Pulse
Starving with Age
Older women are now seeking treatment for bulimia, anorexia, and other eating disorders.
An increasing number of Joel Jahraus’ patients are celebrating high school reunions, noticing their hair turning gray, and raising children or even grandchildren. This is quite a change, given that for years, most of the patients in the eating disorders program he directs at Park Nicollet in Minneapolis have been teen-aged girls who are starving themselves to look like runway models or to compete in sports such as figure skating and gymnastics.
Over the last four years, the percentage of “mature” women—those age 30 and older—being treated at Park Nicollet for anorexia nervosa, bulimia, and other eating disorders increased from 13 percent to 38 percent. Jahraus, who is a family physician by training, says he has worked with more women in their 40s and 50s than ever before. “Our oldest patient is 68 years old.”
Donald McAlpine, M.D., director of the adult outpatient eating disorders service at Mayo Clinic, hasn’t kept track of numbers but has noticed a similar trend in his program. “In the last five years or so, this has become an issue, and treatment centers are trying to adjust.”
What’s behind the growing number of older women being diagnosed with eating disorders? According to Jahraus, these patients are feeling the same pressures as younger women: to achieve perfection. But the older women also are trying to hold on to the way they looked—or wanted to look—at 15 or 20 or 25. “They’re not trying to make the cheerleading squad, but they are in the athletic clubs trying to stay in shape, and they don’t know what to make of a fading physical condition,” says McAlpine, who adds that many of his older patients have had a previous brush with an eating disorder.
Harder on the Body
Jahraus explains that these types of eating disorders shouldn’t be confused with the “anorexia of aging,” which is often used to describe elderly patients’ lack of interest in food caused by a reduced sense of taste or smell, poor dentition, depression, systemic illnesses, or the side effects of medication. “We do know anecdotally that individuals in this population, ages 30 to 50, are demonstrating true issues with body image and have all the other characteristics consistent with an eating disorder diagnosis.” The criteria for anorexia nervosa, for example, include having an abnormal view of one’s body, the absence of menstrual periods for three consecutive months, and being less than 85 percent of ideal body weight.
Older women suffering from eating disorders can experience the same physiological effects as younger ones: extreme changes in vital signs such as a lowering of heart rate and blood pressure, bone loss, liver abnormalities, and cognitive defects. However, the cumulative effects of anorexia nervosa and bulimia can be devastating later in life. “This is when the chickens come home to roost,” McAlpine says. He explains that repeated bouts of dehydration, abnormal diet, and fluctuating electrolytes may cause kidney problems, and that years of laxative abuse can lead to cathartic colon—a condition that’s painful and difficult to treat. Infertility is another problem middle-aged patients with eating disorders may experience.
In addition, Jahraus says, stress fractures may be more common in older women with anorexia nervosa. “By virtue of the aging process and the loss of bone density in some individuals, you increase your risk of fractures by dropping to a low body weight.”
An Older Woman’s Place
Jahraus, who believes his group was one of the first to start collecting data on the increase in the number of older patients, says more research needs to be done on the prevalence of, reasons behind, and consequences of eating disorders in older women. He also says physicians need to understand that caring for patients in their 30s and beyond is different than treating those in their teens and 20s. For one thing, older patients tend to be more motivated to get well. “Many middle-aged women have children of their own who are getting old enough to figure out that [their mother] has an eating disorder, and they don’t want them to see that,” McAlpine says. Other times, they’re experiencing kidney failure or other serious health problems that leave them no choice but to go through treatment and stick with it.
Jahraus says treatment of older patients involves the same team of specialists that work with younger ones—physicians, psychologists, dietitians, nurses, physical therapists, and counselors—but must be relevant to their stage of life. Team members must consider an older patient’s work situation, her relationships with her spouse or partner and family members, and whether she’s dealing with issues associated with perimenopause (mood changes, weight changes, accumulation of fluid) or menopause (hot flashes). “In addition, many of these women have experienced emotional trauma that has gone on over a long period of time,” Jahraus says. “All these things need to be taken into account.”
Jahraus says being able to go through treatment with other women who are in similar life situations and coping with the same issues as they are can help older patients in their recovery. “People with eating disorders feel so isolated anyway,” he says. “When they find out there are other women like them struggling with these issues, … it gives them added incentive to move ahead knowing they are not alone.”—Kim Kiser