EAL

Food Safety Older Adults and Nutrition

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To investigate safe food handling, timing, and temperature issues of clients receiving home-delivered meals.

Inclusion Criteria:

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.

Exclusion Criteria:

Unwilling to participate or unresponsive to survey.

Description of Study Protocol:

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.

Data Collection Summary:

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.

Description of Actual Data Sample:

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.

Summary of Results:

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.

Author Conclusion:

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.

Funding Source:

Other:

No funding reported

Reviewer Comments:

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
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