Choking is the second most common cause of preventable death in residential aged care in Australia (Ibrahim et al., 2017) and the leading cause of premature death in people under the age of 65 in residential aged care (Cartwright et al., 2021).
But what exactly is choking? And how can we keep our residents safe from it?
Choking occurs when a person’s airway is partially or fully obstructed (blocked) by a foreign body such as food.
This means that air cannot move in or out of the lungs and the person cannot receive enough oxygen. Choking is a medical emergency and requires immediate attention and first aid.
If a resident is coughing, talking, audibly crying, or visibly breathing then they are NOT choking, as their airway is open. Coughing can be a voluntary or reflexive response to an irritant in the airway and may occur in response to food or fluid particles entering the airway.
Coughing occurs when air is drawn into the lungs and then is forcefully expelled, in an attempt to clear the irritant from the airway.
Coughing is noisy and resolves when the irritant is expelled. If a resident is coughing, encourage them to stay calm and to keep coughing to clear their airway.
Do NOT pat or hit them on the back or give them something to drink as this could make the problem worse.
Make sure that the resident is positioned correctly (90 degrees upright) for all oral intake and has all necessary equipment for the meal, including dentures and glasses.
Reduce distractions in mealtime environments e.g. turn off TVs and loud music, limit non-mealtime related conversations or activities, so that residents can concentrate on their meals.
Be aware of residents who are at higher risk of choking. This includes residents who have poor positioning, those who eat alone in their rooms, and residents who are impulsive when they eat – i.e. they eat quickly, put a lot of food in their mouth at once and/or who refill their mouth before clearing the previous mouthful.
Ensure that the resident is receiving the correct diet texture that has been prescribed for them. All food must meet IDDSI (International Dysphagia Diet Standardisation Initiative) requirements, which specify how soft the food needs to be and how big the food particles are. If a resident is given food that is harder or larger than what they have been prescribed, then they are at an increased risk of choking on that food.
Provide assistance and/or supervision to residents with their meals if this has been recommended for them. This means that any difficulties can swiftly be addressed if they arise.
If you’ve observed a resident having difficulties when eating / drinking, such as coughing, throat clearing, a wet / gurgly voice or shortness of breath, they would benefit from being assessed by a Speech Pathologist who can make specific recommendations.
If a resident is choking the most important thing to do is to stay calm. Firstly, make sure the resident is actually choking as per the description above. If they are, encourage them to cough if they can. Sometimes there will be enough air in the lungs to expel the object obstructing the airway.
If this doesn’t clear the obstruction, provide first aid as per St John’s Ambulance (2022):
Cartwright, A., Bugeja, L., & Ibrahim, J.E. (2021). Injury prevention among young people in nursing homes: Recommendations following expert consultation forums. International Journal of Older People Nursing, 16(2): 1-11. https://doi.org/10.1111/opn.12358
Ibrahim, J.E., Bugeja, l, Willoughby, M., Bevan, M., Kipsaina, C., Young, C., Pham, T., Ranson., D.L. (2017). Premature deaths of nursing home residents: an epidemiological analysis. The Medical Journal of Australia, 206(10): 442-447. https://doi.org/10.5694/mja16.00873
St John Ambulance Australia. (2022). First Aid Fact Sheet: Choking adult or child (over 1 year). https://stjohn.org.au/assets/uploads/fact%20sheets/english/Fact%20sheets_choking%20adult.pdf
