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Running Head: Food Safety For Older Adults
Running Head: Food Safety For Older Adults
Running Head: Food Safety For Older Adults
Foodborne illness rates are estimated to be one in four people in the United States
(Kendall, Hillers, and Medeiro, 2006). Typically, these illnesses last a few days of discomfort,
vomiting, and diarrhea, but for older adults it can easily put them in the hospital. Hospitalization
rates for foodborne illnesses are highest for adults over the age of 75, and this age demographic
is 33x more likely to die while hospitalized for gastroenteritis. It is estimated that by 2030 one in
five people will be over the age of 65 in the United States. With this growing population
demographic that is at a higher risk for hospitalization it is important for them to know the risks
Many factors impact these increased rates of illness among older adults including, aging
immune system, chronic disease, and risky food behaviors (Kendall, Hillers, and Medeiro, 2006).
Older adults may be handling food as they always have, but because of the changes in their body
they are putting themselves at higher risk for sickness or death. According to Kendall, Hillers,
and Medeiro (2006) older adults are less likely to perform hand hygiene and are more likely to
have problems with cross-contamination between raw foods. Since older adults are at such a high
risk for sickness that could be avoided through proper training the purpose of this wellness group
is to educate older adults to food safety practices that they can implement into everyday food
preparation.
Evidence
According to Oyarzabel and Backert (2012), there are limited widespread programs to
address food safety for any demographic. Most of the resources that have been implemented are
in textbooks, and are secondary to primary course content. That is to say that if the book is on
cooking there is a chapter on food safety, but it is not the entire focus of the course. Kamp,
Wellmen, and Russell (2010) overviewed all of the nutritional programs for community-residing
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older adults, and found that there is a significant lack in programs addressing food safety
specifically. Since food safety is secondary to program focus there isn’t a lot of evidence on the
Due to this lack of specific programs in order to develop this program it is important to
focus evidence that supports on who is at most risk, what should be the focus of course content,
and how should the information be presented. In a self-report study on the effectiveness of public
health efforts for safe food handling among older adults, Hanson and Benedict (2002) found that
programs that focus on instructing participants on how to handle food safely instead of the risks
were more effective at creating a change. Cues to action increased the likelihood of older adults
incorporating what they learned more than being scared into changing. Anderson, Verrill, and
Sahyoun (2011) found that as someone gets older they are more likely to follow safety
recommendations if they understand them clearly. Surprisingly, these researchers also found that
higher educated, higher SES, and men were at the most risk for not following food safety
standards. Kendall et al. (2006), also found that adults with cognitive decline were at higher risk
Cates et al. (2009) in their examination of food safety knowledge found that older adults
lacked education on proper food storage, using a meat thermometer, and checking the
temperature for the refrigerator. Dickinson, Wills, Meah, and Short (2014) and Evans and
Redmond (2016) also found strong evidence that older adults were most at risk for poor food
storage and food temperatures. In particular they found that ready to eat foods posed the most
risk because they are less likely to heated up to the proper temperature and are less likely to be
General Description
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Our wellness program will consist of four sessions that will be 30 to 40 minutes in length
and held once a week. The name of the program will be, “The Greatest Offense is a Great
Defense: A Food Safety Program”. The basis for the length of the sessions is to keep the focus,
interest and attention of our targeted population. With older adults, attention and interest could
be shortened, thus it is necessary to keep sessions short, concise and to the point. Holding the
class once a week gives ample time in between sessions for all participants to implement food
safety practices, develop any questions and schedule further participation in the program. Our
target population is community dwelling adults, so the delivery system of this program will be
community based, desired physical location would be a community senior citizen center.
The four sessions will be as follows: introduction, food storage and expirations, proper
food preparation and sanitation, and safe food temperatures. These sessions are pertinent to older
The first session, titled “Knowledge is Power”, will focus on what food safety is and the
objective of the program. This session will also explain why older adults need to be food safety
conscious, especially considering many older adults place “common-sense” knowledge on equal
Meah, & Short, 2014). A pre-test will be administered to get a baseline of food safety knowledge
and be administered at the end of the program to see if the program was effective in promoting
food safety. We will also be educating on Salmonella and Listeria and what foods are most
associated with them and signs and symptoms of infection. This will set a foundational
Food storage and expirations session, titled “You got to keep them separated”, will focus
on proper storage of different kinds of foods and how to determine if food is still safe for
consumption. It has been shown that majority of older adults are aware of the importance of
proper food storage and the utilization of expirations dates on packaged food, but majority of
older adults don’t know what the proper set temperature on a refrigerator should be and that food
is still good after the expiration date (Evans & Redmond, 2016).
The third session, titled “‘Clean’ eating”, focuses on proper food preparation and
sanitation to prevent contraction of foodborne pathogens. The session will include using separate
surfaces and tools for different meat, fruit and vegetable preparation. It will also focus on proper
The final session, titled “Let me take your temperature”, will educated older adults on
temperature guidelines for meat and other raw food ingredients. This session will give examples
of different food temperature gauges and the proper use of them. Although most older adults are
good at making sure meat is done, there are many who prefer undercooked foods or are unaware
of temperature recommendations (Kendall, Hillers, & Medeiro, 2006). Lastly, the post-test will
be administered to see if the participants scored better than their pretest. We will also be giving
The main reason why occupational therapy should be involved in food safety is because
meal preparation is a defined area of occupation; which is, “Planning, preparing, and serving
well-balanced, nutritious meals and cleaning up food and utensils after meals” (AOTA, 2014).
Meal preparation holds meaning to many adults, especially those who are older and want to
continue to live independently. But, to live independently as an older adult, safety should be a
top priority, even in meal preparation. Most incidents of food poisoning in older adults is due to
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either a gap in knowledge or the effects of cognitive decline (Kendall, Hillers, & Medeiro, 2006).
OTs are equipped to provide skilled therapy to remediate, promote or modify food safety skills in
the face of cognitive decline. Not only can OTs provide older adults with these skills through the
occupation of food prep, but generalize these skills to all areas of their occupations.
Theories/models
As part of this program we are utilizing two different models to address the needs of
group members. The first is the Person, Environment, Occupation (PEO) Model which focuses
on congruence and interaction between these three components (Law et al., 1996). We are
focusing on the person by educating the participants on proper food temperatures, hand hygiene,
cross-contamination, and proper food storage. The environment can also be a focus of
intervention because participants may need to change refrigerator temperatures or where they
The second model we are utilizing is the Health Belief Model, which focuses on people’s
perceived risk of an activity, and their perceived control over that risk (Rosenstock, 1974). First,
people need to understand that some behavior poses a risk to their health, and then they need to
understand that they have the ability to change that outcome through their effort. As part of our
program we are focusing on increasing the participant’s awareness of the risks involved when
not handling food safely, and help them know what steps they can take to avoid those risks.
Occupational Balance
offering the opportunity of older adults to participate in meal preparation of their choosing,
instead of having to rely on pre-packaged/pre-made food items due to lack of food safety
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preparation confidence or fear. This program gives older adults the ability to diversify their diets
OTPF/AOTA Position
According to the OTPF (AOTA, 2014) a health promotion program is designed to enrich
activities for a general population that will enhance their occupational performance. For older
adults being able to prepare their own meals safely can help enhance their ability to safely
participate in a meaningful daily activity and enhance the already existing skill of cooking by
It is important that occupational therapy practitioners promote a healthy lifestyle for all
individuals and their families, including people with physical, mental, or cognitive
to carry out health promotion interventions to prevent injury and maximize well-being
(AJOT, 2013).
Through a food safety program, occupational therapist can promote a healthy lifestyle by
lowering the incidence of foodborne illness in older adults through education through a primary
preventive program.
As stated above, a food safety program will give patients a peace of mind by knowing
that they carry less of a chance of foodborne infection when preparing meals through the skills
that they learn. The value of that peace of mind will encourage and promote older adults to
continue to cook homemade meals, thus preserving the occupation of meal preparation and
The payers and healthcare facilities would benefit greatly from this program because it
would lower the expenditure costs on older adults. As previously mentioned, older adults have
higher hospitalizations caused by foodborne illness due to lowered immune systems (Cates et al.,
2009). Therefore, a food safety program will lower insurance and facility cost by lowering the
Program goal: To empower older adults in the implementation of food safety skills into
Objectives: By the 4th session 80% of individuals will score 2 points higher on food
By the 4th session 70% of individuals will independently measure correct temperature of two
Session outline
The session outline for “You got to Keep Them Separated”: The first 15 minutes will be
instruction on following good food expiration practices. A handout will be given that lists basic
foods’ edible shelf life from each of the major food groups. Instruction will then be given on how
to find the “sell by” date on a variety of food packages. Different kinds of food packaging will be
brought in so that the participants can practice finding the date and a game on who can find the
date the fastest. Lastly, we will emphasize the importance of following the sell by date always in
determining food edibility and to not trust visual, gustatory, or olfactory senses since older adults
The next 10 minutes will be showing a slideshow of refrigerators full of food and their set
temperature. Instruction will be given on the proper temperature for the refrigerator and the
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freezer and proper storage of food in the refrigerator. Instruction will include storing high risk
foods on the top shelf of fridge. Next, having ready to eat foods, followed by fresh produce, and
finally raw meats. Also including proper storage containers such as tupperware or tightly sealed,
zipper plastic bags for any foods that do not have original containers they were bought it.
The last 20 minutes we will have a refrigerator organized with improper storage
techniques and the wrong temperature set. We will then have the participants work as a group to
identify the problem areas and reorganize the refrigerator following the above guidelines.
In order to measure this program’s effectiveness, we plan to use both quantitative and
qualitative post-assessments. The purpose of these questions are to explore how to present the
information in a way that is engaging to the members, and use the information to incorporate in
future classes to continually improve the delivery system. The quantitative information will be
gathered using likert scales to assess if the course adequately taught the content, and if the
information was easy to incorporate into daily food preparation. The qualitative information will
be gathered with free response questions addressing more of the teaching style of the group
Conclusion
There is a lack of programs to address food safety in community dwelling older adults.
We feel that this program could set a foundation to address that need, in order to decrease
hospitalization of older adults, and increase older adults’ competence in an important everyday
activity. By participating in this program, it will enable older adults to remain independent longer
References
Anderson, A. L., Verrill, L. A., & Sahyoun, N. R. (2011). Food Safety Perceptions and Practices
of Older Adults. Public Health Reports, 126(2), 220–227.
Cates, S. C., Kosa, K. M., Karns, S., Godwin, S. L., Speller-Henderson, L., Harrison, R., & Ann
Draughon, F. (2009). Food safety knowledge and practices among older adults:
identifying causes and solutions for risky behaviors. Journal of Nutrition for the Elderly,
28(2), 112-126.
Dickinson, A., Wills, W., Meah, A., & Short, F. (2014). Food safety and older people: the
Kitchen Life study. British Journal Of Community Nursing, 19(5), 226-232.
Evans, E. W., & Redmond, E. C. (2016). Older Adult Consumer Knowledge, Attitudes, and
Self-Reported Storage Practices of Ready-to-Eat Food Products and Risks Associated
with Listeriosis. Journal of Food Protection, 79(2), 263-272.
doi:10.4315/0362-028x.jfp-15-312
Hanson, J. A., & Benedict, J. A. (2002). Use of the Health Belief Model to examine older adults'
food-handling behaviors. Journal of Nutrition Education and Behavior, 34, S25-S30.
Kamp, B. J., Wellman, N. S., & Russell, C. (2010). Position of the American Dietetic
Association, American Society for Nutrition, and Society for Nutrition Education: food
and nutrition programs for community-residing older adults. Journal of nutrition
education and behavior, 42(2), 72-82.
Kendall, P. A., Hillers, V. V., Medeiro, L. C., (2006). Food safety guidance for older adults. Clin
Infect Dis, 42(9): 1298-1304. doi: 10.1086/503262
Kennedy, J., Jackson, V., Blair, I. S., McDowell, D. A., Cowan, C., & Bolton, D. J. (2005). Food
safety knowledge of consumers and the microbiological and temperature status of their
refrigerators. Journal of food protection, 68(7), 1421-1430.
Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The
Person-Environment-Occupation Model: a transactive approach to occupational
performance. Canadian Journal of Occupational Therapy, 63, 9-23.
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Lobb, A. E., Mazzocchi, M., & Traill, W. B. (2007). Modelling risk perception and trust in food
safety information within the theory of planned behaviour. Food Quality and Preference,
18(2), 384-395.
Occupational Therapy in the Promotion of Health and Well-Being. (2013). American Journal of
Occupational Therapy, 67(6_Supplement). doi:10.5014/ajot.2013.67s47
Oyarzabal, O. A., & Backert, S. (2012). Food Safety Resources. In Microbial Food Safety (pp.
235-239). Springer New York.
Rosenstock, I. (1974). Historical origins of the health belief model. In M. Becker (Ed.), The
Health Belief Model and personal behavior. Thorofare, NJ: SLACK.
Wilcock, A., Pun, M., Khanona, J., & Aung, M. (2004). Consumer attitudes, knowledge and
behaviour: a review of food safety issues. Trends in Food Science & Technology, 15(2),
56-66.
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Appendix A
How likely are you to use this information in your daily food preparation:
This program has changed the way I previously stored, handled, and prepared my food:
What part of the class did you feel was most effective?
How did the teaching style match/not match with your learning style?