Overlooked and undertreated: gendered ageism in primary care management of eating disorders

Eating disorders (EDs) in older adults remain underrecognised due to persistent stereotypes framing them as conditions of youth. This study investigates how general practitioners (GPs) in Austria perceive, diagnose, and manage EDs in patients aged 65 and over, and explores the potential role of ageism in the context of clinical decision-making.

A vignette-based, semi-structured interview design was used with nine Austrian GPs experienced in treating older patients. The vignette described an older woman presenting with symptoms of Anorexia Nervosa. Data were analysed using a content-structuring qualitative approach, identifying patterns in awareness, diagnostic reasoning, and treatment practices.

Two overarching themes emerged: (1) Awareness and knowledge of EDs in later life and (2) Diagnostics, treatment, and differential diagnosis. Most GPs reported little familiarity with EDs in older adults, often attributing appetite or weight loss to ageing or somatic illness. Gendered stereotypes shaped perceptions, with older women viewed as less concerned with appearance and older men's EDs largely invisible. Diagnostic challenges included the absence of validated screening tools for older populations, symptom masking by multimorbidity, and reliance on physical rather than psychiatric explanations. Treatment pathways varied, ranging from interdisciplinary collaboration to psychiatric referral or antidepressant initiation, often targeting depression rather than the ED itself.

The underrecognition of EDs in older adults reflects structural gaps, ageist and gendered assumptions, and lack of tailored clinical guidelines. Age- and gender-sensitive screening tools, specific treatment pathways, targeted GP training, and public health campaigns are needed to improve detection and care for this underserved population.