Choking: the second highest cause of preventable death in aged care


By Australian Hospital + Healthcare Bulletin Staff
Tuesday, 13 December, 2016


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Surprisingly, bread and toast require the same number of ‘chews’ as raw apple, nuts and steak. Those who aren’t able to chew toast sufficiently are at a high risk of choking.

Bernadette Dutton, principal speech pathologist at Loqui Speech Pathology, surveyed health professionals at a Primary Health Network (PHN) Aged Care Forum and alarmingly, 40% of those surveyed incorrectly believed that toast was suitable for those on a ‘soft’ food texture diet1.

The flow-on implications for residents living in residential aged-care facilities are potentially dangerous. When we acknowledge that choking is the second highest cause of preventable death in residents living in aged-care facilities2, the survey results present an alarming figure.

Why do bread and toast have a high choking risk? “From a food texture point of view, bread and toast are fibrous, generally dry with a low moisture content and importantly, can’t be cut with the edge of a fork, which is what is required for a ‘soft’ food texture diet,” said Dutton. “Eating toast requires good oral strength and control to chew and swallow. Without this, a person is at increased risk of choking. In addition to assessing communication ability, a speech pathologist is trained in assessing a person’s swallow ability and whether someone is at increased risk of choking,” she said.

Of course, there are exceptions to every rule. Following an individualised swallowing assessment, a speech pathologist may include toast in his or her recommendations, though they still need to be assessed by the speech pathologist to ensure safety. Adequate teeth and/or well-fitted dentures are also required to chew bread and toast safely.

Aged-care facilities that do not follow the Australian Modified Foods and Fluids Standards are putting residents at risk if they provide toast to residents with a prescribed modified texture diet (including soft, minced and moist or smooth puree) without prior speech pathologist approval.

Death as a result of choking is preventable. Choking risk is reduced when residents are correctly assessed, prescribed and provided with their optimal diet, and staff and family are educated on swallowing disorders and safe swallowing strategies. Informed consent, clear communication regarding recommendations, thorough documentation, consideration of residents’ informed choice and quality of life are all paramount when speech pathologists are managing residents in aged-care facilities.

1. Brisbane North Primary Health Aged Care Forum, 24 September 2015. 67 respondents.

2. Ibrahim et al (2015), Nature and Extent of External-Cause Deaths of Nursing Home Residents in Victoria, Australia. Journal of the American Geriatrics Society.

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