What do you do when an elderly person is choking? A Critical First Aid Guide

According to the National Council on Aging, choking is a leading cause of accidental death for adults over 65. Knowing what to do when an elderly person is choking is not only a vital skill but can be the single most important action you ever take in an emergency situation.

Quick Summary

When an elderly person is choking, perform a combination of five back blows and five abdominal thrusts (Heimlich maneuver) to dislodge the object. If the person becomes unconscious, begin CPR immediately and have someone call for emergency help. This process includes special considerations for older adults to ensure safety.

Key Points

• Assess the Situation: Check if the person can cough, speak, or breathe. If they can cough forcefully, encourage it; do not intervene with blows or thrusts.

• Perform the 5-and-5 Approach: For a conscious, non-coughing person, alternate five back blows and five abdominal thrusts until the object is expelled.

• Modify Technique for Special Cases: Use chest thrusts for wheelchair-bound, obese, or pregnant individuals instead of abdominal thrusts.

• Begin CPR If Unconscious: If the person becomes unresponsive, lower them to the ground, call 911, and start CPR immediately, including chest compressions.

• Prioritize Prevention: Reduce choking risk by adjusting food consistency, promoting proper eating posture, and taking small bites.

• Do Not Attempt Blind Finger Sweeps: Only attempt to remove an object from the mouth if you can clearly see it. A blind sweep can push the obstruction deeper.

Recognizing a Choking Emergency

Recognizing the signs of a choking incident in an elderly person is the crucial first step. While some signs are obvious, others can be more subtle, especially if the individual has underlying health conditions. A person who is truly choking will be unable to speak, cough, or breathe effectively, which is known as a complete airway obstruction. You might observe them clutching their throat—the universal sign for choking—or notice a panicked or distressed facial expression. As the body is deprived of oxygen, their skin, lips, and fingernail beds may turn pale or bluish. Conversely, if the person is still able to cough forcefully and speak, it is a partial obstruction. In this case, you should encourage them to keep coughing and monitor them closely, but do not intervene with back blows or abdominal thrusts yet.

The 5-and-5 First Aid Approach for a Conscious Senior

For an elderly person who is conscious but cannot clear their airway, the American Red Cross recommends the '5-and-5' approach.

Performing Five Back Blows

1. Stand slightly to the side and behind the person, placing one arm across their chest to offer support.
2. Have the person lean forward at the waist so their upper body is parallel to the ground. This position helps ensure the object is dislodged and expelled from the mouth, rather than falling deeper into the airway.
3. Use the heel of your free hand to deliver five firm, separate blows between the person's shoulder blades.

Performing Five Abdominal Thrusts (Heimlich Maneuver)

If back blows do not clear the airway, proceed with abdominal thrusts. Perform these cautiously, as an elderly person may be more fragile.

1. Stand behind the person with your arms wrapped around their waist.
2. Place one foot slightly in front of the other for better balance.
3. Position your clenched fist just above the person's navel (belly button).
4. Grasp your fist with your other hand.
5. Deliver five quick, inward and upward thrusts, as if trying to lift the person. For an elderly individual, use firm but gentle pressure to avoid injury.

Continue alternating between five back blows and five abdominal thrusts until the object is expelled or the person becomes unresponsive.

Addressing Special Cases: Wheelchairs or Obesity

Elderly individuals with physical limitations, such as those in a wheelchair or who are obese, require special adjustments to the standard procedure.

• For a person in a wheelchair: Position yourself behind them, secure the wheelchair, and give abdominal thrusts as usual. If this is difficult, or the person is too large, use chest thrusts instead.
• For a pregnant or obese person: Use chest thrusts instead of abdominal thrusts. Place your hands at the base of the breastbone, just above the joining of the lowest ribs, and deliver quick, hard thrusts.

When the Person Becomes Unconscious: The Shift to CPR

If the elderly person becomes unresponsive, it is a medical emergency requiring immediate action.

1. Lower the Person: Gently lower the person to the floor, placing them on their back with their arms at their sides.
2. Call 911: If you are alone, perform one cycle of CPR before calling emergency services. If another person is present, have them call 911 immediately while you begin care.
3. Begin CPR: Start with chest compressions. After each set of compressions, and before attempting rescue breaths, open the person's mouth and look for the object. If you see it and it is loose, try to remove it with a finger sweep. Crucially, never perform a blind finger sweep if you can't see the object, as this risks pushing the obstruction further down the airway.

Comparing First Aid Methods

Feature	5 Back Blows	5 Abdominal Thrusts (Heimlich)	Chest Thrusts	CPR Chest Compressions
Application	Responsive choking victim	Responsive choking victim	Pregnant, obese, or wheelchair-bound victim	Unconscious choking victim
Action	Firm blows with heel of hand	Quick, inward and upward thrusts	Quick, inward thrusts on chest	Firm, rhythmic compressions
Location	Between shoulder blades	Above navel, below ribs	Middle of breastbone	Center of chest
Purpose	Dislodge object from airway	Force air from lungs to expel object	Force air from lungs, used as alternative to Heimlich	Circulate blood and can dislodge object

Prevention is Key: Reducing Choking Risks in Seniors

Prevention is always the best strategy. Many factors contribute to an increased risk of choking in older adults, including weakened swallowing muscles (dysphagia), poor dentition, and medical conditions like dementia.

• Modify Food Consistency: Choose foods that are soft, moist, and easy to chew and swallow. Pureed or mechanically altered diets may be recommended by a healthcare professional.
• Practice Safe Eating Habits: Encourage the person to sit upright during meals and remain so for at least 30 minutes afterward. Ensure they take small bites, chew thoroughly, and eat slowly without distractions.
• Use Proper Swallowing Techniques: Instructing them to tuck their chin towards their chest when swallowing can help prevent food from entering the windpipe.
• Avoid Common Hazards: Be aware of common choking hazards like hard candies, large chunks of meat, or dry, crumbly foods. For individuals with swallowing difficulties, liquids may need to be thickened.

Stay Informed and Prepared

Knowing how to react in a choking emergency for an elderly person is a life-saving skill. It's important to remain calm, act quickly, and follow the proper first aid steps. In any situation, do not hesitate to call for emergency medical help. Taking a certified first aid course can provide hands-on experience and further confidence. For additional resources and training, you can visit the American Red Cross.

Conclusion: A Quick Response Saves Lives

In a moment of crisis, a calm and informed response can prevent a tragedy. Knowing what to do when an elderly person is choking involves recognizing the signs, administering the correct 5-and-5 procedure (with modifications if needed), and knowing when to escalate to CPR. Preparedness, combined with proactive preventative measures, can significantly improve the safety and well-being of the seniors in your care.

Frequently Asked Questions

What are the first signs that an elderly person is choking?

The initial signs of choking often include a panicked or surprised expression, inability to speak, and a weak or absent cough. The person may also clutch their throat, which is the universal sign for choking.

Is the Heimlich maneuver safe for an elderly person?

Yes, but with caution. Abdominal thrusts (the Heimlich maneuver) can be performed on an elderly person, but it's important to use firm but gentle pressure to avoid causing injury, as their ribs and internal organs can be more fragile.

How do you help an elderly person choking in a wheelchair?

If a person is choking while in a wheelchair, give abdominal thrusts as you would normally, kneeling behind them if necessary. If they are too large to wrap your arms around, use chest thrusts instead.

What should I do if an elderly person choking becomes unconscious?

If they lose consciousness, lower them gently to the floor. Call 911 immediately (or have someone else do it). Begin CPR, starting with chest compressions, as chest compressions can help dislodge the obstruction.

Should I try to remove the object with my fingers?

You should only attempt to remove an object if you can clearly see it and it is loose. Never perform a blind finger sweep, as this can inadvertently push the object further down the airway and worsen the situation.

Can modifying food help prevent choking in seniors?

Yes. Modifying food consistency is a key preventative strategy. Offering soft, pureed, or mechanically altered foods can make them easier to chew and swallow, reducing the risk of choking.

What eating habits can reduce the risk of choking?

Encourage the person to eat slowly, take small bites, and chew food thoroughly. Proper posture, like sitting upright and tucking the chin, is also very helpful. Avoid talking while chewing.