Preventing Foodborne Illness in the Elderly: A Guide for Caregivers

With foodborne illness in the news and on the rise, caregivers for older adults and other at-risk populations need to remain vigilant. Foodborne illness is largely preventable, but it still causes an estimated 48 million illnesses and 3,000 deaths each year in the United States. For older adults, an infection that might cause a few miserable days for a younger person can lead to serious complications or hospitalization.

For family caregivers, preventing food poisoning means paying close attention not only to how food is prepared, but also to what foods a loved one eats, how groceries and leftovers are stored, and whether recalled or expired foods remain in the home. It also helps to recognize the symptoms of foodborne illness and know when an older adult needs medical attention.

In this article, we explain:

• The risks of food poisoning in the elderly
• Why the elderly are more at risk from foodborne illness
• The symptoms of food poisoning in older adults
• Causes of foodborne illness
• How home care providers can help prevent food bourne illness
• Treatment for foodborne illness and when to see a doctor

Elder adults are at higher risk for food poisoning

Infections from contaminated food are more prevalent in the elderly population. For example, adults 65 years and older are four times more likely to get Listeria infections,  the third leading cause of death from food poisoning in the United States. According to the Food and Drug Administration, “approximately 1,600 people get sick from Listeria each year, and about 260 die. Older adults are at particular risk — more than half of all Listeria infections occur in people 65 and older.”

The Centers for Disease Control note that, “older adults have a higher risk of getting sick from food poisoning and having a more serious illness.” In fact, “nearly half of people aged 65 and older who have a lab-confirmed foodborne illness from Salmonella, Campylobacter, Listeria or E. coli are hospitalized.”

Why are older adults more at risk of serious illness from contaminated food?

People over 65 have a higher risk of contracting a food borne illness and of having more serious effects from the illness. According to the Centers for Disease Control, nearly half of people aged 65 and older who have a lab-confirmed foodborne illness from Salmonella, Campylobacter, Listeria or E. coli are hospitalized.

In part this is because as we age, the body’s immune response to disease grows weaker. As foodsafety.gov explains, the digestive tract holds onto food for a longer period of time, allowing bacteria to grow. Other organs also become less effective with advanced age. The liver and kidneys may lose their ability to completely expel bacteria and toxins. The stomach may not produce enough acid which  would help to reduce the number of bacteria.   Besides the natural effects of aging, underlying chronic conditions, such as diabetes and cancer, may also increase a person’s risk of foodborne illness.

What are the symptoms of food poisoning in older adults?

Symptoms vary depending on the germ or toxin involved, but common signs of foodborne illness include diarrhea, stomach pain or cramping, nausea, vomiting, and fever. Symptoms may begin within hours of eating contaminated food, although some infections do not cause symptoms until days or even weeks later.

Caregivers should pay particular attention to dehydration. Vomiting and diarrhea can cause an older adult to lose fluids and electrolytes quickly. Warning signs may include a dry mouth, intense thirst, reduced urination, dark-colored urine, weakness, dizziness, or lightheadedness. Older adults can become dehydrated more easily, and serious dehydration may require medical treatment.

Some foodborne infections can cause more severe symptoms, including bloody diarrhea, a high fever, frequent vomiting that makes it difficult to keep liquids down, confusion, severe weakness, or neurologic symptoms. Because adults over 65 have a higher risk of complications, caregivers should have a lower threshold for contacting a healthcare provider when symptoms are severe, persistent, or accompanied by signs of dehydration.

What causes foodborne illness?

Food poisoning occurs when someone eats or drinks something contaminated with disease-causing germs or toxins. Bacteria such as Salmonella, Campylobacter, E. coli, and Listeria are common causes, but viruses and parasites like Cyclospora can also contaminate food.

Contamination can happen at many points between food production and the dinner table. Food may already contain germs when it is purchased, or it may become contaminated at home through unwashed hands, dirty surfaces, contact between raw and ready-to-eat foods, inadequate cooking, or improper refrigeration. Leaving perishable food at room temperature for too long can allow bacteria to multiply rapidly.

How can caregivers help prevent foodborne illness? 

For an older adult who needs help shopping, cooking, remembering when leftovers were prepared, or keeping the refrigerator organized, a caregiver can play an important role in food safety. Regularly checking expiration dates, discarding questionable foods, monitoring refrigerator temperatures, preparing meals safely, and watching for food recalls can reduce risks that may otherwise be easy to overlook.

Four Steps to Preventing Foodborne Illness

The USDA recommends four basic food-safety practices: Clean, Separate, Cook, and Chill.

Clean: Wash hands and surfaces often. Wash hands with soap and water before preparing or eating food and after handling raw meat, poultry, seafood, or eggs. Clean counters, cutting boards, dishes, and utensils after use.

Separate: Prevent cross-contamination. Keep raw meat, poultry, seafood, and eggs away from foods that will be eaten without additional cooking. Use separate plates or cutting boards when possible, and never put cooked food back onto an unwashed plate that held raw food.

Cook: Cook foods to safe internal temperatures. A food thermometer is the most reliable way to determine whether meat, poultry, seafood, and other foods have reached a safe temperature. Follow current USDA guidance for the specific food you are preparing rather than relying on appearance alone.

Chill: Refrigerate promptly. Refrigerate perishable foods and leftovers within two hours, or sooner when food is exposed to high temperatures. Keep the refrigerator at 40°F or below and the freezer at 0°F or below.

Avoiding Riskier and Recalled Foods

Some foods are more likely than others to carry germs that cause food poisoning. The CDC cautions that because the consequences can be more serious for adults over 65, caregivers should help their loved ones avoid or take extra precautions with higher-risk foods, including:

• Raw or undercooked poultry, meat, seafood, or eggs
• Raw or undercooked sprouts
• Unwashed fruits and vegetables
• Cut melon
• Unpasteurized milk, juice, cider, or soft cheese
• Raw dough or raw batter made with uncooked flour

 Safer alternatives include thoroughly cooked foods, pasteurized dairy products and juices, and produce that has been properly washed and stored.

Caregivers should also pay attention to food recalls. If a food in the home has been recalled, do not taste it to determine whether it is safe. Follow the recall instructions for returning or discarding it, and clean surfaces or refrigerator areas that may have come into contact with the recalled product.

Safe Food Handling: Cooking & Storing Food Safely

Good day-to-day kitchen habits can significantly reduce the risk of food poisoning. The National institute of Health’s food safety guidelines recommend the following precautions:

• Wash hands before preparing food and after touching raw meat, poultry, seafood, or eggs.
• Wash dishes, cutting boards, utensils, and counters that have contacted raw animal products before using them for other foods.
• Use a food thermometer and follow USDA safe-temperature guidance for the particular protein you are cooking — Cook beef to at least 160°F (71°C), poultry to at least 165°F (73.8°C), and fish to at least 145°F (62.7°C)
• Keep raw and cooked foods separate.
• Refrigerate perishable foods and leftovers promptly and keep the refrigerator at 40°F or below.
• Follow package instructions when cooking frozen foods.
• Discard foods that are expired, spoiled, improperly stored, or in damaged packaging. Bulging or leaking cans should not be used.
• When in doubt about whether a food has been stored safely, throw it out rather than tasting it.

Treating Food Born Illness

Homecare

Many cases of food poisoning improve with rest and adequate fluids, but older adults require closer monitoring because dehydration and other complications can develop more quickly. Encourage small, frequent amounts of water or other appropriate fluids if the person can drink safely. A healthcare provider may recommend an oral rehydration solution to replace both fluid and electrolytes.

Do not automatically use anti-diarrheal medicines or other over-the-counter treatments without checking with a healthcare professional. Depending on the cause and severity of the illness, slowing diarrhea may not be appropriate. A clinician can also determine whether prescription treatment is necessary.

When Should a Caregiver Contact a Doctor?

Because adults age 65 and older are considered a higher-risk group, caregivers should contact a healthcare provider promptly when an older adult develops significant symptoms of food poisoning or when there is any concern about dehydration or worsening illness. Seek medical advice especially for:

• bloody diarrhea
• diarrhea lasting more than three days
• fever over 102°F
• repeated vomiting that prevents liquids from staying down
• signs of dehydration such as very little urination, dry mouth, or dizziness when standing

Urgent or emergency care may be needed for severe dehydration, fainting, confusion, difficulty breathing, severe weakness, seizures, or other rapidly worsening symptoms. If you know or suspect that the person ate a recalled food associated with a serious outbreak, tell the healthcare provider what was eaten and when, even if symptoms initially seem mild.

Professional treatment

When your loved one does see a doctor or clinician, there are several possible treatments they might undergo:

• Fluid replacement: Fluids and electrolytes keep the balance of fluids in the body. Electrolytes include minerals such as sodium, potassium and calcium. After vomiting or having loose stools, replace fluids to prevent dehydration. Serious dehydration may result in a hospital stay to get fluids and electrolytes through a vein, called IV fluids.
• Antibiotics: A healthcare professional may prescribe an antibiotic for illness caused by bacteria. Antibiotics are mainly for people with serious illness or with a higher risk of complications.
• Antiparasitics: For parasitic infections like those caused by Cyclospora, healthcare professionals most often prescribe medicines that target parasites. These medicines are called antiparasitics.
• Probiotics:  A healthcare professional may suggest probiotics. These are treatments that replace healthy bacteria in the belly.

Helping an Older Loved One Stay Safe

Food safety can become one more responsibility on a caregiver’s already long list, but a few consistent habits can make a meaningful difference. Keeping the refrigerator organized, dating leftovers, checking recalls, separating raw foods, cooking foods thoroughly, and discarding questionable items can all help protect an older loved one from preventable illness.

Caregivers also know their loved ones best. If an older adult seems unusually weak, confused, dehydrated, or simply much sicker than expected after a possible foodborne illness, it is worth seeking medical guidance rather than waiting for symptoms to become severe.

Caring for an older loved one at home can require a mix of compassion and medical care. Get the training, support and medical expertise you need through Mass Care Link.