What is the most common cause of choking in adults is CNA? A Comprehensive Guide for Patient Safety

According to the National Safety Council, choking is a leading cause of unintentional injury death, with rates rising rapidly after age 71. This article explores what is the most common cause of choking in adults is CNA, focusing on the critical role of Certified Nursing Assistants in preventing and responding to this serious risk.

Quick Summary

A large, poorly chewed piece of food is the most common cause of choking in adults, exacerbated by conditions like dysphagia common in the elderly. CNAs are vital in supervising meals, identifying risk factors, and responding appropriately to prevent these incidents.

Key Points

• Food is the primary cause: The most common cause of choking in adults is food, particularly large pieces that are not chewed adequately.

• Elderly are at higher risk: Older adults face an elevated choking risk due to weakened swallowing muscles, poor dental health, dry mouth, and certain neurological conditions.

• CNA's role is preventive: CNAs are responsible for supervising residents during meals, ensuring correct posture, and providing appropriate food textures to prevent choking.

• Immediate action is necessary: In a choking emergency, CNAs must act swiftly by performing back blows and abdominal thrusts, and calling for medical help.

• Dysphagia management is critical: Many patients have dysphagia, or difficulty swallowing, which requires strict adherence to modified food and liquid diets.

• Vigilance is key: Constant monitoring during mealtime, managing distractions, and reporting concerns are crucial CNA duties for patient safety.

Understanding the Primary Cause of Choking

Food is overwhelmingly the most common cause of choking incidents in adults. Blockage typically occurs when a large piece of food is swallowed without being adequately chewed. Certain food items are more hazardous than others, including large chunks of meat, hard candy, whole grapes, nuts, and dry, sticky foods like peanut butter. Beyond the food itself, several behavioral and physiological factors can contribute to the risk:

• Eating too quickly: Rushing through a meal leaves less time for thorough chewing.
• Talking or laughing while eating: This can cause food to be accidentally inhaled into the airway.
• Alcohol consumption: Alcohol is a depressant that can relax the muscles and depress the gag reflex, interfering with normal swallowing mechanisms.
• Distractions: Lack of focus during meals can lead to improper eating habits.

Factors That Increase Choking Risk in Older Adults

While choking can affect anyone, older adults face a significantly higher risk due to a number of age-related changes and health conditions. CNAs must be particularly vigilant with this population.

Physiological Changes

As individuals age, natural changes can compromise the swallowing process (dysphagia). These include:

• Weakened muscles: The muscles in the throat and esophagus can weaken with age, making it harder to move food properly toward the stomach.
• Reduced saliva production: A dry mouth makes it more difficult to chew and form a food bolus that is easy to swallow.
• Poorly fitting dentures: Loose or ill-fitting dental appliances can affect a person's ability to chew food effectively.

Related Medical Conditions

Certain medical conditions common in seniors also increase the risk of choking:

• Neurological disorders: Conditions like stroke, Parkinson's disease, and advanced dementia can affect the nerves and muscles responsible for swallowing.
• Side effects of medication: Some medications can cause dry mouth or drowsiness, increasing the risk during mealtimes.

The Critical Role of the CNA in Choking Prevention

The CNA's role is instrumental in ensuring patient safety and preventing choking incidents in a healthcare setting. Their responsibilities go beyond just serving meals.

1. Supervise during meals: Never leave high-risk residents unattended while they are eating. Maintain a calm, focused environment to minimize distractions.
2. Ensure proper positioning: Make sure residents are seated upright in a chair or bed at a 90-degree angle during and for at least 30 minutes after meals to assist with swallowing.
3. Encourage small bites and thorough chewing: Remind residents to take small bites and chew their food completely before swallowing.
4. Offer the right food consistency: Adhere strictly to the care plan's dietary recommendations, including thickened liquids or pureed foods for those with swallowing difficulties.
5. Use adaptive tools: Provide straws or special cutlery as needed, as some swallowing difficulties are helped by specific techniques.
6. Report any eating difficulties: Promptly report any issues like coughing, gagging, or pocketing food in the cheeks to the nurse for further assessment.

Emergency Response: What to Do When Choking Occurs

When choking occurs, a CNA's quick and correct response is crucial. Training in emergency procedures is a fundamental part of the job.

• Recognize the signs: A person who is choking may clutch their throat (the universal sign), cough silently, or be unable to speak or breathe.
• If the person can cough: Encourage them to keep coughing forcefully to try and dislodge the object themselves.
• If the person cannot cough, speak, or breathe: Call for help immediately, or have someone else call 911.
• Perform back blows: Give five firm back blows between the shoulder blades with the heel of your hand.
• Perform abdominal thrusts: If back blows are unsuccessful, perform five abdominal thrusts (the Heimlich maneuver). Repeat the cycles of five back blows and five abdominal thrusts until the object is expelled or the person loses consciousness.
• If unconscious: Begin CPR chest compressions to help dislodge the obstruction and move the person to a hard, flat surface.

Recognizing and Managing Dysphagia

Dysphagia, or difficulty swallowing, is a medical condition that requires careful management and is a significant risk factor for choking. A CNA's ability to recognize the signs and follow prescribed care plans is essential.

Feature	Regular Diet	Modified Dysphagia Diet
Food Texture	Varied textures, including hard or chewy items.	Uniform, soft textures such as pureed, ground, or mechanically soft.
Liquid Thickness	Thin liquids like water and juice.	Thickened liquids (nectar-like or honey-like consistency) to prevent aspiration.
Preparation	No special preparation required.	Foods are chopped, ground, or pureed to eliminate lumps.
Risk Level	Higher risk for individuals with swallowing problems.	Significantly lower risk when properly implemented.

It is vital that CNAs adhere to the meal plans prescribed by speech-language pathologists (SLPs) and dietitians, who have assessed the resident's swallowing ability. For comprehensive guidance on safe eating habits, the Canadian Red Cross offers valuable resources.

Conclusion

While a large piece of improperly chewed food is the most common cause of choking in adults, the risk is often compounded by age-related changes and medical conditions. Certified Nursing Assistants are on the front line of defense, with a duty to supervise meals, ensure proper eating techniques and posture, and be ready to provide immediate emergency care. Through constant vigilance and adherence to a resident's care plan, CNAs play an indispensable role in safeguarding patient well-being and preventing fatal choking incidents.

Frequently Asked Questions

What is the most common cause of choking in adults is CNA?

The most common cause of choking in adults is large pieces of food that have been improperly chewed. The CNA's role involves implementing preventative measures and responding to emergencies to mitigate this risk.

Why are CNAs so important in preventing choking?

CNAs are crucial in preventing choking because they are often directly assisting residents with meals. Their responsibilities include supervising mealtime, ensuring proper resident positioning, and monitoring for signs of difficulty swallowing.

What is dysphagia and how does it relate to choking in adults?

Dysphagia is the medical term for difficulty swallowing and is a major risk factor for choking in adults. It can be caused by weakened muscles, neurological disorders, or other conditions, making it harder for a person to safely consume food and liquids.

What foods are considered high risk for choking in seniors?

High-risk foods for seniors include hard candies, large chunks of meat, hot dogs, popcorn, nuts, and dry or sticky foods like peanut butter. CNAs should prepare these carefully or avoid them based on the care plan.

What should a CNA do if a resident starts choking?

If a resident is choking, the CNA should first determine if they can cough or breathe. If not, they must call for help, perform cycles of back blows and abdominal thrusts, and begin CPR if the person loses consciousness.

How can a CNA adapt a meal for a patient with dysphagia?

For a patient with dysphagia, a CNA should adhere to the prescribed diet by providing foods with a modified, soft texture, such as pureed or ground options, and using thickening agents for liquids to make them easier to swallow.

Does eating posture affect choking risk?

Yes, proper eating posture is critical. CNAs should ensure residents are sitting fully upright during and for a period after meals to reduce the risk of aspiration and choking.

What if a resident has dentures? Does that affect choking risk?

Ill-fitting dentures can significantly increase choking risk by impairing proper chewing. CNAs should ensure dentures are securely in place or consult with a nurse if issues arise.