The death rate from choking is higher among people aged 65 or older than for any other age group. Recent data indicates that over 2,000 people aged 65 or older die each year from choking on food in the United States, and the majority of these deaths that occur in the nursing home or assisted living facilities can be attributed to human error.
Choking is usually caused by dysphagia, which is defined as difficulty or discomfort in swallowing food. It is estimated that 40% – 60% of institutionalized older adults have identifiable signs or symptoms of a swallowing disorder. This condition becomes more dangerous with advancing age due to continued wear on the esophagus. Certain neurological or nervous system disorders associated with aging also increase the likelihood of experiencing dysphagia.
Some of the conditions that can affect a person’s ability to swallow include:
- Neurological disorders such as multiple sclerosis, muscular dystrophy, and Parkinson’s disease
- Neurological damage caused by strokes, brain damage, spinal injuries or other trauma
- Alzheimer’s disease, especially in the later stages
- Certain types of cancers as well as some cancer treatments, such as radiation
- Aging causes the throat muscles to wear and increases the potential for other conditions that affect swallowing
There are two types of dysphagia: (1) esophageal dysphagia, which refers to the sensation of food sticking or getting hung up in the base of the throat or chest after swallowing; and (2) oropharyngeal dysphagia, which is a weakening of the throat muscles.
The signs and symptoms of a swallowing disorder include:
- Pain while swallowing (odynophagia)
- Inability to swallow
- The sensation of food getting stuck in the throat or chest or behind the breastbone
- Drooling
- Hoarseness
- Regurgitating food
- Frequent heartburn
- Food or stomach acid that backs up into the throat, also known as acid reflux
- Unexpected weight loss
- Coughing or gagging when swallowing
- Cutting food into smaller pieces or avoiding certain foods because of difficulty swallowing
Preventing Choking Hazards
Oral Assessment
One way nursing homes can prevent choking incidents is to perform a thorough oral assessment as part of the initial medical assessment performed upon a resident’s admission to a nursing home or assisted living facility. This examination should include assessing the condition of the gums, tongue, and teeth, including whether the resident has missing teeth or dentures. The gums and tongue should also be inspected. If a resident is not able to answer questions about their oral health history, the nursing home or assisted living facility staff should ask a family member to provide additional information.
Individualized Eating Plans
Based on this evaluation, the physician or medical practitioner will determine an eating plan that includes what foods the resident should eat and whether the food needs to be cut into small pieces or even pureed. The plan should include whether the individual needs supervision while eating or whether it is safe for them to eat alone in their rooms. This plan should cover every situation that involves eating or swallowing, including meals, snacks, liquids, and medications. These plans should be should be placed in each resident’s chart so all caregivers are familiar with each resident’s eating plan. Failure to adhere strictly to the plan could result in choking.
Once a plan is put into place, staff must carefully monitor and supervise the food intake and eating conditions of all residents. It is especially important to enforce dietary restrictions and pay careful attention when residents who are more susceptible to choking are eating.
If it is determined that a resident needs staff supervision while eating, family members should be informed, and a sign should be posted in the resident’s room to prevent visitors from bringing food that could pose a hazard.
Reassessment and Continuous Monitoring
Because illness or advancing age can affect a person’s ability to eat and swallow, it is important to reassess residents on a periodic basis or when they become ill. Staff members should receive ongoing updates about changes in the health of the residents in their care. This important aspect of care should also be an integral part of new staff training. Staff members who care for patients with ventilators and breathing tubes (endotracheal tubes) should receive specialized training on the care and cleaning of this equipment to avoid choking or oxygen deprivation, which can occur with dirty, clogged or malfunctioning machines.
Some of the factors that can contribute to the risk of choking include:
- Untrained, unqualified or insufficient nursing home staff
- Disregarding a resident’s dietary plan
- Neglecting to update a resident’s dietary plan when health changes occur
- Leaving an at-risk resident to eat without necessary supervision
- Failing to perform a thorough oral evaluation upon admission or after illness or other health changes
- Inadequate supervision in the dining room or other areas where residents consume food and beverages
If you suspect a loved one has suffered a choking injury or death as a result of negligent care in a nursing home or other facility, contact us immediately.