Eating Disorders in Older Patients. by Fragiskos Gonidakis, MD and Dafni Karapavlou, MSc

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1 Eating Disorders in Older Patients by Fragiskos Gonidakis, MD and Dafni Karapavlou, MSc

2 Eating disorders, especially anorexia nervosa, have traditionally been considered an illness of the young, and their etiologies have been linked to the stress of the transition from childhood to adolescence and adulthood

3 The literature on eating disorders in the elderly is sparse, with only a few studies and case reports published during the past decade

4 Although quite infrequent, there are cases of tardive eating disorders that manifest in middle age or late in life

5 There are a considerable number of aging patients with an eating disorder who have only partial symptom remission or who remain ill for many decades

6 As illustrated in the following case vignette, eating disorders not only exist in late life, but there is also a legitimate demand from patients to get the best possible treatment rather than just palliative care

7 CASE VIGNETTE

8 Mrs K is 68 years old, married with 2 children and 3 grandchildren. She has suffered from binge eating disorder and obesity since her early 30s

9 During her visit, she confesses that the main reason for her decision to return to treatment was that because of the disorder, she is constantly gaining weight and losing her ability to act independently

10 In her 40s and 50s, she had had 10 years of group psychodynamic psychotherapy and 5 years of individual psychodynamicoriented psychotherapy that helped her with her marital problems but not with the binge eating disorder

11 Late life eating disorders are highly comorbid with depression. Weight loss may be due to a medical condition, and malnutrition is quite frequent in the elderly population. Special attention should be given to diagnosis and treatment, no matter the age of the patient

12 Early recognition and proper treatment of eating disorders in the elderly are essential to reduce the psychosocial and medical impact of the disorder and improve the patient s quality of life

13 OVERVIEW

14 Onset most cases are early-onset with minimal or no remission late-onset eating disorders are less frequent

15 Epidemiology less frequent than in adolescence or early adulthood mortality increases with age

16 Clinical symptoms no major differences between young and old body dissatisfaction can be attributed to bodily features associated with aging

17 Precipitating events stressful experiences depression death of a loved one

18 Treatment adversities most patients are socially isolated the majority of treatment plans are designed for young adults and adolescents elderly patients often feel unappreciated and stigmatized

19 Hindrances to therapeutic efforts cognitive impairment chronicity polypharmacy fear of stigma paucity of studies

20 Treatments that work therapy that targets grief and loss may be beneficial the role of pharmacotherapy is limited and should be used with caution a variety of medical, psychological, and social factors can influence the effectiveness of treatment

21 Note: This slideshow is based on the Psychiatric Times article, "Eating Disorders in Late Life: Implications for Clinicians," by Fragiskos Gonidakis, MD and Dafni Karapavlou, MSc

22 About the authors Dr Gonidakis (L) is Assistant Professor of Psychiatry at Athens University Medical School. He is currently the Head of the Eating Disorders Unit of Athens University 1st Psychiatric Department at Eginition Hospital, Athens, Greece. Ms Karapavlou (R) is currently a PhD student at University of Athens Medical School and Scientific Associate of the Eating Disorders Unit, 1st Psychiatric Department, Athens University Medical School at Eginition Hospital, Athens, Greece.

Eating Disorders in Old Age

Eating Disorders in Old Age Dr. William Rhys Jones Consultant Psychiatrist & Clinical Lead CONNECT: The West Yorkshire and Harrogate Adult Eating Disorders Service r.jones9@nhs.net 0113 855 6400 Eating