1. Eating Disorders in the Elderly Kelly Bigley

2. Agenda -Activity - Introduction -Definition - Prevention and Treatment

3. About Me - Nutrition Student at Cal State Los Angeles - Geriatric nutrition is my goal - Caregiver for the elderly with Alzheimers and Dementia - 50 in-service hours in Acute Care for the Elderly and Assisted Living

4. Activity What do you think of when you hear the words “Eating Disorder?”

5. Definition: Psychological Eating disorders are a group of serious conditions in which you're so preoccupied with food and weight that you can often focus on little else. The main types of eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder. - Mayo Clinic

6. Definition: Physical ● Refusal to eat and denial of hunger ● An intense fear of gaining weight ● A negative or distorted self-image ● Excessive exercise ● Irritability ● Fear of eating in public ● Preoccupation with food ● Social withdrawal ● Thin appearance ● Soft, downy hair present on the body (lanugo) ● Menstrual irregularities ● Constipation ● Dry skin ● Frequently being cold ● Irregular heart rhythms

7. EDs and the Elderly Increasing prevalence Italian study found the following: - 34.1% women and 27.2% men in long term care had eating disorders - 33.3% women and 26.7% men in rehab/acute care facilities had eating disorders - 3.3% of women and 11.3% men living at home or in their community had eating disorders

8. Why Care? - Muscle wasting is not a normal part of aging, nor is a 5-10% loss of body weight in 1-12 months - 5% loss of body weight in one month increases likelihood of death in one year 4x

9. Causes - Depression is primary cause - ED’s can go into remission for decades - Poorly fitting dentures/loss of teeth - Chewing and swallowing difficulties - Ulcers and nonmalignant gastrointestinal disorders - Polypharmacy

10. Causes Unique to Elderly - Alzheimer’s and Dementia - Affects rewards center of brain - May believe they have already eaten - May not be aware food has arrived - Some foods may be frightening - Control - Loss of independence, “no” is last form of control - Protest against caregiver - Silent Suicide - Loss of loved one - Suicide in the elderly approaches a 100% success rate.

11. What can we do? With screening tools upon move-in, clearer communication and awareness, we can help to narrow a resident’s chances of getting an eating disorder.

12. Upon Move in - Obtain all anthropometric data we can, and keep them updated. - lab panels mean little when we don’t know what their norm is. - Obtain Medical history - screening for depression, eating disorders, compulsive habits - Obtain food preferences and habits. - May help us feed them later on.

13. While with us - Communication - Make staff aware if a resident has had depressed appetite for more than a day. - Feed them food that they want - Stick as closely to food preferences and restrictions as possible - Limiting distractions - Televisions and other loud noises can distract our residents from eating - Make them aware that their food has arrived - When possible, have family feed them. - Family will be aware of anything suspicious - Interaction - Caregivers/ CNAs who enjoy their job - Positive interaction - Asking “How are you doing?” and meaning it.

14. If an ED is Suspected - Order labs and weight - if already taken, evaluate - Screen for depression - Use Geriatric Depression Scale Observe for chewing and swallowing difficulties - may need a special diet - Evaluate medications - look for medications that may be causing upset stomach - Lift some dietary restrictions - in cases of controlled Diabetes and Hypertension - Get them exercising - Exercise can stimulate appetite - Don’t go straight for supplements - More likely to eat less calories, as opposed to consuming extra

15. Case Study Mrs. X is a resident who has been with your facility for 6 months. She has lost 10 pounds in that amount of time. Brainstorm and write out/list concerns, what you want to know and how you will utilize facility resources to assess and treat this patient.

16. What we did not cover - Prevention of muscle wasting - Healing from injury, infection, open wounds - increased protein needs