The elderly

At the opposite age extreme of infants and children, the elderly are also highly susceptible to foodborne illnesses. Hypochlorhydria from use of H2-receptor antagonists, proton pump blockers or frequent use of antacids reduces the ability to resist infection (Feldman et al., 1996; Klontz et al., 1997; Donskey, 2004). Interestingly, histamine H2 blocker therapy and antacid use, which is sometimes advocated as a calcium source for women, were risk factors in a reported outbreak of listeriosis in the elderly (Cobb et al., 1996).

There is a decrease in intestinal motility (Bitar and Patil, 2004) and mucosal immune function (Fujihashi and McGhee, 2004) with aging. Fecal impaction may result from loss of smooth muscle contractility, but it is not clear if prolonged exposure of pathogens to intestinal epithelium is a risk factor for pathogen infection. However, studies have found that the elderly are at greater risk of infection from the senescence of gut-related immune tissues (Fujihashi and McGhee, 2004).

Systemic infections are more likely because of disruption in cell-mediated immunity in the aging body (Cakman et al., 1996; Pahlavani and Richardson, 1996). Undernutrition, which is common in the elderly, may exacerbate immune dysfunction because of nutrient deficiencies (High, 1999). Risk for under-nutrition has been associated with eating alone, depression and dementia, dental pain and poverty (American Dietetic Association, 2000). Deficiency of protein, zinc, selenium, iron, copper, vitamins A, C, E, B-6 or folic acid in the elderly have been associated with decreased immune function (Lesourd, 1997).

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