Nursing Home Residents and Choking Risk
Failing eyesight, poor balance, and loss of hearing are commonly recognized symptoms of aging. However, an often-overlooked side effect of growing older is difficulty swallowing, called dysphagia.
As the body grows older, loss of muscle strength in the throat and mouth make it increasingly difficult to swallow hard or dry foods.
Other physical issues that can lead to choking include:
- Degenerative diseases like Parkinson’s
- Dry mouth (either from aging or certain medications)
- The aftermath of a stroke
- Trouble chewing with dentures
“Choking is the fourth most common cause of unintentional injury death. Of the 5,051 people who died from choking in 2015, 56% were older than 74.” – National Safety Council
The most obvious risk of choking is death. Irreversible brain damage caused by a lack of oxygen to the brain sets in around 3-4 minutes, and death is not far behind after that.
Even when the immediate danger passes, choking can cause other problems.
Aspiration pneumonia, for instance, is caused when bits of food are inhaled and infect the lungs. Healthy adults can often cough out these foreign objects, but bodies weakened by age or disease cannot dislodge them.
A physician should establish strict food guidelines and dietary restrictions when a new nursing home resident arrives. This guards not only against allergic reactions but choking hazards.
Failing to closely follow these guidelines, either through impatience, neglect, or ignorance, opens serious choking hazards.
While there are many caring, compassionate nurses providing for the elderly, there are also abusive situations. A momentary flash of anger can have permanent consequences.
Causes of Choking Among Nursing Home Residents
Swallowing is a reflexive motion that requires a perfectly coordinated muscle performance. That balance is disrupted when disease and age weaken the throat and esophagus.
Difficulty swallowing, called dysphagia, can affect all ages, but it’s more common in aging adults.
Some of the signs and symptoms of dysphagia include:
- A hoarse voice
- Coughing or gagging when swallowing
- Cutting food into small pieces to help with swallowing
- Frequent heartburn
- Inability to swallow
- Pain while swallowing
- The sensation of food stuck in your throat or chest
All of these symptoms could be the side effects of disease and illness. A stroke that twists the mouth or loss of control from amyotrophic lateral sclerosis (ALS) directly impact the ability to chew and swallow.
Indirectly, radiation therapy from cancer can scar the esophagus, or medications that cause dry mouth can affect swallowing.
Diseases of the mind like dementia and Alzheimer’s can also lead to choking. Residents left unsupervised can fail to properly chew their food or cut it into small enough bits. Even with someone by their side, an untrained or inexperienced staff member can hurt instead of help their resident.
Slow chewing, other residents’ needs, or overworked staff are also factors that can lead to a fatal distraction.
Nursing home abuse is also a tragic reality.
Some of the reasons for abuse include:
- Lack of training and experience
- Poor supervision and accountability
- Staffing shortages
- Underpaid staff
Signs and Symptoms of Choking
Choking occurs when food travels into the windpipe instead of the esophagus and becomes stuck. This blocks airflow and immediately starts a countdown toward brain damage and death.
Signs of choking include:
- A panicked look on the face
- Coughing or gagging
- Hand signals like pointing at the throat
- Inability to speak
- Loss of consciousness
- Turning blue around the face, lips, and fingernails as oxygen depletes
Vulnerable populations like the elderly may struggle to communicate they are choking, especially if they become easily confused or are weak.
It is critical that action is immediately taken when choking starts because permanent brain damage and death can occur within just minutes.
Complications from Choking
The most serious risk of choking is death, but failure to act rapidly carries its own dangers.
Brain cells begin to die within five minutes without oxygen and continue to deteriorate until the point of death. Areas of the brain that suffer most are those that govern balance and movement and memory.
Rapid inhalation or poor swallowing habits can also result in food in the lungs. This leads to infection and pneumonia.
Nursing home residents who know they cannot properly chew or have experienced a choking scare may struggle to eat.
In instances of abuse, residents will show physical signs like bruising and cuts. They will also be nervous, irritable, and distrustful. In severe cases, these symptoms are aggravated through post-traumatic stress disorder (PTSD).
Choking Prevention and Treatment
A person’s physical state increases their risk of choking, but steps can be taken to minimize risk.
These steps include:
- Adding prescribed thickening agents to drinks, either gum-based or starch-based, to increase density and make swallowing easier
- Carefully tracking the foods a resident is served
- Making food easier to swallow through puree or julienne cutting
- Monitoring how fast a resident is eating
- Supervising residents during meal times
Here are the steps you should take if someone does begin to choke:
- The Heimlich maneuver involves five quick thrusts into the abdomen just above the navel. Some experts recommend five strong blows between the shoulder blades as well.
- If food does not become dislodged and the person stops breathing, cardiopulmonary resuscitation (CPR) is necessary. Begin chest compressions and breaths.
- Call 911 for professional help as soon as someone cannot breathe. A partial obstruction can quickly become a full blockage.
Steps for Family Members
It takes a lot of trust to leave a resident at a nursing home. While there are many wonderful, compassionate care facilities, it’s critical to be diligent and aware of signs of abuse.
Here are some steps to keep your loved one safe:
- Follow-up on your loved one’s health care needs, including prescriptions.
- Keep staff aware of special dietary restrictions, either for allergic reasons or choking hazards.
- Note any changes in behavior (more scared or irritated than usual) and monitor suspicious bruises or cuts.
If you suspect abuse or neglect, or if a loved one has been already been injured, there are legal options to take.
Legal Options for Choking Victims in Nursing Homes
Choking is the fourth-highest cause of death in the U.S., and the elderly are particularly susceptible to this.
You should feel confident about your choice of care for a loved one, and abuse of that trust is unacceptable.
If a loved one has died from choking or is living with the long-term effects like brain damage, you may be eligible for compensation. Legal compensation can cover medical expenses and provide justice for the wrongs suffered by a negligent nursing home.