Older adults–along with pregnant women, young children and immune-compromised individuals–face a higher risk of severe illness from foodborne pathogens than the rest of the population. However, a new study suggests that the elderly and their caregivers may not be getting the food safety education they need to implement safe cooking and eating practices. Researchers at RTI International and Tennessee State University conducted focus groups with 55 people who work with older adults, including doctors, nurses, home healthcare providers and relative caregivers, and found that most participants lacked training and knowledge regarding safe food practices for the elderly. High Risk for Older Adults Foodborne disease can be especially dangerous for older adults. Studies have shown that adults aged 60 or above are more likely to experience complications, hospitalization and death as a result of foodborne illness infections. Three bacteria to which older adults are particularly susceptible are Listeria, Campylobacter and Salmonella. A review of government data on Campylobacter illnesses between 1996 and 1999 showed that while adults aged 60 and older were least likely to contract infections from this bacterium, people in this age group were 3.5 times more likely to be hospitalized as a result of Campylobacter infections. A review of data on Salmonella illnesses during the same time period found that 47 percent of infected individuals aged 60 or over were hospitalized, compared with an overall hospitalization rate of 22 percent. The 2008-2009 Salmonella outbreak linked to contaminated peanut butter that sickened over 700 people claimed the lives of 9 people, all of whom were aged 59 or older. The median age of the 30 people who died in last year’s Listeria outbreak linked to cantaloupes – the deadliest in the U.S. in the last 100 years – was 82.5 years old, according to the final report from the Centers for Disease Control and Prevention (CDC). Since that report was released, three more outbreak victims have died from complications of their infection. The first was a 92-year-old man, the second a 62-year-old woman and the third a 75-year-old man. Training in Food Safety for Older Adults The results of the RTI/TSU study, published last week in Educational Gerontology, suggest that some healthcare providers may not be equipped to educate older adults about how to avoid foodborne illness. While physicians and physicians’ assistants had received training in diagnosis and treatment of foodborne illness, they were not trained in preventative measures for older adults, the study found. Registered nurses and nurse practitioners received no foodborne illness training. Some home health providers had received formal instruction in safe cooking and food preparation, while others had not. Food Safety Knowledge Many of these healthcare professionals had limited knowledge about food safety recommendations for older adults. When asked what foods elderly people should avoid, all participants mentioned undercooked meats and fish and many named undercooked shellfish. Most respondents were not aware of measures to prevent Listeria infection among older adults, such as only eating deli meats that have been reheated to steaming hot and avoiding deli salads. Overall, physicians, physicians’ assistants and nurses were more informed about food safety recommendations for pregnant women and chemotherapy patients than for older adults. Interestingly, these groups thought that low-income individuals are at an increased risk for foodborne illness because they have older appliances, buy marked down foods that may be close to expiration and use poor food safety practices. In reality, however, higher income individuals are thought to practice riskier methods of food preparation. Those providing care to an elderly relative were the most likely to answer food safety questions correctly. While all groups were knowledgeable about safe food preparation techniques, only relative caregivers knew how to store food correctly, i.e. in air-tight, shallow containers (to allow for rapid cooling) at proper temperatures. Among the two groups who provide in-home care–professionals and relatives–both named E. coli, Salmonella and Staphyloccocus as pathogens that can cause foodborne illness in older adults. Only the relative caregivers, however, named Listeria infection, Campylobacter infection and botulism as other foodborne illnesses that affect the elderly. Education for Elder Adults Most physicians, physicians’ assistants and nurses said they do not provide food safety education to older adults because there is not enough time to share this information during appointments. However, both groups said they would be willing to provide educational brochures or post food safety information on office bulletin boards if these materials were provided. And previous studies have shown that elderly people look to healthcare professionals as reliable and desired sources of information on food safety. “Focus groups identified a gap between older adults’ trust in healthcare providers as a credible source of food safety information and healthcare providers’ lack of training, knowledge, and willingness to provide food safety information to older adults,” says the study. “What came out of this is just that there’s real a need to integrate food safety information into preventative health for older adults,” said Kelly Wohlegenant, lead researcher, a policy analyst at RTI and the study’s lead author in an interview with Food Safety News. “So now it’s just thinking of ways to do that.” The authors provide a list of the leading food safety recommendations for older adults, along with the pathogens each measure helps guard against. These include: – Avoid eating raw or undercooked seafood (Vibrio species and Noroviruses) – Avoid eating raw sprouts (E. coli O157:H7) – Avoid eating soft cheeses, cold smoked fish, and cold deli salads (Listeria monocytogenes) – Avoid eating hot dogs and deli meats that have not been reheated to steaming hot or 165 degrees F (Listeria monocytogenes) – Use cheese and yogurt made from pasteurized milk (Salmonella species and Listeria monocytogenes) – Avoid eating foods containing raw eggs and cook eggs until firm (Salmonella Enteritidis) – Drink only pasteurized milk and juices (E. coli O157:H7 and other pathogens) Getting the Word Out Food safety materials for older adults are already being developed at Tennessee State, says Wohlegenant. RTI is currently evaluating and revising these educational tools to make them as effective as possible, says Wohlegenant. Care providers who participated in the study indicated that they would like to receive information about food safety for older adults online via news sources, medical websites, government sites or phone applications, but that they would also like to have brochures or pamphlets available to share with older adults for whom they are caring. Wohlegenant says it’s important to note that because only a small number of people were interviewed for this study and participants were not selected randomly, these results cannot necessarily be used to make generalizations about all people who care for older adults. The RTI International/Tennessee University study was conducted with physicians, physician’s assistants, registered nurses, nurse practitioners, home healthcare professionals and relative caregivers from the Midwest and East Coast in focus groups conducted telephonically. The research was funded through a grant from the National Integrated Food Safety Initiative of the U.S. Department of Agriculture’s Cooperative State Research, Education and Extension Service. The full study is available for purchase here.