At some point in our lives, most of us in one way or another will be dealing with an aging parent, relative, friend, or even ourselves as we navigate through the medical and psychological issues related to aging. Let’s focus on one particular issue: the natural or unnatural occurrence of an eating disorder late in life and what, if any, treatment is necessary and appropriate.
According to a 1997 Psychology Today poll, gaining weight is at the top of the list for negative influences on body image in both men and women, and this sample did include persons up to 90 years of age. The segment most dissatisfied were women between 50 and 59 years of age. Most of the women were preoccupied with weight and finding displeasure regardless of their age. Anorexia nervosa, on the other hand, is a prolonged loss of appetite which leads to severe weight loss. Anorexia is not a normal consequence of aging. It is a significant symptom that does require treatment. Bingeing and purging have been occurring in all ages among 50 years of age and older for centuries. Let’s think about what we need to understand. What might be an eating disorder versus the general aging process.
We need to be cognizant of the length of time an eating issue has been part of someone’s life. Interestingly, as women age, body dissatisfaction goes up rather than down. Wouldn't you think otherwise? But, not the case. Scarily, younger and younger girls are truly suffering from body image negativity, and these attitudes about their bodies stay with them, and as time goes on prevent the normal transition into the next stage of development. If one is battling an eating disorder in their youth, these feelings of unacceptance continue throughout a lifetime. An elderly person needs to be assessed for psychological comorbidities such as depression. It is often difficult to diagnose this in the geriatric population because of the issues of loneliness and loss. They are particularly serious in the elderly because their health is already compromised. Inadequate nutrition can result in falls, memory deficits, cognitive decline, slow healing, dizziness, and disorientation. Thus, it is extremely important for family and caregivers to be on the lookout for signs of depression, anxiety, loss of motivation to eat, excuses for skipping meals, and frequent claims of not being hungry or feeling sick. Eating disorders may be a way of coping with life.
I recently spent time with a 92-year-old man whose caregivers reported that he wants to stop eating. They are finding his food in trash cans and by the side of his bed and in the toilet. The support staff were troubled how to make sense of his behavior and, in fact, what should they do about it? As Al and I spoke, he told me that he had no interest in food, and he was worried that if he ate, he would then suffer from stomach pains. I asked him how often this occurred, and he said, “Well, not that often,” but he was worried about it nonetheless. So, eating, he said, was just another difficult task for him, because most everything is difficult. His hearing is impaired, and he has macular degeneration. He said he is just not particularly interested in anything. I asked him if there was anything he enjoyed. He said sleeping, and then he brightened up, and, very enthusiastically, he told me about the script he is writing. The script is in his mind. The script involves feeling as though the person is in jail and everyone is telling him what he should do. We talked more. I asked him if he felt as though he was in jail, particularly so when everyone telling him that he must eat. He thought about it and said yes. This seemed to facilitate his talking about many parts of his life and the decisions he had made, the mistakes, and the stupid things. How could he have done them? He was present and animated and sorrowful. We ended by my suggesting that maybe he needed to keep eating so he could have a final ending to his story.
I came back the following week. When I asked him how the story was going, he looked at me and responded that he did not really have time because he was focusing on eating the meals that were prepared for him. I asked him if he could do both, and he said no. He needed to focus. He needed to spend his time thinking about how food would keep him alive. As I was leaving, the caretaker said that she had no idea what had transpired the previous time I was there, but everything seemed different. My sense is that he was able to take control over his eating. If he wanted to live, it was up to him to do his part in keeping himself alive.
Points to remember
Not eating can mean:
- An attempt to get attention
- May regulate a mood
- Eating less as aging occurs (protein is very important)
- May be a protest against living conditions
- May be a way to deal with significant life events
The main aim of any treatment for an eating disorder is:
- Treat any medical problems, develop healthy eating behaviors and maintaining a healthy weight
- Everyone’s feelings need to be recognized and dealt with because family members often get drawn into participating
- Teach the person how to differentiate and self-delineate in a safe, positive way so that they can form their own self definition and boundaries
- Establish consultation networks to promote evidence and effective care for the person being cared for
- Build trust and rapport and agreement about what the goals for that person are
- Assess for psychological comorbidity
- Be aware of medication side effects because geriatric patients are more prone to side effects
- Work with them around issues of loss, anger, and depression
I hope this information has been helpful in discerning the difference between an eating disorder and the natural aging process.