Eating disorders are not commonly diagnosed in individuals aged >50 years, yet they are associated with significant psychiatric comorbidities and overall morbidity. Anorexia nervosa is the most common eating disorder among this age group, and women are affected most often. We present the fatal case of a 66-year old woman with severe malnutrition and newly diagnosed anorexia nervosa. Inpatient refeeding was unsuccessful, and she succumbed to multisystem organ failure. The timely recognition of eating disorders among older people is important for family physicians who care for patients across the life spectrum. ( The onset of eating disorders has been most commonly described as occurring among adolescent and young adult women (16 to 25 years old). More controversy over the emergence of eating disorders in women aged Ͼ50 years has evolved regarding whether the eating disorder emerges at that time or is diagnosed from onset at an earlier age.1-3 The behaviors that coincide with eating disorders, such as restrictive eating patterns and body dysmorphia, have been documented among older women. Among a random community sample of 475 women aged 60 to 70 years, 3.8% met the criteria for an eating disorder. 4 Among older Canadian women, 2.6% of those aged 50 to 64 years, and 1.8% of those aged Ͼ65, reported symptoms of disordered eating. 5A strong association has been noted with comorbid psychiatric disorders in late-onset eating disorders. Major depression has been shown to be 2.4 to 4 times more likely in individuals with anorexia than in controls.6 Anxiety disorders, obsessive compulsive disorder, and social phobias have also been associated with eating orders. 7,8 In a study of women aged Ն50 years that investigated the relationship between eating disorder symptomatology (scores Ͼ20 on the EAT-26 eating disorders screening tool, where scores Ͼ20 indicate high risk of an eating disorder) and mood disorders, older women with eating disorder symptomatology had a significantly higher risk of a mood disorder than did those women who scored Յ20 on the EAT-26 module (odds ratio, 6.9 [95% confidence interval, 4.5-10.4] and 1.0, respectively). 2 A recent review of the literature regarding eating disorders in individuals aged Ͼ50 years revealed comorbid psychiatric conditions in 60% of this population; major depression was the most common mood disorder among patients in this age group.
Objectives Currently, there are no Canadian guidelines for discharge instruction to be given to patients receiving an opioid prescription in the ED. This likely contributes to inadequate discharge instructions for these potentially dangerous medications. The principal goal of this study was to develop an interdisciplinary Canadian consensus regarding important concepts to be included in written opioid discharge instructions within the ED setting. Methods We conducted a modified Delphi study between May and August 2021. The national multidisciplinary panel consisted of 23 healthcare professionals and one patient partner. The survey consisted of 19 initial concepts developed after a review of the literature and a meeting with local experts. The panel added four new concepts after the first survey round. Three rounds of online surveys were distributed in total. Panel consensus was defined a priori as a disagreement index score less than 1, in accordance with the RAND/UCLA Appropriateness Method. ResultsWe achieved a 100% response rate in round one and a 96% response rate in rounds two and three of our Delphi study. There was group consensus (disagreement index = 0.66, median importance = 9) that all patients receiving opioid prescriptions from the ED should receive written discharge instructions. The interdisciplinary panel arrived at a consensus on 21/23 concepts for ED opioid discharge instructions. The concepts with the highest level of agreement were related to minimizing the use of the prescribed opioid medication and opioid use safety (mixing with drugs/alcohol, storage, and impairment). Conclusion This Delphi study with a national, multidisciplinary panel achieved consensus on 21 concepts that should be included in written discharge instructions to patients receiving an opioid prescription upon discharge from the ED. Keywords Emergency department • Opioid • Delphi consensus method • Discharge instructions • Patient education RésuméObjectifs Actuellement, il n'y a pas de lignes directrices canadiennes sur les instructions de sortie à donner aux patients qui reçoivent une ordonnance d'opioïdes aux urgences. Cela contribue probablement à des instructions de sortie inadéquates pour ces médicaments potentiellement dangereux. L'objectif principal de cette étude était d'établir un consensus canadien interdisciplinaire sur les concepts importants à inclure dans les directives écrites de sortie des opioïdes dans le contexte des urgences.
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