Food Safety Issues for Older Adults

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Food SafetyIssues for Older Adults
Pat Kendall, PhD, RD Professor and Extension
Specialist Food Science and Human
Nutrition Colorado State University
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Foodborne Illnesses

• More than 200 known diseases are transmitted
  through food.
• Causes include
• Bacteria
• Viruses
• Parasites
• Toxins
• Prions

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Foodborne Illness in U.S.

• 76 million cases/yr
• 62 M from unknown pathogens
• 325,000 hospitalizations
• 5,000 deaths
• Not all persons at equal risk of contracting a
  foodborne illness
• Estimates reported cases are much lower
• Mead et al., 1999

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Sensitive Populations in the U.S

• Population Individuals pop.
• Pregnancies 6.0 mil 2.1
• Neonates 4.0 mil 1.4
• Elderly (gt65) 35 mil 12.5
• Nursing Care Residents 1.6 mil 0.6
• Cancer patients (non-hosp.) 8.9 mil 3.2
• Organ transplant patients 110,270 0.04
• AIDS patients 223,000 0.08
• Total 55.8 mil 19.9
• Sources US Census Bureau, 2001, CDC, 1996,
  1997, 2001

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Factors Affecting Risk of Foodborne Illness

• Aging Population
• As of 2000
• 35 million in U.S. ?65 years (12.5 of pop.)
• 4 million in U.S. ?85 years (2 pop.)
• 5 of ?65 20 ?85 year-olds in nursing homes
• By 2030
• 70 million in U.S. ?65 years (20 pop.)
• By 2050
• 20 world population ?65 years

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Immune System and Aging Background
Ganong, 2001
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Changes in Immune Function with Aging

• Ability of immune system declines with age
• Gradual decline in T-cell function
• Fewer naïve and more memory T-cells, which
  reduces ability to mount immune response when new
  exposures to pathogens occur
• Gradual decline in B-cell function
• Decreased response by naïve B cells to newly
  introduced antigens
• Aging B cells may produce abnormal antibodies
• Sources Smith, 1997 Medeiros, 2004

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GI Tract and Aging

• Atrophy inflammation of gastric mucosa
  increases with aging
• Seen in 50 of those over age 50
• Decreased GI motility with aging
• Digestion rate slows, enables growth of pathogens
  
• Use of antacids
• May block gastric output and reduce ability to
  resist infection

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Food Safety Risk Factors Associated with Chronic
Diseases

• Diabetes
• Affects 18-20 of persons over age 65
• Higher risk of FBI if in poor control
• Cancer
• Chemotherapy may suppress immune system
• Immuno-suppressive drugs used with solid organ
  transplant patients
• Prolonged use of antibiotics

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Other Food Safety Risk FactorsAssociated with
Aging

• Sense of taste and smell declines
• Greater likelihood of dementia and malnutrition
• NAIDS (Nutritionally Acquired Immunodeficiency
  Syndrome)
• Lack of exercise
• Can adversely affect immune function
• Entry into nursing homes

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Food Preference Factors that Affecting Risk of
Foodborne Illness

• In General
• Eat out more often
• Purchase more convenience and take-out foods that
  require minimal cooking
• Prefer our foods rare or raw
• Less food safety education in home and school
• Among elderly
• 50 reported eating undercooked eggs
• Men and those living alone more like to
  practice unsafe food handling behaviors
  than women and couples

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Environmental Factors Affecting Risk of Foodborne
Illness

• Complexities of the Food System
• Industry consolidation and mass distribution
• Wide geographic distribution of foods
• Multiple uses of transport vehicles
• Changes in Travel and Commerce
• Increased international travel
• Increased diversity of foods in
• market place

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Environmental Factors Affecting Risk of Foodborne
Illness

• Economic Development and Land Use
• Food animals generate 1.6 billion tons of
  manure/yr
• Shift from cold season oyster harvest in Gulf of
  Mexico to year round harvest has resulted in
  increase in V. vulnificus
• Breakdown of Public Health Infrastructure
• Less than 2 of cases reported to health dept.

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Pathogen-based Factors Affecting Risk of
Foodborne Illness

• Changing micro-organisms
• More virulent strains
• E. coli O157H7, Salmonella Enteritidis
• Development of antimicrobial resistance
• Salmonella Typhimurium DT140
• Resistant to ampicillin, streptomycin,
  tetracycline
• Camplyobacter jejuni
• Resistant to fluroquinolones

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Pathogen Issues in Foods are Changing

• Newly recognized pathogens
• Pathogens have spread worldwide with transport of
  food
• Many pathogens have reservoirs in healthy food
  animals
• Associated with new food vehicles
• Tauxe EID 1997

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Pathogens in Foods Today

• Food usually looks, smells and tastes normal
• Traditional food preparation methods may not kill
  some emerging pathogens
• Undercooked eggs
• Rare ground beef

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Typical Symptoms of Foodborne Infection

• Gastrointestinal upset
• Vomiting
• Diarrhea
• Pain and cramps
• Fever, chills
• Headache, muscle pain

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Chronic Sequelae

• Chronic persisting for a long time
• Sequelae secondary to initial infection
• May be permanent and very severe
• May occur in 2 to 3 of foodborne disease cases
• Lindsay EID, 1997

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Examples of Chronic Sequelae

• Arthritis
• Autoimmune thyroid disease
• Inflammatory bowel disease
• Kidney failure
• Neuromuscular disorders
• Congenital impairments
• Encephalitis (inflammation of the brain)
• Meningitis (inflammation of the membranes
  covering the brain spinal cord)

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The ElderlyPathogens of Special Importance

• E. coli O157H7
• Salmonella species
• Listeria monocytogenes
• Vibrio species
• Yersinia
• Campylobacter jejuni
• Clostridium perfringens
• Staphylococcus aureus

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E. Coli O157H7 and Older Adults

• E. coli O157H7
• About 12 of cases occur in persons over 60 years
• Mortality rate of 12-35 in nursing home
  outbreaks
• Elderly at risk for two complications of E. coli
  infection
• Hemolytic uremic syndrome (HUS)
• Thrombotic thrombocytopenic purpura (TTP)

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Salmonella and Older Adults

• Salmonella outbreaks have been associated with
• Raw eggs
• Undercooked poultry and meat
• Raw milk
• Produce and unpasteurized juice
• Salmonella Enteritidis can be present both inside
  the egg and on the outside of shells
• Consumption of undercooked eggs most common risky
  food behavior among persons gt 60 years

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Salmonella and Older Adults

• Onset time can take up to 48 hours
• Salmonella symptoms are severe in the elderly
• Seniors may exhibit classic symptoms such as
  gastroenteritis, nausea, cramps, diarrhea
• Seniors more likely to have invasive
  salmonellosis with bacteremia, septicemia
• Septicemia associated with subsequent infection
  of organs
• Source FDA Bad Bug Book

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Salmonella and Older Adults

• Salmonella outbreaks in nursing homes have high
  potential for morbidity/mortality
• Groups of susceptible elderly individuals sharing
  meals
• Visitors and staff may carry pathogens from
  outside the homes
• Eggs are a major cause of Salmonella Enteritidis
  outbreaks
• Most nursing homes and hospitals serve only
  pasteurized eggs

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Other Pathogens of Special Importance among Older
Adults

• Listeria monocytogenes
• Immune compromised elderly at highest risk
• Hospitalization rate if gtage 60 96
• Vibrio species
• Highest rate in 65-74 year olds
• Sources Levine et al., 1991 Altekruse et al.,
  1999 FoodNet, 2001 Ailes et al., 2004

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Other Pathogens of Special Importance among Older
Adults

• Campylobacter jejuni
• Elderly not more susceptible to illness, but more
  at risk for complications subsequent death
• Clostridium perfringens Staph. aureus
• More common among nursing home residents than in
  general population

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Food Safety Recommendationsfor Seniors

• Practice proper hygiene
• Wash hands thoroughly with warm, soapy water
  before food preparation and consumption
• Cook foods thoroughly
• Cook meats, poultry, and fish thoroughly
• Cook eggs until both the yolk and white are firm
• Use a thermometer to make sure egg dishes are
  cooked to 160 degrees F
• Reheat lunch meats and hot dogs to steaming hot
  or 165 degrees F

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Food Safety Recommendationsfor Seniors

• Avoid cross-contamination
• Wash knives and food preparation surfaces with
  warm, soapy water after contact with raw poultry,
  meat, seafood
• Rinse fresh produce thoroughly before consuming
• Keep foods at safe temperatures
• Refrigerator temperature should be 35 to 40 F
• Freezer temperature should be 0 F or lower
• Keep hot foods hot
• Refrigerate perishable food within 2 hours or less

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Food Safety Recommendationsfor Seniors

• Avoid the following foods
• Raw fish, seafood, poultry
• Raw milk and raw milk cheeses
• Raw sprouts
• Unpasteurized juices, cheese, yogurt, milk
• Cold smoked fish
• Source www.fsis.usda.gov

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Recap

• Immunity and gastrointestinal function change
  with aging
• Older adults at greater risk of complications
  from certain foodborne illnesses
• Pathogens of particular importance include
• Listeria monocytogenes
• E. coli O157H7
• Salmonella spp.
• Vibrio

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Questions?