THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Transcripts 536-4 and 536-5

Week: 536.4 Guest: Dr. William Adler, Chief Immunologist, National Institute on Aging Topic: Food, Water Bacterial effects on the Elderly- Part One Producer/Host: Steve Girard

NEMA: All of us are affected by water and food borne bacteria...it makes us feel queasy, out of balance, and can make us dehydrated. We're talking today with Dr. William Adler, Chief Immunologist with the National Institute on Aging....

ADLER: I think that the elderly, the major difference between us and the elderly...or between different age groups is going to be that any infection is going to be more serious in the elderly...they're not going to be able to just throw it off. And mortality is going to be higher, so that what you're dealing with is perhaps the same level of organisms for everyone, but in many cases, it isn't going to cause disease in the younger populations, whereas in the older populations...that smaller number of organisms may still cause disease, and with that increased level of illness, and perhaps increased mortality levels. Now, the problems that can be in the food supply, and in the water supply have been evidenced in several of the cities in this country. And that has been the increase in micro-organisms which can cause gastro-intestinal illness..and under those situations, what you see is both ends of the age spectrum getting sick to a greater degree than the middle...the young adult, middle-aged adult. Then another big difference between the two ends of the age spectrum is, that the youngsters, even though they may get sick at a higher rate, usually there is not an associated death rate with that. But with the elderly, they do get sicker, and they do have a higher incidence of very serious complications from food and water borne infections.

NEMA: What kinds of symptoms and effects does this kind of infection have on the elderly?

ADLER: Most food borne or water borne infections have an element of perhaps, nausea, vomiting, and diarrhea. In other words, fluid loss...and that's one of the big problems...secondary to that is infection. In other words, there are food poisonings in which you don't get infection, you ingest a toxin. For example, this is seen in some of the reactions to contaminated mayonnaise, or things like that. it isn't the organism that's infecting you, what's happening is the organism is supplying a toxin, and then the toxin is causing the illness, and its self-limited, because it isn't replicating. It's still serious. But in the elderly, if you run into the problem of infection then that just complicates everything beyond just the fluid loss...in other words, the individual will have, perhaps, fever...perhaps organisms appearing in the blood, and then lodging in other places, with subsequent infections throughout the body, and its just a much more serious problem all the way around.

NEMA: A published report says about one third of the cases of intestinal distress in one Canadian study were tracked to the water supply, so it may be wise for our seniors to take aggressive steps to avoid getting sick. We'll talk again with Dr. William Adler about the steps to take in helping the elderly avoid food and water infections, including reviewing the refrigeration and food handling situation... and possibly using bottled or boiled water, instead of tap water. I'm Steve Girard.

Transcripts:

Week: 536.5 Guest: Dr. William Adler, Chief Immunologist, National Institute on Aging Topic: Avoiding Food and Water Infections in the Elderly- Part Two Producer/Host: Steve Girard

NEMA: We've been talking with Dr. William Adler about the greater adverse effects of food and water borne infections in the older population. He's Chief of Immunology at the National Institute on Aging. In the elderly, I would guess that it takes longer to get rid of an infection...and they may have other health problems that complicate things further...

ADLER: That's true, and I think that's a good point...because the longer something lasts, perhaps the more fluid they're also losing, with the diarrhea and the vomiting. And that is another large component of the problem in the elderly is the fluid loss...perhaps some of these people do already have some decline in renal function, and they can't save water as a middle aged adult might be able to do. They may have cardiac function, in which they are on the verge of heart failure and this marked change in fluid levels will affect that. They may have contraction of their fluid component to the point where strokes will increase in that group. And this is all modified by ambient temperatures...so the sort of things you see in the summer with food poisoning or water poisonings are much more serious when there's a stress already, a heat stress already on the individual, then this just compounds the problem.

NEMA: What kinds of steps can someone take to ensure an elderly relative or friend is okay, especially during the warmer months?

ADLER: What we hear about are large scale epidemics of food poisonings, or gastro-intestinal infections. What we don't really hear about are individual problems, people in their own home...and what you touch on there is, what can they do to prevent any of these problems? And I would say its two fold: one is adequate refrigeration...perhaps the older person may not have up- to- date freezer and refrigeration capability, and therefore food will spoil faster in a temperature that's higher than it should be. The water supply is something we all deal with, and the water supply can be, as we saw in the District of Columbia just recently, can be contaminated for whatever reason, either sewage spills or increased rain with runoff from the land, or perhaps a mix-up in the chlorination process, whatever ...and in those cases, bottled water is perfectly adequate. Or boiling water from the tap prior to use is again perfectly adequate. The problem with bottled water or with things like Gatorade as substitutes for tap water is that, in many cases with the elderly, they're not going to be able to cart all that stuff home. Fluids are heavy. Families can make sure that things are on hand, that the older individual has access to these bottled waters or canned supplements...and that the refrigeration is adequate, that the individual is maintaining a nutritional diet, that fresh vegetables and fresh foods are available to them...and that's one of the major things a family can do for an older relative.

NEMA: Thanks to Dr. William Adler of the National Institute on Aging. I'm Steve Girard.