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Anorexia


 

What Is Anorexia?

In its simplest terms it is prolonged loss of appetite that leads to severe weight loss.  Anorexia is not a normal consequence of aging; it is a significant symptom requiring treatment. [1]

 


 

What Is Anorexia Nervosa?

Anorexia and anorexia nervosa are somewhat different.

"Anorexia nervosa" is often described as a serious psychological disorder characterized by an extreme aversion to food. It is defined in American diagnostic criteria as a refusal to maintain minimal body weight within 15% of an individual's normal weight, along with fear of gaining weight and disturbance in the way the person sees their body image.

It is often a chronic condition and it is a life-threatening eating disorder. It is important to differentiate anorexia nervosa from general medical conditions that may affect appetite; including major depression; social phobias (eating around people);  and obsessive-compulsive disorder.

 


Who Develops Anorexia Nervosa?

 

Like other eating disorders, anorexia nervosa tends to occur in pre- or post-puberty, but can develop at any major life change. Anorexia nervosa predominately affects adolescent girls and young adult women, although it also occurs in men and older women.

 


Do Older Adults Develop Anorexia?

 

Yes. The Eating Disorders Textbook [2] for example points out that anorexia in the elderly was first described in 1890 in Guy’s Hospital when it was termed "senile marasmus." Patients were anorexic and died with no apparent cause of death [3].

Here is something you may not know:

It is not usually teenagers who die from anorexia.

A review of 10,655,721 death records registered with the National Center for Health Statistics conducted between 1986 and 1990 found that the median age of death for women with anorexia was 69 and for men was 80. [4] The researchers suggest that anorexia contributes to death across the age span and may in fact be more closely related to death in older adults rather than adolescents and young adults. "The pattern of the data suggests that there may be 2 fatal forms of the disorder: one that impacts mainly younger women and a second form that appears considerably later in life and affects women and men in a 3-to-1 ratio." [4]

 


What Does Anorexia Look Like in Later Life?

 

There is wide spectrum of anorexia occurs among older adults. If a person is grieving the loss of spouse, friends or other person or things important to them, you can often see markedly diminished appetite in the person and overt depression may or may not be apparent. [2]

A second anorexic pattern occurs in older adults where the person decides to stop eating. They deny being hungry and refrain from eating, they may become emaciated and die. There is a distortion of body image, as they do not consider themselves thin even if seriously underweight. They deny having thoughts about suicide (suicidal ideation) and, if asked, they may say they wish to be resuscitated in the event of cardiac arrest [3]. Morley & Castele describe one person who engaged in sham eating: he would chew and then spit out most ingested food. In spite of weight loss, he felt his body size was "just right" [3].

We may not see much binging or purging in older adults. However, it has been suggested that laxative use among older adults, which is very common, may be a possible form of purging.[3]

 

Food refusal is another form of anorexia among some older adults. It can represent a hunger strike and an attempt to regain some control in their lives (e.g., where they will be living) that the person otherwise would not have. [5]

 


 

What Causes Loss of Appetite in Later Life?

 

There are several physiological causes for loss of appetite in later life. Unintentional reduced energy intake causing weight loss may be caused by social or physiological factors. [6] Diminished sense of smell or taste often happens more as people age and that may influence food choice and limit the type and quantity of food that some older adults eat. Zinc deficiency produces absence or distorted sense of taste and may also have a role in decreasing enjoyment of food [3].

Poverty, loneliness, and social isolation are the predominant social factors that contribute to decreased food intake in older adults. Depression is a common problem that can cause loss of appetite. The reduced food intake may be due to the reduced drive to eat (hunger) resulting from needing less (a lower need state), or because of the brain/stomach signals it is "full" faster. [6]

Then there are physical factors such as poor dentition and ill-fitting dentures. [6] Prescription drugs can be the culprit too: a number of them can cause mal-absorption of nutrients, gastrointestinal symptoms, and loss of appetite. [6]

Other common causes of anorexia are pulmonary and cardiac diseases, cancer, dementia, and alcohol problems; contributing factors include depression and certain medications such as chemotherapeutic drugs. [1]

 

Why Care?


Anorexia and loss of appetite is not a normal aspect of growing older. Obviously the situation is stressful for the older person and those who care about the person. Poor nutrition has a big effect on the development and progression of chronic diseases commonly affecting older adults.

 


What Do We Know About Anorexia among Older Women?

 

There has been little research on anorexia among older women. [7]  In a 1997 study of women aged 50-84, a small percentage (7.7%) of the women sampled were preoccupied with thoughts of thinness.

For those older women, the researchers found that among other things the "drive for thinness" was significantly correlated with low family cohesion, and high family conflict. It was also tied to how easily the women were able to express their emotions, their level of independence, and the level of feeling in control (they don't). These are similar to what studies of younger women report. The researchers also suggested that tools used for looking at disorders in younger women may not be appropriate for older women, in other words, it is only "capturing " a few of the situations.

 


Anorexia Can Be Found in Any Setting

 

Anorexia in older adults has been seen in all types of settings, older adults living independently, or in supportive environment or in long term care. In one example a woman was admitted to a supportive housing (sheltered care retirement home) with lack of appetite and weight loss. She weighed 85 pounds (75% of her ideal body weight) and ate only a third to a quarter of her meals. She denied having any history of anorexia nervosa, induced vomiting, or any concern about her figure or weight, but the staff noticed various gastrointestinal complaints like gagging, vomiting, and episodes of diarrhea, and found a collection of laxatives. It took a lot of investigation by a multidisciplinary team and they needed to rule out of other possibilities for what they were seeing. [8]

Men can experience anorexia too. [9] Anger and control issues seem to be linked to the condition. To be treated successfully it often takes to a coordinated interdisciplinary effort to work with the eating disorder as a psychological problem rather than merely a food-choice, dietary, or low-weight difficulty.

 


 

Is There a Connection Between Alcohol Use Problems and Anorexia?

 

Yes, often. Alcohol use problems may produce anorexia at three time points [1]:

Chapman et al. note "Alcohol affects absorption, storage, and excretion of most nutrients, so secondary vitamin and mineral deficiencies can also occur. Zinc deficiency may develop due to poor intake, reduced absorption, and increased urinary excretion. Iron absorption and iron stores may increase with heavy drinking, leading to iron overload. Conversely, iron deficiency may develop secondary to bleeding varices and ulcers. Thiamine deficiency may occur due to poor intake, inability to metabolize to the active form, increased excretion, or increased need with large carbohydrate loads. Depending on the extent of organ damage from alcohol, virtually every nutrient will be adversely affected." [1]

 


We are increasingly recognizing that alcohol consumption can also cause stomach problems, including gastritis. Alcohol consumption, even at moderate levels also relaxes the lower esophageal sphincter (LES) so it does not close properly. This can  cause gastro-esophageal reflux disease, and damage the esophagus. This, in turn, affects whether the person feels like eating and what they can safely eat.


 

References

[1] Chapman, KM & Nelson, RA. (March 1994) Loss of appetite: managing unwanted weight loss in the older patient. Geriatrics. 49 (3), 54-59.

[2] Blinder BJ . The Eating Disorders: Medical and Psychological Bases of Diagnosis and Treatment. Online at : www.ltspeed.com/bjblinder/index.php

[3] Morley JE, & Castele SC. Death by starvation: The Sepulveda Grece Method No. 6. Geriatric Medicine Today, 1985; 4(11), 76-8, 83.

[4] Hewitt, PL, Coren S &  Steel, GD. (Feb. 2001). Death from anorexia nervosa: age span and sex differences Source: Aging and Mental Health, 5 (1), 41-46.

[5] Duggal A, &  Lawrence, RM. ( Sept. 2001) Aspects of food refusal in the elderly: the "hunger strike". International Journal of Eating Disorders. 30 (2), 213-216.

[6] Donini LM,  Savina C,  &  Cannella, C. (March 2003) Eating habits and appetite control in the elderly: the anorexia of aging. International Psychogeriatrics. 15 (1). 73-87.

[7] Perkins AJ., Fritz JJ,  Barber, CE & Turner, JG . (1997). Prevalence and family correlates of eating disorder tendencies in older women. Journal of Women and Aging. 9 (3), 67-84.

[8] Pobee, KA, &  LaPalio, LR. (1996) Anorexia nervosa in the elderly: a multidisciplinary diagnosis. Clinical Gerontologist. 16 (3), 3-9.

[9] Ronch, JL. (Fall, 1985). Suspected anorexia nervosa in a 75-year-old institutionalized male: issues in diagnosis and intervention. Clinical Gerontologist. 4 (1), 31-38.

 

Page last updated Thursday November 18, 2004

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