This paper explores factors contributing to gastroenteritis and foodborne illness in elderly residents of long-term care facilities. The authors reviewed literature from 1970-2009 relating to pathogens and compared data between facilities. Main pathogens identified were norovirus, rotavirus, E. coli, salmonella, and C. difficile. The elderly are at higher risk due to poor immunity and hygiene. Prevention relies on prompt detection and management of outbreaks through handwashing, sanitation, and monitoring food safety. Further research is still needed to address gaps in knowledge, especially regarding norovirus prevention and sources of foodborne illness.

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IN LONG-TERM CARE
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Gastroenteritis and Food-Borne Diseases in Elderly People Living in Long-Term Care
Dave Manriquez
Edeline Villastiqui
Jagjot Grewal
Margaret O’Brien
Vancouver Community College
Author Note:
This paper was prepared for Professional Practice taught by Catherine Overton.

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Abstract
This paper explores the factors that contribute to gastroenteritis and food-borne diseases in the elderly
population, which live in long-term care facilities. The authors, Gastroenteritis and Food-Borne Diseases in
Elderly People Living in Long-Term Care, researched articles relating to the care facilities and possible
pathogens causing infections and compared the data with other countries outcomes. With comparison to other
countries’ data, authors concluded methods of preventing transmission of infection, treatment of infection,
and management of the outbreaks. The paper also contains why and how we as nurses can include the
research in our everyday practice.

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Gastroenteritis and Food-Borne Diseases in Elderly People Living in Long-Term Care
Gastroenteritis and food-borne diseases in elderly people are caused by many factors such as: food,
water and air contamination, infected persons, poor personal hygiene, infected pets and environment.
Assessed measures such as prevention, detection and management can evade food-borne diseases and
gastroenteritis.
We will be discussing the causes and factors of gastroenteritis and food-borne disease targeting older
adults living in long term care facilities. And methods used for the prevention, treatment and management of
the contactable disease in the care facilities.
Purpose
The aim of the study is to trace and explain the factors of the epidemiology of gastroenteritis
(inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and
causing vomiting and diarrhea) and food-borne disease (colloquially referred to as food poisoning; is any
illness resulting from the food spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that
contaminate food) in elderly residents living in the long term facilities. And to explore supportive measures
and treatment aimed at preventing sporadic diseases, infection and outbreaks such as handwashing and
proper food handling.
Methods
The authors, Kirk, Veitch, and Hall, searched up articles from the time period of 1970 to 2009, which
could be relatable to long term care facilities and pathogens. They have collected and compared data from
other long-term care facilities in the United States as well in other countries around the world such as United
Kingdom, Australia and Netherlands.
By collecting data, the authors found many articles that had inconclusive results because key
questions such as “What is the role of contaminated living environments for transmission of enteric
agents?”(Kirk,Veitch,Hall, 2010) and “What is the most useful diagnostic strategy for a case of

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gastroenteritis in a LTCF resident?”(Kir, Veitch, Hall, 2010) were not answered. Even though those articles
did not have definite results, the recommendations made were considered in the research.
For articles that were conclusive, surveillance and diagnostic tests were done and pointed out the
factors causing and contributing to the spread of gastroenteritis and food born diseases. Also, main pathogens
causing the outbreaks such as Norovirus and Clostridium Difficile, Salmonella enterica, Shiga Toxin
producing Escherichia coli and ect. were identified.
Conclusion
The main pathogens causing gastroenteritis and food borne diseases in residents living in long-term
facilities are noroviruses, rotavirus, shiga toxin-producing Escherichia coli, salmonella enterica,
campylobacter, Clostridium perfringers, clostridium difficile and Listeria. Gastroenteritis in elderly people is
primarily acquired from other infected persons and contaminated foods, although residents could also catch it
through poor personal hygiene, contaminated environment and having contact with infected pets. Elderly
people living in care homes may be more vulnerable to the infection and more at risk to experience serious
outcomes. Early detection of outbreaks and implementation of control measures is needed to decrease the
effects on residents and staff. Even though outbreaks among elderly in facilities are common, they are still
paucity of information from well-designed trials and evidence is largely derived from epidemic surveys.
These surveys and data are often deficient; there are still major gaps in the knowledge especially on
preventing measures on noroviruses, finding causes for infections and sources of food borne diseases.
Analysis Part A
The review concluded that prevention, detection and management of outbreak is very important in
controlling the outbreaks. Prevention of sporadic diseases can be accomplished by stopping the transmission
from “ingestion of microorganisms or toxins via exposure to (1) an infected person, (2) contaminated food or

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(3) infected animal”(Kirk,Veitch Hall, 2010). Enforcing risk-based food safety programs and educating staff
on food safety can prevent food-borne diseases.
Detecting the outbreak can be difficult because residents might not have the resources such as
laboratories where they can receive their etiology or the doctors and patient is reluctant on investigating what
virus or bacteria the older adult might have. But the facility can make a team, which includes a doctor and
staff members, who prevent the spread of infection and have another team to evaluate the food and facility to
monitor future infection control.
If there is an outbreak, management of the facility should plan ahead to have adequate supplies such
as stool samples kits for all older adults who are experiencing an illness. Also, supplying the facilities with
personal protective equipment (gloves, gowns, mask, and glasses) and appropriate concentrated solutions and
disinfectants to clean areas to minimize the risk of transmission of bacteria and viruses. Lastly, hand washing
and using alcohol based hand sanitizers after contact with clients and infected environments.
Analysis Part B
Gastroenteritis and food borne diseases are serious public health problems and nurses have a critical
role in the prevention and control of disease outbreaks. This study is relevant to the nursing practice because
it is very important for nurses to have practical and concise information on the certain kinds of diseases; its
treatment and prevention. It is very essential for the nurses to provide appropriate education to their patients.
The study has connection with health promotion and the prevention of the outbreak of diseases. Finding out
all this information, it will give us the chance to explore better interventions that we can implement to
prevent and minimize the occurrence of these epidemics. Finding out improved interventions would be very
beneficial to the immunocompromised elderly people who are living in the long term facilities since they are
most vulnerable to these diseases and infections. As nurses it is our duty and obligation to protect them from
illnesses. Having enough knowledge about gastroenteritis and food-borne diseases (its causes and factors)

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and educating our patients will be helpful in preventing these outbreaks and making our residents safe and
free of illnesses.
Application
We as nurses should implement the research in our nursing practice for the safety of the patients,
visitors and our colleagues. By being aware of the modes of transmission of infections it will decrease the
death and infections rates in vulnerable older adults in long term care facilities. Also, limit the spread of
infection to outside community.
We as nurses need to monitor our patient’s health conditions and report everything irregular that we
observe. We need to encourage the community (patient, co-workers and families) to perform hand washing,
sanitizing hands between interaction with others, education (putting signs and posters), food safety and
providing clean environment to put a stop to the spread of diseases and infection. Educating and providing
proper equipment for our patients will greatly help in preventing these outbreaks. As nurses we need to be an
advocate for patients.
Conclusion
Filthy environments, infected persons, contaminated food and poor hand hygiene are a few of the
causes of gastroenteritis and food borne diseases in long term care facilities. The significant keys to focus on
so we can implement the reduce of spread of the diseases and infection in elderly are well planned infection
control programs and education about proper hand washing, use of alcohol rub and proper food handling.
Although gastroenteritis and food borne diseases are familiar diseases in long-term facilities, there is still a
need for further and deeper research to address the gaps in the literature.
In writing this paper we have learned that we need to be systematic and organized with our thoughts
before starting. Making an outline using mind mapping was very helpful. It was also important to have an

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open communication among group members, collaborating ideas and opinions as well as providing
productive feedback.

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Reference
Kirk, M., Veitch, M., & Hall, G. (2010). Gastroenteritis and Food-Borne Disease in Elderly People
Living in Long Term Care. Clinical Infectious Diseases.