Older people and eating disorders: not 'just a teenager's problem'

Eating disorders are often portrayed as a disease that only affects the young and privileged, yet this is not the case. Eating disorders can affect anyone at any time, regardless of age, gender identity, race, ethnicity, sexuality or cultural background.

Eating disorders can affect people regardless of their age, race, gender identity, ethnicity or sexuality.

While eating disorders are often considered to be a "teenager's problem," older people can also be affected by these diseases.

Not only are they susceptible to eating disorders, but there are a number of unique problems that are experienced by this social group.

There are cases where physicians have told patients that they should have 'grown out of' eating disorders. Or that they are 'too old' to be suffering fromanorexia, bulimia or binge-eating disorder.

In this Spotlight feature, we investigate precisely how older people can be affected by eating disorders, what unique problems they face and what is currently being done to raise awareness of this issue.

What are eating disorders?

Eating disorders are serious conditions that can have a significant impact on an individual's physical and emotional health, as well as affecting their productivity and their relationships.

These diseases have the potential to be life-threatening, and anyone that develops an eating disorder should seek professional help. The National Institute of Mental Health (NIMH) state that people with anorexia nervosa are 18 times more likely to die early, compared with people of similar ages in the general population.

According to the National Eating Disorders Association (NEDA), around 20 million women and 10 million men in the US experience a clinically significant eating disorder at some point in their lives.

Common forms of eating disorder include:

• Anorexia nervosa: a disorder characterized by a distorted perception of body weight and a significant fear of gaining weight. People with anorexia nervosa often go to extreme measures to lose weight or prevent weight gain
• Bulimia nervosa: a disorder characterized by people eating a lot of food (bingeing) and then attempting to get rid of the extra calories in unhealthy ways. This can take the form of "purging," through self-induced vomiting or the misuse of laxatives, for example
• Binge-eating disorder: a condition whereby unusually large amounts of food are frequently consumed, accompanied by a compulsion to do so.

Each of these conditions is associated with food and weight to varying degrees. However, such is the complexity of these disorders that they usually arise from a combination of factors - biological, interpersonal, psychological and social.

These factors can be directly related to food and weight, such as cultural pressures that place great value on obtaining "the perfect body," and feelings of low self-esteem that may or may not tie into these. Equally, eating disorders can be associated with seemingly unrelated factors such as depression, anxiety, loneliness, introversion and a history of abuse.

Food can be seen as a way in which painful emotions and experiences that might otherwise feel overwhelming can be controlled and dealt with - a coping mechanism. Despite potentially providing a feeling of control, however, eating disorders can severely damage a person's physical and emotional health.

In terms of physical health, obesity caused by binge-eating disorder can increase the risk of diabetes, hypertension,heart disease and some forms of cancer. Likewise, anorexia can lead to anemia, kidney problems, bone loss and heart problems, such as arrhythmias or heart failure.

Why are eating disorders less recognized in older adults?

While the dangers of eating disorders are well documented, their effect on older adults is not. But why is it that this is the case? One of the overriding responses was a general misconception that eating disorders are disorders of youth.

Older people may have difficulty buying or obtaining groceries, but missing food could also be a sign of an eating disorder.

People fail to recognize that eating disorders can strike people of any age. They think that people magically grow out of eating disorders when they leave adolescence. Nothing could be farther from the truth.

Although the majority of literature and research on eating disorders focuses on younger people - females in particular - and while many eating disorder cases may feature young people, there is plenty of evidence to demonstrate that these diseases are not exclusive to those under 30.

Rather than growing out of eating disorders, many people with these diseases continue to live with their condition from adolescence all the way into late adulthood.

In fact, an erroneous assumption that older adults are not affected by eating disorders has an adverse effect on diagnosis:

"Rather, many family members or helping professionals may attribute weight loss, malnutrition or unexplained symptoms such as vomiting or diarrhea to a 'normal' aging process or some other medical condition, rather than a mental health disorder."

In addition, many individuals who have recovered from eating disorders can experience relapses. Due to their age and status of being in "recovery," any signs of relapse can be interpreted differently to how they may have been interpreted when the individual was younger.

Unfortunately, some of the symptoms of eating disorders are similar to those associated with the aging process. Older adults may require medication that causes nausea, or they may have functional problems that impair their ability to obtain groceries or plan an adequate diet.

However, even when older adults are living with assistance, eating disorders can still manifest and remain undiagnosed. 

"We have seen cases of laxative abuse in assisted care facilities, where they often hand laxatives out like candy, but the patients clearly had eating disorders and were using laxatives to purge. We have seen cases of anorexia motivated by beliefs that caloric restriction will extend life."

The erroneous assumption of eating disorders being exclusive to the young represents one of several unique problems that older adults have to cope with in their fight with these diseases. Help is nearly always required for treating eating disorders, and the first step toward treatment is diagnosis.

A series of unique problems

Age plays an important role in how people cope with disease, both physically and mentally, and this is precisely the case when it comes to eating disorders. As specified earlier, eating disorders can lead to various other serious health problems, and as age increases so do the risks these entail.

One of the main concerns is that eating disorders take a tremendous toll on just about every bodily system. In old age, these body systems are less resilient to begin with, just because of the aging process, so eating disorders can erode them more quickly and more seriously.

Conditions that are more common among older people, such as cardiac problems, gastrointestinal problems,osteoporosis and obesity, can all be exacerbated and complicated further by the presence of an eating disorder.

The combination of older bodies becoming more vulnerable and the underdiagnosis of eating disorders can also make older adults less likely to seek help for these conditions. Even if an individual knows they have a problem, this combination could be enough to put people off seeking help.

Many unique and often irreversible life changes occur among the elderly, such as the death of a spouse.

Besides, dismissive comments from physicians - telling patients that they should have "grown out of" eating disorders or that they are "too old" for them - can be a real disincentive to pursue treatment. 

Those sorts of comments just lead people to go back into the shadows and not reach out for the treatment they deserve.

Older people could have less support and motivation provided by others to go and seek treatment. 

Some individuals may have fewer future goal-related motives for recovery as they see themselves in an end-of-life phase, already anticipating poor health or death.

Whereas young people may look forward and see a bright future to be had after overcoming an eating disorder, older people may accept these diseases as just another symptom of getting older.

A final unique and inescapable problem comes from the fact that eating disorders are often related to an individual having to cope with stressful life events and needing a way to take control back at a time when they may feel as though they have none at all.

As people age, the chances of them experiencing such an event - the death of a loved one, retirement, increasing loss of independence - increase. "Coping with these mood changing, stressful life events may leave the elderly finding that their current coping skills are not adequate for their present life circumstances," said Cooper.

Each of these factors represents a challenge posed by eating disorders that are far less likely to be experienced by the young and otherwise healthy individuals who are traditionally associated with these serious diseases.

What is being done?

This week marks National Eating Disorders Awareness Week. One thing that is apparent is how great the need is for awareness to be raised about eating disorders - particularly among smaller sociodemographic groups who are not traditionally associated with eating disorders.

To this end, the NEDA are collaborating with the feminist activist and  Everyday Feminism, on the Marginalized Voices Project.

The goal is to create a collection of stories that tells the whole truth - by spanning the entire spectrum, highlighting stories from people of marginalized identities and that challenge misconceptions - so that we can present the world with what the reality of most eating disorders look like.

Stories have been collected specifically focusing on underrepresented experiences and communities with the aim of creating a platform for people to share what it is like having and recovering from an eating disorder.

The project will be launched in the near future, and it is projects like this that are likely to have the biggest impact on the treatment of eating disorders. Raising awareness will hopefully lead to more people seeking treatment and improved rates of diagnosis.

This year's awareness week theme is "I had no idea," specifically addressing the need to acknowledge the diverse experiences of people who are affected by eating disorders. Too often, signs and symptoms are overlooked as insignificant behaviors when in fact many of these are early warning signs of eating disorders.

Anyone can get involved with these efforts. NEDA suggest that educating yourself and others about eating disorders, debunking myths and spreading the facts are great ways to raise awareness of these diseases in older people. There are also a number of charities that focus on providing information, research and treatment for these diseases.

The triggers may differ in late life, but the disorders can still take hold. In order to improve the lives of thousands of people, this message needs to be heard loud and clear.

References:

1.     Mayo Clinic, Anorexia nervosa - definition, accessed 25 February 2015.

2.     Mayo Clinic, Binge-eating disorder - definition, accessed 25 February 2015.

3.     Mayo Clinic, Bulimia nervosa - definition, accessed 25 February 2015.

4.     NEDA, Factors that may contribute to eating disorders, accessed 25 February 2015.

5.     NEDA, Get in the know, accessed 24 February 2015.

6.     NEDA, Get the facts on eating disorders, accessed 24 February 2015.

7.     NEDA, Key messages, accessed 26 February 2015.

8.     NEDA, Untold truths: the Marginalized Voices Project, accessed 26 February 2015.

9.     NIMH, What are eating disorders?, accessed 25 February 2015.

10.   Today’s Geriatric Medicine, Elder eating disorders: surprising new challenge, accessed 25 February 2015.