Anorexia kills elderly men, records suggest

by Gavin Wilson
Staff writer

UBC psychologists have uncovered evidence that fatal cases of anorexia nervosa may strike more older people, and men, than is commonly believed.

Their findings fly in the face of conventional wisdom that anorexia nervosa is almost exclusively a condition affecting young females and does not exist beyond the age of 35.

Assoc. Prof. Paul Hewitt and Prof. Stan Coren examined 10.5 million death records in the U.S. spanning the years 1986-90, looking for records of those whose death certificates listed anorexia nervosa as a contributing factor.

The results showed that the median age of death from anorexia nervosa for women is 69, and for men, 80. And while at younger ages anorexia victims are 90 per cent female and 10 per cent male, for those over 45, the rate of men doubled to 21 per cent.

The eating disorder is more common among young people, but when it strikes the elderly, it is more deadly, accounting for 78 per cent of all anorexia nervosa deaths.

The results also suggest that anorexia nervosa may be responsible for fewer deaths than is usually believed--just 149 a year in the United States, a rate of 6.67 per 100,000.

"The death rate is actually very low. It is not an epidemic," Hewitt said.

The researchers expected their findings to stir up controversy, and they did at an international congress where they presented their results. They also have a paper currently being reviewed for publication by the British Journal of Psychiatry.

"We scoured the literature and found that other clinicians had noted cases of anorexia nervosa among people in their 60s, 70s and 80s. This suggests that our results were not just artifacts of the data," Hewitt said.

Problems inherent in death record data were accounted for, and they were careful to ensure the records did not confuse anorexia nervosa with the related syndrome simply known as anorexia, in which appetite loss is caused by cancer and other wasting illnesses.

Hewitt said there are a number of reasons why anorexia nervosa is considered a young person's ailment.

Fatalities drop off after the late 30s, which could lead to a belief that the condition disappears with age.

Hewitt and Coren's numbers show, however, that fatalities make a dramatic increase at age 50 and continue to climb until peaking at age 80 to 85.

Hewitt and Coren suggest that there may be two types of anorexia nervosa, with the type that strikes older people responsible for a greater number of deaths and more often affecting men.

As well, Hewitt said the elderly are usually ignored in diagnostic studies because "adults" are defined as people between the ages of 18 to 65.

"The elderly are in general very much neglected in terms of research," he added.

As to why the elderly would fall victim to anorexia nervosa, Hewitt noted that there could be many social, genetic, family and biological reasons, but no definitive answers.

"We don't know the cause in younger women, yet alone in seniors," he said.

Common across all age groups, however, is that the onset or reappearance of anorexia nervosa may be triggered by major stressful events. In older people, these could include the death of a spouse, retirement or simply adjusting to different income levels.