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. Age is one risk factor that must be taken in consideration.
The aging adult population is increasing in the United States and worldwide. In 2000, there was an estimated population of 35 million seniors in the U.S. By 2030, it is estimated that 71 million Americans and more than 1 billion individuals worldwide who 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 consume medicine and are administered chemotherapy which 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 Center for Disease Control (CDC) in the United States estimates that each year nine microbial pathogens cause 3.5 million foodborne illness and over 1,200 deaths. Of the nine pathogens, Salmonella has the highest rate of infection for adults age 60 and older; Listeria is the pathogen most severe with the highest number of deaths among the same age group. According to European Centre for Disease (ECDC), more than 2,500 confirmed cases of Listeria and 220 deaths were reported in 2017. Raising awareness amongst of listeriosis and risky food among the elderly where the majority of cases occur is important, added the agency. Thermal treatment when efficiently applied has sufficient penetration to destroy Listeria but 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 target consumer or intended customer. HACCP has always been based on a preventive approach and that means that we must adequate our food safety systems not only to our product or facilities but also to 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 to target, control recommendations may go further than what 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).
In the U.S., two government agencies regulate the safety of food production: USDA and 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 3 alternatives as follows:
PLT – Post-lethality Treatment – 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
AMAP – Anti-microbiological Agent or Process – 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 hotdogs 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 which considers 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 commonly is the case of the elderly. If it is necessary to be more critical than regulation suggests or requires, then increase the number of samplings 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 the senior population which is considered high risk population.
In order to prevent foodborne illness from occurring, 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 define what procedures should be in place but also to engage top management to support and lead food safety practices; as well as to develop strategic mutual goals and partnerships with ingredient and packaging suppliers, customers and agencies to ensure food safety at all levels.
An institutional culture wherein employees, suppliers, top management and anyone involved in the process understand why food safety procedures and measures are established, and all efforts are aligned to produce safe products is more than necessary to prevent and decrease the number of foodborne illness cases of elderly people reported worldwide.
Buzby, Jean. (2002). Older adults at risk of complications from microbial foodborne illness. Food Review. 25. Accessed 4 February 2020.
Kendall PA, Hillers VV, Medeiros LC. Food safety guidance for older adults. Available at hppt://ncbi.nlm.nih.gov/pubmed/16586390. Accessed 3 February 2020.
USDA (2001). Food safety for older adults. Available at https://www.fda.gov/food/people-risk-foodborne-illness/food-safety-older-adults. Accessed 3 February 2020.
FSIS Compliance Guideline (2014). Controlling Listeria monocytogenes in Post-lethality Exposed Ready-to-Eat Meat and Poultry Products
European Centre for Disease Prevention and Control. Listeriosis. In: ECDC. Annual epidemiological report for 2017. Stockholm: ECDC; 2020.
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This article was written with Júlio Guimarães – Food Safety Specialist.
Special thanks to Jocelyn Lee Lion for contributing and editing this article.
Disclaimer: The information contained on this article is based on research done in the last months and the authors personal experience and opinion. It is not intended to represent the view of any organization they work for or collaborate with. The authors will not be held liable for the use or misuse of the information provided in the article.