Choking is a sudden, life-threatening medical emergency that demands immediate, effective intervention. This condition occurs when an object, often food, blocks the airway and prevents the victim from breathing. The elderly population faces a high risk of choking due to age-related physiological changes and underlying medical conditions. Caregivers and family members must know the specific, modified response protocols for this demographic, which necessitate a tailored approach to clear the obstruction while minimizing the risk of secondary injury.
Identifying Complete Versus Partial Obstruction
Quickly assess the severity of the airway obstruction. A partial obstruction allows some air to pass, meaning the person can still cough forcefully, speak, or make weak breathing sounds. If the person can cough, encourage them to continue doing so forcefully, as their own cough is the most effective tool to dislodge the object.
A complete obstruction requires immediate action. Signs of a complete blockage include the inability to cough, speak, or breathe, often accompanied by the universal sign of choking—hands clutched to the throat. Older adults who are frail or medically compromised may not display strong signs of distress, so an inability to produce any sound should be taken as a severe emergency requiring intervention.
Modified Abdominal Thrusts for a Conscious Elderly Person
If a conscious elderly person is completely choking, call emergency services immediately, or have a bystander do so, while you begin intervention. The standard sequence involves alternating five back blows with five abdominal thrusts until the object is expelled or the person loses consciousness. The back blows are delivered with the heel of your hand between the person’s shoulder blades, bending them forward at the waist to use gravity to help expel the object.
When performing abdominal thrusts, it is paramount to apply force with caution due to the possibility of osteoporosis, which increases the risk of rib fractures. Place your fist just above the navel and grasp it with your other hand, delivering quick, inward and upward thrusts. The force should be sufficient to dislodge the object but less aggressive than what might be used on a younger, healthier adult.
If the person is seated in a chair or wheelchair, you must first lock the wheels and then lean the person forward over their lap to facilitate the back blows. For abdominal thrusts on a seated individual, you may need to stand behind the chair, or kneel, and wrap your arms around them, ensuring they are tipped slightly forward. If the person is too frail, or if you cannot get behind them, an alternative is to perform five chest thrusts by placing your fist on the center of the breastbone, covering it with your other hand, and thrusting inward.
Managing an Unconscious Elderly Person
If the conscious person collapses or is found unconscious, carefully lower them to the floor onto a firm, flat surface. At this point, the goal shifts to Cardiopulmonary Resuscitation (CPR), as chest compressions can help dislodge the airway obstruction. Begin the CPR sequence by starting with 30 chest compressions.
After the compressions, open the person’s mouth to look for the object before attempting rescue breaths. You should only perform a finger sweep to remove the object if you can clearly see it in the mouth. Blindly sweeping the mouth is highly discouraged as it risks pushing the blockage further down the airway.
If the object is not visible or cannot be removed, attempt two rescue breaths. If the chest does not rise with the first breath, reposition the head and attempt the second breath. Whether the breaths go in or not, immediately resume chest compressions, repeating the cycle of 30 compressions, checking the mouth, and giving two breaths until emergency medical services take over.
Reducing Future Choking Risks
Proactive prevention is the most effective strategy to safeguard an elderly person from choking incidents. Older adults are at increased risk due to conditions like dysphagia, or difficulty swallowing, which is often related to stroke, Parkinson’s disease, or weakened swallowing muscles. Dry mouth, a common side effect of many medications, and poor dentition or ill-fitting dentures also impair the ability to chew food adequately.
To mitigate these risks, food preparation should focus on soft, moist textures and be cut into small, manageable pieces. Encourage the individual to eat slowly, take small bites, and avoid talking or laughing while chewing. Proper posture is also important; the person should sit fully upright during meals and remain seated for at least 30 minutes afterward to aid digestion. For individuals with known swallowing difficulties, consulting a speech-language pathologist for a swallowing assessment is a suitable step to develop a customized diet plan.