How to prevent choking in elderly

What not to serve at dinner to protect loved ones from foods that can prove dangerous.

According to the CDC's most recent data, there were 463 choking deaths related to food among people aged 65 to 85+ years old in 2006. There is a lot you can do to safeguard your loved ones and avoid this.

When you’re planning a menu for family get-togethers that will include elderly folks, consider what Ellen Krasnoff, RRT, says to avoid: steak, hot dogs, popcorn, peanut butter, and several other no-nos.

That’s because Krasnoff, an emergency care instructor and registered respiratory therapist who teaches basic, advanced and pediatric cardiac life support and cardiopulmonary resuscitation (CPR), has seen firsthand the choking hazards in common foods. Krasnoff, a 44-year veteran in the field, has personally performed the Heimlich maneuver and has performed CPR on many people.
 

Why The Elderly Face Greater Choking Risks

Krasnoff asserts that the Heimlich maneuver is a common procedure at elderly healthcare facilities. There are many reasons for this. The elderly are very dry, either from the saliva drying up due to aging or from certain medications. Krasnoff notes that the elderly very often have a hard candy in their mouth to keep the saliva going. “Without saliva, you can’t digest food,” she explains.

The trouble is, hard candy itself is a choking hazard. It's preferable for the elderly to have something that liquefies rapidly—such as a popsicle or ice cream, as recommended by their health care professional.

Another problem is that in nursing home or hospital settings, often the elderly are fed too quickly. The nurse assistants don’t realize how long it takes them to chew and swallow. In addition, the nursing home may be short-staffed. “They might have one nurse’s aide for ten patients,” says Krasnoff. In addition, medical conditions such as strokes make it difficult to swallow, or elders may not chew well because of loose teeth. Some may forgo using their dentures, so they swallow food whole and choke on it.

Choking Hazards: Be On The Alert

Common choking hazards to avoid include:

• Water. Believe it or not, the fluid is so thin that the elderly choke on it. Nursing homes use thickening agents to make water more viscous.
• Hot dogs. If you must serve them, remove the peel (it’s a choking hazard) and julienne into slim pieces.
• Steak or other big pieces of meat
• Chicken with bones
• Popcorn and pizza, especially when it’s cold. “It gets stuck in the airway and is hard to cough or Heimlich out,” Krasnoff notes. Never serve popcorn and pizza together.
• Hard candy
• Bread, especially white bread. When the elderly drink water, the bread expands. “It becomes like a big sponge, blocking the airway,” says Krasnoff.
• Cake and milk, for the reasons above.
• Crackers, rice cakes or other dry foods
• White bread and peanut butter. “It’s like glue. Add lots of jelly if you serve peanut butter,” Krasnoff advises.
• Large chunks of fruit, such as pineapple and apples.

Better Choices: Foods With Low Choking Risks

Here are some food choices that are easier to swallow:

• Fish, if it’s filleted
• Ground meat
• Soups
• Chocolate (if it gets stuck, it melts)
• Applesauce, pudding and Jello
• Lightly toasted bread with butter or jelly

Dos and Don’ts of Eating

These tips will also help reduce incidences of choking:

• Don’t drink fluids while you’re eating. People do this to make the food go down and it can lead to choking.
• Don’t talk while you eat. The epiglottis—the hinge like flap at the base of your tongue that keeps food from entering your windpipe—doesn’t know whether to open or close because it doesn’t know whether food or air is coming.
• Don’t eat lying down.
• Don’t drink alcohol while eating.
• Do learn to eat more slowly.
• Do put less on your plate so you can’t eat too much too fast. Have a second helping afterward instead.
• Do julienne the food.
• Do peel apples before serving or, better yet, serve applesauce

If someone does choke, if you have training in CPR you can help them. The American Heart Association and the American Red Cross both offer this service.

Have you ever choked on your food? It can be a terrible a feeling – the realisation you can’t take your next 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, which can be weak or even absent. The surfaces in the mouth and throat are also 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.

The following factors can increase the risk of choking:

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

Why is choking common in aged care?

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

Dysphagia can affect healthy people, but it can also be the result of a stroke, head and neck cancer, dementia, and Parkinson’s disease.

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.

Page 2

Have you ever choked on your food? It can be a terrible a feeling – the realisation you can’t take your next 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, which can be weak or even absent. The surfaces in the mouth and throat are also 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.

The following factors can increase the risk of choking:

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

Why is choking common in aged care?

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

Dysphagia can affect healthy people, but it can also be the result of a stroke, head and neck cancer, dementia, and Parkinson’s disease.

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.

Page 3

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