Food Standards Scotland Study Identifies Factors Driving Foodborne Illness Risk Among Older Adults

A study conducted through a Scotland's Environment, Food, and Agriculture Research Institutions (SEFARI) fellowship in collaboration with Food Standards Scotland (FSS) identified a range of health, social, environmental, and economic factors that may increase foodborne illness risks among adults aged 65 years and older.
According to the research, older adults are disproportionately affected by foodborne illness in Scotland despite representing approximately 20 percent of the population. Public Health Scotland surveillance data showed that adults aged 65 years and older accounted for:
- 68 percent of laboratory-confirmed listeriosis cases between 2012 and 2022
- 23 percent of Campylobacter infections between 2013 and 2017
- 60 percent of confirmed norovirus cases between 2012 and 2023.
The study used online and in-person focus groups involving adults aged 65 years and older and family caregivers to examine food safety perceptions, behaviors, and perceived vulnerabilities. Researchers analyzed findings using a framework that combined the Health Belief Model—which suggests that specific health behaviors are influenced by an individual's perceptions of severity and personal susceptibility, combined with perceived benefits and barriers to that behavior—with biological, physical, psychological, economic, and social determinants of food safety behavior.
Factors Influencing Older Adults’ Food Safety Practices
Researchers identified several factors that increase older adults’ likelihood of contracting foodborne illness. Specifically:
- Age-related health challenges: Reduced mobility, vision impairment, cognitive decline, and decreased appetite affect food purchasing, preparation, storage, and consumption practices. Caregivers reported concerns about prolonged storage of food in the home, difficulties following cooking instructions, and reduced adherence to use-by dates.
- Environmental factors: Limited transportation options, reliance on weekly grocery shopping or online deliveries, and reduced access to food retailers could result in longer food storage periods, increasing the importance of proper refrigeration and safe thawing practices.
- Social isolation: Participants living alone reported lower motivation to prepare fresh meals and greater reliance on ready meals, frozen foods, and batch-cooked meals, which could increase the likelihood of improper storage and reheating practices.
- Economic pressures: Participants described purchasing discounted foods, buying in bulk, and freezing food to manage rising costs. Researchers noted that unfamiliarity with newer cooking appliances, such as air fryers and pressure cookers, could create additional food safety challenges if foods are not cooked to safe internal temperatures.
Risk Perception Gaps
The study found that many older adults did not perceive themselves to be at increased risk for foodborne illness and often associated foodborne infections with meals prepared outside the home. Family caregivers generally demonstrated greater awareness of age-related vulnerability and the potential severity of foodborne illness among older adults.
Researchers reported that personal experience with foodborne illness, concern for vulnerable family members, and access to food safety tools such as refrigerator thermometers influenced motivation to follow recommended food safety practices.
Recommendations for Future Food Safety Messaging
Based on the findings, researchers recommended that FSS develop targeted food safety communications for older adults and other clinically vulnerable groups. Suggested strategies include:
- Increasing awareness of age-related susceptibility to foodborne illness
- Emphasizing the potential severity of infections
- Addressing barriers to safe food handling
- Providing practical guidance tailored to older adults' circumstances.
The report concluded that future food safety campaigns should incorporate behavior-change principles, clear calls to action, and messaging that acknowledges the interconnected effects of health, financial, and environmental factors on food safety practices among older adults.
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