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Morley and Castle [97] have reported atypical anorexia syndromes in the elderly. Anorexia in the elderly was first described in 1890 in Guy’s Hospital when it was termed "senile marasmus." Patients were anorexic and died with no apparent cause of death [97].

A spectrum of anorexia occurs in the elderly. In bereavement appetite can be markedly diminished and overt depression may not be apparent. A second anorexic pattern occurs in the elderly where patients decide to stop eating. Denying hunger and refraining from eating, they may become emaciated and die. A distortion of body image is present as they do not consider themselves thin. They deny suicidal ideation and, if asked, wish to be resuscitated in the event of cardiac arrest [97]. One atypical patient engaged in sham eating in that he would chew and then spit out most ingested food. In spite of weight loss, he felt his body size was "just right" [97].

Morley [98] has not seen bulimia in the elderly manifested by binging or purging. However, he considers the almost universal laxative use in the elderly a possible iatrogenic form of purging.

Diminished olfactory sensitivity, appetite disorders and impaired taste sensation may contribute to eating disorders in the elderly. Zinc deficiency, sometimes present in the elderly, produces dysguesia and may also have a role in decreasing enjoyment of food [97].


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