Scotland's 2022 Census shows that Scotland’s population is ageing. With people aged 65 and over outnumbering people aged 15 and under by more than quarter of a million. Numerous physiological changes occur with increasing age which can result in chronic medical conditions and illnesses. Furthermore, the medication used to treat such conditions or age associated immune decline can increase susceptibility to infection.
With some foodborne pathogens, people over the age of 65 are often disproportionately affected. Therefore, this project aims to determine the lifestyle factors which cause members of the older population to become ill with foodborne disease by exploring shopping practices, food safety knowledge, attitudes, and behaviours. This will allow Food Standards Scotland to segment a particularly diverse vulnerable group in targeted food safety messaging.
Food Standards Scotland’s (FSS) vision is to create a safe, healthy, and sustainable food environment that protects the health and well-being of people in Scotland. To achieve this, FSS have key strategies for reducing illness from foodborne pathogens (commonly referred to as food poisoning), this includes the distribution of food safety information to all consumers. The FSS Strategy for 2021–2026 Healthy, Safe, Sustainable: Driving Scotland’s Food Future aims to connect with consumers in Scotland to understand their needs and influence change, promoting a positive food culture, safe food practices and a healthier diet.
However, the level of risk from food poisoning is not the same for all consumers. Recent research activity on behalf of Food Standards Scotland has established that clinically vulnerable groups are more likely of becoming ill with foodborne disease and the severity of illness is worse. These clinically vulnerable groups are commonly referred to as the YOPI category, namely, the Young (under the age of 5 years), the Old (over the age of 65 years), the Pregnant, and the Immunosuppressed (due to disease or medication).
Older adults equate to 20% of the Scottish population, but 75% of listeriosis cases, 31% of campylobacteriosis cases, and 63% of norovirus cases in Scotland are among people over the age of 65 years. Although food safety information is relevant for all consumers, advice does need to target specific groups to ensure awareness, such as those over the age of 65 years. However, it also may not be appropriate to target everyone over the age of 65 in one campaign or message, there may be a need to target according to underlying conditions or according to food safety perceptions or according to specific lifestyle factors that impact upon people’s relationships with food.
Therefore, the purpose of this joint SEFARI Gateway and FSS fellowship project is to explore some of the lifestyle factors which cause members of the older population to become ill with foodborne disease. This fellowship compliments ongoing work assessing prevalence data to determine who in Scotland is clinically vulnerable to foodborne disease.
To ensure the interviews and discussions capture meaningful data, an interview schedule has been created utilising the Health Belief Model (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy) relating to key food safety practices and consider how factors relating to the dimensions of wellness impact upon relationships with food and the influence on food safety.
To date, in-depth telephone interviews and online focus groups have been undertaken with individuals over the age of 65, and individuals who support relatives who are over 65 years (n=80) to explore the factors that influence the food shopping, storage, cooking and eating behaviours, along with their food safety perceptions and practices.
Although analysis of data has not yet quite commenced, many interesting points have already been explored. Discussions indicate that some of the key factors that influence food related practices include finances; for some this resulted in modifying what foods they were able to purchase, with some being heavily reliant upon “yellow sticker foods” that are reduced in price due to short shelf life. Many were aware of the need to use such foods promptly and many resolved to freezing such foods until required. Whereas others were sceptical about date labelling on foods and preferred to rely on their sense suggesting “I can tell if it is safe to eat”, this sentiment was often linked with concerns regarding food waste and food insecurity. Also, in relation to finances, a significant number of respondents discussed that they opted to use smaller cooking appliances, such as air fryers, and pressure cookers to reduce their energy costs, as many couldn’t justify “heating up the whole oven just to feed one”, some went further and described changing the time at which they cooked their main meal due to cheaper energy tariffs earlier in the day. Positive attitudes were expressed towards the importance of many food safety practices such as ensuring thorough cooking and not washing raw poultry. However, discussion indicated that many older adults may subject foods to prolonged storage at potentially unsafe refrigeration temperatures.
Many factors that influenced people’s relationships with food included having more time after retirement for planning, shopping, preparing, and cooking food. Learning to shop and cook after the loss of a partner or spouse. The significant impact of mobility changes and cognitive decline resulted in some people becoming reliant on children, relatives, or neighbours for food shopping. Discussions with those that supported their parents or relatives with food related tasks provided very different insights to those age of 65 living independently. These family caregivers were often aware of potential food safety risks, expressed significant concerns, and reported being cautious to ensure the safety and wellbeing of their relatives. Some shared their apprehensions regarding the carers that visit their relatives and questioned their food safety perceptions, practices, and training. The relatives described “falling into the role of caring” for their relatives, some described themselves as “floundering” and “struggling” when combining their own family commitments, full-time jobs and being a family caregiver. Many indicated that they were more concerned about the safety of food for such relatives as they were aware of their “frailty”.
Following completion of the online discussion groups, six in-person discussion groups have been scheduled across various locations in Scotland. Once data capture is complete, data analysis will take place. No doubt, this will further broaden the interesting points already being raised.
Ultimately, the outputs of this fellowship will provide the evidence needed to allow Food Standards Scotland (FSS) to identify any areas of change in relation to current consumer advice to ensure that food safety messaging for people over the age of 65 is appropriate, and in an attempt to reduce the risk of foodborne illness among this age group.
Dr Ellen Evans, ZERO2FIVE Food Industry Centre Food & Drink Research Unit, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University.
Images: Are all royalty-free and obtained using Ellen’s institutional license with Adobe Stock.