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Anyone concerned about any form of eating distress needs to consult their GP, who can assess and advise, and who is the gateway to further help, such as access to a dietician or referral to a specialist.
We hope the following notes will be helpful but they are not a substitute for seeking medical advice.
Some specialists believe that eating problems which begin after a person has reached about sixty are likely to be due to problems such as depression and disorientation, rather than a ‘classic’ eating disorder with a psychological basis - such as anorexia nervosa or bulimia nervosa.
What's the difference between anorexia & anorexia nervosa?
A diagnosis of ‘anorexia’ in an older person who has not had an eating disorder before will simply be referring to loss of appetite, whereas the diagnosis of ‘anorexia nervosa’ involves a dedicated pursuit of thinness and an avoidance of normal weight, often accompanied by misperceptions of the person's own body size. If food refusal is accompanied by weight concerns of this type then the possibility that a recurrence of an earlier episode of an eating disorder has been triggered by recent life changes should be considered and discussed by concerned relatives with the sufferer's GP. Forty to fifty years ago many anorexic illnesses went unrecognised and untreated so the absence of any positive history of a prior eating disorder is by no means conclusive. Secrecy and denial remain common features of eating disorders. A known positive history should certainly not be ignored. If weight loss is occurring then a consultant's opinion is required along with practical measures to improve nutritional intake. Unfortunately iron deficiency and also malnutrition itself can be the causes of a profound loss of appetite so it is very easy for a vicious circle to develop if no action is taken.
What other issues could affect eating in older people?
Physical or emotional causes may be behind the loss of appetite. Badly fitting dentures can make it painful and difficult to eat. Loss of the sense of smell or taste makes food unattractive. An unrecognised infection in the urinary tract can make people feel too ill to want to eat. Bowel problems such as severe constipation cause pain and make people unwilling to eat. Older people may fail to recognise when they are thirsty and any problems with mobility can stop them getting themselves a drink. Dehydration is a common risk in older people and a dry mouth makes it hard to chew or swallow. Ideally water or a drink would always be served with their meals. Recent life events such as bereavement, or an unwanted move to a new place to live, or loss of contact with friends can diminish appetite due to grief. Many people lose interest in food when they no longer have someone with whom to share their meals.
Digesting solid food takes a lot of energy, so the act of eating a meal can be tiring to a frail person. Frequent small snacks may be a better option than spaced-out larger meals. Sip feeds which provide complete nutrition can be very useful. One or two cartons can be taken to supplement a too-small intake of solid food or, in severe situations, four to six cartons with appropriate additional clear fluids can provide adequate daily nutrition which will prevent the worsening of any pre-existing deficiency state. When malnutrition is present these sip-feeds can be prescribed, and patients may agree to take these cartons as necessary "medicine ".
Changes in the pattern of a person's eating or drinking can be a symptom of other physical illnesses. One example would be adult onset diabetes where the patient drinks more but remains thirsty. GPs can arrange for tests that would confirm or rule out the presence of this kind of illness.
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Counselling can be helpful both for the person with the problem and for concerned or anxious carers.
Discussing exactly what worries you with a counsellor often swiftly helps to clarify what needs to be done. To continue worrying while refraining from any action at all is not a good option, for you or for the person with the eating distress.
There is also an interview from Five News about eating disorders and older people, available on our YouTube page.
