Anorexia and the Elderly

Although anorexia nervosa is often associated with teenage girls, it can strike at any stage of life. The previous article explored anorexia among young children. At the other end of the spectrum is evidence suggesting that middle-aged and elderly women are sufferers.

There are few statistics on older anorexics. A January 9, 1997 University of British Columbia (UBC) press release reported Associate Professor Paul Hewitt saying that the elderly are often ignored in studies because only people between ages 18 and 65 are considered “adults.” Eating disorders specialist Barton J. Blinder, M.D. observes that the number of aged anorexics is unknown. According to Blinder, less than 100 cases have been reported. The latter statement, however, can be deceiving.

A November 28, 1996 UBC release noted a study by Hewitt and Professor Stanley Coren. Hewitt and Coren examined 10.5 million U.S. death records for the years 1986-90 listing anorexia nervosa as a factor contributing to mortality. They found that although the illness is more common among young people, it is more deadly for the elderly, “accounting for 78 percent of all anorexia nervosa deaths.” According to the release, the median age of women who die from the disorder is 69. Among men, it is 80. The study also found that 21 percent of anorexics over 45 are men, double the proportion among young people, and that all fatalities increase sharply after 50 and continue rising until age 80 to 85. No reasons are given for the age and sex disparities.

Blinder observes that teenage-onset anorexia may go into remission for decades and then recur during an emotionally difficult period. He cites findings that post-menopausal women who develop anorexia are severely depressed and suicidal, which may account for their higher death rate.

The Mirror-Mirror Website suggests several stressors triggering eating disorders among older women: divorce, discovery of infidelity, and grown children leaving home. The site emphasizes the double standard among the sexes: greying, older men are often considered “distinguished” and appealing, while their female counterparts are disdained. According to Mirror-Mirror, divorced women–or those with unfaithful husbands–may attribute their marital problems to physical appearance and begin obsessive dieting in an attempt to make themselves more attractive. The site notes that children leaving home can cause loneliness and an elusive search for happiness through weight control.

The 1996 UBC release identifies several other factors: retirement, death of a spouse, and reduced income.

One aspect of the Hewitt and Coren study may be seriously flawed. The 1997 UBC release noted that the survey found an extremely low incidence of anorexia deaths in the U.S.: only 149 per year. But using death certificates for measuring the incidence of anorexia is tricky business: there is much shame and embarrassment associated with the illness, and many families may request the attending physician not to list it. My mother’s story provides a good example.

She suffered from anorexia for 10 years before her death, weighing less than 70 pounds during most of that time. A light smoker throughout her adult life, she suddenly developed lung cancer at age 48 and was dead within a matter of months. In preparing the death certificate, the doctor had two obvious choices: he could have listed the immediate cause of death, lung cancer, or the root cause, anorexia. Instead he exercised a third option, using a boilerplate form indicating that death resulted from “natural causes” without foul play.

As a trusts and estates administrator, I have seen many such death certificates–especially in cases involving shame-inducing diseases such as AIDS. I, therefore, suspect that Hewitt and Coren’s findings grossly understate the actual number of fatalities.

When dealing with extreme ends of the life cycle, it is important not to confuse anorexia nervosa with unrelated disorders. Young children who are finicky eaters, or elderly people who have lost interest in food, are not necessarily anorexics. ANRED notes the most common reasons why seniors rapidly lose weight: undiscovered illness; loss of appetite due to medication; decaying teeth; poorly fitting dentures; memory lapses causing missed meals; depression; and poverty.

Another major cause is physical disability.The Family Haven Site discusses a survey finding 25 percent of elderly hospital patients malnourished, with the proportion rising to 40 percent in nursing homes.

The site interviewed Susan Schiffman, Ph.D., professor of medical pharmacology at Duke University Medical Center. According to Schiffman, many elderly people become emaciated because of a diminished sense of taste and smell. Her solution: add herbs and spices to their diets.