What To Do When Someone Is Choking On Food – For those with chronic swallowing and choking problems, mealtime can be a source of anxiety and dread rather than a time of joy. Much of our pleasure in life comes from eating, as well as the socializing that surrounds mealtime. Having a swallowing disorder changes that; it can be very frustrating to have to think so much about what you eat, as well as living with the fear that accompanies frequent episodes of choking. Choking problems not only affect the person with the disorder, but also those around them. As family caregivers or professionals, one of the scariest things we can see is a loved one or patient choking on food, medicine, or even drinks. Choking can quickly become life-threatening and cause further complications such as esophageal tears and aspiration pneumonia (a lung infection due to a foreign body entering the lungs). It can be scary and embarrassing for the person who is choking. If your loved one lives in a shared living environment, such as assisted living or memory care, there may be ethical issues, as well as what you see in the story below.
In one of the assisted living communities where I worked as a manager, we had housing for residents with advanced care needs. Mr. Keske lived on this high needs floor and although he could walk with a walker and feed himself, he needed help in all other areas of his personal care. As part of his dementia progression, he began to lose his ability to speak, although he could respond
What To Do When Someone Is Choking On Food
Day and could nod yes or no to simple questions. Along with the ability to speak, Mr. Keske lost muscle tone in his esophagus and began choking on food. Suffocation became a daily occurrence. There came a point where he couldn’t clear his throat on his own, and the staff had to perform the Heimlich Maneuver on him from time to time. Care meetings were held with the nursing staff, our food staff, family members and we informed the doctors. He was prescribed a pureed diet by the dietitian to reduce his chances of choking.
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The new diet plan was a relief to staff who had to sit by Mr Keske at every meal to observe, train and intervene if necessary. It was a relief to Mr. Keske’s fellow residents, who were tired of their fellow boarders choking on food during their quiet mealtimes. It was a relief to the doctors and I, as we knew he was a candidate for aspiration pneumonia unless we changed his diet. Mr. Keske didn’t like his mashed food, who would? Minced meat, vegetables and lasagna are not very appealing. But it beat the other options. The person who had the hardest time with the new food preparation routine was Mr. Keske’s daughter, Julie. Julie hated seeing her father with a plate of ground food in front of him. She fought us at the behest of this new doctor, not caring about the daily Heimlich treatment that had been required or her father’s loss of dignity when he choked on his meal in front of his colleagues. Nor was she concerned about the health risks Mr. Keske’s chronic suffocation might pose.
Julie tried to put her father in the hospital and thought that would solve the problem. “My dad can eat whatever he wants because he goes to hospice!” she would tell me. But we, the nursing staff and the management team, had to sit down with Julie and explain that we didn’t want to take the risk of her father getting aspiration pneumonia, that we couldn’t continue to do the Heimlich every day, and neither U.S. we want to do something to embarrass him even more at mealtime. We had ethical concerns about his dignity and had to advocate for his fellow residents who no longer wanted to see him strangled. We also didn’t agree to sequester him in his living room, which was the girl’s second suggestion, because we didn’t have the staff to do that and couldn’t support the lack of socialization that would occur with takeaway meals alone in his apartment. (nor would it solve his swallowing problems). Finally, we made a breakthrough with Julie, whose main problem was coming to terms with her father’s declining health and developing dementia. Compassion, education and support were what Julie needed, and Mr. Keske needed the mash to stay healthy and vital. Dysphagia was a horrible side effect of Mr. Keske’s health, but when our diet team worked with him, his family, and our nursing staff, they were able to come up with many creative solutions. These personal food preparation solutions allowed Mr. Keske to eat his favorite meals, prepared in a safe and appropriate way, in the dining room with his friends. He stayed safe and happy at home and no longer had to live with the fear and embarrassment surrounding his swallowing problems.
Dysphagia is the fancy medical term for difficulty swallowing. Food, even if well chewed, can get stuck and block, or at least cause discomfort, as it passes through the esophagus or food can be accidentally inhaled into the trachea which must be located next to the esophagus (see diagram above). “It has been estimated that up to 20% of people over the age of 50, and most people up to the age of 80, have some difficulty swallowing.”¹ We all struggle from time to time to get a large bite or dried meat or bread, but chronic dysphagia can affect the elderly and cause serious health problems. Why do older people have particular difficulty with dysphagia? A reduction in neck muscle tone is one reason, but below is a comprehensive list of reasons why older people in particular are at risk.
“It has been estimated that up to 20% of people over the age of 50 and most people up to the age of 80 have some difficulty swallowing.”
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Coughing when eating dried meat is just one of the many symptoms of dysphagia. Older people often hide the fact that they have chronic problems at mealtime out of fear or embarrassment. Sometimes changes in a person’s ability to swallow happen slowly, and the older person may be so used to the problems that they don’t notice or think much about it. It is often a family or senior carer who notices that swallowing is becoming increasingly problematic.
Just because an older person is “used to” swallowing difficulties and has adapted specific eating styles to avoid choking, frequent swallowing events can increase the likelihood of further complications. It is essential that a senior officer’s health be advised as soon as a problem is noticed to avoid life-threatening situations. According to experts, aspiration pneumonia “is the leading cause of hospitalization and death in nursing home residents.”² and is one of the many problems that swallowing problems left unchecked can lead to. Below are some additional problems and risks of chronic difficulty swallowing.
There are certain foods that are especially difficult to swallow as we age. Older people will often compensate and adapt a dish that gives them trouble by adding gravy or another sauce. While this can be helpful, it’s not the answer for everyone, as most dressings and sauces are heavily salted, contain gluten, and can be high in fat, all of which may be prohibited in some prescribed diet plans. Below is a list of the most common culprits:
Steak is one of the most common foods that can cause a choking episode, especially in those with swallowing disorders.
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A doctor, registered dietitian, or speech and language therapist can help determine the exact cause of your senior’s swallowing problems. It’s best to start with your primary care physician to determine if further testing is needed and to get the necessary referral to see a specialist. The doctor will review the senior’s medical history, medication list and symptoms and then decide on the next step. If referred to a speech pathologist or therapist, an evaluation and swallowing study will likely be done. If necessary, a dental exam may also be recommended.
A senior should see their doctor right away if they develop a problem swallowing, especially if it came on suddenly.
A speech therapist or pathologist, as well as a registered dietitian, will have many suggestions to help with swallowing problems. A therapist can provide valuable guidance that will reduce the chances of choking, including providing strengthening and retraining exercises. There are adaptive devices, electrical stimulators, and other methods that can be used, as well as many dietary adjustments that can be made to make swallowing easier and safer. Special diets for severe swallowing problems, even prescribed temporarily while the muscles are retrained, include shredded or mechanical diets, pureed foods, or thickening liquids. There will also be patients
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