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Effectively managing the risk of choking

by Lisa Carr

This short piece about choking in the adult care sector should take the average person around 3 minutes to read. If you are the average person and were to attempt to hold your breath for the entire 3 minutes – it probably wouldn’t make for the most comfortable experience, so I suggest you don’t try.

If you were to ignore my advice, as you reached the last word you would most likely show symptoms of cyanosis as your skin and lips turned blue. Shortly afterwards, if not already, you would probably start to lose consciousness as you brain became starved of oxygen.

As an average person you may frantically wave your arms about, desperately pointing at your throat and inviting people to hit you hard on the back. Anyone who has themselves experienced a severe choking incident will know only too well how frightening the experience is.

Supporting vulnerable adults due to their age, disability and many other condition often brings with it the additional challenge of managing a high risk of choking. Data from the Office for National Statistics (ONS) shows the death rate associated with choking is significantly and associated with aging.

This increase in risk is associated with several factors including physiological changes to the body and other neurological comorbidities, which when combined are estimated to increase the risk of choking in people over the age of 65 sevenfold.

Playing a large part in the significance of these figures are conditions such as COPD, Dysphagia and others that can increase the risk of choking. In addition to this we see pica, cramming and other disorders playing a role demonstrating that age is not always a factor.

Another significant characteristic of choking is the high percentage of incidences caused by soft foods relative to large solid pieces. When compared to the younger age group this suggests where a severe choking incident occurs in the elderly population, their mortality rate is over 50%

Choking is also reported as the second highest preventable cause of death in the over 65s age group. Worth remembering that when a person begins to choke it is, to put it simply, a lack of air that is killing them. If you can remove the obstruction quickly enough you are very likely to resolve the problem.

What is often overlooked is the practicality of managing someone who is choking, particularly if they present physical challenges to delivering emergency assistance. This is unlikely to helped by the guidance for the management of choking – back blows and abdominal thrusts – which has barely changed in 60 years.

The practicalities of placing your arms around a person’s waist and hoisting them in the air at least 5 times, before returning to back blows if it proves ineffective, need to be thought through when considering care planning for those groups at higher risk.

When Dr Heimlich first started promoting is thrust technique in the 1960s, he clearly didn’t have a wheelchair using 86-year-old with Alzheimer’s in mind.

It was encouraging to see the adult care sector starting to address the problem of choking at the start of 2020 and is something I hope continues when ‘normality’ has resumed. Already we are seeing care provider writing separate policies around choking, both in terms of prevention and response whilst being open about doing so.

This is supported by the publication of a study by an NHS Trust late last year. It explored not only the issues surrounding the risks and management of choking in care homes, but also the emotional impact on care staff who experience a choking emergency.


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