Abstract
Between 2010 and 2013, Rutgers University collaborated with the Meals on Wheels Association of America (MOWAA) on a national study to improve food safety and emergency preparedness among homebound elderly recipients of home delivered meals. Older adults are at greater risk for foodborne illness and for scalds and burns from hot water. Therefore, as part of this study, we measured the freezer, refrigerator and hot water temperatures in client’s homes. To avoid foodborne illness, the FDA specifies that temperatures be kept at or below 40ºF in refrigerators and at or below 0ºF in freezers. There are no current US regulations regarding hot water temperatures. In 1988, water heater manufacturers voluntarily adopted the 120ºF standard recommended by the Consumer Product Safety Commission. However, because of their thinner skin and slower reaction times, older adults are vulnerable to burns even at 120ºF. Moreover, water heater thermostats only determine when the burner cycles on and off (often at 105ºF and 135ºF respectively), and so cannot be relied upon to control the temperature of hot water at the tap. The study was conducted with elderly adults receiving Meals on Wheels (MOW) deliveries in five US states (AR, CA, IA, NJ, and SC). During the home-visits to MOW recipients, data collectors administered a computer-assisted survey, and used a thermocouple to measure temperatures of the refrigerator, freezer and hot water at the kitchen sink. Individuals 60 years of age and older, who lived alone and received home delivered meals for at least 6 months prior to the in-home visit participated (N=747; participation rate 93%). Overall, participants were 65% female; 68% White, 28% African American, and 4% other; with a mean age of 80 and a median age of 81 years. 48% resided in a detached one-family house; 45% in a building with ≥ 2 apartments; and 7% in other types of residences. This study adopted an ideal, safe and effective water temperature range of 114.8 to 118.4ºF since studies have shown that water at this temperature is hot enough for thorough removal of grease, but minimizes the risk of scalding. Of the 747 households tested, hot water temperature measurements were available for 720 (96.3%) homes. Mean hot water temperature was 120ºF with a range of 73.9ºF to 184.5ºF. Five households had no hot water at all. Only 26.5% had hot water temperatures within the ideal range, 37.5% had a temperature >120ºF (the recommended temperature for hot water heaters), and 11% had a temperature that would result in first or second degree burns within seconds (>131ºF). Refrigerator temperature measurements were available for 685 (91.7%) homes. The average refrigerator temperature was 37ºF with a range of 23ºF to 60ºF. However, 17% of the homes had unsafe refrigerator temperatures above 40ºF. Homes in IA and NJ had refrigerator temperatures that were statistically significantly higher than those in CA. Freezer temperature measurements were available for 685 (91.7%) homes. The mean freezer temperature was 3ºF with a range of -16ºF to 41ºF. Almost two-thirds (60%) of the households surveyed had unsafe freezer temperatures >0ºF. The temperatures of freezers in CA were statistically significantly greater than those in the other states. In >50% of the homes surveyed, the hot water temperature measured was > 118.4ºF, significantly increasing the risk of burns; 79 individuals (11%) were at risk for scalding within seconds. In 20%, the temperature was <114.8ºF, impairing food safety. In 17% of the homes the refrigerator temperature was above 40ºF posing an increased risk for food spoilage and foodborne illness. In 60% of the homes the freezer temperature was above 0ºF, potentially decreasing the quality and nutritional value of the frozen foods and increasing the risk of food spoilage. The results suggest that the risks of scalding and microbial exposure are high for a large number of older individuals, and highlight the need for surveillance and the development of prevention strategies to ensure safer water, refrigerator and freezer temperatures in the homes of these individuals. Refrigerator and freezer temperatures were a consistent food safety problem. Providing two thermometers to MOW clients and education on their use may help reduce the number of MOW recipients with out-of-range appliances, and thus increase food safety. Older individuals are more vulnerable to scalding which has been documented as a reason for frequent and long hospitalizations in this population. Conducting checks on clients’ appliance and hot water temperatures and adjusting as necessary, could decrease the risk of food-borne illness and burns.