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Disorders of Eating in the Elderly

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Abstract

The most common eating disorder in the elderly in both community and hospital settings is food refusal. This may lead to weight loss and malnutrition with all the adverse consequences on independence and function. The management of disorders of eating in the elderly is a diagnostic and therapeutic challenge, requiring the combined skills of the medical and nursing staff. The causes are often multifactorial and require careful and repeated assessment of the patient's social, psychological, and medical history. Approach to treatment involves these factors, as well as ethical and cultural considerations. Eating is the most basic biological drive for survival in nature. In human societies there are additional cultural and social aspects that may override this instinct, as in the case of hunger strikes for political motives. In the elderly, food is one of the major sources of possible pleasure and it is the challenge for health providers to try and give this enjoyment to their patients for as long as possible.

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REFERENCES

  • Abbasi, A. A., & Rudman, D. (1994). Undernutrition in the nursing home: Prevalence, consequences, causes and prevention. Nutrition Reviews, 52, 113–122.

    Google Scholar 

  • Ahronheim, J. C. (1996). Nutrition and hydration in the terminal patient. Clinics in Geriatric Medicine, 12, 379–391.

    Google Scholar 

  • Alford, D. M. (1986). Behavioral responses of the institutionalized elderly to eating and to food services. Nursing Homes, 35, 20–24.

    Google Scholar 

  • Allaz, A-F., Bernstein, M., Rouget, P., Archinard, M., & Morabia, A. (1998). Body weight preoccupation in middle-age and ageing women: A general population survey. International Journal of Eating Disorders, 23, 287–294.

    Google Scholar 

  • Amella, E. J. (1998). Assessment and management of eating and feeding difficulties for older people:ANICHE protocol. Geriatric Nursing, 19, 269–274.

    Google Scholar 

  • Amella, E. J. (1999). Factors influencing the proportion of food consumed by nursing home residents with dementia. Journal of the American Geriatrics Society, 47, 879–885.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • American Dietetic Association. (1998). Position of the American Dietetic Association: Liberalized diets for older adults in long term care. Journal of the American Dietetic Assocation, 98, 201–204.

    Google Scholar 

  • Athlin, E., Norberg, A., Axelsson, K., Mo¨ ller, A., & Nordstro¨ m, G. (1989). Aberrant eating behavior in elderly Parkinsonian patients with and without dementia: Analysis of video-recorded meals. Research in Nursing Health, 12, 41–51.

    Google Scholar 

  • Axelsson, K., Norberg, A., & Asplund, K. (1984). Eating after a stroke—Towards an integrated view. International Journal of Nursing Studies, 21, 93–99.

    Google Scholar 

  • Bayley, J. (1999, August 2). Last Jokes. TheNew Yorker, 75, 38–43.

    Google Scholar 

  • Beck, D., Casper, R., & Andersen, A. (1996). Truly late onset of eating disorders: A study of 11 cases averaging 60 years of age at presentation. International Journal of Eating Disorders, 20, 389–395.

    Google Scholar 

  • Berlin, R. M. (1990). Psychiatric consultation for elderly patients who refuse to eat. [letter] American Journal of Psychiatry, 147, 812.

    Google Scholar 

  • Bernat, J. L., Gert, B., & Mogielnicki, R. P. (1993). Patient refusal of hydration and nutrition: An alternative to physician-assisted suicide or voluntary active euthanasia. Archives of Internal Medicine, 153, 2723–2728.

    Google Scholar 

  • Berry, E. M. (1992). Undernutrition in the elderly: A physiological or pathological process? In H. Munro, & G. Shlierf (Eds.), Nutrition in the elderly. Nestlé Nutrition Workshop Series, 29, (pp. 65–78). New York: Raven.

    Google Scholar 

  • Berthélemy, P., Bouisson, M., Vellas, B., Moreau, J., Vaysse, N., Albarede, J. L., & Ribet A. (1992). Postprandial cholystokinin secretion in elderly with protein-energy undernutrition. Journal of the American Geriatrics Society, 40, 365–369.

    Google Scholar 

  • Brocker, P., Vellas, B., Albarede, A. L., & Poynard, T. (1994). A two-center, randomized, double blind trial of ornithine oxoglutarate in 194 elderly, ambulatory, convalescent subjects. Age and Ageing, 23, 303–306.

    Google Scholar 

  • Buckler, D. A., Kelber, S. T., & Goodwin, J. S. (1994). The use of dietary restrictions in malnourished nursing home patients. Journal of the American Geriatrics Society, 42, 1100–1102.

    Google Scholar 

  • Carr-Lopez, S. M., & Phillips, S. L. (1996). The role of medications in geriatric failure to thrive. Drugs and Aging, 9, 221–225.

    Google Scholar 

  • Cassens, D., Johnson, E., & Keelan, S. (1996). Enhancing taste, texture, appearance, and presentation of pureed food improved resident quality of life and weight status. Nutrtion Reviews, 54 (suppl II), S51–S54.

    Google Scholar 

  • Castle, S., Nguyen, C., Joaquin, A., Coyne, B., Heuston, C., Chan, A., Percy, L., & Ohmen, J. (1995). Megestrol acetate suspension therapy in the treatment of geriatric anorexia/cachexia in nursing home patients. Journal of the American Geriatrics Society, 43, 835–836.

    Google Scholar 

  • Chapman, K. M., & Nelson, R. A. (1994). Loss of appetite: Managing unwanted weight loss in the older patient. Geriatrics, 49, 54–59.

    Google Scholar 

  • Clarke, D. M., Wahlqvist, M. L., & Strauss, B. J. G. (1998). Undereating and undernutrition in old age: Integrating bio-psychosocial aspects. Age and Ageing, 27, 527–534.

    Google Scholar 

  • Clarke, D. M., Wahlqvist, M. L., Rassias, C. R., & Strauss, B. J. G. (1999). Psychological factors in nutritional disorders of the elderly: Part of the spectrum of eating disorders. International Journal of Eating Disorders, 25, 345–348.

    Google Scholar 

  • Clarkston, W. K., Pantano, M. M., Morley, J. E., Horowitz, M., Littlefield, J. M., & Burton, F. R. (1997). Evidence for the anorexia of aging: Gastrointestinal transit and hunger in healthy elderly vs. young adults. American Journal of Physiology, 272, R243–R248.

    Google Scholar 

  • Conwell, Y., Pearson, J., & DeRenzo, E. G. (1996). Indirect selfdestructive behavior among elderly patients in nursing homes: A research agenda. American Journal of Geriatric Psychiatry, 4, 152–163.

    Google Scholar 

  • Cosford, P., & Arnold, E. (1992). Eating disorders in late life: A review. International Journal of Geriatric Psychiatry, 7, 491–498.

    Google Scholar 

  • Council for Nutritional Clinical Strategies in Long-Term Care (1999). Nutritional clinical strategies in long-term care: Anorexia in the elderly. Author.

  • Cullen, P., Abid, F., Patel, A., Coope, B., & Ballard, C. G. (1997). Eating disorders in dementia. International Journal of Geriatric Psychiatry, 12, 559–562.

    Google Scholar 

  • Davidson, B., Vander Laan, R., Davis, A., Hirschfeld, M., Lauri, S., Norberg, A., Phillips, L., Pitman, E., Ying, L. U., & Ziv, L. (1990). Ethical reasoning associated with the feeding of terminally ill elderly cancer patients: An international perspective. Cancer Nursing, 13, 286–292.

    Google Scholar 

  • Doty, R. L. (1991). Olfactory capacities in aging and Alzheimer's disease: Psychophysical and anatomic considerations. Annals of the New York Academy of Science, 640, 20–27.

    Google Scholar 

  • Dresser, R. (1985). When patients resist feeding: Medical, ethical and legal considerations. Journal of the American Geriatrics Society, 33, 790–794.

    Google Scholar 

  • Durnbaugh, T., Haley, B., & Roberts, S. (1996). Assessing problem feeding behaviors in mid-stage Alzheimer's disease. Geriatric Nursing, 17, 63–67.

    Google Scholar 

  • Eaton, M., Mitchell-Bonair, I. L., & Friedmann, E. (1986). The effect of touch on nutritional intake of chronic organic brain syndrome patients. Journal of Gerontology, 41, 611–616.

    Google Scholar 

  • Edelstein, E. L. (1992). Anorexia and other dyscontrol syndromes. Berlin: Springer Verlag.

    Google Scholar 

  • Fabiny, A. R., & Kiel, D. P. (1997). Assessing and treating weight loss in nursing home residents. Clinics in Geriatric Medicine, 13, 737–751.

    Google Scholar 

  • Feutz, A., & Rapin, C-H. (1994). An observational study of the role of pain control and food adaptation of elderly patients with terminal cancer. Journal of the American Dietitic Association, 94, 767–770.

    Google Scholar 

  • Gallagher, J. (1984, September). Health facilities' obligations when a patient refuses treatment. Health Progress 65, 40–43.

    Google Scholar 

  • Gazewood, J. D., & Mehr, D. R. (1998). Diagnosis and manage ment of weight loss in the elderly. Journal of Family Practice, 47, 19–25.

    Google Scholar 

  • Glick, S. M. (1997). Unlimited human autonomy-a cultural bias? New England Journal of Medicine, 336, 954–956.

    Google Scholar 

  • Hall, P., & Driscoll, R. (1993). Anorexia in the elderly—An annotation. International Journal of Eating Disorders, 14, 497–499.

    Google Scholar 

  • Hallfrisch, J., Muller, D., Drinkwater, D., Tobin, J., & Andres, R. (1990). Continuing diet trends in men: The Baltimore longitudinal study of aging (1961-1987). Journal of Gerontology, 45, M186–M191.

    Google Scholar 

  • Hanauer, L. B. (1992, September, 30). Elderly patients afraid to eat [Letter]. Hospital Practice (Off Ed), 27 (9A), 19.

    Google Scholar 

  • Hendy, H. M., Nelson, G. K., & Greco, M. E. (1998). Social cognitive predictors of nutritional risk in rural elderly adults. International Journal of Aging and Human Development, 47, 299–327.

    Google Scholar 

  • Hetherington, M. M. (1998). Taste and appetite regulation in the elderly. Proceedings of the Nutrition Society, 57, 625–631.

    Google Scholar 

  • Hetherington, M. M., & Burnett, L. (1994). Aging and the pursuit of slimness: Dietary restraint and weight satisfaction in elderly women. British Journal of Clinical Psychology, 33, 391–400.

    Google Scholar 

  • Hodges, M. O., & Tolle, S. W. (1994). Tube feeding decisions in the elderly. Clinics in Geriatric Medicine, 10, 475–488.

    Google Scholar 

  • Jenkins, C., & Bruera, E. (1998). Assessment and management of medically ill patients who refuse life-prolonging treatments: Two case reports and proposed guidelines. Journal of Palliative Care, 14, 18–24.

    Google Scholar 

  • Jury, M., & Jury, D. (1976). Gramp. Psychology Today, February, 57–63.

  • Kamel, H. K., Thomas, D. R., & Morley, J. E. (1998). Nutritional Deficiencies in long-term care: Part II. Management of protein energy malnutrition and dehydration. Annals of Long Term Care, 6, 250–258.

    Google Scholar 

  • Kane, R. A., Caplan, A. L., Urv-Wong, E. K., Freeman, I. C., Aroskar, M. A., & Finch, M. (1997). Everyday matters in the lives of nursing home residents: Wish for the perception of choice and control. Journal of the American Geriatrics Society, 45, 1086–1093.

    Google Scholar 

  • Katz, I. R., & DeFilippo, S. (1997). Neuropsychiatric aspects of failure to thrive in late life. Clinics in Geriatric Medicine, 13, 623–638.

    Google Scholar 

  • Kayser-Jones, J. (1997). Inadequate staffing at mealtime: Implications for nursing and health policy. Journal of Gerontology Nursing, 23, 14–21.

    Google Scholar 

  • Keller, H. H. (1993). Malnutrition in institutionalized elderly: How and why? Journal of the American Geriatrics Society, 41, 1212–1218.

    Google Scholar 

  • Lange-Alberts, M. E., & Shott, S. (1994). Nutritional intake: Use of touch and verbal cueing. Journal of Gerontological Nursing, 20, 36–40.

    Google Scholar 

  • Lennard-Jones, J. E. (1999). Giving or withholding fluid and nutrients: Ethical and legal aspects. Journal of the Royal College of Physicians of London, 33, 39–45.

    Google Scholar 

  • Lloyd, G. E. R. (Ed.), (1986). Hippocratic writings. Middlesex, England: Penguin Books.

    Google Scholar 

  • Lucas, A. R., Beard, C. M., O'Fallon, W. M., & Kurland, L. T. (1991). 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: A population-based study. American Journal of Psychiatry, 148, 917–922.

    Google Scholar 

  • Lundquist, R. S., Bernens, A., & Olsen, C. G. (1997). Comorbid disease in geriatric patients: Dementia and depression. American Family Physician, 55, 2687–2694.

    Google Scholar 

  • Markson, E. W. (1997). Functional, Social, and psychological disability as causes of loss of weight and independence in older community-living people. Clinics in Geriatric Medicine, 13, 639–652.

    Google Scholar 

  • Marcus, E. L., & Berry, E. M. (1998). Refusal to eat in the elderly. Nutrition Reviews, 56, 163–171.

    Google Scholar 

  • Mattiasson, A-C., & Andersson, L. (1994). Staff attitude and experience in dealing with rational nursing home patients who refuse to eat and drink. Journal of Advanced Nursing, 20, 822–827.

    Google Scholar 

  • McCardle, D. R., & Bader, D. (1991, April). Confronting conflict. A nursing home staff comes to grips with an elderly patient's decision to refuse nutrition. Health Progress, 72, 31–35.

    Google Scholar 

  • McIntoch, J. L., & Hubbard, R. W. (1988). Indirect self-destructive behavior among the elderly: A review with case examples. Journal of Gerontological Social Work, 13, 37–48.

    Google Scholar 

  • McIntosh, W. A., Shifflett, P. A., & Picou, J. S. (1989). Social support, stressful events, strain, dietary intake, and the elderly. Medical Care, 27, 140–153.

    Google Scholar 

  • Michaelsson, E., Norberg, A., & Norberg, B. (1987). A quality of life issue: Feeding methods for demented patients in end stage of life. Absence of pain is the goal for these patients. Geriatric Nursing, 8, 69–73.

    Google Scholar 

  • Miles, S. H. (1985). The terminally ill elderly: Dealing with the ethics of feeding. Geriatrics, 40, 112–120.

    Google Scholar 

  • Miller, D. K., Morley, J. E., Rubenstein, L. Z., & Pietruszka, F. M. (1991). Abnormal eating attitudes and body image in older undernourished individuals. Journal of the American Geriatrics Society, 39, 462–466.

    Google Scholar 

  • Morley, J. E. (1996). Anorexia in older persons: Epidemiology and optimal treatment. Drugs and Aging, 8, 134–155.

    Google Scholar 

  • Morley, J. E. (1997). Anorexia of aging: Physiologic and pathologic. American Journal of Clinical Nutrition, 66, 760–773.

    Google Scholar 

  • Morley, J. E. (1999). Protein-energy malnutrition in older subjects. Proceedings of the Nutrition Society, 57, 587–592.

    Google Scholar 

  • Morley, J. E., Flood, J. F., & Silver, A. J. (1990). Opioid peptides and aging. Annals of the New York Academy of Sciences, 579, 123–132.

    Google Scholar 

  • Morley, J. E., & Kraenzle, D. (1994). Causes of weight loss in a community nursing home. Journal of the American Geriatrics Society, 42, 583–585.

    Google Scholar 

  • Morley, J. E., & Morley, P. M. K. (1995). Psychological and social factors in the pathogenesis of weight loss. Annual Review of Gerontology and Geriatrics, 15, 83–109.

    Google Scholar 

  • Murphy, C. (1999). Loss of olfactory function in dementing disease. Physiology and Behavior, 66, 177–182.

    Google Scholar 

  • Nelson, F. L., & Farberow, N. L. (1980). Indirect self-destructive behavior in the elderly nursing home patient. Journal of Gerontology, 35, 949–957.

    Google Scholar 

  • Nelson, F. L., & Farberow, N. L. (1982). The development of indirect self-destructive behaviour scale for use with chronically ill medical patients. International Journal of Social Psychiatry, 2, 5–14.

    Google Scholar 

  • Nemeroff, C. B., Widerlo¨v, E., Bissette, G., Walleus, H., Karlsson, I., Eklund, K., Kilts, C. D., Loosen, P. T., & Vale, W. (1984). Elevated concentrations of corticotropin-releasing-factor immunoreactivity in depressed patients. Science, 226, 1342–1344.

    Google Scholar 

  • Nicholson, S. D., & Ballance, E. (1998). Anorexia nervosa in later life: An overview. Hospital Medicine, 59, 268–272.

    Google Scholar 

  • Norberg, A., & Athlin, E. (1989). Eating problems in severely demented patients: Issues and ethical dilemmas. Nursing Clinics of North America, 24, 781–789.

    Google Scholar 

  • Norberg, A., Bäckström, A., Athlin, E., & Norberg, B. (1988). Food refusal amongst nursing home patients as conceptualized by nurses' aids and enrolled nurses: An interview study. Journal of Advanced Nursing, 13, 478–483.

    Google Scholar 

  • Norberg, A., Hirschfeld, M., Davidson, B., Davis, A., Lauri, S., Lin, J. Y., Phillips, L., Pittman, E., Vander Laan, R., & Ziv, L. (1994). Ethical reasoning concerning the feeding of severely demented patients: An international perspective. Nursing Ethics, 1, 3–13.

    Google Scholar 

  • Pobee, K. A., & LaPalio, L. R. (1996). Anorexia nervosa in the elderly: A multidisciplinary diagnosis. Clinical Gerontologist, 16, 3–9.

    Google Scholar 

  • Ragneskog, H., Kihlgren, M., Karlsson, I., & Norberg, A. (1996). Dinner music for demented patients: Analysis of video-recorded observations. Clinical in Nursing Research, 5, 262–282.

    Google Scholar 

  • Rolls, B. J. (1999). Do chemosensory changes influence food intake in the elderly? Physiology and Behavior, 66, 193–197.

    Google Scholar 

  • Rosenbloom, C. A., & Whittington, F. J. (1993). The effects of bereavement on eating behaviors and nutrient intakes in elderly widowed persons. Journal of Gerontology, 48, S223–S229.

    Google Scholar 

  • Roth, G. S., Ingram, D. K., & Lane, M. A. (1999). Caloric restriction in primates: Will it work and how will we know? Journal of the American Geriatrics Society, 47, 896–903.

    Google Scholar 

  • Russell, J., & Gilbert, M. (1992). Is tardive anorexia a discrete diagnostic entity? Australian and New-Zealand Journal of Psychiatry, 26, 429–435.

    Google Scholar 

  • Saltzman, J. R. (1995, Jan-Feb). Commentary on “Ornithine oxoglutarate improved nutrition in elderly patients'' ACP Journal Club, 122, 16.

    Google Scholar 

  • Schiffman, S. S. (1997). Taste and smell losses in normal aging and disease. The Journal of the American Medical Association, 278, 1357–1362.

    Google Scholar 

  • Schiffman, S. S., & Warwick, Z. S. (1993). Effect of flavor enhancement of foods for the elderly on nutritional status: Food intake, biochemical indices, and anthropometric measures. Physiology and Behavior, 53, 395–402.

    Google Scholar 

  • Schostak, R. Z. (1994). Jewish ethical guidelines for resuscitation and artificial nutrition and hydration of the dying elderly. Journal of Medical Ethics, 20, 93–100.

    Google Scholar 

  • Schreiber, S., & Lerer, B. (1997). ''Failure to thrive'' in elderly depressed patients: A new concept or a different name for an old problem? Israel Journal of Psychiatry and Related Sciences, 34, 108–114.

    Google Scholar 

  • Steele, C. M., Greenwood, C., Ens, I., Robertson, C., & Seidman-Carlson, R. (1997). Mealtime difficulties in a home for the aged: Not just dysphagia. Dysphagia, 12, 43–50.

    Google Scholar 

  • Tayek, J. A., Bistrian, B. R., & Blackburn, G. L. (1988). Improved food intake and weight gain in adult patients following electroconvulsive therapy for depression. Journal of the American Dietetic Association, 88, 63–65.

    Google Scholar 

  • Thompson, M. P., & Morris, L. K. (1991). Unexplained weight loss in the ambulatory elderly. Journal of the American Geriatrics Society, 39, 497–500.

    Google Scholar 

  • Volicer, L., Rheaume, Y., & Cyr, D. (1994). Treatment of depression in advanced Alzheimer's disease using sertraline. Journal of Geriatric Psychiatry and Neurology, 7, 227–229.

    Google Scholar 

  • Volicer, L., Stelly, M., Morris, J., McLaughlin, J., & Volicer, B. J. (1997). Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer's disease. International Journal of Geriatric Psychiatry, 12, 913–919.

    Google Scholar 

  • Wallace, J. I., & Schwartz, R. S. (1997). Involuntary weight loss in elderly outpatients: Recognition, etiologies, and treatment. Clinics in Geriatric Medicine, 13, 717–735.

    Google Scholar 

  • Watson, R. (1993). Measuring feeding difficulty in patients with dementia: Perspectives and problems. Journal of Advanced Nursing, 18, 25–31.

    Google Scholar 

  • Wilson, M-M. G., Vaswani, S., Liu, D., Morley, J. E., & Miller, D. K. (1998). Prevalence and causes of undernutrition in medical outpatients. American Journal of Medicine, 104, 56–63.

    Google Scholar 

  • Winograd, C. H., & Brown, E. M. (1990). Aggressive oral refeeding in hospitalized patients. American Journal of Clinical Nutrition, 52, 967–968.

    Google Scholar 

  • Wood, P., & Vogen, B. D. (1998). Feeding the anorectic client: Comfort foods and happy hour. Geriatric Nursing, 19, 192–194.

    Google Scholar 

  • Wurtman, J. J., Lieberman, H., Tsay, R., Nader, T., & Chew, B. (1988). Calorie and nutrient intakes of elderly and young subjects under identical conditions. Journal of Gerontology, 43, B174–B180.

    Google Scholar 

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  1. Elliot M. Berry
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  2. Esther-Lee Marcus
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Berry, E.M., Marcus, EL. Disorders of Eating in the Elderly. Journal of Adult Development 7, 87–99 (2000). https://doi.org/10.1023/A:1009575706990

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