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Obesity, Nutrition, and Eating Disorders

Session: Poster Session

(113) "Isn't She Too Old for Treatment?" Challenges in the Management of Anorexia Nervosa in an Elderly Patient in the General Hospital

Location: Griffin Hall

Trainee Involvement: Yes

Background/Significance: Eating disorders are complex conditions affecting individuals across their lifespan and are associated with significant medical and psychiatric comorbidity (Luca, 2015). Eating disorders in some patients fall under the sparsely-studied category of Severe and Enduring eating disorder (SE-ED) (Kotilahti, 2020), and even less is known about these disorders in older-aged patients.


Case: Ms. P is a 68-year-old woman with beta thalassemia trait, cold agglutinin hemolytic anemia, stress cardiomyopathy, and cirrhosis of unknown etiology. She has a history of inpatient medical admissions for chronic malnutrition and an eating disorder. On this occasion, the patient was found with altered mental status in the community with hypotension and failure to thrive and was admitted for severe malnutrition. Consultation-liaison psychiatry was initially consulted to assess the patient's decision-making capacity, as she wanted to leave the hospital against medical advice and advise on a hospital-specific eating disorder protocol. The patient was found to lack capacity and remained in the hospital. The eating disorder protocol was initiated, and the patient was monitored for re-feeding syndrome and progressive weight gain. After gaining about 27 lbs, the patient was considered stable enough for discharge to an inpatient treatment program. Notably, in this patient with a three-to-four-decade history of disordered eating, this was her first known admission to an eating disorder-specific program. After several weeks, the patient left inpatient treatment prematurely and was ultimately discharged home. The aftercare plan involved follow-up with the patient's PCP.


Discussion: About 20% of eating disorder cases can progress to enduring status (Keel, 2010). With the average age of women included in studies related to enduring eating disorders being 20-40 (Kotilahti, 2020), a case of SE-ED in a patient aged 60+ is rare. Further illustrative of this point, of the 3128 total consults placed in 2022-2023 at the general hospital where we saw this patient, 42 patients carried diagnoses of anorexia nervosa. Of those, only two patients were 60 or older. A multidisciplinary team approach to this patient involving internal medicine, psychiatry, nutrition, nursing, social work, and a hospital-specific eating disorder protocol successfully directed this patient to an inpatient treatment program. We will describe our institution's guidelines for managing a medically unstable patient with an eating disorder.
Conclusion/Implications: As the population ages, CL psychiatrists and psychiatrists, in general, may encounter growing numbers of patients similar to the one presented in this case. However, there is a paucity of robust evidence-based guidance on eating disorders in older adults, specifically those disorders that are severe and enduring.

References:
1. Luca A, et al.: Eating disorders in late-life. Aging and Disease. 2015; 6; 1: 48-55.
2. Keel PK and Brown TA: Update on course and outcome in eating disorders. Int J Eat Disord. 2010; 43: 195-204.
3. Kotilahti, et al.: Treatment interventions for severe and enduring eating disorders: systematic review. Int J Eat Disord. 2020; 53: 1280-1302.