Eating disorders and disordered eating behaviour in older adults: a scoping review

Eating disorders (ED) and disordered eating behaviours (DEB) in older adults have important implications for physical morbidity and mortality. Thus far, there has been no attempt to systematically evaluate the research landscape of ED and DEB in older adults.

A scoping review adhering to PRISMA-ScR reporting standards was conducted. We searched MEDLINE, Google Scholar, and PsycINFO (2000-2025) for English-language, peer-reviewed articles on ED/DEB in older adults covering diagnosis, epidemiology, determinants, clinical features, progression, or treatment, in any setting.

A total of 53 publications were included in the final review, comprising four systematic reviews, five longitudinal studies, and 44 cross-sectional studies. All original studies were observational in design. Research was predominantly community-based and relied on single-step screening, limiting diagnostic validity. Healthcare facility-based studies have examined ED in patients with comorbidities such as obesity, diabetes, and those undergoing bariatric surgery. Most study participants were Caucasian, with limited representation from minority groups. ED in older adults were mostly in women, with presentations characterised by dietary restriction, binge-purge behaviours, and body image preoccupation. The data on prevalence of subtypes of ED was variably reported. Most late-onset cases were precipitated by psychosocial stressors such as bereavement, caregiving responsibilities, or social isolation. Biological factors, particularly menopausal age in women, were found to be associated with an increased prevalence of DEBs, such as binge eating and restrictive eating patterns. Comorbid depression, anxiety, and medical conditions were frequent. Combined behavioural and pharmacological interventions offered better outcomes. Poorer outcomes were linked to chronicity, low body mass index, presence of comorbidities, and poor treatment engagement. Protective factors, including cognitive adaptation and positive attitudes toward ageing, may confer resilience.

ED and DEB in older adults are a significant but underrecognized public health issue. Existing research is constrained by limited diversity, Western-centric samples, and reliance on self-reported measures, underscoring the urgent need for inclusive, longitudinal, and interventional studies that better capture biopsychosocial determinants of EDs and DEBs, while also promoting the provision of age-sensitive care.