Have you ever choked on your food? It can be a terrible a feeling – the moment of realisation that you can’t breath. It’s a moment where your life flashes before your eyes.

Choking is a particular problem in aged care. After falls, it is the second most-common cause of death in nursing homes.

What causes choking?

For older people as they age their swallowing function can deteriorate along with their teeth often weak or absent. The mucosal surfaces in the mouth and throat are less moist. There is a loss of muscle strength in the mouth and throat that slows swallowing and makes it difficult to swallow hard or dry solid foods.

  • Eating or drinking too quickly
  • Swallowing food before it is properly chewed
  • Swallowing small bones or small objects
  • Inhaling small objects

The Federal Government’s Australian Aged Care Quality Agency says any object smaller than a table-tennis ball can be a choking hazard.

Why is choking common in aged care?

Two-thirds of aged care residents – 67% – suffer from ‘dysphagia’, which means ‘swallowing problem’.

That’s a significant number – in a dining room of sixty resident, a total of forty will have dysphagia. Dysphagia can affect healthy people, but it can also be the result of a stroke, head and neck cancer, dementia, and Parkinson’s disease.

Not surprisingly, failure to properly manage dysphagia can be fatal. People with dysphagia can choke, become malnourished or dehydrated, or get pneumonia.

How can you tell if someone has dysphagia?

Speech pathologists are able to diagnose dysphagia. In rural and remote areas, where a speech pathologist may not be available, nurses can diagnose dysphagia.

They will look for:

  • Coughing during or after eating or drinking
  • Taking a long time to eat their meals
  • Leaving meals incomplete
  • Spitting out food
  • Drooling
  • Saying they feel full quickly
  • There is a ‘wetness’ in their vocal tones
  • They have recurrent chest infections and temperature spikes
  • They keep food in their mouths
  • Refuse food and fluids
  • Weight loss

How can dysphagia be managed?

Once a speech pathologist has made a diagnosis of dysphagia, the person’s meals must be adjusted immediately.

The speech pathologist will recommend a ‘texture-modified diet’ that will reduce the risk of choking.

A dietitian can help the resident and the facility develop a diet that ensures the resident is receiving adequate nutrients and fluids that meet the speech pathologist’s texture requirements.

Aged care facilities should regularly screen residents for dysphagia, and train staff to recognise signs of the condition.

Common food choking hazards

Foods that present a choking hazard include:

  • Sweets
  • Raw peas
  • Meat, including chicken and fish
  • Nuts
  • Raw carrot
  • Raw apple
  • Fruit pips and stones

Read Monash University’s recommendations for preventing injury-related deaths in aged care, including managing the risk of choking.

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