and chronic dizziness.

Other indicators might be a kitchen that looks unused, little food in the fridge or cupboards, and unopened packages of meals in the fridge from a meal service such as Meals on Wheels.

Solutions for treating older people with eating disorders can be put in place.

As with young people, working through psychological issues has proved more effective than dealing with weight loss or merely food choices.

Providing supportive counselling can help with feelings around loss, anger, purposelessness, family conflicts, and self-esteem.

Caregivers of older people who are exhibiting possible signs and symptoms might consider: reviewing prescriptions, prescribing medications that increase appetite, addressing depression, supporting the family in resolving any conflicts, and providing help with shopping and cooking. Finally, older people can be encouraged to:

• Attend day programs to be more socially active
• Eat healthy meals that are prepared for them.
• Dine with others for socialization and to ensure that those individuals with poor memory are actually eating adequately.
• Participate in a physical rehabilitation program to increase endurance, mobility and balance. This will improve an overall sense of well-being and increase independence as well as increase appetite and food intake

In my father’s case, getting a proper diagnosis was difficult. The health team involved with his care wasn’t sure his refusal to eat was related to an eating disorder. However, when another fall landed him back in the hospital, his determination to lose more and more weight became clear.

So, a plan was put in place to help him increase his food intake. The dietitian provided better food choices. Family was asked to bring in some of his favorite dishes.

A social worker worked with him around issues of loss, anger, and depression, and his medications were reviewed and adjusted.

When my father continued to refuse food, even becoming quite angry if the subject was broached, a feeding tube was inserted and he was given medication to increase his appetite. Slowly he began eating. He gained weight, his mood lifted, and once he reached a healthy weight, he was discharged back home.

Unfortunately, after a few weeks of doing really well, he started to refuse food again. When he was readmitted to the hospital after another fall, he died from a heart attack two days later—so emaciated that I didn’t recognize him anymore.

Had he been diagnosed with anorexia earlier, the disease might not have progressed so far.

Loss of appetite is not a normal characteristic of growing older.

However, with an increasingly aging population, more cases of eating disorders in the elderly are being reported. Recognizing this fact is key to making an early diagnosis and providing our elder population, and their families, with better quality of life in the years they still have together.



About the Author

Nikki Rosen R.S.W. works as a social worker in a local hospital and runs a counselling practice. In December 2009, she published her first book, In the Eye of Deception, a true story of one woman's struggle to overcome the effects of child abuse, rape, and addictions. Her book has recently been shortlisted for The Grace Irwin Literary Award. Her passions include hiking in the hills near her home, spending quality time with her family in Canada, and writing stories to inspire. Visit her website at gentlerecovery.webs.com.

Reprinted from: Eating Disorders Review - Eating Disorders Articles

[Villages PL]

I would suggest taking the above article, by Nikki Rosen, with a grain of salt. She's a social worker. She may have good intentions but she's a bit mixed up, in my opinion. She's unable to separate one elderly problem from another, so she ends up turning it into one big "jumble" of possible disorders.

Of all the many possible disorders she mentioned that could cause loss of appetite, anorexia seems to be her biggest fear. I wonder why?

[Parker]

I agree with you Villages PL. Why harass an old man who knows what he's doing? Inserting a feeding tube was cruel. Leave him to his own choices if he is of sound mind. Adult children don't always know best. Life at any price isn't always the right thing.

[senior citizen]

Originally Posted by Parker

I agree with you Villages PL. Why harass an old man who knows what he's doing? Inserting a feeding tube was cruel. Leave him to his own choices if he is of sound mind. Adult children don't always know best. Life at any price isn't always the right thing.

I agree. We would not want our lives extended with feeding tubes.

When we registered my mom for the end of life skilled nursing home, she already had her wishes down on paper from ten years earlier.....
"no feeding tubes".

What I was trying to point out was that many elders are suffering from anorexia which goes unnoticed........they often are widowed or widowered (is that a word?) with no one to actually see what they are eating or not eating.

After my stepfather died, we had my mom over every night for supper and would drive her back to her home with a covered dish for her lunch the next day. She kept losing weight. Obviously, she was forgetting to eat.
The dishes would disappear. It was very strange. I finally figured out she was giving them away.

We soon realized how confused she was. She had lost a tremendous amount of weight.......long story which I have written about on other posts. Once she came to live with us, she was back on the road to good nutrition.

When we cleaned out her refrigerator, she had dozens of OLD OLD OLD expired containers and expired milk......LONG STORY....but this is a typical saga of adult children who discover their parent's confusion and anorexia when the spouse of the elder dies. It's like one was the "brain" for the other........and the surviving one cannot cope. Or could not cope to begin with. Alzheimers is truly the long goodbye......as many adult children find out.

Loss of appetite and loss of weight is a very big concern re the elderly.

[Parker]

Senior, you are correct that there is a big difference between an elder who chooses not to eat for whatever reason, and an elder that isn't aware. We should always default to maintaining the dignity of our older folks, "with kind hands".

[senior citizen]

Originally Posted by Parker

Senior, you are correct that there is a big difference between an elder who chooses not to eat for whatever reason, and an elder that isn't aware. We should always default to maintaining the dignity of our older folks, "with kind hands".

Yes. It's true. I've been there as well as many of my friends, neighbors....actually all of our peers have experienced it, some with two parents as well as a set of inlaws.......that is those of us whose parents lived to a ripe old age and didn't succumb to cancer at an earlier age.

I was fortunate in that it was just my mom. She wasn't the belligerent sort and became docile once she moved in with us and didn't have to make decisions any more. When the food was put before her, on a timely meal schedule, she ate. Left to her own devices, she did not eat.

Had we moved to Florida then, leaving her in her own home, I doubt she would have survived very long.

The "discovery of expired and rotten food in the frig's of the elderly" is very very common and a story I heard over and over again........

She lived with us for six years.......she went from 85 pounds back up to her lifelong normal of 100 pounds...........until years later when they "tried her" on Aricept......she lost her appetite (which is one of the side effects) and went back down to the 85 pounds. She was 4 feet 11 inches, barely five feet tall........but you do need food for good nutrition. One can't just live on tea and coffee.

After our home, she lived in an assisted living place for about two years and then 18 months in the skilled nursing care for end stage Alzheimers.

No one prepared us for that. No matter how much one reads......no one is truly prepared. But, it was a learning experience in aging.....for sure.

She was in the Alzheimers wing so we became quite knowledgable about all the other patients as well.

This morning we saw a documentary on a 91 year old lady who lived alone with help from her family......she did very well until the end, when she passed. They explored the possibility of putting her into an assisted living place....at the end she became ill and died. EVERYONE WHO WANTS TO LIVE TO BE 100 should realize that even the most independent and healthy adults (such as my mom was and this lady in the documentary who also died at 91, like my mother) will reach "the end of the road"......

Some, like my grandmother who died at 95, with all her faculties and mobility intact.......and a friend of ours in town who is past 96 now and still runs in marathons.........however, they are not the norm......will live a fairly good life until the end............others will be incapacitated in one form or another.

If you don't go from one thing......you will go from another......

[Villages PL]

Here's a link to: PubMed - U.S. National Library of Medicine National Instutes of Health. (Much more reliable than the OP link.)

Eating habits and appetite control in the ... [Int Psychogeriatr. 2003] - PubMed - NCBI

Notice in the body of the article (abstract) the phrase "Anorexia nervosa" is never used. Instead, the single term "Anorexia" is used. Webster's definition of Anorexia: 1. loss of appetite and inability to eat. 2. Anorexia Nervosa

Yes, the definition includes Anorexia Nervosa, but the PubMed article NEVER mentions Anorexia Nervosa in describing the appetite problems of the elderly. They use the single term "Anorexia" to simply mean, "loss of appetite and inability to eat," for the various reasons given in the article.