Food safety and the older consumer: A systematic review and meta-regression of their knowledge and practices at home

Older adults are a high-risk population for foodborne illness because of weakened immune systems, chronic illnesses, and a resulting increased likelihood of complications. A systematic review was undertaken to identify, characterize, and synthesize the published research on the food safety knowledge and behaviors of older adults (60 +) in the domestic setting. The review consisted of a comprehensive search strategy, relevance screening, article characterization, data extraction, and risk-of-bias assessment. Outcomes were analyzed using meta-regression to explain variance in prevalence estimates across studies. Fifty-seven relevant studies published between 1996 and 2018 were identified. Knowledge gaps included older adults' awareness of Listeria (median = 40%; range = 33-58%; n = 5 studies), and knowledge on the safe operating temperatures of refrigerators (median = 43%; range = 12-65%; n = 11 studies). Older consumers reported refrigerating leftovers within 2 h of cooking, with an average prevalence of 87% (95%CI = 0.86-0.88; I-2 = 0%; n = 7 studies). Of the high-risk foods, older adults consumed undercooked eggs most often (median = 33%, range = 8%-50%, n = 8 studies). Meta-regression explained the across-study variability in prevalence of handwashing before food preparation, where self-report measures reported a higher prevalence than in-person observations (beta = 0.66; CI = 0.49-0.83; I-2 = 82.3%; adj. R-2 = 97.8%, n = 10 studies). Future training programs should target knowledge gaps identified in this review.