First Aid Certificate Training and Courses

Choking risks with Elderly

Common causes of choking with elderly?

Weak muscles and other physical issues make choking a very real danger for the elderly, but there are steps that can mitigate that risk, like diet choices and cutting food into small bites. Failure to take these steps in nursing homes threatens the safety of its residents and constitutes negligence.

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
  • Drooling
  • Frequent heartburn
  • Inability to swallow
  • Pain while swallowing
  • Regurgitation
  • 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.


(Airway Obstruction from a Foreign Object)

Choking caused from a Foreign Body Airway Obstruction can be a partial or complete blockage of the breathing tubes to the lungs. It is a life-threatening condition that must be treated immediately. If the obstruction is partial the casualty will have an effective cough or crying in young children, and if the obstruction is causing a complete blockage the casualty will have an ineffective cough and be making no sounds.


Common causes of choking include:

Fish or chicken bones.

Food that has not been chewed properly.

Any small objects that children can put into their mouths.

Vomit, especially in the unconscious casualty.

Partial Obstruction with Effective Cough

Difficulty breathing.

Some escape of air can be felt from the mouth.

Persistent cough.

Wheezing or noisy breathing (stridor).

Blue colour to skin and lips.


Children and infants may have flaring of the nostrils.

Children and infants may have in-drawing of the tissues above the sternum and in between the ribs.

Follow the DRSABCD emergency action plan

Encourage the casualty to keep coughing.

If the obstruction does not clear call 000 for an ambulance.

Reassure casualty and continue to give encouragement to cough.

DO NOT slap the casualty on the back.

DO NOT reach into the casualty’s mouth to dislodge the object; this may force the object further down the casualty’s throat.

If the casualty’s condition does not improve, treat as for a complete obstruction.

Complete Obstruction with Ineffective Cough

Unable to breath, speak or cough.

Blue colour to skin and lips.

Holding of the throat (universal choking sign).

Agitated and distressed.

No breath sounds and no escape of air from nose and/or mouth.

Rapid loss of consciousness.

Conscious Casualty

Follow the DRSABCD emergency action plan.

Call 000 for an ambulance .

Stand slightly behind the casualty and to the side.

Support the chest with one hand and lean the casualty forward.

Give up to five sharp back blows with the heel of one hand in the middle of the back between the shoulder blades.

If the casualty is an infant place in a head downwards position prior to delivering back blows i.e. across your lap.

Check the casualty’s mouth after each back blow to see if the obstruction has been relieved.

If the obstruction is still not relieved, continue alternating five back blows with five chest thrusts until the ambulance arrives.







Unconscious Casualty

Follow the DRSABCD emergency action plan.

The finger sweep can be used in the unconscious casualty with an obstructed airway if solid material is visible in the airway.

Call 000 for an ambulance – Call First and Call Fast.

Commence CPR.


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