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by Brenda Richardson, MA, RDN, LD, CD, FAND 1 HOUR CE CBDM Approved Foodborne Illness Life-Altering and Life-Threatening in the Aging

NUTRITION CONNECTION

OLDER ADULTS ARE AT HIGHER RISK FOR FOODBORNE ILLNESS COMPLICATIONS

Foodborne illness—also known as foodborne This article addresses some of the factors specific to the or —is any disease that enters the body aging population that increases their vulnerability. Also through eating or handling food. There are more than discussed are some long-term consequences that may 250 different foodborne , and they can be caused result when a foodborne illness occurs. by , , parasites, or harmful and chemicals that have contaminated food. Every person —ESPECIALLY is at risk for foodborne illness, but for the aging there IMPORTANT FOR THE AGING is increased risk that a foodborne illness can be life- As we age, it is normal for the body not to work as well as threatening. With aging it becomes more challenging it did when we were younger. Sense of taste or smell may to fight off microbes and can result in long-term be altered with taste dysfunction or olfactory impairment. consequences or even . Chronic health conditions, Changes in organs and body systems occur as one grows like diabetes or kidney disease, also increase the chances older. These changes often make the senior population of getting sick from eating that are unsafe. So, for more susceptible to contracting a foodborne illness. For the aging, preventing foodborne illness is critical. example, with aging there are altered gastrointestinal

12 NUTRITION & EDGE | March-April 2018 [email protected]

Brenda Richardson, functions and the recognizing and ridding the Barré Syndrome), mental MA, RDN, LD, CD, and intestinal tract may hold body of harmful bacteria retardation, schizophrenia, FAND is a lecturer, on to foods for a longer and other that and visual impairment. author, and owner/ period of time. Stomach cause , such as president of Brenda Dehydration is serious Richardson, LLC. acids which help reduce foodborne illness. Should in any situation, but it’s intestinal bacteria decrease, older adults contract a particularly dangerous and the and kidneys foodborne illness, they for the elderly. Severe may not readily rid the body are more likely than the dehydration can result in of toxins. general population to have a drop in pressure a lengthier illness, undergo Adults 65 and older which affects blood supply hospitalization, or even die. are at a higher risk for to essential organs such as hospitalization and death To avoid foodborne illness, the kidneys. This results in from foodborne illness. it is critical that food is safe kidney failure which can be For example, older adults when purchased and then is fatal. residing in nursing homes handled, stored, prepared, When someone does not are 10 times more likely and served in a safe manner. drink enough fluids to to die from bacterial replace those that are lost than the COMPLICATIONS through and general population. Food OF FOODBORNE , dehydration can safety is particularly ILLNESS IN THE result. When dehydrated, important for adults 65 and ELDERLY the body lacks enough older. If an elderly person fluid and electrolytes— contracts food poisoning, By age 65, many have been minerals in , including the symptoms are likely to diagnosed with one or more sodium, potassium, and be much worse than for a chronic conditions, such as chloride—to function younger person. Short-term diabetes, arthritis, cancer, properly. Infants, children, symptoms and conditions or cardiovascular disease, older adults, and people may be experienced such and are taking at least one with weak immune systems as dehydration or lactose medication. The side effects have the greatest risk of intolerance. The older of some medications or the becoming dehydrated. person will experience a chronic disease process severe form of this illness Signs of dehydration may may weaken the immune which may then lead to include: system, causing older adults other complications. Recent to be more susceptible to • Excessive thirst research has shown that the foodborne illness. After age • Infrequent urination following long-term health 75, many adults having a conditions are associated • Dark-colored urine weakened with several known • Lethargy, dizziness, or are at an even higher risk foodborne diseases: high faintness for contracting a foodborne blood pressure, irritable illness. Lactose Intolerance. bowel syndrome, reactive Foodborne illness inflames Essentially, with aging, arthritis, diabetes, kidney the lining of the gut the immune system and dysfunction, urinary tract (digestive system) which other organs become infections, neurological slower and less active in conditions (such as Guillain- Continued on page 14

NUTRITION & FOODSERVICE EDGE | March-April 2018 13 Continued from page 13

prevents lactase from being Irritable bowel produced. Lactase is an syndrome (IBS) is a enzyme which is needed to disorder of unknown help with the absorption of cause that is associated lactose. with abdominal pain, bloating, and diarrhea People who have undergone or constipation or both abdominal surgery or suffer and may result in being a from celiac disease can long-term consequence of develop lactose intolerance food poisoning. In fact, the as can anyone who has version known as ‘post- experienced gastroenteritis, infectious irritable bowel however it may occur when syndrome (PI-IBS)’ can someone has experienced occur following a bout of diarrhea, often as a result of bacterial food poisoning. foodborne illness. The reason for this is This is because cells within that the caused the small intestine have during food poisoning become damaged as a affects the function of the result of this infection, and which prevents them from increases its sensitivity. This, producing lactase. Once the combined with a change in lining of the intestine heals, the immune system, results lactase is produced and this in an increased amount of condition disappears of its inflammatory chemicals. own accord. This predisposes the Research suggests that infected person to IBS. acute foodborne illnesses Guillain-Barré syndrome may lead to chronic is a disorder characterized disorders, including the by muscle weakness or following. paralysis that begins in the is a type lower body and progresses of joint inflammation that to the upper body. This usually affects the knees, syndrome may occur after ankles, or feet. Some people foodborne illnesses caused develop this disorder by bacteria, most commonly OLDER ADULTS AND PEOPLE following foodborne C. jejuni. Most people WITH SUPPRESSED IMMUNE illnesses caused by certain recover in six to 12 months. SYSTEMS OR CHRONIC ILLNESS bacteria, including C. jejuni The Center for Foodborne and . Reactive may become severely dehydrated Illness Research & arthritis usually lasts fewer Prevention (www. when they lose more fluids than they than six months, but this foodborneillness.org) has condition may recur or can replace. In that case, they may produced a report which become chronic arthritis. need to be hospitalized and receive argues that more research intravenous fluids.

14 NUTRITION & FOODSERVICE EDGE | March-April 2018 is needed into the long-term effects of food poisoning (or that case, they may need to be hospitalized and receive foodborne illness) which can lead to chronic health issues intravenous fluids. In extreme cases, dehydration can be such as high blood pressure, diabetes, kidney failure, and fatal. irritable bowel syndrome. EATING, DIET, AND NUTRITION TREATMENT FOR FOODBORNE The following steps may help relieve the symptoms of ILLNESSES foodborne illnesses and also prevent dehydration in adults: The only treatment needed for most foodborne illnesses • Drinking plenty of liquids such as juices, sports is replacing lost fluids and electrolytes to prevent drinks, caffeine-free soft drinks, gelatin, sherbet, soup or dehydration. broth, and fruit ices to replace fluids and electrolytes Fluids and electrolytes — minerals such as sodium, • Sipping small amounts of clear liquids or sucking on ice potassium, and calcium that maintain the balance of chips if vomiting is still a problem fluids in the body — lost to persistent diarrhea need to be • Reintroducing food gradually, starting with bland, easy- replaced. Some adults with persistent diarrhea or vomiting to-digest foods such as rice, potatoes, toast or bread, may need hospitalization, where they can receive salts and cereal, lean meat, applesauce, and bananas fluids through a vein (intravenously) to prevent or treat • Avoiding fatty foods, sugary foods, dairy products, dehydration. caffeine, and until recovery is complete If the specific cause of the foodborne illness is diagnosed, • Providing access to fluids at all times to include water a healthcare provider may prescribe medications, such as pitcher and cup at the bedside, water bottle on a , to treat the illness. wheelchair, travel mug, offering a hydration cart, or Antibiotics may be used for certain kinds of bacterial food providing beverages every few hours poisoning and if symptoms are severe. Food poisoning CONCLUSION caused by may be treated with intravenous antibiotics during hospitalization. Prevention is the first step in combatting foodborne illnesses. Guidelines for safely handling and preparing Antibiotics will not help food poisoning caused by viruses. food should be followed regardless of the setting in which Antibiotics may actually worsen symptoms in certain kinds food is consumed, however it’s important to remember of viral or bacterial food poisoning. that the impact of foodborne illness for the aging can Older adults and people with suppressed immune systems be life-threatening and/or life-altering. Proper training, or chronic illnesses may become severely dehydrated education, and monitoring of food safety for staff and when they lose more fluids than they can replace. In family/guests is essential in providing safe food to this vulnerable population. E

REFERENCES AND RESOURCES

• National Institute of Diabetes and Digestive and Kidney Diseases https://www.niddk.nih.gov/health-information/digestive- diseases/foodborne-illnesses • FoodSafety.gov https://www.foodsafety.gov/risk/olderadults/index.html • Am Fam Physician. 2015 Sep 1;92(5):358-65. Diagnosis and Management of Foodborne Illness. Switaj TL1, Winter KJ2, Christensen SR1. • Partnership for Food Safety Education http://www.fightbac.org/ • United States Department of https://www.usda.gov/topics/health-and-safety • Centers for Disease Control and Prevention https://www.cdc.gov

NUTRITION & FOODSERVICE EDGE | March-April 2018 15 1 HOUR CE Questions | NUTRITION CONNECTION CE CBDM Approved

This Level II article assumes that the reader has a foundation of basic concepts of CBDM II the topic. The desired outcome is to enhance knowledge and facilitate application of continuing competence knowledge to practice. where education advances performance

Reading Foodborne Illness: Life-Altering and Life-Threatening in the Aging and successfully completing these questions online has been approved for 1 hour of continuing education for CDM, CFPPs. CE credit is available ONLINE ONLY. To earn 1 CE hour, purchase the online CE quiz in the ANFP Marketplace. Visit www.ANFPonline.org/market, select “Publication,” then select “CE article” at left, then search the title “Foodborne Illness: Life-Altering and Life-Threatening in the Aging” and purchase the article.

1. Chronic health conditions like diabetes or kidney disease 5. Reactive arthritis may occur for some individuals following ______the chances of an individual getting sick from foodborne illness and usually lasts fewer than ____ eating unsafe foods. months, but may recur or become chronic arthritis. A. Decrease A. Two B. Increase B. Four C. Do not alter C. Six 2. As one ages, the stomach and intestinal tract may hold 6. Generally, the only treatment for most foodborne on to foods for a ______period of time, increasing illnesses is replacing lost ______and ______to prevent susceptibility of acquiring a foodborne illness. dehydration. A. Reduced A. Fluids, electrolytes B. Longer B. Kcalories, protein C. Predetermined C. Pitchers, mugs 3. With aging, stomach acids which help ______intestinal 7. The impact of foodborne illness for the aging can be life- bacteria decrease, thus increasing susceptibility of ______and/or life-altering due to acute and/or long-term acquiring a foodborne illness. effects. A. Reduce A. Enriching B. Feed B. Empowering C. Transmit C. Threatening 4. Recent research has shown there are ______health conditions associated with several of the known foodborne MAKE YOUR CE HOURS AUDIT PROOF illnesses. Attention CDM, CFPPs! Purchase your online CE products in A. No the ANFP Marketplace and your completed CE hours will be B. Long-term automatically reported in your continuing education record. This C. Positive includes all ANFP online courses, archived webinars, and online CE articles.

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