SEFARI fellowship: the older population and foodborne illness

The findings from this study highlight the complex interplay of physical, biological, social, psychological, and economic factors that shape food-related behaviours, particularly among older adults.

• Physical Environment: The physical environment, particularly food deserts, impacts access to healthy food, and the context of food safety hasn't been explored much. For individuals relying on weekly shopping or online grocery deliveries, improper storage, refrigeration, and thawing of food in domestic kitchens can pose safety risks.
• Biological Factors: Biological factors, like age and health conditions, affect food safety behaviours. Older adults, especially those with reduced mobility or vision impairment, may struggle with buying, transporting, and preparing food. Family caregivers face challenges ensuring food safety, as reduced appetites and improper use of food storage or cooking instructions are common among older adults.
• Social Environment: The social environment greatly influences food-related behaviours, especially for older adults. Social isolation, like living alone, may reduce motivation to prepare fresh meals, increasing reliance on ready meals and frozen foods, which can lead to unsafe food practices. Social interactions and cooking for others can encourage safer food handling practices. Understanding these dynamics is essential for developing targeted food safety messaging for older adults.
• Psychological Factors: Psychological issues like low motivation, cognitive decline, and dementia increase the risk of unsafe food practices. Older adults with cognitive impairments may forget meals or mishandle food storage. Caregiver support and clear food safety reminders are essential to address these challenges.
• Economic Factors: Economic pressures influence food safety behaviours, as people prioritize affordability and may purchase discounted or bulk foods with concerns over safe storage. The use of smaller appliances, like air fryers and microwaves, can also create food safety risks due to unfamiliarity with their proper use. Financial constraints may also lead to unsafe practices, such as consuming food past its use-by date or using limited resources from food banks. Future food safety campaigns should consider these economic factors and offer practical advice on ensuring food safety.

• Threat perception: The findings highlight differences in the perceived threat of foodborne illness between individuals over 65 and their family caregivers. Many older adults did not perceive themselves as susceptible to foodborne illness, often associating it with food consumed outside the home and not recognizing the impact of age-related immune changes.
• However, when informed about these changes, some acknowledged their increased vulnerability. Family caregivers, in contrast, were more aware of the heightened risk their elderly relatives faced due to frailty or health conditions, which influenced their food safety practices. Caregivers also exhibited a stronger understanding of the potential severity of foodborne illness, recognising its serious or life-threatening consequences for older adults. These findings emphasize the need for targeted education on food safety to increase awareness and improve practices among both older adults and caregivers.
• Motivation: Some individuals were motivated by personal experiences with foodborne illness, while others, especially those with underlying health conditions, were motivated by the need to protect themselves or family members. For instance, individuals who had experienced foodborne illness were more cautious about food safety practices, whereas some participants who hadn’t had such experiences didn’t prioritize food safety as much. Additionally, family caregivers were particularly motivated to ensure food safety for their loved ones, especially if they believed their relatives were no longer capable of managing it themselves. There were also differences in the use of food safety gadgets, with some participants showing interest in tools like refrigerator thermometers and temperature probes, while others were less inclined to use them, viewing such practices as unnecessary or burdensome.
• Behavioural evaluation: The evaluation of food safety behaviours reveals that perceived benefits, such as preventing foodborne illness and increasing confidence in food safety, play a crucial role in motivating individuals to adopt food safety practices. However, these benefits are often weighed against perceived barriers, including financial constraints, lack of knowledge, complacency, and emotional resistance. Motivations for food safety behaviours vary greatly, influenced by personal experiences, such as previous foodborne illnesses, underlying health conditions, and practical considerations like the use of food safety tools (e.g., temperature probes and refrigerator thermometers). Additionally, for some individuals, cultural attitudes and misconceptions, such as disregarding use-by dates or overconfidence in cooking abilities, can act as barriers to adhering to recommended practices. Understanding these factors, particularly in groups like the elderly or family caregivers, can help inform the development of more effective food safety education campaigns that emphasize relatable experiences, practical benefits, and the accessibility of key tools.
• Cues to action: Cues to action, such as media campaigns, personal communication, and food labelling, serve as triggers that encourage individuals to adopt recommended food safety behaviours. However, responses to these cues vary based on individual perceptions and lifestyle factors. For instance, media campaigns have been effective in altering behaviours, like discouraging the washing of raw poultry to prevent contamination, while other individuals may resist changing ingrained practices. The effectiveness of cues to action can be enhanced by providing clear, relevant information tailored to specific groups, such as older adults or individuals with underlying health conditions. Additionally, future food safety education should include diverse communication methods to reach wider audiences, focusing on providing evidence-based, relatable content.

The cumulative findings of this study confirm the need for Food Standards Scotland food safety educational resources for clinically vulnerable groups, such as older adults. The findings from this study can be utilised to inform the development of future food safety messaging approaches. It is clear from the body of work undertaken that there is a need to create Food Standards Scotland food safety campaign messaging to communicate who is at an increased risk of illness, why they are susceptible and how to reduce the risks. 

To enable this there is a need to utilise the overarching constructs of the Health Belief Model, namely threat perceptions, motivation, behavioural evaluation and cues to action as indicated in Table 17.

Considerations for future Food Standards Scotland food safety messaging

In addition to utilising the Health Belief Model, there is a need to incorporate the modifying variables discussed in this report. However, despite initially proposing the five separate modifying variables for the purpose of this research, analysis of the data and reflection of the findings suggest that these are not individual factors, they are in fact three factors, namely health, finance and environment that are often interconnected, individually, or combined, they can influence the perceptions that lead to food safety actions as demonstrated below in Figure 5. 

This proposed model needs to be utilised to help inform the development of future Food Standards Scotland food safety information resources.