Clinical Blindness to Eating Disorders in Older Adults: A Qualitative Study of Primary Care Nurses' Perspectives
Abstract
Background/Objectives: Eating disorders (EDs) have historically been associated with young women, and their presence in older adults remains poorly recognized despite evidence that they can persist, recur, or emerge in later life. Primary care nurses are strategically positioned for community-based detection, yet their perspective has been scarcely explored. This study aimed to examine the experiences, perceptions, and described practices of primary care nurses regarding EDs and disordered eating in older adults, identifying patterns, barriers to detection, and training needs. Methods: A qualitative study with a descriptive design was conducted in three Primary Health Care Centers from different health areas of Spain. Thirty-two registered practicing nurses participated in three focus groups, guided by a clinical vignette and a semi-structured interview guide. Data were analyzed following Braun and Clarke's reflexive thematic analysis, supported by ATLAS.ti software (version 24.2, 2024). Results: EDs in older adults frequently remained invisible to professionals, sustained by three interrelated mechanisms: the cultural hegemony of the biomedical paradigm, which reframes symptoms as organic or cognitive; a selective historicization that attributes altered eating to the postwar "hunger years"; and an "ageism of care" that normalizes warning signs as expected features of aging. Notably, when the diagnostic possibility was explicitly named, participants retrospectively…
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