It’s a common misconception that eating disorders are the province of the young.
Although anorexia nervosa is most commonly associated with teenage girls and young women, research shows that it is increasingly likely to occur in the elderly – and that eating disorders in the elderly are more deadly, accounting for 78 per cent of all anorexia deaths. This is exacerbated by the fact that the disorder is hard to diagnose in the older population, largely because many elderly people living independently have limited contact with others.
Even in nursing homes however, up to a quarter of patients refuse to eat and are malnourished. Of course there are a number of psychological reasons for this, such as difficulty swallowing or various diseases including dementia that mean patients forget to eat. But this is not the only explanation.
Psychologists at the University of British Columbia examined 10.5m death records, for a four-year period, in the US. They found that the average age of death from anorexia nervosa for women was 69 and for men 80. And while in younger cases anorexia victims are 90 per cent female and 10 per cent male, for those over 45, the percentage of men doubled to 21 per cent.
Anorexia in the elderly can have a variety of causes. Not only are more people developing it later in life, but increasing numbers of young people with the disorder are growing older with it. Aging is itself a taboo, and with the rise of procedures such as Botox, expectations for youthfulness and vigour are higher than ever.
Unresolved anger is frequently a trigger, particularly for men. Whilst, older women sometimes develop a disorder called ‘anorexia tardive’ after menopause, which is believed to be caused by a form of depression, and which can be difficult to diagnose and treat as it can be obscured by common digestive problems and body changes that are a natural feature of ageing.
While some elderly people stop eating because of depression, there is a sub-group of older anorexics that stop eating because of a traumatic event that has to do with food. Such people tend to be anxious or fastidious about their personal habits and may have had a bad reaction to something they ate. Their fear of a repeat event such a choking or incontinence grows and turns into a food phobia, (‘sitophobia’), that is stronger than their natural impetus to feed their body.
Refusing food can also be a protest aimed at loved ones, or even an attempt at suicide, particularly after the death of a spouse or with the loss of independence that can accompany ill health and aging. Another reason for a development of anorexia in the elderly is their inability to actually visit the supermarket or prepare adequate meals – sometimes exacerbated by financial concerns. They may find themselves choosing between hot water, heated homes or a nutritious shopping list.
Eating disorders in the elderly are particularly serious because their health is already compromised. Warning signs may include depression, loss of motivation to eat, excuses for skipping meals, a fixation on death, unexplained weight loss, and chronic dizziness. Other indicators might be an unused kitchen, bare fridge or cupboards or unopened packages of meals in the fridge. However, specialist help is available. It’s never too late to get better.