Food Safety and the Elderly: Special Concerns for Families and Institutions that Care for Older People

Food Safety and the Elderly: Special Concerns for Families and Institutions that Care for Older People

Families, and to an even greater extent institutions that specialize in elder care, face unique challenges when trying to protect older Americans from the dangers of food poisoning.  Older Americans are one of the sub-groups, along with the very young, pregnant women, and people with underlying health concerns, that are the most susceptible to serious injury after contracting food poisoning.  As with any illness, the elderly are less apt to be able to fight off, and in some cases survive, the onset of food poisoning.   According to Dr. Limin Wijaya, Senior Consultant at the Department of Infectious Diseases at Singapore General Hospital: “The weaker immune system of the elderly makes them more vulnerable to developing serious bacterial infections and complications.”   But a weakened immune system is only one part of why elderly persons are more likely to develop a serious injury or even death from food poisoning.  Other factors can also lead to complications, including (1) an acute or long-term condition or disorder, such as a neurological disorder, elevated blood pressure, or COPD; (2) harmful interactions with current medications or treatments; and (3) an older gastrointestinal tract.

Acute, Long-Term Conditions or Disorders

Acute, long-term conditions or disorders can cause what would otherwise be a mild or passing case of food poisoning a potentially deadly or otherwise serious illness requiring hospitalization.  For example, in one recent case study, a senior citizen in the earliest stages of Alzheimer’s was severely handicapped after contracting Listeriosis.  Given her predisposition, it caused the rapid onset of dementia.  In a similar vein, the onset of Shiga Toxin-Producing E. coli (STEC), while always serious, can cause even more severe illness in those with COPD or high blood pressure.  And for those victims of Salmonella, the post-infectious onset of irritable bowel syndrome or reactive arthritis can be long-lasting and debilitating. In addition, elderly Americans are much more likely to suffer from cancer, diabetes (which can greatly increase a person’s chances of acquiring hemolytic uremic syndrome after contracting STEC).

Harmful Interactions with Current Medications or Treatments

Elderly Americans are also more likely to be taking medications, such as antibiotics, blood pressure medications, or such things as corticosteroids, TNF inhibitors, or biologics like Enbrel to fight inflammation related to arthritis or bowel disease.  These medications are meant to suppress the immune system to fight the symptoms of inflammation.  Thee may also prove an advantage to dangerous viral and bacterial pathogens that seek to replicate in the body.

An Older Gastrointestinal Tract

As people age, like every other physical ability (sight, ability to run, or lift weights), age can have a dampening effect on the body’s performance.  The stomach and gastrointestinal tract, along with the liver and kidneys are all affected by age.  One notable change is often a reduction in the amount of acid in the stomach and an important first-line defense against harmful pathogens.   Another effect of aging is the slowing of the digestive tract or the gastrointestinal system.  Because food lingers in a slower digestive tract, bacteria can replicate and grow.  In addition, corollary systems like the kidneys and liver may fail to filter out or dispose of harmful substances like it did in previous decades.

Listeria, E. coli, Salmonella and Norovirus:  Which are Dangerous?

Notwithstanding that these complications can be triggered by many of the foodborne pathogens in circulation today, not all foodborne pathogens are created equal.  Among the more common bacterial sources of food poisoning, Listeria is seen by many as the most serious danger to elderly Americans, but E.coli and Salmonella are also of great concern.  According to the United States Center for Disease and Prevention,  an older immune system may be hampering the body’s ability to recognize harmful pathogens like Listeria, or to fight the replication of the bacteria, and as a result, over one-half of all confirmed Listeria cases are in people who are older than 64. This translates to a four-fold increase in Listeriosis among seniors, or about 900 of the average 1600 Listeriosis cases identified each year in the U.S.  Of these, almost all cases of Listeriosis in older Americans require hospitalization, and about 30% fail to survive.

As dangerous as Listeria is, in terms of the number of injuries caused by bacteria, STEC and Salmonella are far more common, with STEC sending three to four thousand victims to the hospital each year, and Salmonella sending well over 20,000 to the hospital.  The fatality rate, across the entire population, and not just among the elderly, is about the same between the two, with about one-half of one percent failing to survive. And in terms of viruses, the most common pathogen, Norovirus, sends approximately 56,000 to the hospital annually but has a 99.9 percent survival rate across all victims.  

Behavioral Considerations that Might Increase Likelihood of Food Poisoning

Finally, the elderly may be more prone to food poisoning given certain behaviors that may have been shaped by their history and cultural background.  Some elderly persons (1) have experiences like living through war, famine, of an economic collapse, or may find themselves living on social security/fixed income, and may be less inclined to throw away older food and more inclined to eat leftovers.  Leftovers are susceptible to contamination and bacterial growth; (2) many elderly persons also eat at home more often and are less inclined to eat fast foods when they do eat out.  Most studies show that a majority of food poisoning cases begin in the home or are linked to sit-down restaurants; and/or (3) many elderly persons tend to use more raw or natural ingredients in their meal preparation and cooking, raising the risk of acquiring foodborne illness.  While there may be significant criticisms of highly processed foods, they are less likely to contain a foodborne pathogen.