SEFARI fellowship: the older population and foodborne illness

The Food Standards Scotland strategy (2021-2026) sets out a vision to create a safe, healthy and sustainable food environment that benefits and protects the health and well-being of everyone in Scotland (Food Standards Scotland, 2021). A key objective for delivering this vision and which is set out in the Food (Scotland) 2015 Act is to protect the public from risks to health which may arise in connection with the consumption of food.

Dissemination of food safety advice to consumers to reduce foodborne illness in Scotland is a key priority for Food Standards Scotland. However, the level of risk from foodborne illness is not equal across consumers, with vulnerable groups within society being more susceptible to or at greater risk of severity from acquiring food poisoning.

A recent comprehensive review undertaken on behalf of Food Standards Scotland consolidated available evidence (Evans & Ilic, 2024). The report summarised that people aged ≥65 years make up 20% of the population of Scotland (Scotland's Census, 2023), however 68% of listeriosis, 23% of campylobacteriosis and 60% of norovirus infections are among the age group. Although the report provides comprehensive information detailing why the age group are particularly susceptible to illness from foodborne illness (e.g. senescence, comorbidity and polypharmacy), completion of the study suggested the need to explore the perceptions and practices of this clinically vulnerable group along with their preferences for future food safety communication approaches (Evans & Ilic, 2024). 

Therefore, the aim of this SEFARI fellowship with Food Standards Scotland is to determine the lifestyle factors which cause members of the older population to become ill with foodborne illness. The outputs of this independent, external review will provide the evidence needed to allow Food Standards Scotland to identify any areas of change in relation to current consumer advice. Ultimately, this will inform the updating of consumer advice and communications approach to target the clinically vulnerable consumer group within the Scottish population with relevant food safety advice routinely but also in response to foodborne incidents (SEFARI, 2023).

My background as a Reader of Food Safety Behaviour at Cardiff Metropolitan University has nurtured a fascination with the intricate interplay between individuals and their relationship with food. Specifically, I am captivated by how knowledge, perceptions, and life circumstances shape behaviour and subsequently impact food safety. This intrigue extends across various contexts, from food handlers in the industry to consumers in domestic environments. However, it is the prevention of foodborne illnesses among clinically vulnerable groups, particularly older adults, that deeply resonates with me, which is why I was excited by this Fellowship opportunity.

I have a substantial portfolio of research experience and an extensive body of publications concerning the food safety behaviours of older adults and vulnerable populations. I have significant scientific expertise relating to key food safety risks specifically associated with older adults. Moreover, I have experience of engaging with older adult and relevant stakeholders for data collection purposes. As an experienced academic, I have experience of using desk-based methodologies to undertake evidence and literature reviews, I can capture, analyse, and report on new and existing data to explore this area further. I regularly prepare reports, research publications, and communicate with non-technical audiences.

Due to the shift in incidence of listeriosis from pregnant women (1980s – 1990s) (Tappero et al., 1995) to older adults (2000 onwards)(ACMSF, 2008; EFSA Panel on Biological Hazards, 2007; Public Health Laboratory Service, 2015), my PhD explored older adult (individuals aged ≥60 years) domestic food handling and storage practices associated with the risk of listeriosis (Evans, 2015). As part of the PhD, I undertook a desk-based review of consumer food safety research studies (n=165), which identified that the majority of studies reported knowledge and self-reported practices, and that data detailing older adult behaviours and attitudes were particularly lacking (Evans & Redmond, 2014). Consequently, I undertook extensive research with adults over the age of 60, including;

• interviews regarding attitudes towards domestic food safety practices (Evans & Redmond, 2019c),
• questionnaires concerning food safety knowledge and self-reported practices (Evans & Redmond, 2016a),
• domestic kitchen food preparation sessions to observe food safety behaviours (Evans & Redmond, 2018a),
• observation of storage practices in consumer domestic refrigerators (Evans & Redmond, 2015),
• microbiological survey of domestic kitchens (Evans & Redmond, 2019a),
• time-temperature profiling of domestic refrigerators (Evans & Redmond, 2016b). 

A comparison of the results from these studies revealed that while older adults were knowledgeable of some food safety practices, disparities were identified between self-reported and observed behaviours, and many failed to express positive attitudes towards essential food safety practices (Evans, 2016a, 2016b). Although my research established that the identified malpractices significantly increased the growth rate of Listeria monocytogenes (Evans & Redmond, 2019b), the research does not tell us why these behaviours exist, which is why I felt compelled to undertake this Fellowship.

In addition to the described research with older adult consumers, I have recently undertaken a comprehensive review of the “clinically vulnerable groups” susceptible to foodborne illness on behalf of Food Standards Scotland (Evans & Ilic, 2024), which involved:

• consolidating Scottish prevalence data to determine who are the clinically vulnerable groups in Scotland, with regards to Campylobacter, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Listeria monocytogenes and norovirus.
• collating additional evidence from comparable developed countries to undertake a systematic review of foodborne illness prevalence among clinically vulnerable groups.
• undertaking a narrative review to obtain an in-depth understanding of the physiological background to susceptibility among clinically vulnerable groups.
• identifying the current definitions of clinically vulnerable groups used by other food safety organisations to establish the groups most referred to as being clinically vulnerable.

Several of the findings from the comprehensive review report for Food Standards Scotland are also of benefit to this report and are referred to as necessary.