By Nuno F. Soares, Ph.D. and Julio Guimaraes
The population of aging adults is increasing in the United States and worldwide. In 2000, there was an estimated population of 35 million seniors in the United States. By 2030, it is estimated that 71 million Americans and more than 1 billion individuals worldwide will be older than 65 years of age.
According to United States Department of Agriculture (USDA), foodborne illness represents a greater risk for the elderly for different reasons. As we age, our bodies are less able to resist bacteria, including bacterium which cause food poisoning. Many elderly adults live with chronic conditions such as diabetes and cancer, and they often consume medicine and/or are administered chemotherapy treatments that are known to weaken the immune system. Also, stomach acid production decreases as people age, thereby reducing their natural defense against ingested bacteria. The sense of taste, vision, and smell, affected by medication or illness, may not detect when food is spoiled or contaminated (e.g., discolored, moldy, or with uncharacteristic odors).
The U.S. Centers for Disease Control and Prevention (CDC) estimates that each year nine microbial pathogens cause 3.5 million foodborne illness and more than 1,200 deaths. Of the nine pathogens, Salmonella has the highest rate of infection for adults age 60 and older; Listeria is the most virulent pathogen, with the highest number of deaths among the same age group. According to European Centre for Disease (ECDC), there were more than 2,500 confirmed cases of Listeria (and 220 deaths) reported in 2017. The ECDC adds that it’s important to raise awareness among the elderly of risky food and listeriosis (the infection caused by the Listeria bacterium). Thermal treatment, when efficiently applied, has sufficient penetration to destroy Listeria. However, when such treatments are not practical on certain products, such as ready-to-eat, fresh fruit, vegetables, or salads, the industry must emphasize hazard prevention.
What can we do?
First you must know your clients/consumers. Who is your target market? Are your products consumed mainly by the elderly?
If you look to food safety systems and HACCP, it is common to see a reference to the target consumer or intended customer. HACCP has always been based on a preventive approach and that means that we must ensure that our food safety systems are adequate not only to the requirements of our product or facilities but also for the clients/consumers we serve.
This means that when defining control measures and even conformance criteria we must take in consideration not only our organization’s position in the food value chain but also how consumers are susceptible to some specific hazards. And of course, as explained above, age is one risk factor that must be taken in consideration.
Considering the pathogen Listeria, for example, control recommendations may go beyond that which government agencies require. Therefore, professionals are encouraged to develop a risk-based environmental monitoring program (EMP), an efficient and detailed sanitation program, and appropriate good manufacturing practices. The EMP is better designed when the monitoring area is mapped according to the traffic patterns of people, equipment, forklifts, and waste, with the understanding that Listeria can travel and spread itself throughout a facility. Then define the swabbing sites by selecting hard-to-reach places such as connections, welded or bolted joints, uneven surfaces, and rarely cleaned areas. For the sanitation program, the recommendation is to change the chemical agents while alternating the pH of detergents used to clean drains and floors in order to create a more hostile environment for Listeria. The most important point is to remember that the objective of an EMP is not to prove the organism is absent, rather, it is a tool to detect the Listeria before it becomes a food safety risk.
When you define your EMP and sanitation program, don’t hesitate to customize it to the product or process. If you have defined to conduct a swab once a day, don’t do it only when it’s convenient for the person who is doing it but do it when it matters (frequency and efficacy).
An example from the United States
In the United States, two government agencies regulate the safety of food production: the United States Department of Agriculture (USDA) and the Food and Drug Administration (FDA). Meat and poultry products are under USDA regulations and all other food production come under FDA inspections. USDA states that food establishments producing ready-to-eat (RTE) products that are exposed to the post-lethality environment must implement steps to control and prevent Listeria contamination. Under the USDA’s Listeria Rule, food producers must apply one or a combination of the three alternatives as follows:
Post-lethality treatment (PLT): A lethality treatment that is applied or is effective after post-lethality exposure; it is applied to the final product or sealed package of product in order to reduce or eliminate the level of pathogens resulting from contamination from post-lethality exposure
Anti-microbiological agent or process (AMAP): A substance/process in or added/applied to an RTE product that has the effect of reducing or eliminating/ suppressing or limiting a/the growth of a microorganism, including a pathogen such as Listeria monocytogenes, in the product throughout the shelf life of the product
According to the alternative chosen by the establishment, the minimum sampling frequencies for testing must be applied as per the following table:
* It is recommended that 3-5 samples per production line are withdrawn
** Establishments producing deli or hot dogs have specific recommendations for
sampling according to production volume
The FDA has not issued specific and mandatory regulation but has issued guidance which provides recommendations. A suggestion for food safety professionals is to design the EMP to consider the specific product, process, and environment conditions of your company and the condition of consumers, particularly in cases
where their immune system may be debilitated as is commonly the case with the elderly. If it is necessary to be more critical than regulation suggests or requires, then increase the number of sampling for testing. The frequency of sampling collected for food contact surfaces is typically designed to be weekly.
As we become elderly, our organs and immune system generally weaken. Thus, the likelihood of contracting a foodborne illness increases. For this reason, elderly people should be especially vigilant with the food they eat and avoid high-risk products (e.g., undercooked meat and poultry, unpasteurized milk, unwashed fresh salads, etc.).
As food safety professionals, we also have a role in preventing this problem. A food safety culture should be cultivated that understands the necessary actions to protect consumers, especially when the finished product is intended to be consumed by a high-risk senior population.
To prevent the occurrence of foodborne illness, a well-designed food safety plan is crucial. The efforts by food safety professionals to reduce the risks of any type of microbiological contamination are not limited to defining what procedures should be in place. It is also necessary to engage top management in supporting and leading the proper food safety practices as well as developing strategic mutual goals and partnerships with ingredient and packaging suppliers, customers, and agencies to ensure food safety at all levels.
To prevent and decrease the number of foodborne illness cases in elderly people worldwide, it is necessary to establish an institutional culture wherein employees, suppliers, and top management—everyone in the organization involved in the food production process—understand why food safety procedures and measures are established, and how efforts may be aligned to produce safe products.
About the authors
Nuno F. Soares, Ph.D. is the founder of The Why of Food Safety – Become the SLO initiative and author of several books and articles on food safety, namely FSSC 22000 V5 and ISO 22000:2018 BluePrint and Food Safety in the Seafood Industry (Wiley). He is an author, consultant, and trainer in food safety with over 20 years background in food industry as food safety/quality and plant manager. You can reach him at www.nunofsoares.com.
Julio Guimaraes has more than 20 years of experience in the Food and Beverage industry working in Brazil and in the US. He has led several leadership roles, developing and implementing programs across quality, food safety, and supply chain systems.