What to do when a senior is choking? A step-by-step emergency guide

According to the National Institute of Health, older adults are at a higher risk of choking due to factors like dysphagia. Knowing what to do when a senior is choking is a critical, life-saving skill for anyone providing care or living with an elderly loved one.

Quick Summary

Immediate action is crucial during a choking incident involving an older adult. This involves recognizing the signs, applying modified back blows and abdominal thrusts, or performing chest thrusts for immobile individuals, and calling for emergency medical help promptly.

Key Points

• Act Quickly: Time is critical in a choking emergency. Recognize signs like inability to breathe or speak immediately.

• Adapt the Heimlich: For frail or wheelchair-bound seniors, use modified abdominal thrusts or switch to chest thrusts.

• Know When to Call 911: If the senior cannot cough effectively or becomes unresponsive, call emergency services immediately.

• Focus on Prevention: Adjust diet, encourage slow eating, and ensure an upright posture to reduce choking risks.

• Be Prepared for Unresponsive Scenarios: If the senior becomes unconscious, start CPR after calling 911, as chest compressions can dislodge the object.

Understanding the Risk: Why Seniors Are More Vulnerable to Choking

Older adults face a heightened risk of choking for several reasons, including age-related changes to their swallowing muscles and dentition, as well as the effects of certain medications or neurological conditions. Conditions like dysphagia (difficulty swallowing), Alzheimer's, or Parkinson's can significantly impair the ability to chew and swallow safely. Recognizing these risks is the first step toward prevention and preparedness.

Recognizing the Signs of Choking

The signs of choking in a senior can vary depending on whether the blockage is partial or complete. A partial obstruction may allow some air to pass, resulting in coughing or noisy breathing, while a complete blockage is a true emergency.

Signs of a Mild (Partial) Obstruction

• Can speak, cough, or breathe, though with difficulty.
• May be wheezing or making a high-pitched sound.
• Face may look red.

Signs of a Severe (Complete) Obstruction

• Inability to speak, cry, or make any noise.
• Inability to cough forcefully.
• Clutching the throat with one or both hands (the universal sign for choking).
• Skin, lips, and nails turning blue or dusky (cyanosis).
• A panicked or confused facial expression.

Step-by-Step First Aid for a Conscious Senior

If the senior is conscious and can cough, encourage them to do so. If they cannot cough forcefully or speak, immediate intervention is necessary. Call 911 or your local emergency number immediately or have someone else do it while you begin first aid.

1. Perform Back Blows: Stand or kneel behind the person and wrap your arms around their chest. Position one hand on their chest for support, then deliver up to five separate, firm blows between their shoulder blades with the heel of your other hand.

2. Perform Abdominal Thrusts (Heimlich Maneuver): If back blows do not dislodge the object, proceed with abdominal thrusts. Stand behind the person and wrap your arms around their waist. Make a fist with one hand and place it just above their navel. Grasp your fist with your other hand. Deliver quick, inward, and upward thrusts to dislodge the object. Continue alternating between five back blows and five abdominal thrusts until the object is expelled or the person becomes unresponsive.

3. Adapt for Specific Needs: For seniors who are in a wheelchair or have mobility issues, kneel behind them and administer back blows. For abdominal thrusts, position your fist slightly higher, between the navel and breastbone, but take care not to press directly on the ribs to avoid injury.

First Aid for an Unconscious Senior

If the senior becomes unresponsive, the protocol shifts to preparing for CPR.

1. Lay Them Down: Gently and carefully lay the person on their back on a firm, flat surface.

2. Call for Emergency Help: If not already done, call 911 immediately. If alone, do this now before beginning CPR.

3. Check the Mouth: Open the senior's mouth and look for the obstructing object. If you can see it and it is loose, attempt to remove it carefully with your fingers. Do not perform a blind finger sweep, as this can push the object further down.

4. Begin CPR: If the airway is still blocked and the person is not breathing, start CPR. Chest compressions may help dislodge the object. Perform 30 chest compressions, followed by checking the mouth again, and then attempt two rescue breaths. Continue cycles until help arrives or the person starts breathing on their own.

Comparison of Choking Rescue Techniques

Technique	Application	Target Area	Consideration for Seniors
Back Blows	Used for both conscious and unconscious choking victims.	Between the shoulder blades.	Often the first step; effective and less forceful than abdominal thrusts.
Abdominal Thrusts (Heimlich)	Used for conscious choking victims who cannot cough effectively.	Above the navel, below the breastbone.	Apply with moderate force to avoid internal injury; adapt for wheelchair-bound individuals.
Chest Thrusts	Used for pregnant individuals, obese individuals, or if abdominal thrusts are not possible.	On the breastbone, similar to CPR.	A safer alternative for seniors with frail bones or underlying conditions like osteoporosis.
CPR	For unresponsive victims when the airway remains blocked.	Chest compressions on the breastbone.	Essential for unresponsive choking; may help dislodge the object.

Reducing the Risk of Choking in Seniors

Prevention is always the best strategy. Caregivers and seniors can take several proactive steps to minimize the risk of a choking incident.

• Modify Diet and Food Texture: Serve food that is soft, easy to chew, and finely chopped. Avoid foods that are sticky, very dry, or hard to chew, such as nuts, hard candy, or steak.
• Ensure Proper Hydration: Drinking plenty of water during and after meals can help with swallowing.
• Encourage Slow Eating: Remind the senior to take small bites, chew food thoroughly, and not to talk while chewing.
• Maintain an Upright Position: Ensure the senior eats while sitting upright, and remains in that position for at least 30 minutes after eating.
• Address Swallowing Issues: Consult with a doctor or speech-language pathologist if dysphagia is suspected. They can offer specialized exercises and strategies.
• Address Oral Health: Ensure dentures fit properly and that oral health is maintained, as poor dental hygiene can impact chewing efficiency.

Conclusion: Preparedness Saves Lives

Learning what to do when a senior is choking is a responsibility that all caregivers and family members should take seriously. By understanding the risk factors, recognizing the signs, and being prepared to administer the appropriate first aid, you can act confidently and effectively during a crisis. These skills, combined with simple preventive measures, can make a profound difference in the safety and well-being of an older adult. For more detailed instructions on first aid techniques, consult reputable organizations like the American Red Cross and their comprehensive guidelines here.

Frequently Asked Questions

What is the universal sign for choking?

The universal sign for choking is when a person clutches their throat with one or both hands, indicating they cannot breathe. They may also be unable to speak, cough, or make noise.

Is the Heimlich maneuver safe for older adults?

Yes, but it may need to be modified. Due to potential osteoporosis or frailty, it's crucial to use moderate force and consider chest thrusts as a gentler alternative for individuals with fragile bones.

What if the senior is in a wheelchair when choking?

If the senior is in a wheelchair, stand behind them and administer back blows. For abdominal thrusts, position your hands higher on their abdomen to avoid pressure on their chest or ribs.

Should I try to remove the object with my fingers?

Only if the person is unconscious and you can clearly see the object and it is loose. Never perform a blind finger sweep, as it can push the obstruction further into the airway.

What are some high-risk foods for seniors?

High-risk foods include nuts, hard candy, raw vegetables, large pieces of meat, sticky foods like peanut butter, and tough-to-chew items. A diet of soft, moist, and chopped foods is often safer.

What is dysphagia and how is it related to choking?

Dysphagia is the medical term for difficulty swallowing. It is a major risk factor for choking in older adults, as it can be caused by conditions like stroke, dementia, and nerve damage, which weaken the swallowing muscles.

When should I start CPR during a choking incident?

Begin CPR only if the senior becomes unresponsive after attempting back blows and abdominal thrusts. Chest compressions in CPR may help dislodge the object while also providing life support.