Choking presents a serious risk for older adults, often becoming the fourth leading cause of accidental death in this population. Physiological changes accompanying aging, such as reduced muscle strength in the throat and diminished swallowing reflexes, contribute to this increased vulnerability. Standard emergency protocols require careful adjustment for elderly individuals due to factors like bone fragility, the presence of dentures, or underlying health conditions. Understanding the signs of obstruction and the modified physical interventions is paramount for providing immediate, effective aid.
Identifying Choking and Initiating Emergency Response
Recognizing the signs of a blocked airway is the first step in a life-saving response. A person with a partial obstruction can still move air, often indicated by a loud, forceful cough or the ability to speak. If the person is coughing effectively, encourage them to continue, as their own body is attempting to clear the object.
A complete obstruction is far more serious, marked by the inability to speak, cough, or breathe, sometimes accompanied by the universal sign of distress—clutching the throat. If a bystander is present, immediately delegate them to call 911 or the local emergency number while you begin physical aid. If you are alone, initiate the physical steps first, then call for help yourself as soon as possible.
Emergency Steps for a Conscious Elderly Person
For a conscious elderly person with a completely obstructed airway, the protocol involves alternating between five back blows and five abdominal thrusts. To administer back blows, stand slightly behind the person, supporting their chest with one arm. Bend the person forward at the waist so their upper airway is parallel to the ground, allowing gravity to assist in dislodging the object.
Use the heel of your free hand to deliver five distinct, firm blows between the shoulder blades. Ensure the force is directed to clear the airway without causing undue trauma. If the obstruction is not cleared, transition immediately to abdominal thrusts (the Heimlich maneuver).
Wrap your arms around the person’s waist from behind, placing a clenched fist just above the navel and below the breastbone. Grasp your fist with your other hand, then deliver five quick, inward and upward thrusts. Moderate the force used, as excessive pressure can lead to fractured ribs or internal organ injury, risks greater in a frail older person.
If abdominal thrusts are not possible (due to wheelchair use, obesity, or medical contraindications), perform chest thrusts instead. Position your hands on the center of the breastbone, similar to CPR, and deliver five quick thrusts inward. Continue alternating the five back blows and five abdominal or chest thrusts until the object is dislodged or the person loses consciousness.
What to Do If the Person Becomes Unconscious
If the person becomes unresponsive during the choking attempt, the rescue protocol changes. Carefully lower the person to the floor, ensuring they are lying flat on their back. The priority now shifts to initiating cardiopulmonary resuscitation (CPR).
Begin chest compressions immediately, performing 30 compressions in the center of the chest. After the compressions, open the person’s mouth and look for the foreign object. Only attempt to remove the object with a finger sweep if you can clearly see it; blind finger sweeps can push the obstruction deeper into the airway.
If the object is not visible, attempt two rescue breaths. If the chest does not rise, the airway remains blocked. Continuous compressions are prioritized over rescue breaths if the object remains lodged, as they maintain some oxygen circulation to the brain.
Repeat the cycle of 30 compressions, checking the mouth for a visible object, and attempting two rescue breaths continuously. Do not stop until emergency services arrive, the person begins to breathe on their own, or you are physically unable to continue. Even if the object is successfully removed, the individual requires immediate medical evaluation to check for potential injuries or complications from lack of oxygen.
Reducing the Risk of Choking
Preventative measures focus on mitigating common risk factors like dysphagia, poor dentition, and neurological conditions that impair swallowing. Modifying food texture and consistency is an effective strategy. Foods that are crumbly, stringy, or extremely dry should be avoided, and liquids may need to be thickened with commercial agents to reduce the speed at which they are swallowed.
During mealtimes, ensure the person is seated fully upright, ideally at a 90-degree angle, and remains in this position for about 30 minutes after eating. Encourage small bites and thorough chewing. Avoid talking or laughing while food is in the mouth, as this can misdirect the food toward the windpipe. Checking that dentures fit correctly or addressing missing teeth can significantly improve chewing efficiency. If swallowing difficulties are suspected, a consultation with a speech-language pathologist can provide tailored exercises and diet recommendations.