Posted: November 5, 2017 | Last Updated: November 19, 2017
Nursing home residents should never choke or suffocate in nursing homes. Choking and suffocation deaths in nursing home are preventable. Unfortunately, they do happen. And probably much more often than most people can imagine. Choking and suffocation continue to be leading causes of death in nursing homes.
Anyone who has trouble swallowing is at risk for choking in a nursing home. The medical term for having trouble swallowing is “dysphagia.” Many elderly and disabled people have problems swallowing.
According to Injury Facts 2017, choking is the fourth leading cause of unintentional injury death. Of the 5,051 people who died from choking in 2015, 2,848 were older than 74.
In addition to choking, difficulty swallowing can cause aspiration pneumonia (food or fluid entering the lungs), malnutrition and dehydration if not treated properly.
There is no good reason that a nursing home resident should ever die from choking. Nursing homes have a duty to provide a safe environment for their residents. This includes providing a choking-free environment and training staff to react immediately if a resident shows any signs of choking.
The nursing home must provide foods that the resident can tolerate.
The nursing home must closely monitor residents, especially residents at an increased risk of choking.
The nursing home must oversee and supervise medication intake, mealtime, and assist residents who need help eating.
Unfortunately, choking and suffocation continue to be leading causes of death in nursing homes in the United States.
There are many conditions that limit a person’s ability to swallow.Some of the most common conditions that affect swallowing include:
Dementia is caused by any one of a number of disorders that affect memory, behavior, thinking, the ability to perform activities of daily living. It is more of a category of disorders than a specific disease.
More than 5 million people in the United States are affected by some form of dementia.
In a study of 323 nursing home residents with advanced dementia observed for a period of 18 months, 86% were observed to have eating problems, including swallowing or chewing problems, refusal to eat or drink, suspected dehydration, and persistently reduced oral intake.
Alzheimer’s disease affects the memory. It is a kind of dementia. Just as people with Alzheimer’s often do not remember how to drive a car or ride a bike, they may forget how to chew altogether. Even if a resident with Alzheimer’s does remember how to chew, she may not remember what foods are safe for her to eat.
Some conditions affect the body’s ability to control nerves and muscles. These are called neurological disorders. While these can affect muscles anywhere in the body, the can also attack the muscles in the mouth, throat, and esophagus that control swallowing.
Neurological disorders such as muscular dystrophy, multiple sclerosis, and Parkinson’s disease may influence the ability to swallow.
The brain controls the body. When the brain is damaged from injury, stroke, or other cause, it can limit the body’s ability to process the need to swallow.
There are more than 50 pairs of nerves and muscles that control swallowing. As we age, these nerves and muscles often become weaker. Being elderly is a risk factor for choking.
Some types of cancer can affect swallowing. This includes cancer of a person’s mouth, throat, and esophagus. Additionally, difficulty swallowing occurs after some cancer treatments including surgery, radiation therapy, and chemotherapy.
If a nursing home resident wears dentures, they can become a choking hazard if they are not checked regularly. They should be checked regularly.
It’s important for nursing homes to be aware of subtle signs of swallowing problems.
There are three phases of swallowing. A breakdown in any one or more of them results in dysphagia.
Food is chewed, formed into a ball and moved from the mouth to the back of the throat . A person with dementia or brain injury may have trouble recognizing food in the mouth. They may also not remember how to swallow. It is also common for patients to become confused about the order of how to eat food. This results in them attempting to swallow food before chewing it. Another common problem for dementia patients is where they hold the food in their mouth without swallowing it. This is called “pocketing.”
Food is moved from the throat to the esophagus using muscles that protect the airway from being blocked with food. If the muscles are weak, food or liquid can get into the airway causing choking.
Food enters the esophagus. The esophagus tightens to “squeeze” the food down toward the stomach. Pressure from the food or liquid causes the bottom of esophagus to relax and open so food can enter the stomach. When the esophagus does not open as it should, it causes difficulty swallowing. The esophagus can tighten up and the person may spit up or vomit.
Choking happens when a piece of food or other items blocks the airway preventing the ability to breathe. The body needs oxygen to survive.
Without oxygen rich blood, the body’s tissues will begin to shut down and die within minutes.
When a person begins to choke, nursing home staff only have minutes to act. This is why it is so important to prevent choking before it occurs. However, when it does occur, nursing home staff must be prepared to recognize the signs of choking and act immediately! Without immediate action, death by choking is certain.
All of the following are choking signs and behaviors.
Not all of these signs will be present when a nursing home resident chokes. For example, a resident with dementia may not initially realize he is choking or may not have the ability to cough or gag.
When a patient enters a nursing home, the nursing home is required to assess that patient. This is needed in order to determine the kind of treatment the patient needs. The patient needs are used to create a treatment plan that is appropriate for that patient.
This assessment should take into consideration any risks the patient has for swallowing or chewing. If it cannot be determined whether the patient has risks for choking, that patient should be referred to a doctor or speech language pathologist for an assessment to determine her abilities.
The nursing home should reassess the patient periodically to look for any changes in the patient’s abilities.
It is standard for nursing home residents to receive tests to measure how well they swallow. These tests not only look for whether residents have trouble swallowing, they seek to identify what areas of the mouth and throat are affected.
Treatment for dysphagia includes may include:
It is the job of the nursing home to provide their residents with foods that are safe to eat. A nursing home must never provide a nursing home resident with foods that increase their risk of choking.
For mild swallowing problems, a nursing home may implement a plan to have the resident eat several smaller meals. This can alleviate some of the choking hazards of larger meals.
Nursing homes can also implement a “dysphagia diet.” This is a diet that prevents choking. This usually consists softened or pureed foods, such as cream-based soups and foods that are the consistency of baby food.
How do these diets help? When people choke, it is on a clump of food, called a bolus. The consistency of these foods prevent such a bolus from forming. Therefore, the resident cannot choke.
It’s not enough to assess the patient’s needs and create a treatment plan. The nursing home must make sure that the treatment plan is being communicated by the people who need to know it.
A treatment plan that says a patient needs to be monitored while eating or can only getting pureed foods does no good unless everyone at the nursing home knows about it.
A nursing home must have policies and procedures about diet and meal service. Like anything else in life, a policy and procedure does no good unless it is being followed.
A nursing home must clearly communicate the policies and procedures concerning meals and diet to its nursing and dietary staff.
A nursing home must not only communicate these policies and procedures, it must provide enough resources to (1) have enough staff to carry out the policy and (2) train its staff on how to carry out the policy.
Understaffing of nursing home personnel has been described as a patient safety crisis. Nursing home understaffing is when there are not enough nursing home staff to meet the specific needs of all the residents.
Because understaffing of nursing homes is such a critical issues for patients and families, we have devoted an entire section of our website to educating the public about the evils of understaffing here.
In order to prevent choking deaths in nursing homes, all nursing homes must make sure that they have trained their staff on choking risks factors, assessing the patient for choking risks, and responding to choking emergencies.
Without sufficient training in these areas, nursing home patients will surely die, and any nursing home manager knows this.
Does the nursing home have a protocol for managing choking emergencies? It is never acceptable for a nursing home to refuse to develop a protocol to save the lives of patients who are choking. Nursing homes know that eventually someone will have a choking event. To not have a management plan to save a choking resident’s life is nothing short of homicide.
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