Gastroenteritis and Food‐Borne Disease in Elderly People Living in Long‐Term Care

Abstract

Elderly people in long-term care facilities (LTCFs) may be more vulnerable to infectious gastroenteritis and food-borne disease and more likely to experience serious outcomes. We review the epidemiology of gastroenteritis and food-borne diseases in elderly residents of LTCFs to inform measures aimed at preventing sporadic disease and outbreaks. Gastroenteritis in elderly people is primarily acquired from other infected persons and contaminated foods, although infections may also be acquired when residents have poor personal hygiene, have contaminated living environments or water, or have contact with infected pets. Early recognition of outbreaks and implementation of control measures is critical to reduce the effects on LTCF residents and staff members. Although outbreaks among LTCF residents are common, they are challenging to investigate, and there are still major gaps in our knowledge, particularly in regards to controlling noroviruses, the incidence and causes of specific infections, and sources of food-borne disease.

Foodborne and Waterborne Infections in Elderly Community and Long-Term Care Facility Residents, Victoria, Australia

“…Although clinicians might elect not to collect specimens when LTCF residents have diarrheal illness, we think it more likely that reporting is more complete in LTCFs. Most of the diseases in our study are serious illnesses, and infected persons would have severe gastrointestinal and extraintestinal symptoms lasting for several days or weeks ( 3 , 4 ). In a case–control study of campylobacteriosis in Australia, 41% of case-patients had bloody diarrhea, and 75% had fever; both of these symptoms are strong predictors for physicians ordering laboratory tests ( 30 , 31 ).…”

“…The CFRs were consistent with reports in the literature for elderly persons, although we assessed deaths only short term (i.e., in the weeks after infection) ( 34 , 35 ). In general, elderly persons have more severe outcomes from foodborne infections than do younger persons ( 4 , 18 ). Large-scale studies that used population-based registers have demonstrated that enteric diseases contribute to more deaths than recognized from short-term follow-up, even when controlling for concurrent conditions ( 36 , 37 ).…”

“…In many countries, elderly persons unable to care for themselves live in long-term care facilities (LTCFs) where they receive assistance with meals, daily living, and health care ( 3 ). Food preparation practices and various exposures in LTCFs may modify the risk of foodborne and waterborne infections in these residents ( 4 , 5 ) when compared with elderly persons living in the community, who may have less safe food preparation practices ( 6 – 8 ). …”

“…Elderly persons can become infected by ingesting contaminated water or food or, as with Legionella spp., inhaling contaminated aerosols ( 13 ). Some infections are predominantly foodborne; others can be acquired from infected persons or animals or through contact with contaminated environments ( 4 ). …”

Animal Models for Salmonellosis: Applications in Vaccine Research

“…In addition, elderly patients are known to be especially susceptible to Salmonella gastroenteritis (31). Those in long-term-care facilities are particularly vulnerable, with a casefatality rate up to 70 times greater than the general population (32,33). As such, a vaccine that could protect this population specifically is also desirable.…”