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June 6, 2001 Article Level: Advanced
The OTHER Anorexic in the Family
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Wendy Meyeroff, Medical Writer
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Jackie Stevens (not her real name) isn't eating. There's perfectly nutritious food in the refrigerator, but Jackie hasn't touched it. She won't prepare something. She won't zap one of her daughter-in-law's casseroles in the microwave. She won't even take herself out to dinner. Not surprisingly, Jackie's losing weight and is undernourished. But if you think Jackie is some teenager with an eating disorder, think again. Jackie is 63 years old. Jackie does indeed have an eating problem. She may even be classified as having anorexia. Howard Berkowitz, MD, director of consultation and emergency psychiatry at Maimonides Medical Center in Brooklyn, New York, points out that the word "anorexia" simply means "loss of appetite." Dr. Berkowitz says he sees quite a number of seniors with some form of anorexia. This is not the same disorder as anorexia nervosa, however. That very well defined illness almost exclusively affects young people. "It's rare to see someone with anorexia nervosa who's survived to 60+," Berkowitz says. "They usually die young, from heart failure, suicide, or other complications." That doesn't mean anorexia in seniors is something to be dismissed as unimportant. It can be just as dangerous as the better-known eating disorder. What's sadder is that it can be easier to treat. "Older Americans develop one of four kinds of anorexia," Dr. Berkowitz explains. "There's anorexia that's due to refusal to eat, an inability to eat, an indifference to eating, and having nothing to eat." Consider the second problem first, the Dr. Berkowitz says he inability to eat. "I've seen people who sees quite a number of were told they were depressed when seniors with some form they really had a physical problem," of anorexia. says Dr. Berkowitz. "Maybe they had a carcinoma blocking the esophagus that
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made it difficult to swallow. Or they've developed a motor problem, like literally not having the strength to lift the food to their mouth. Or maybe they're in constant pain, and it's affecting their appetite." All of these problems have resolutions (though some may be more complex than others): The carcinoma can be removed. The motor problems can be helped with special tools or a companion. And a medication may help the pain. Rita Landberg, director of counseling services at the Jewish Board of Family & Children's Services in New York City, picks up on the question of indifference to eating. "The very old often lose their sense of taste, so they're not interested in eating." Another problem is the bland diets even not-so-old Americans find themselves facing: "Someone has high blood pressure and maybe diabetes as well, so they're on a no-salt, no-sugar, diet and the food just doesn't entice them." This is particularly true of some patients with particular ethnic backgrounds. "We've got one lady who was brought up on a kosher diet, which is very high in salt," says Landberg. "No matter what we do, she cheats: She has people sneak her a piece of something highly salted, like gefilte fish." But what about Jackie not using her daughter-in-law's casserole? "She may be in the early stages of dementia," notes Dr. Berkowitz, "and she's forgotten how to work the stove or the microwave." (Some seniors have the opposite problem when dementia arises, he notes. They may eat a week's worth of casseroles in a day or 2 because they just don't remember eating.) Or Jackie's behavior may be an example of refusal to eat. Says Berkowitz, "There may be a power play going on. Maybe Jackie doesn't like her daughter-in-law and she'd rather go hungry than eat her food. Better yet, maybe Jackie can land in the ER and spoil her daughter-in-law's weekend!" Finally, there's the situation in which there simply is not enough to eat. We've all heard stories of seniors on limited incomes choosing between paying the rent and eating. Berkowitz notes that some seniors choose between buying tobacco and buying food. Maybe Jackie doesn't go out to eat because it's too expensive. Fortunately, there are solutions to many of the causes of anorexia in older family members. Among the experts' suggestions: ● Are you fighting 40 years of ethnic cooking? If so, see if you can find another way to season food that provides spicy taste without loading up on salt or sugar (like adding extra garlic in place of salt). Or ask the doctor how important this strict regimen really is. Maybe the patient can cheat once in a while. ● Watch your loved one prepare a meal. Maybe food and cookware are on shelves that are too high and they are (justifiably) reluctant to climb ladders. Simply rearranging the shelves can help. ● Watch while they eat. Are they having trouble chewing? Maybe they need new dentures. If they're arranging the food endlessly on their plate so that they never actually http://cbshealthwatch.medscape.com/cx/viewarticle/202846 (2 of 3) [6/6/2001 1:30:33 AM]
The OTHER Anorexic in the F...
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eat, that may be a sign of early Alzheimer's. Are medications, prescription or over-the-counter, causing problems? (If your loved one doesn't know, talk to the doctor.) Examples: Calcium and iron supplements can cause constipation. Antidepressants can cause loss of appetite. Lack of money can be a more difficult problem, since a loved one may not want to admit to financial difficulties. Maybe you can arrange a gift certificate to some places that deliver nutritious meals. (Check on-line or with the Department of Aging.) Loneliness keeps people from eating, so explore options: Two possibilities are setting up potluck suppers with various neighbors contributing and encouraging visits to a senior center that serves meals.
Wendy Meyeroff has been a professional medical writer since 1978. Reviewer: Beth Israel Deaconess Medical Center. Reviewed for medical accuracy by physicians at Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School. BIDMC does not endorse any products or services advertised on this Web site. Source: CBSHealthWatch Copyright: © 1999 Medscape, Inc. Posted On Site: Dec. 1999 Publication Date: Dec. 1999
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