Help for Older Patients

Our casual friend finally reached out for help. AJ, whom we hadn’t seen in many years, called to ask us to take her to an emergency room. This confident, extremely independent and private person had longtime weight and eating patterns that were always troublesome. But now she had painful GI problems that had prevented her from eating for several days. For several years, even as we thought she was dangerously thin and told her so, she quickly changed the subject. After all, she was in her early 60s! and knew better than all of us. This time was different: now she weighed 95 lb at 5’6” tall, and hadn’t been able to eat for several days. This meant a trip to the ER. Would she accept help, we wondered? And was this AN, which we had suspected for some time? She had no primary care physician, no car, no family close by, and no health insurance beyond Medicare. What were we all thinking? How could we intervene? Would she accept help, and what did “help” mean to a stubborn senior citizen? Was eating disorders treatment available for her? In the end, after a physical workup, she was sent home.

How can we increase recognition of EDs across the lifespan? How could we help her? Who could help her when she refused all help? In a future issue, we will explore the dilemma and challenges of older adult patients who have never been diagnosed or treated for an ED. [Also see “Working with Patients with Severe and Enduring Eating Disorders” in the September-October 2021 issue.]

In this issue, also see an article on a program that uses the Internet to administer cognitive behavior therapy (“Internet-based Cognitive Behavioral Therapy during the COVID-19 Pandemic”) and a study looking at the use of BMI to classify patients with severe anorexia nervosa.

As we happily greet spring, we are reminded that there is no season for treating eating disorders—cases arise in all seasons, with and without pandemics, and among all age groups.

—MKS