Food Safety Older Adults and Nutrition
To investigate safe food handling, timing, and temperature issues of clients receiving home-delivered meals.
Clients from 50 home-delivered meal preparation sites in six states selected by:
- Geographic dispersion based on 10 regions established by the Administration on Aging's Regional Offices
- Size of program to include all quartiles when states ranked by size
- Willingness to participate.
Unwilling to participate or unresponsive to survey.
Recruitment
Directors of home-delivered meal preparation sites were contacted to participate. If amenable, clients were given a survey by the delivery drivers.
Design
Cross-sectional; survey research design.
Statistical Analysis
- Descriptive statistics used to determine frequency of responses
- Chi-square analysis used to determine differences in responses across groups (high-risk vs. neutral vs. low risk) for demographic variables and response options on survey.
Timing of Measurements
Survey was conducted between 2003 and 2004.
Dependent Variables
- Food handling of home-delivered meals:
- How food was held before consumption
- Length of time between delivery and consumption
- Handling of leftovers before consumption
- Participants were classified as high-risk, neutral or low-risk according to points received from survey responses regarding four food-handling scenarios. If responses were not in agreement with proper food handling procedures, respondents were classified as high-risk, low-risk if responses were in agreement and neutral if equal split on responses.
- General food safety knowledge
- Average time for delivery
- Consumption of meals.
Independent Variables
Home-delivered meal program clients' demographic information.
Initial N
- 20 home-delivered meal preparation sites from four states:
- Indiana (eight sites,395 participants)
- Texas (seven sites, 249 participants)
- Washington (three sites, 119 participants)
- New Hampshire (two sites, 106 participants)
- Total: 869 participants
- 258 male (31%)
- 575 female (69%).
Attrition (final N)
- Initial plan was to receive surveys from 50 home-delivered meal prep sites in six states
- Four states responded; two states were not responsive (33%-states not listed)
- 20 sites were used instead of 50
- 833 survey responses were usable from a total 869 participants (4% not usable).
Age
Mean age of participants was listed as 79.5 years (no SD provided):
- Less than 69 years: 85 (10.3%)
- 65 to 74 years: 144 (17.3%)
- 75 to 84 years: 302 (36.3%)
- 85 years or more: 293 (35.6%).
Location
- Indiana
- Texas
- Washington
- New Hampshire.
Key Findings
Variables | N (%) |
High-risk* | 154 (23.5) |
Neutral* | 481 (73.4) |
Low-risk* | 120 (18.3) |
Consumed meal immediately | 536 (63) |
Cold food cold (N=508) | 446 (87.8) |
Hot food hot (N=515) | 479 (93) |
Food heated before eating (N=212) | 91 (42.9) |
Consumed meal later | 315 (37) |
Cold food stored (N=285) | |
Counter/table | 43 (15.1) |
Refrigerator | 234 (82.1) |
Freezer | 8 (2.8) |
Hot food stored (N=274) | |
Counter/table | 93 (37.7) |
Refrigerator | 39 (9.8) |
Freezer | 142 (58.5) |
Foods heated before eating (N=298) | 267 (89.6) |
Mean Hours** (Minimum to Maximum) |
|
Time to deliver | 1.95 (0.9 to 4.26) |
Time until meal eaten | 1.22 (0.10 to 1.06) |
Total time before meal consumed | 3.17 (1.06 to 24.22 |
* Sample size decrease due to missing data.
** STD deviation not provided.
Other Findings
- No significant differences in demographic variables between risk groups
- 536 of 869 clients (63%) reported that they ate their meals as soon as they were delivered
- While 63% of respondents reported that they ate their meals as soon as they were delivered, of those who did not eat their meals immediately, 82% stored the cold food in the refrigerator, but many participants stored the hot food in the freezer (58%) or on the counter or table (38%) and 10% did not reheat the hot food before eating
- More than one third of the clients (N=277, 35%) reported that they had leftovers and only 34 (15%) ate the leftovers within two hours
- The low-risk group consumed meals as soon as delivered compared to high-risk group (P<0.05)
- Significant differences among groups on the basis of a derived food safety knowledge score that were observed in terms of whether or not they ate their meal immediately (P<0.05)
- 30 clients did not report their time of consumption and the remaining 839 clients consumed their meals an average of 1.22 hours after delivery.
Demand for home-delivered meals has been increasing. Food preparation and delivery operations of home-delivered meals appear to be doing a credible job of controlling time in conjunction with temperature to help reduce food-borne illness caused by improper food handling. However, there is room for improvement in food-handling procedures. Consumers need more information on proper food handling of meals in their homes and a better understanding of the importance of proper handling for prevention of food-borne illness. Foodservice providers also need to continue efforts to properly hold, handle and package home-delivered meals to help protect the at-risk consumer.
Other: | No funding reported |
- Sample used in this study may not be representative of all home-delivered meal clients
- No indication of ethnic dispersion; may be differences in practices between groups
- Self-report with reliance on subjective opinion to determine food temperature
- Surveys returned to drivers, which may have influenced self-reported responses.
Quality Criteria Checklist: Primary Research
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Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | N/A | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | N/A | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | Yes | |
2. | Was the selection of study subjects/patients free from bias? | No | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | Yes | |
2.2. | Were criteria applied equally to all study groups? | Yes | |
2.3. | Were health, demographics, and other characteristics of subjects described? | No | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | No | |
3. | Were study groups comparable? | N/A | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | N/A | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | N/A | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | N/A | |
3.4. | If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? | N/A | |
3.5. | If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) | N/A | |
3.6. | If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? | N/A | |
4. | Was method of handling withdrawals described? | Yes | |
4.1. | Were follow-up methods described and the same for all groups? | Yes | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | Yes | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | Yes | |
4.4. | Were reasons for withdrawals similar across groups? | Yes | |
4.5. | If diagnostic test, was decision to perform reference test not dependent on results of test under study? | N/A | |
5. | Was blinding used to prevent introduction of bias? | N/A | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | N/A | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | N/A | |
5.3. | In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? | N/A | |
5.4. | In case control study, was case definition explicit and case ascertainment not influenced by exposure status? | N/A | |
5.5. | In diagnostic study, were test results blinded to patient history and other test results? | N/A | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | Yes | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | N/A | |
6.2. | In observational study, were interventions, study settings, and clinicians/provider described? | Yes | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | N/A | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | N/A | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | N/A | |
6.6. | Were extra or unplanned treatments described? | N/A | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | N/A | |
6.8. | In diagnostic study, were details of test administration and replication sufficient? | N/A | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | ??? | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | N/A | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | Yes | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | N/A | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | ??? | |
7.5. | Was the measurement of effect at an appropriate level of precision? | Yes | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | No | |
7.7. | Were the measurements conducted consistently across groups? | ??? | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | Yes | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | Yes | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | Yes | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | Yes | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | N/A | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | N/A | |
8.6. | Was clinical significance as well as statistical significance reported? | Yes | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | N/A | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | Yes | |
9.1. | Is there a discussion of findings? | Yes | |
9.2. | Are biases and study limitations identified and discussed? | Yes | |
10. | Is bias due to study's funding or sponsorship unlikely? | ??? | |
10.1. | Were sources of funding and investigators' affiliations described? | No | |
10.2. | Was the study free from apparent conflict of interest? | Yes | |