Abstract
BACKGROUND: Anorexia nervosa (AN) in older adults presents with medical complexity, psychiatric comorbidity, and diagnostic ambiguity, often overlapping with depression, cognitive decline, or anorexia of aging. A literature base dominated by case reports limits practical guidance for consultation-liaison (C-L) psychiatry.
OBJECTIVE: To describe key clinical features of AN in older adults, integrating systems-level barriers that shape diagnosis, care transitions, and prognosis.
METHODS: We describe 2 late-life AN cases and conducted a systematic review of studies including adults aged ≥60 years with AN defined by the Diagnostic and Statistical Manual of Mental Disorders. Two reviewers independently screened and extracted data and appraised quality using Joanna Briggs Institute tools. Extracted variables included demographics, Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria, psychiatric and medical comorbidities, care setting, and outcomes. We used narrative synthesis with descriptive statistics like n/N, %, median (interquartile range), and ranges to summarize case reports. The AN course was categorized as late-onset (≥60 years), chronic diagnosed, chronic undiagnosed, or recurrence.
RESULTS: Forty publications met criteria: 31 case reports/series, eight cross-sectional studies, and one cohort. Cross-sectional studies showed 3-6% prevalence of disordered eating behaviors with rare AN. Across 47 individually described patients, most were women in their early seventies with severe undernutrition and multimorbidity. Care most commonly occurred on medical units. Nutritional rehabilitation (e.g., supervised meals, enteral feeding) was the most common intervention. Outcomes were mixed, with many patients achieving weight gain, but mortality remained substantial. System-level barriers, such as insurance coverage and access constraints, were not reported in the literature but were prominent in our 2 cases.
CONCLUSIONS: In older adults, AN is rare in population samples but severe when clinically detected. The review highlights diagnostic complexity, medical risk, limited psychotherapy/medication detail, and systems barriers central to consultation-liaison practice. Consultation-liaison psychiatrists play a key role in identifying and coordinating treatment for this complex population.